Remote patient monitoring (RPM) enables providers to get reimbursed by The Centers for Medicare and Medicaid Services (CMS) by caring for people from a distance with the goal of proactively keeping people healthy. For many healthcare organizations, RPM will be the first leap into a broader healthcare transformation.
Getting Reimbursement For RPM
COVID-19 has made waves in the digital health space. Health and Human Services (HHS) Office for Civil Rights (OCR) and the Centers for Medicare & Medicaid Services (CMS) relaxed certain regulations and expanded payment policies to help physicians ramp up their telemedicine capabilities. Suddenly, people couldn’t go to in-person visits and interest quickly grew in telehealth, virtual care, and remote patient monitoring.
“Remote patient monitoring has taken off this year and it’s a tremendous value,” said Dr. Michael Stearns, Founder and CEO of Apollo HIT during a recent Health IRL webinar. “Interest is increasing in both small and large centers because it’s a way to provide care safely and generate a new revenue stream. It can also help justify retaining professionals that they otherwise might have to let go, a big challenge facing healthcare organizations in the middle of the pandemic.”
From a reimbursement perspective, RPM is an incentive for healthcare providers to collect biometric data from patients in real-time using medical devices and wearables. Remote patient monitoring pays up to $123 per patient per month.
The robust data set collected through RPM can then be used to collaboratively engage with patients around their health. By educating people on their condition and how their lifestyles, medications, and daily activities impact their overall health, they’re more empowered to change their behaviors and improve their outcomes.
At the moment, Medicare is the primary payer for RPM services through fee-for-service reimbursement.
There’s also interest from organizations investing in new payment models, such as value-based payment and bundled payments, because of their need to control costs. According to KLAS, RPM also reduces emergency room visits and hospital readmissions.
Other Reimbursable Virtual Care Programs
“Medicare keeps adding incentives to get people to invest in virtual services such as RPM, Chronic Care Management, and the newly introduced Principal Care Management,” Stearns said. “CMS has cited published data that shows CCM improves care quality while reducing cost, and RPM and PCM will likely demonstrate the same value.”
RPM’s CPT codes mostly deal with reviewing patient-generated data from medical devices, but they’re complementary to Chronic Care Management (CCM) codes. CCM pays up to $118 per patient per month and can be billed in the same month, for the same patient.
The combination of these codes allows for sufficient payments for both the data collection and the education — and through this revenue stream, organizations can develop virtual care models to connect with patients via asynchronous messaging and video chat.
Principal Care Management (PCM) was introduced in 2020 — it’s very similar to CCM, but only requires you to focus on one chronic condition. PCM pays about $54 per month when staff provides the PCM services, but that increases to about $90 when providers perform the service personally.
Ready to learn more about how Carium’s RPM package can be your organization’s springboard to digital transformation? Schedule a demo today.