How fee-for-service and value-based care organizations benefit in 2022
By Tom Spalla, VP Sales
Years ago, did you (or someone you know) buy a watch or other device that counted steps walked in a day? Unbeknownst to us at the time, that technology was much more than a pedometer. It was a first step in the path to what has become known as Remote Patient Monitoring (RPM), a growing body of technology that monitors patient health data between provider visits.
Today, RPM goes far beyond keeping track of steps. In addition to wearable devices that record and report data, smartphone applications have become a front-line resource to help patients and providers manage chronic conditions. Providers can use them to prompt patient feedback to get a deeper picture of symptoms, assess pain severity according to standardized rubrics, increase adherence to health plans with medication reminders, or educate patients about their condition at opportune times. And, the list of RPM functionalities continues to develop.
CMS-approved RPM care is expanding
In addition to remotely monitoring physiological symptoms to track wellness and manage chronic conditions, 2022 brings an expanded code set for Remote Therapeutic Monitoring/Treatment Management (RTM). The 2022 CPT reimbursement codes for RTM are 98975, 98976, 98977, 98980, +98981. With RTM, providers are reimbursed for collecting and interpreting non-physiological data of respiratory system status, musculoskeletal system status, therapy adherence, and therapy response.
Capturing the patient’s voice on a day-in, day-out basis has the potential to individualize care on a previously unobtainable level, leading to a greater quality of life through optimized, targeted treatments.
Patients and providers are ready for RPM
Studies show that patients and providers alike are eager to embrace new RPM technologies that foster continuous, proactive health management. MSI Internationalfound 80% of Americans are in favor of using RPM, and almost 50% are very favorable to its incorporation into medical care.
A recent Insider Intelligencesurvey estimates thirty million US patients will use remote care tools by 2024, which is not a surprising statistic given that today’s remote patient monitoring technology monitors multiple health conditions such as COVID, diabetes, and IBD symptoms management.
The many benefits of RPM
Today, RPM is transforming patient care. It provides precise patient health information between in-person visits to improve patient outcomes, increase patient engagement, streamline clinical and administrative efficiency, lower costs, and provide an additional revenue stream for healthcare organizations.
Improve patient outcomes
Health information gathered between visits is at the provider’s fingertips during face-to-face encounters. Accurate data saves time, improves documentation accuracy, and can lead to more effective health management.
Increase patient engagement
Automated triage empowers patients to alleviate symptoms, encourages care plan compliance, and alerts staff when intervention is needed.
Enhance medication compliance
Failure to adhere to medication plans not only impacts patients’ health, but also costs the US health care system. One studypublished on PharmacyTimes.com estimated $528.4 million was wasted on nonoptimized drug therapies in a single year, resulting in approximately 275,689 deaths.
Expand CCM and telehealth
RPM and RTM services are easily inserted into existing Chronic Care Management (CCM) and telehealth workflows, giving providers a more comprehensive view of patient health.
Boost team capacity
RPM can automate many non-critical care-related tasks, allowing organizations to focus resources where they are needed most.
Hospital readmissions are a significant source of uncompensated care. A recent studyat Mount Sinai Hospital noted that its 30-day readmission rates for heart failure patients decreased to 10% with the aid of RPM. There are numerous other studies that support the same findings.
Create additional revenue
Built-in CPT code reporting tracks claim codes relating to RPM, RTM, CCM, and telehealth, simplifying billing processes.
Multi-specialty RPM made easy
Clinical and administrative labor are driving factors of the high cost of health care in the US. Datos Health streamlines workflows with its capability to merge all remote care plans for chronic conditions onto a single platform, focusing clinical and administrative labor in one place and simplifying technology infrastructure. Easy drag-and-drop functionality creates programmable responses that target care when and where needed, allowing clinicians to broaden their reach while conserving resources.
Example #1: Oncology Care Management
The side effects of cancer treatments often go unreported, impacting the patient’s quality of life and adherence to care plans. Proactive outreach to patients between visits creates a significant workload that may overlook symptoms, side effects, and trends that lead to adverse events. Through rules set by the care team, the Datos Health system prompts patients to report symptoms, which triggers automated responses to help alleviate discomfort or unwanted side effects. Automated self-care management is part of a larger rules-based triage construct used to identify patients requiring intervention or other appropriate action based on established workflows, best practices, and validated questionnaires- such as CCTAE.
