- What patients benefit from RPM and how is it delivered?
- RPM can be used for both chronic and acute conditions
- RPM is an E&M service, not a telehealth service
- RPM services must be ordered by physician or QHCP, but can be performed by any clinical staff
- Clinical staff provides devices to patients and reviews data, and then brings abnormal readings to attention of physician
- How do the economics work?
- For device supply and 40 min of monitoring (codes 99454, 99457, and 99458), patient co-insurance for a typical traditional plan (not high deductible) is $20-30/month.
- If you are concerned about a patient’s cost due to a high deductible plan or other circumstances, we recommend pre-verifying the patient’s specific plan – the significant revenue opportunity is worth a phone call to the payer.
- RPM should be prescribed based on your recommendation as the patient’s trusted healthcare provider, not sold as an optional add-on service. This is a practitioner ordered medical care treatment plan. Care plan success is dependent on patient engagement and compliance to reach goals.
- Avg. patient care plan we see for chronic conditions is 6 months, so approximately $1,000 revenue per patient at 70% margin for the practice.
- We recommend negotiating w/ OON payers to maximize rates and payment speed.
- How often should I review data?
- Depends on the protocol, but we recommend 5-10 min/week to reach 20-40 min/month to reach 99457 and 99458.
- What are your billing tips?
- For efficiency, we recommend billers review and submit claims at the end of each month.
- CC billing report tracks eligibility for each claim for each patient and requirements to submit next claim – provides point of reference for practice management system.
- Can’t be billed for same date of service as an office visit or other E&M service, so you should set up a separate audio or video call to explain device setup.
- Must wait 16 days from setup to submit a claim, but use date of service device provided to the patient.
- Submit only once per episode of care – follow claim eligibility dates on CC billing report to confirm.
- Providers should give patients devices, not charge them because insurance pays for the devices.
- Must wait 16 days from device supply to submit first claim, but use date of service device provided to the patient.
- Device must transmit alerts or data at least 16 days of the month, but CC automatically alerts patients every day, which fulfills device transmission requirement.
- Submit once every 30 days (even if multiple devices used) – follow claim eligibility dates on CC billing report to confirm.
- On first submission, use date of service device provided to the patient.
- Must complete full 20 min of monitoring to be eligible.
- CC system automatically tracks time spent monitoring and communicating with patients – billing report will tell you how much more time is needed.
- Monitoring time is cumulative throughout month for all staff activities (reviewing clinical data, notes, messages, and live interactions)
- Bill 99457 and 99458 together and at the end of the month, if appropriate.
- Add-on to 99457, maximum of two units per month
- Must complete full 20 min of monitoring to be eligible for each unit
If there are any questions about RPM Best Practices contact us at Support@CoachCare.com.