FREQUENTLY ASKED QUESTIONS
The Big Picture: Why is CMS doing this?
CMS understands that new, affordable wireless remote monitoring technologies will help patients remain in their homes longer and reduce hospital stays. Initial results have already shown great promise but until now, the upfront financial burden of these technologies have been cost-prohibitive for most physicians. We believe the leadership at CMS should be commended for their foresight in supporting and driving healthcare innovation. While this new mechanism creates an enormous new financial opportunity for certain types of providers (e.g. primary care providers) it is expected to help reduce overall medical spending.
Where do I get the equipment and software?
We can provide you with the remote monitoring devices and required software to get your remote physiological monitoring program up and running in as little as two weeks. Our platform is also able to integrate with various EHR systems (at scale) creating an unprecedented revenue opportunity for physicians and health systems alike.
Because CMS’ RPM reimbursement codes are still very new, software and equipment options that meet the code requirements remain limited. Fortunately, Carematix has been following the evolution of these codes carefully.
Our remote monitoring devices include:
The healthcare provider team gets access to web-based software that includes the following capabilities and more:
Contact us for a free consultation and for pricing. Most of our program options are profitable in the first month and generate recurring revenue on a monthly basis.
Because CMS’ RPM reimbursement codes are still very new, software and equipment options that meet the code requirements remain limited. Fortunately, Carematix has been following the evolution of these codes carefully.
Our remote monitoring devices include:
- Wireless Blood Pressure Monitor
- Wireless Weight Scale
- Optional mobile app for patient to track recorded biometrics.
The healthcare provider team gets access to web-based software that includes the following capabilities and more:
- Secure viewing of patient remote monitoring data in your own portal.
- Flagging at risk patients who may need more outreach, so that your team can reach out to the right patient at the right time.
- Two-way communication with patients on the portal.
- Note taking of patient interactions, for compliance with CMS billing requirements.
- Assigning patients to caregivers and groups for easy organization or to compare the performance of different parts of your care team.
- Direct integration with electronic health record systems is possible for enterprise partners (minimum commitments may apply).
Contact us for a free consultation and for pricing. Most of our program options are profitable in the first month and generate recurring revenue on a monthly basis.
What are the detailed definitions of these new codes?
- CPT code 99453: “Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.”
- CPT code 99454: “Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.”
- CPT code 99457: “Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.”
Can the patient be at home for RPM reimbursement?
Yes, the patient can be at home. In fact, this is the intention behind the new codes.
Must the patient be in a rural area for RPM reimbursement?
No, the patient need not be located in a rural area or any specific geographical area. CMS does not consider RPM to be a Medicare telehealth service. Instead, CMS pays for RPM services under the same conditions as in-person physicians’ services, with no additional requirements related to their geography.
Does RPM require an in-person exam or interactive audio-video connection for ongoing communication?
No, RPM services do not require the use of an interactive video connection. However, for new patients or patients who have not been seen by the practitioner within one year, the practitioner must first conduct a face-to-face visit with the patient prior to billing for RPM.
Who can deliver RPM services?
According to the Foley law blog, “CPT 99457 allows RPM services to be performed by the physician, qualified healthcare professional, or clinical staff. Clinical staff includes, for example, RNs and medical assistants (subject to state law scope of practice and state law supervision requirements). The inclusion of “clinical staff” is the most significant differentiator from CPT 99091, as that code is limited only to “physicians and qualified health care professionals.” All practitioners must practice in accordance with applicable state law and scope of practice laws. The term “other qualified healthcare professionals” used in CPT 99457 is a defined term, and that definition can be found in the CPT Codebook.”
Must the patient give consent to RPM services?
Yes, the patient must give consent and such consent must be documented in the patient's medical record.
Can RPM also be billed with chronic care management (CCM)?
Yes. However, the time spent performing RPM analysis may not be applied towards the same time being billed to CCM (e.g. no double-counting of time).
Can your system be integrated into my existing electronic health record system?
Yes. The Carematix platform has API protocols that can be integrated into any existing EHR.