Example #2: Cardiac rehab and heart failure monitoring
Unlike other RPM platforms that require a specific tool, Datos Health works with care teams to determine the best device to monitor their patients. For example, a heart failure patient could be monitored using a smart device, blood pressure monitor, or pulse oximeter. Post-walk, patients are automatically sent the appropriate standardized survey and prompted to report symptoms via the Datos Health user-friendly app. Any symptoms or results outside of standard thresholds are reported to the care team, prompting treatment plan changes and potentially mitigating adverse events. Not only is clinical information streamlined, but built-in reporting also optimizes coding and billing activities.
The Datos Health revenue opportunity
There are 5 CMS-reimbursable CPTs available for RPM and 5 for RTM
|RPM CPT||Description*||RTM CPT|
|99453||Initial set-up, patient education||98975|
|99454||Remote monitoring, monthly||98976 (respiratory system)|
|98977 (musculoskeletal system)|
|99457||Treatment management, first 20 min||98980|
|+99458||Treatment management, add’l 20 min||+98981|
|99091||Collection and interpretation of data transmitted by patient||N/A|
*Please consult AMA or CMS resources for specific descriptions
Datos Health ROI
Providers that enroll patients into a Datos Health RPM program will be reimbursed approximately $22 for 99453 (initial set-up) and $49 for 99454 (monthly transmission), based on Medicare rates. In the first year, reimbursement for 50 patients (CPTs 99453 and 99454) amounts to approximately $62,400, with an ROI of roughly $49,900. ROI can vary depending on the number of patients in a program, FTE costs, and other factors such as the complexity of the condition monitored. Providers are reimbursed via 99457 and 99458 for additional time managing monitored patient when medically necessary, with approximate payments of $52 and $41, respectively.
Smooth the path to value-based care
More challenging to quantify but equally as relevant to the financial future of healthcare organizations is the potential effect of RPM on value-based care. Payment model evolution will continue to stress better health management, positive health outcomes, and reward for performance. RPM not only helps patients monitor their health, but also creates a record of progress toward achieving the critical thresholds of reportable health measures that unlock enhanced reimbursement.
RPM is a win-win for patients and their providers. Patients are more engaged with their care plan, receive timely information about their symptoms, and enjoy better health outcomes. Providers can boost clinical efficiency and effectiveness while creating additional revenue that allows them to continue serving their communities. RPM is poised to be a catalyst in successfully pursuing healthcare’s Triple Aim of optimizing performance.
If you haven’t done so already, I strongly urge you to investigate everything RPM has to offer. We are on an exciting trajectory that can improve wellness, positively impact chronic condition management, and lower the cost of care. Contact us to learn how Datos Health can improve patient outcomes as well as your organization’s bottom line.
