Remote patient monitoring reimbursement can be hard to navigate. Providers must properly document and have the correct RPM service codes to successfully receive their reimbursements. It can be a complicated process you don’t want to get wrong, given the potential losses.
So in this article, we will be looking at ways to properly document and code for RPM services for your facility to receive the reimbursement it deserves.
Documentation & Coding Best Practices
Because remote patient monitoring (RPM) is a professional service, you must ensure complete and accurate RPM documentation and coding as a healthcare provider to get timely and correct payment for your telehealth and RPM services, whether from government or private insurers. Be sure to properly document your patients’ diagnoses and the services you provided to have a complete diagnosis and procedure code selection to calculate your reimbursement.
The following are some general practices and tips that can better help your RPM documentation and coding process as a provider:
- Work closely with your administrative staff to understand the documentation and coding requirements for successful RPM reimbursement.
- Always complete your documentation at the time of service to ensure accuracy.
- Document the time spent providing the service.
- Have the correct documents and code for place of service (POS):
- For Medicaid, reach out to your state agency.
- For private insurers, the POS code requirements can vary.
- Verify that your documentation can support the codes being used.
Documentation for Time-Based Codes
For documentation of time-based CPT codes (such as CPT 99457 or CPT 99458), you will want to record the start-stop times and include the provider’s name and a detailed description of the work performed.
While detailed documentation is always preferable, you can make do with less demanding methods as long as a thorough review of the documentation provides enough information.
However, suppose you cannot demonstrate significant documentation variation between patients or different months. In that case, your practice may struggle to adequately comply with all billing requirements as it can seem automatically generated.
To circumvent this, providers should create detailed documentation and a staff education policy during the implementation of their RPM program to ensure accurate service and time tracking for time-based CPT codes.
An Example: How to Document CPT Code 99453
The CPT billing code 99453 accounts for patient setup with remote patient monitoring devices. This code reimburses providers for the time spent setting up devices and educating patients on how to use their new RPM devices. CPT code 99453 is also distinct from other CPT codes because you can only use it once per patient, per episode of care.
The major RPM devices associated with CPT code 99453 include blood pressure cuffs, pulse oximeters, glucose monitors, and digital weight scales.
As CPT code 99453 will be used for new patients, providers must obtain their patients’ informed beneficiary consent to receive RPM services.
To properly document CPT code 99453, you will need:
- Device deployment order from a practitioner
- The condition(s) being monitored
- Device identification
- The date you delivered the device to the patient
- The date(s) on which the patient receives training for the RPM device
If you need help with billing codes and RPM reimbursement, contact HRS’ reimbursement specialists for further guidance.
How to Create a RPM Patient Implementation Workflow
If you are still figuring out RPM implementation in your facility, you can use the suggested steps below as a guide to creating your RPM patient implementation workflow.
- Identify a patient or patient population that could be a good RPM candidate.
- Communicate with the patient the desire to implement the RPM program, its expected value, and potential patient responsibility.
- Obtain verbal and documented consent from your patient(s).
- Document the medical necessities of the patient (what’s being measured, why, goals, etc.)
- Set up and educate the patient regarding the usage of their RPM device.
- Ensure the patient performs daily measurements.
- Review each patient’s results daily and take action if there are abnormal measurements.
- Properly document and code your RPM service to obtain the right reimbursements.
Stay On Top of Your Telehealth and RPM Reimbursement
At HRS, we have a host of resources on reimbursement and RPM billings modeled after the best practices established from working with our healthcare partners. Get in touch with us to find out how to optimize reimbursement for your RPM program today.