Verification: 14d7391ff1fb1726e3262371e62da4ec294a79a0 What is an RPM Billing Program?
Home Health What is an RPM Billing Program?

What is an RPM Billing Program?

by Shahbaz Ali
RPM Billing

RPM billing refers to a new way of billing for a physician’s services. It’s not a new concept, but it’s new for many physicians. They’re concerned about technology requirements, set-up issues, lack of office staff to implement the program, and confusion about reimbursement rules. This is one of the reasons why the RPM program is still in its infancy. Although CMS is still working through some preliminary medical billing problems, they have included new category codes for RPM services in the proposed 2022 Physician Fee Schedule.

No double-counting of activity minutes

An RPM billing program will ensure that the labor costs for each activity are accurate. Using a dedicated database will ensure that the labor costs are tied directly to the activity minutes. Physicians’ time is significantly higher than that of non-provider clinical staff, but the time spent by each physician is only a small portion of the total activity minutes.

Remote patient monitoring billing is complementary to CCM billing. Both programs may be delivered to the same patient within the same month. However, the same monitoring or care team member cannot be used for both services. If a patient has received care from more than one care provider, a single care team can bill for up to 120 minutes of virtual care time in a given month.

RPM services are eligible for reimbursement under CPT 99091. The services are performed by a physician or other qualified health care provider, including nurses and medical assistants. The services must be rendered for a minimum of 30 minutes.

CMS waives restriction on RPM billing

A new CMS waiver has eased the restrictions on RPM billing for certain medical conditions. This will allow providers to bill for RPM services for all patients, whether the patient is new to the practice or has been a patient for a long time. However, providers should be aware of the terms of this waiver and how to implement it correctly.

To qualify for the RPM billing program, a patient must be an eligible Medicare patient. Currently, the service can only be ordered by physicians. The new rule will make remote patient monitoring accessible to anyone who can provide E/M services. The CMS ruling also removes the requirement for patients to have a chronic illness or disease to receive the service.

The waiver also relaxes the licensing requirements for remote patient monitoring services. Moreover, it allows clinicians to provide remote monitoring services for established and new patients. These services can be provided for acute and chronic illnesses, including end-stage renal disease. Additionally, telehealth is now permitted for Medicare patients who live in nursing homes.

It improves patient outcomes.

An RPM billing program can improve patient outcomes by reducing readmissions and improving overall patient health. The program should be paired with clinical data such as symptomatology and functional status to assess its overall impact. The overall impact of RPM should be measured in terms of fewer adverse events, readmissions, and hospitalizations. For example, a study from a Pure Cardiology practice revealed that RPM-enrolled patients were 5.3% less likely to be readmitted to the hospital.

In addition to the overall improvement in patient outcomes, the RPM billing program can also help physicians increase their revenue streams. Value-based care is a method of providing care that focuses on improving patient outcomes while reducing costs. RPM allows providers to focus on patient-centered care while reducing unnecessary visits to the emergency room and hospitalizations.

While using remote patient monitoring software is not easy, it does bring several advantages. First, it improves the workflow of healthcare providers. The RPM billing program allows physicians to spend more time on patient care. The new RPM codes are better suited to reflect the services provided. For example, billing is now based on calendar months and not minutes. Furthermore, a physician can now delegate monitoring duties to clinical staff. This frees up the provider’s time, especially concerning patient safety.

It increases revenue

The RPM billing program has several benefits for physicians and practices. It can enhance their patient care programs, help them generate more revenue, and improve health outcomes for patients. RPM can also help physicians attract more patients and get more reimbursement from payers. However, it is important to remember that RPM is not for every physician or practice. For instance, some physicians may not have health insurance or be uncomfortable with new technology. But, for those who do, this new billing system could dramatically increase their revenue.

Another benefit is the reduction of costs. With Remote Patient Monitoring, physicians do not have to spend countless hours daily, yet their revenues rise. In addition, patients will have the peace of mind that comes with knowing their healthcare provider is monitoring their health. RPM can improve telehealth programs as well.

The proposed changes to Medicare’s Physician Fee Schedule will also increase the reimbursements for RPM. This will help third-party providers future-proof their services. By using RPM, physicians can receive up to $1470 per patient if they have 50 eligible patients. While this may seem small, the additional revenue generated by RPM is significant for a practice. Additionally, these reimbursements can even increase practice revenue during a pandemic.

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