Remote Therapeutic Monitoring codes (98975, 98976, 98977) generally describe initial setup, patient education, and device supply. The two RTM Treatment Management service codes (98980 and 98981) are meant to be used to report the time the clinician spends managing the RTM treatment.How often can you bill CPT 99454? ›
1. CPT 99453 - One time code with a date of service equal to the patient's first successful reading. 2. CPT 99454 - Billed every 30-days with the first Date of Service equal to the first successful reading.What are the new CPT codes for 2022? ›
What New CPT® Codes Were Added for 2022? There are five new CPT codes to report therapeutic remote monitoring: 98975, 98976, 98977, 98980, and 98981. These new CPT codes “expand on remote physiologic monitoring codes that were created in 2020 (99453, 99454, 99457, and 99458),” reports the AMA.How much does rpm reimburse? ›
Using CPT code 99091, Medicare provides a monthly payment of $56.41 for collecting and interpreting the transmitted and stored physiologic data provided by the remote patient monitoring device. The amount of time spent interpreting and analyzing must be at least 30 minutes to qualify for reimbursement.Can CCM and TCM be billed together 2022? ›
For calendar year 2022 and beyond, CMS will allow RHCs and FQHCs to bill concurrently for care management services. This means that, going forward, RHCs and FQHCs can provide CCM, TCM, and other care management services for the same beneficiary in the same service period.Can rpm and RTM be billed together? ›
Q: Can we bill RPM and RTM on the same patient at the same time? No. The American Medical Association's CPT Manual (the “CPT Manual”) states that RTM and RPM should not be billed for the same patient in the same month.Does Medicare pay for 99454? ›
How much does Medicare reimburse for 99454? Under CPT 99454, clinicians and physicians can be reimbursed $62.80 for supplying devices and monitoring.What is the POS for CPT 99454? ›
The standard reimbursement for CPT Code: 99454 regardless of the cost of devices, is $62.00 for technologies provided under this code.Can you bill RPM and CCM in same month? ›
Can RPM be billed in conjunction with chronic care management (CCM)? Yes, a provider can bill both the RPM CPT code 99457 and CCM CPT code 99490.Where can I look up CPT codes for free? ›
The Centers for Medicare & Medicaid Services offer a free search (CPT code lookup) for RVU for every CPT code. Users can also request a CPT/RVU Data File license from the AMA to easily import codes and descriptions into existing claims and medical billing systems.
(CPT codes 92585 and 92586 were deleted on January 1, 2021. CPT code 92564 was deleted on January 1, 2022.) 2. Speech language pathologists may perform services coded as CPT codes 92507, 92508, or 92526.What CPT codes are most frequently used? ›
Routine office visits (CPT codes 99213 & 99214) are the most common and heavily reimbursed of all physician procedures, numbering over 288 million with total Medicare payments of over $53.8 billion in 2021, according to Definitive Healthcare.What is the difference between RTM and RPM? ›
Unlike RPM codes, which are evaluation/management codes billed by physicians or qualified healthcare providers, RTM codes are general medicine codes and the major utilizers of RTM codes are expected to be physical therapists, clinical psychologists, speech-language pathologists, and occupational therapists.Who pays for remote patient monitoring? ›
Medicare provides a monthly payment of $55 for spending 20 minutes communicating with the patient or a caregiver about the transmitted data and any changes to the care management plan.How is RPM billed? ›
RPM services can only be billed by one practitioner per 30-day period and cannot be reported for a patient more than once during a 30- day period (even when multiple medical devices are provided to a patient).Can CCM and TCM be billed together? ›
In the CY 2020 PFS final rule (84 FR 62685) and CY 2021 PFS final rule (85 FR 84547), CMS indicated that TCM may be billed concurrently with CCM codes when relevant and medically necessary. Note that the minutes counted for TCM services cannot also be counted towards other services (including CCM).Can CCM be billed with TCM? ›
2) CCM can be billed concurrently with TCM
Previously, CCM time couldn't be billed in the same month for a patient that you are already billing TCM time for. This change now allows you to bill for both TCM and CCM in the same month for the same patient when “reasonable and necessary”.
A physician or non-physician practitioner (NPP) may report both the discharge code and appropriate TCM code if he or she provided both services. However, Medicare prohibits billing a discharge day management service on the same day that a required E/M visit is furnished under the CPT TCM codes for the same patient.Who can bill for RTM codes? ›
The RTM codes for non-physician QHPs generally must be furnished directly by the billing practitioner. If these new HCPCS codes are adopted, the current codes CPTs 98980 and 98981 would become non-payable by Medicare (because they would be replaced by the HCPCS codes).How are RTM codes classified? ›
Classified as general medicine codes: Unlike RPM which is classified as an Evaluation and Management (E/M) service, the RTM codes are classified as general medicine codes and not E/M codes. RTM codes can be billed as general medicine services by physicians and eligible qualified healthcare professionals.
Yes. CMS has established both a facility and non-facility payment for this service. Practitioners should report TCM services with the place of service appropriate for the face-to-face visit.Can TCM be billed as telehealth? ›
TCM is on Medicare's list of covered telehealth services. Per Current Procedural Terminology (CPT), CPT codes 99495 and 99496 include one face-to-face (but not necessarily in-person) visit that is not separately reportable.Can 99454 and 99457 be billed together? ›
Yes. All may be billed simultaneously, provided that the requirements for each are met independently. For example, a patient can be in a CCM program and an RPM program at the same time, and both may be billed.Does Medicare require a modifier for telehealth? ›
Append modifier 95 to indicate the service took place via telehealth. .What is procedure code 99348? ›
CPT Code 99348
Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; and. Medical decision making of low complexity.
