Telehealth & RPM Reimbursement Explained

CMS remote patient monitoring and telehealth reimbursement can be difficult subjects to navigate. Luckily, our reimbursement team has put together the following reimbursement resources to simplify things!

Reimbursement & Funding Models

As remote patient monitoring becomes more prevalent, healthcare providers have an opportunity to drive their bottom line while continuing to provide quality care for their patients. Learn how to get reimbursed accurately for your RPM program using the following reimbursement models.

telehealth-billing
payer-provider relationship
private pay
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CMS Reimbursement

In recent years, CMS has expanded Medicare coverage for RPM. Patients can now receive telehealth services from their homes at zero cost instead of having to drive to a CMS-qualified telehealth service center.

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Benefits

  • Revenue stream reimbursement through CMS
  • Large population of patients covered based on population
  • Wide array of programs cover Telehealth, CCM, RPM, and RTM
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Challenges

  • Medicare reimbursement for Part B providers only. Part A is not covered
  • HHAs are unable to receive direct reimbursement from CMS for RPM and RTM services if they do not bill Medicare Part B services or have a palliative care program
Medicare RPM FAQs

Commercial Payor VBP

Partner with a managed care organization (MCO) or accountable care organization (ACO) to pursue reimbursement opportunities for telehealth and remote patient monitoring services. MCOs and ACOs are focused on reducing care costs and utilization of health care services while retaining or enhancing the quality of care. These organizations can adjust CMS guidelines to meet their organizational structure and programs for various lines of business.

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Benefits

  • Commercial payers potentially have higher reimbursement rates than Medicare
  • Providers may have the option to negotiate rates with payers
  • HHAs have the opportunity to obtain reimbursement for CCM, RPM, and RTM services from an MCO and ACO
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Challenges

  • Having proper documentation to support payor mix, case-mix, utilization, the volume of kits, and census
  • Detailed clinical documentation outlining how telehealth and RPM are incorporated into patient care plans

Private Pay

Through a private pay program, patients or their families pay the organization to keep their telehealth equipment to maintain a level of oversight in their care.

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Benefits

  • Create revenue stream to fund telehealth and other care services
  • Increases patient and caregiver satisfaction by providing flexible options
  • Identify exacerbations and prevent repeat hospitalizations and ED visits
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Challenges

  • This model may not be a viable option for many patients and their families due to the cost

Grants & Public Funding

Grants and public funding can help launch or expand telehealth and remote patient monitoring programs. Over 100 HRS partners launched their telehealth and remote patient monitoring programs with funds received from grants.

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Benefits

  • Diverts patients from the emergency department
  • Offers access to specialists
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Challenges

  • Funds don’t come with a guarantee of consistency from year to year
  • Limited to applicants that meet the eligibility criteria set for each grant opportunity to qualify for funds
Explore Available Grants and Resources

How HRS Supports Our Partners

HRS' billing interface and reimbursement reporting, enable providers to more easily track and bill eligible telehealth and RPM Services provided.

Included in HRS' Enhanced Billing Report:

  • Patients that qualify for RPM, CCM, or RTM codes
  • Reimbursement summary by clinician
  • Reimbursement summary by condition
  • Reimbursement summary by subgroup

Reimbursement-Reports

Telehealth Reimbursement Advancements

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HRS WEBINAR SERIES

2024 Telehealth Reimbursement Advancements

In this free, 45-minute webinar, hear from our Vice President of Revenue Cycle Management at Health Recovery Solutions on the 2024 updates to telehealth reimbursement rates and how HRS can support your reimbursement efforts.

Watch On Demand
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Reimbursement CPT Codes

Grant and Reimbursement
EGUIDE

CMS Telehealth & RPM Billing Guidelines

Learn everything you need to know about the Centers for Medicare & Medicaid Services (CMS) physician fee schedule.

Download Now

Prioritizing Reimbursement 

Healthcare organizations are embracing remote patient monitoring as a tool to improve patient outcomes and satisfaction. Not only can the quality of patient care be improved but by properly using CMS-approved CPT codes, clinicians can boost their ROI.

HRS boasts a team of reimbursement specialists dedicated to helping our partners receive reimbursement for RPM services. Through CMS, physician group and ACO partnerships, and private pay programs, HRS is helping our partners create a new revenue stream and enhance patient care with telehealth and RPM.

Calculate Your Estimated Reimbursement


What Type of Reimbursement? 

 

“Proper billing for telehealth and RPM reimbursement requires precise records for the amount of time spent reviewing patient health data. Through our partnership with HRS, our Client Success Manager is able to pull this information on our behalf and send us detailed reports.”

- Yvette Valentine, Director of Operations, Ohio Living


Results

Total Estimated Revenue

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Reimbursement Partner Q&A Series

In the reimbursement partner Q&A series, we share knowledge and expertise from HRS partners across the country who have pursued reimbursement through CMS, commercial payer partnerships, or private pay programs.

Frequently Asked Questions

To bill 99453 and 99454, you must have 16-days of Bluetooth reportable measures.  

This is dependent if the agency is a Medicare Part-B provider and bills for Part-B services. There potentially could be reimbursement opportunities if the HHA has a Palliative Care program.  Commercial payer opportunities do exist for HHA.

99091 is a collection and interpretation of physiologic data stored and/or transmitted by the patient and/or caregiver to the Physician, NP, or PA, requiring a minimum of 30 minutes of time spent engaging in the CarePlan, every 30-days. This code cannot be billed concurrently with 99457 or 99458.

No, based on CMS final rules, 99453 is for the initial set-up and patient education.  99453, episode of care.

It does. CMS 2021 rule states: that time spent can be used to analyze, interpret, and interact with communication.

Incident to billing was used prior to COVID-19 PHE. I expect the leniency around general supervision to return to its pre-covid rules. 

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