- 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.
• CC automatically alerts patients every day, which fulfills device transmission requirement.
• Submit every 30 days – 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.
• 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.