Home Visits Listing - CPT codes 99341 - 99350: Home Services codes, are used to report E/M services furnished to a patient residing in his or her own private residence.What is the difference between CCM and RPM? ›
The main difference between CCM and RPM is that CCM provides ongoing support to patients, while RPM monitors patients' health remotely. CCM is a great option for patients who need regular support and guidance in order to manage their chronic illnesses.What is CCM reimbursement? ›
CCM is a monthly program. At least 20 minutes of patient service must be provided each month for Medicare to offer reimbursement. To enroll a patient, they must have two or more chronic conditions expected to last at least 12 months. The patient's doctor must note any chronic issues 12 months prior to CCM enrollment.How often can CCM be billed? ›
A claim for CCM, using code 99490, may be submitted to Medicare once per month when the requirements of the service are met.Is there an app for CPT codes? ›
The CPT QuickRef app Premium Content (2022 code set information & CPT(R) Assistant articles) are accessible on iOS and Android mobile devices by scanning the QR code affixed to the back of the codebook that comes with this package.
CPT® Codes Lookup
Codify by AAPC helps you quickly and accurately select the CPT® codes you need to keep your claims on track. With Codify by AAPC cross-reference tools, you can check common code pairings. You also get CPT to ICD-10-CM, CPT to HCPCS, and CPT to Modifier crosswalks.
A source of both diagnosis and procedure code information is a codebook. They are available for purchase or may be available at an academic or medical library.What are the three categories of CPT codes? ›
- Category I: These codes have descriptors that correspond to a procedure or service. ...
- Category II: These alphanumeric tracking codes are supplemental codes used for performance measurement. ...
- Category III: These are temporary alphanumeric codes for new and developing technology, procedures and services.
The code description for G0463 is “hospital outpatient clinic visit or assessment and management of a patient”.What are the deleted ICD-10 codes for 2022? ›
- M54.5 - low back pain. M54.50 - Low back pain, unspecified. M54.51 - Vertebrogenic low back pain. ...
- R05 - cough. R05.1 - Acute cough. R05.2 - Subacute cough. ...
- R35.8 - polyuria. R35.81 - Nocturnal polyuria. ...
- Z28.3 - Underimmunization status (*Effective 4/1/2022) Z28.310 - Unvaccinated for COVID-19.
CPT codes are an integral part of the billing process. CPT codes tell the insurance payer what procedures the healthcare provider would like to be reimbursed for. As such, CPT codes work in tandem with ICD codes to create a full picture of the medical process for the payer.What are the 4 types of medical coding systems? ›
Right now, there are five major types of medical coding classification systems that are used by medical coding professionals — ICD-11, ICD-10-CM, ICD-10-PCS, CPT and HCPCS Level II. If you're interested in becoming a medical billing and coding professional, it's important to learn more about each system.What is the most current edition of CPT? ›
CPT(R) 2021 Professional Edition is the definitive AMA-authored resource to help health care professionals correctly report and bill medical procedures and services. Providers want accurate reimbursement.What is RTM healthcare? ›
remote therapeutic monitoring, or RTM, refers to the remote delivery of therapeutic patient care … specifically, monitoring a patient's musculoskeletal status, or respiratory status, as well as related medication and program adherence.What is the difference between remote patient monitoring and remote therapeutic monitoring? ›
Remote patient monitoring is the use of digital technology to capture and analyze patients' physiological data, such as blood pressure, glucose levels, and lung function. By contrast, remote therapeutic monitoring focuses on non-physiological data, such as patient adherence and reported pain levels.
Ensure Reimbursement Accuracy
ReimbursementCodes is the pricing, coding, and clinical source for medical specialty drugs.
