May 21, 2024 1:40:44 PM | 5 Min Read

Improving Reimbursement for Primary Care with RPM and CCM

Improving Reimbursement for Primary Care with RPM and CCM

Remote patient monitoring (RPM) and chronic care management (CCM) offer significant benefits for physicians and their patients. RPM provides real-time data on patient health metrics outside traditional clinical settings, enabling timely interventions and reducing the likelihood of emergency room visits or hospital read missions. This continuous flow of health information facilitates personalized care plans and adjustments, enhancing patient outcomes. CCM, similarly, supports patients with chronic diseases by coordinating care across multiple providers and ensuring consistent follow-ups. It helps patients manage complex health needs more effectively, preventing complications through regular monitoring and education.

It's not just about the improved patient outcomes, incorporating RPM and CCM can also provide significant financial benefits to primary care physicians. Especially for those struggling to create a sustainable practice while still providing care to Medicare beneficiaries. The Centers for Medicare and Medicaid Services (CMS) recognizes the value of RPM and CCM as complementary services to provide preventive and ongoing care to patients with two or more chronic diseases. Several billing codes allow physicians to be reimbursed for delivering this beneficial service to their patients, which we will review here.

Remote Patient Monitoring (RPM)

RPM codes were first introduced in 2019 and can be utilized for patients with at least one chronic disease who would benefit from the collection and interpretation of real-time physiologic data, such as blood pressure or blood glucose. It is important to note that, when billing for RPM, you must state the intervention's goals and the medical necessity for its use.

The codes for RPM reimbursement are as follows (as of 2024)

99453

This is a one-time code that covers the initial setup and patient education on the use of the device. 

99454

This code covers the maintenance of the device and the platform where the readings are recorded. 99454 can be billed monthly as long as the patient is still actively using the device and the system is up and running to accept readings from the patient at least 16 out of 30 days of the billing cycle. 

99457

This code covers the first 20 minutes of clinical staff time and care coordination concerning the device and monitoring. This includes some interactive communications with the patient (phone, text, email), but there are other activities that can be included. Any time spent by staff reviewing data, communicating with other staff members, or recording notations in the chart for review can be counted towards this time. Note that “clinical staff” does not include the physician or other qualified health professional. There are separate codes for these individuals that cannot be billed concurrently with 99457 and 99458. For this reason, we chose not to include them in this overview.

99458

This code covers each additional 20 minutes of clinical staff time spent on care coordination and communication as well as data review. This code can be billed up to three times per month in conjunction with 99457. 

Chronic Care Management (CCM)

In 2015, CMS introduced codes to cover non-face-to-face services provided to Medicare beneficiaries who require additional care coordination for their chronic conditions. Unlike RPM, CCM billing requires that the patient have at least two chronic medical conditions that require care coordination, and the physician or clinical staff member must document the goals of care and the medical necessity for the service. 

These clinical services can include medication reminders, referrals, coordination with other specialists and physicians or non-physician clinicians, and an ongoing assessment and intervention on lifestyle factors that may impact the person’s chronic disease outcomes. 

At ViTel Health, we employ highly trained and dedicated health coaches to help patients better manage and understand their diseases and assist them in achieving sustainable lifestyle modifications that will help them live healthier lives. 

The codes for reimbursement for non-complex CCM are as follows. There are additional codes for complex CCM that we will not cover in this article. 

99490

This code covers the initial 20 minutes of clinical staff time spent coordinating the care of the patient under the supervision of the physician.

99491

This code covers each additional 20 minutes of clinical staff time and can be billed twice in conjunction with 99490.

Complexity and Compliance

As you can see billing these additional codes every month for your chronically ill patients can result in significant monthly recurring revenue for your practice - the national average for all codes listed billed concurrently would be around $350/patient/month. However, this comes with significant additional expenditures for a practice in terms of personnel and administrative burden. Staying compliant with documentation and billing best practices can be a lot for a small physician practice.

Thankfully there is ViTel Health. Our full-service, integrated platform-as-a-service model brings you the best in technology, security, and outcomes without any additional burden for your practice. We also hire, train, and maintain the necessary health coach and clinical staff required to ensure that your patients receive the best quality care without you having to lift a finger. 

Happy Physicians, Healthy Patients - That’s the ViTel Health advantage.

Contact us for a demo today.

 

Topics: Primary Care

Related Posts

Telehealth | Physicians

The Positive Impact of Remote Work on Physicians, Nurses, and Health Coaches

Even five years ago, remote work for healthcare workers seemed impossible. Given the ongoing...

Read More

Chronic Care Management for Physicians and Patients

In 2015 the Centers for Medicare Services created a program for Chronic Care Management (CCM) that...

Read More
Telehealth | Health & Wellness Tips

Health Coaching for Mental Health

In the fast-paced world where we live, stress can take many forms, and we often forget to do the...

Read More