5 Tips Audit-proof Your Remote Patient Monitoring Coding and Billing

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5 Tips Audit-proof Your Remote Patient Monitoring Coding and Billing

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Remote Patient Monitoring Coding

An easy way to add $122 per patient per month for services you already offer is to capture 2020’s new and revised CPT codes for remote patient monitoring. But be sure you can keep your hard earned money by reporting compliant, documentation supported claims.

With the increasing amount of patients having wearable devices such as iwatches,  remote monitoring services for patients with high blood pressure is a service you’re probably already doing without getting paid for. Medicare now covers CPT revised code 99457 and new code 99458. Auditors are carefully watching the usage of these new codes. If you make errors that don’t withstand their scrutiny, you’ll be faced with having to repay your reimbursement in the form of overpayments – and even penalties.

Help is on the way …

Count These Technologies Toward Remote Patient Monitoring Coding

Remote patient monitoring is a telehealth service that uses technology to monitor and track patient data outside of a clinical setting. The service allows your practice to better treat patients. Benefits include:

  • enhanced quality of care
  • improved care coordination
  • maximized clinical efficiency
  • increased patient satisfaction.

CMS has not yet specified what types of technology can be used for remote patient monitoring. The only requirement is that the FDA has approved the device. You’ll be surprised to know that this criteria is met with these commonly owned tools:

  • Apple Watch
  • Fitbit
  • Internal device that transmits signals
  • A portal to “coach” patients at home after surgery

Protect Pay by Following These Coding & Billing Rules

To comply with both CMS and CPT rules for coding remote patient monitoring, follow these tips:

  1. Establish Care Plan: You must conduct a face-to-face visit to establish a new patient relationship before providing remote patient monitoring. An in-person visit is also required if you haven’t seen an existing patient for one year.
  2. Indicate Notification: Clearly document patient consent for remote monitoring in the patient record.
  3. Separately Capture Time: If you are billing remote patient monitoring codes along with Chronic Care Management (99487, 99489, 99490) codes, be sure that you meet the time requirements for each code separately. Time cannot be shared between the two. (Critical: Code 99457 captures the first 20 minutes of monitoring services in a given month and 99458 is billed for each additional 20 minutes. Where as, chronic care code 99490 is billed for at least 20 minutes of clinical staff time, 99487 is for 60 minutes and 99489 is for each additional 30 minutes.) 
  4. Collect Co-Pay: Medicare requires a 20 percent co-payment from patients for remote patient monitoring services. Collect the co-pay from the patient at the visit in which providing the services is set. Routinely waiving co-pays increases your risk for fraud and abuse.

It’s only gotten easier for providers to reap the financial benefits of billing for remote monitoring. However, many providers are still unaware of this revenue stream that’s available to them. And providers who are aware are often not coding and billing their claims correctly to receive the maximum reimbursement.

For example, if you have 50 patients who qualify, at the rate of $122 per patient per month, your additional annual reimbursement is $73,200. Can you really afford NOT to utilize these codes?

National coding expert and educator, Penny Osmon Bahr, CHC, CPC, CPCI, gives you more strategies on how you can get paid more of what you deserve when coding remote patient monitoring services. Here are just some of the Remote Patient Monitoring (RPM) coding tactics you’ll receive.

Regardless of your specialty, if you provide remote patient monitoring services, you deserve to receive the additional reimbursement these codes afford.

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