RPM Best Practices

General

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

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.

Depends on the protocol, but we recommend 5-10 min/week to reach 20-40 min/month to reach 99457 and 99458.

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.

99453

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.

99454

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.

99457

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.

99458

If there are any questions about RPM Best Practices contact us at Support@CoachCare.com.