Claims for remote patient monitoring skyrocketed over the past few years, with claims for this service rising 20-fold between 2019 and 2022. Unfortunately, not all of those claims were justified, according to a Sept. 2024 audit, and the OIG is going to be taking a close look at RPM claims going forward.
Discover what the OIG found during its RPM audit, and how you can avoid getting into trouble when you submit claims for remote patient monitoring.
Practices Failed to Document All Three Parts of Remote Patient Monitoring
CPT includes several RPM codes (99453-99458), each of which has its own purpose. However, Medicare expects providers to perform each step in the process in a consecutive manner:
- First, you’ll educate the patient and help them set up the monitoring device
- Next, you’ll supply the device that can collect and transmit data
- Finally, the provider will use the data from the RPM device to make treatment and management decisions
The OIG found that 43% of Medicare beneficiaries who received RPM services didn’t receive at least one of those three components. Keep in mind that practices are typically not legally required to report all three components. However, “the high percentage of enrollees who did not receive all components raises questions about whether these services are being used as intended,” the OIG said. This could be a sign that changes in coverage or audits may take place going forward.
Practices Often Don’t Document the Condition They’re Monitoring
Remote patient monitoring codes are only allowable when the provider is monitoring an acute or chronic condition. For instance, most claims for this service are for patients with conditions like hypertension and diabetes. However, many providers don’t log which conditions are being monitored with RPM.
In fact, the OIG found that 7,000 patients were said to have received RPM services for “other specified counseling.” Instead of listing the reason as “other,” you should always document which conditions your practice is monitoring using the remote device.
Tighten Your Documentation
To ensure that you can keep collecting for remote patient monitoring and that you don’t end up under scrutiny from auditors, make sure your documentation includes these details:
- The dates and details on when you trained patients on the RPM device, helped them set it up, ordered the device, and analyzed/processed the information that comes from the device
- Information about the specific health data being monitored
- Specifics about the patient’s condition that you’re monitoring
- Details about the device the patient is using and how the information is being sent to you
- Information about which provider is performing the monitoring
By keeping pristine records about every detail of your medically necessary RPM services, you’ll be able to avoid attention from auditors and compliantly collect for these codes.
Auditors are becoming increasingly more brazen when it comes to trying to recoup your pay. Now’s the time to protect your practice against accusations of fraud. Let healthcare attorney Michael R. Lowe, Esq., show you how to prevent issues during his 90-minute online training event, Proven Tactics to Halt Costly Stark & Anti-Kickback Penalties. Register today!
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