Innovations and Efficiencies in Home-Based Care: HCCI Solutions Suite for NPHI Members-Remote Patient Monitoring

Remote Patient Monitoring_HCCI

Pdf Summary

The document is a comprehensive guide intended for house call programs utilizing Remote Patient Monitoring (RPM) services. Born out of the COVID-19 pandemic, which highlighted the importance of telemedicine, this resource clarifies that RPM is not classified as telehealth by the Centers for Medicare and Medicaid Services (CMS). Therefore, its usage and reimbursement opportunities will persist post the Public Health Emergency (PHE).<br /><br />RPM is defined as using technology through medical devices to collect and analyze patient physiological data (e.g., blood glucose, blood pressure) for developing and managing a treatment plan for chronic or acute health conditions. This data must be automatically transmitted to the healthcare provider's practice, not self-reported by patients or caregivers. RPM services can be billed by qualified providers, including physicians, nurse practitioners, and physician assistants, and managed in collaboration with clinical staff under the billing provider's supervision.<br /><br />The guide details essential requirements for RPM services:<br />- Medical necessity must be documented.<br />- RPM services must initiate during a face-to-face visit (or via telehealth during the PHE).<br />- Patient consent must be obtained and documented.<br />- The RPM device must align with the FDA's definition of a "medical device".<br />- Specific CPT codes (99453, 99454, 99457, 99458, 99091) guide the billing process, with each having particular stipulations for use.<br /><br />Key definitions, such as RPM Care Episode, Interactive Communication, and RPM Care Plan, are delineated, stressing the importance of an established treatment plan informed by patient data analysis.<br /><br />The guide emphasizes the sequence and timing involved in submitting RPM codes like 99453, 99454, 99091, 99457, and 99458, providing an organized timeline for providers to follow. Lastly, additional resources, including webinars, virtual office hours, and downloadable tools, are available via the HCCIntelligence Resource Center to support home-based primary care (HBPC) providers. <br /><br />This document ensures accurate coding and adherence to CMS billing guidelines for the year 2021, subject to annual updates.

Keywords

Remote Patient Monitoring

RPM services

telemedicine

Centers for Medicare and Medicaid Services

CMS

Public Health Emergency

PHE

medical devices

CPT codes

HCCIntelligence Resource Center