Understand RCM to succeed in the RPM market

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Remote patient monitoring (RPM) devices – fitness watches, blood pressure, cardio monitors – are growing in popularity as a way to gather and correlate data outside of a traditional clinical setting and share up-to-the-minute data with care providers. However, health tech entrepreneurs and developers must understand the revenue cycle management (RCM) aspects of the telehealth and RPM market and stay up-to-date about regulatory guidelines to ensure profitability. Some basics:

  1. Medicare requires reimbursable telehealth technology to have an interactive audio-video component.

  2. Telehealth technologies must be used in designated sites called “originating sites” – often not the home.

  3. RPM is defined differently from telehealth by Medicare. Medicare pays for RPM services with no additional requirements regarding originating sites or use of the telehealth place of service codes. This allows for patients to receive RPM services in their home.

  4. Because of the complications is using CPT code 99091, the Centers for Medicare & Medicaid Services (CMS) introduced three new codes for RPM services in 2019 – codes 99453, 99454, and 99457.

  5. For telehealth (not RPM), the American Medical Association, released six new CPT codes to support virtual visits. Watch for additional CPT codes coming in 2020 for telehealth and RPM.

Successful reimbursement-based revenue depends on complex billing mechanisms beyond the CPT codes. State-based laws can also affect telehealth and RPM billing. Know how federal and state entities define, fund, and regulate healthcare delivery options when it comes to remote care. Work with RCM experts to determine if your RPM-based care delivery model can generate adequate revenue using these codes.

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Regulatory alignment for the next generation of health tech companies

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