Offering telehealth services to patients now makes up a significant part of every provider’s daily schedule. The digital interactions through video calls and digital platforms, doctors and therapists connect with individuals remotely, offering convenience and accessibility while maintaining the quality of care. Remote Patient Monitoring (RPM) and Remote Therapeutic Monitoring (RTM) have become integral parts of telehealth services by enabling continuous and real-time health monitoring outside traditional healthcare settings.
These involves using digital devices to collect and transmit patient health data. RPM and RCM are non-face to face technology where information is transmitted using connected medical device. Adopting these not only helps in providing more comprehensive care to the patients outside of their traditional in-person doctor’s visits but also saves time and effort for both sides.
Remote Patient Monitoring (RPM)
RPM is used to track and assess patient’s physiological metrics such as oxygen saturation, blood pressure, blood sugar or oxygen levels, weight fluctuations using advanced devices that automatically record and transmit biometric data outside the traditional healthcare settings. Physicians, qualified non-physician practitioners, physician assistants, and nurse practitioners can bill it for patients with chronic conditions such as hypertension, diabetes, obstructive pulmonary disease (COPD), and heart disease. The primary objective is to effectively manage chronic illnesses, decrease hospital readmissions, and enhance patient outcomes by offering continuous monitoring and prompt interventions.
Remote Therapeutic Monitoring (RTM)
Providers can use RTM for outpatient rehabilitation therapy services for monitoring and treatment adherence. This involves collecting data on patients musculoskeletal or respiratory health, medication adherence and treatment response such as pain management. Patients can self-report this data using their devices. This allows practitioners like physical and occupational therapists, physiatrists, speech-language pathologists, clinical social workers to independently bill their services, without a physician or nurse practitioner. They can receive reimbursement for activities like monitoring platform alerts, direct messaging with patients, and collecting feedback data related to pain level and movement.
Reimbursement requirements
- RPM requires an established patient relationship but not the RTM.
- RPM must monitor an acute or chronic condition.
- RPM must collect at least 16 days data out of 30 days. communication between patient and provider related to RPM data or device use is not billable.
- RPM can be bill by only one practitioner in 30 days period.
- RPM and RTM cannot be billed together.
- Monitoring must be medically reasonable and necessary.
- RPM and RTM, but not both, can be billed concurrently with the care management services – chronic care management (CCM), transitional care management (TCM), behavioral health integration (BHI), principal care management (PCM), chronic pain management (CPM)
- For the global periods of surgery, RPM and RTM can be billed by practitioners that are not receiving the global service payment.
- Patient consent must be obtained when RPM is provided.
- In RPM, physiological data must be electronically collected and automatically uploaded and be available for analysis and interpretation by the billing practitioner.
- The device used to collect and transmit data must meet the FDA (US Food and Drug Administration) guidelines.
- The services may be provided by health care personnel under the general supervision of the billing practitioner.
- Visits to the beneficiary home for supplying, connecting, or training the
patient on technology is not separately billable.
Permanent Flexibilities
The Federal Government has extended telehealth services through March,2025 (Consolidated Appropriation Act, 2023), introducing some permanent flexibilities to bill telehealth services.
Removal of geographic restriction
Medicare patients can permanently receive telehealth services for behavioral/mental health care in their home. There are no geographic restrictions for originating site for Medicare behavioral/mental telehealth services on a permanent basis.
Provider
Physicians, physician assistants, nurse practitioners, clinical nurse specialists, nurse-midwives, clinical psychologists, clinical social workers, registered dietitians or nutrition professionals, certified registered nurse anesthetists, marriage and family therapists, and mental health counselors can permanently serve as Medicare distant site providers. Federally Qualified Health Centers (FQHC) & Rural Health Clinics (RHC) can be the distant site providers for non-behavioral/mental telehealth services permanently. They are entitled to the payment under Physician Fee schedule (PFS) through Dec 31, 2025.
Modality
Two-way, real-time, audio-only communication is billable for telehealth services furnished to a patient in their home if the distant site physician or practitioner is technically capable of using an interactive telecommunications system (both audio and video), but the patient is not capable of, or does not consent to, the use of video technology.
Practitioner Address
Practitioners can provide the services from their home while using their enrolled practice location through Dec 31, 2025.
In-Person visit
The in-person visits within 6 months of the initial visit and annually thereafter for Medicare behavioral/mental telehealth services furnished via communication technology to beneficiaries in their homes is not required for FQHC and RHC through Jan 1, 2026.
To sum up, the comprehensive advantages have turned telehealth into a sustainable and profitable part of healthcare delivery. It encourages patients to take an active role in managing their health, leading to better health outcomes and patient satisfaction. It is effective for managing chronic conditions, reducing hospital readmissions, and preventing complications. Remote monitoring aids in streamlining administrative tasks, reducing overhead costs and boosting overall efficiency. Healthcare providers can keep abreast of RTM and RPM billing codes to benefit from reimbursement opportunities.