Remote patient monitoring (RPM) is a type of home telehealth that enables patient monitoring as well as transfer of patient health data to a health care provider.How do you bill remote patient monitoring? ›
CPT Code 99453
CPT Code 99454 is used for the monthly remote monitoring of physiological parameters, and covers the supply of the devices used by patients to monitor and record physiological data.
Remote patient monitoring can be reimbursed with established clients. In 2021, CMS advised that remote monitoring services are limited to established patients. In order to bill Medicare for CPT codes 99456, 99454, 99457, and 99458, there will need to be an established patient-practitioner relationship.How much does RPM reimburse? ›
Using CPT code 99091, Medicare provides a monthly payment of $56.41 for collecting and interpreting the transmitted and stored physiologic data provided by the remote patient monitoring device. The amount of time spent interpreting and analyzing must be at least 30 minutes to qualify for reimbursement.How much is copay for RPM? ›
As with other Medicare Part B services, RPM codes are subject to a 20% beneficiary copay.Can PCM and RPM be billed together? ›
If you're using care coordination software, patient consent will be automatically documented. As well, it is important that when billing for both PCM and RPM, you record billable time for each program. So, for PCM you would record 30 minutes and then an additional 20 minutes for RPM.What does RTM mean in property? ›
Right to manage (RTM) companies
RTM companies allow long leaseholders in blocks of flats to take over the management of their building. Leaseholders must set up a limited by guarantee company to carry out the management functions.
A requirements traceability matrix (RTM) is a tool that helps identify and maintain the status of the project's requirements and deliverables. It does so by establishing a thread for each component. It also manages the overall project requirements.What is an RTM in healthcare? ›
remote therapeutic monitoring, or RTM, refers to the remote delivery of therapeutic patient care … specifically, monitoring a patient's musculoskeletal status, or respiratory status, as well as related medication and program adherence.
The Right to Manage ( RTM ) lets some leasehold property owners take over management of the building - even without the agreement of the landlord. As a landlord, the leaseholders in your building will send you notice if they plan to do this. If they're successful, you'll still own the building but they'll manage it.Who qualifies for RTM? ›
Yes, under the current CPT codes, eligibility for RTM device supply reimbursement is limited to only two clinical use cases: musculoskeletal and respiratory conditions. The current codes do not encompass other conditions, such as neurological, endocrine, digestive, or vascular.How long does RTM process take? ›
In most cases an RTM application will take about five to seven months from start to finish. It may take longer if the landlord decides to contest your application.Whats the difference between RTM and a RMC? ›
RTM is a statutory right that allows leaseholders to apply for the right to manage their block, whereas RMCs are usually set up by the developer on completion of the building, rather than being a tool to enable leaseholders to gain control of their development.What are the types of RTM? ›
There are three types of RTM: forward traceability, backward traceability, and bidirectional traceability.What are the advantages of RTM? ›
Advantage of RTM
With the help of the RTM document, we can display the complete test execution and bugs status based on requirements. It is used to show the missing requirements or conflicts in documents. In this, we can ensure the complete test coverage, which means all the modules are tested.
Ans: Requirement Traceability Matrix (RTM) is a document that records the mapping between the high-level requirements and the test cases in the form of a table. That's how it ensures that the Test Plan covers all the requirements and links to their latest version.What is RTM and when it is prepared? ›
Requirement Traceability Matrix (RTM) or Cross Reference Matrix are other names for it (CRM). It is produced prior to the test execution process to ensure that all requirements are addressed in the form of a Test case, ensuring that no testing is missed.What does RTM stand for in call center? ›
What is Real-Time Monitoring? Real-time monitoring for call centers refers to the tools and software which enables managers to oversee and track agent calls as they are carried out.Do RTM directors get paid? ›
In nearly all cases, a Director of an RMC, RTM or Collective Enfranchisement Company does not get paid.
The RTM company is only required to have one director but will typically have 3-5 directors. There is no requirement for directors to be residents and often relatives of residents will volunteer to join the board.Is right to manage worth it? ›
The main benefit of right to manage is that you gain greater control over the costs of running the building. You may also save money, since you don't have to pay for the services of a property management company. Additionally, by forming an RTM company you can choose and change contractors whenever you like.