Reimbursement Best Practices for Remote Patient Monitoring

Remote Patient Monitoring
Remote Patient Monitoring

Remote Patient Monitoring (RPM) is a norm in the American healthcare sector. It enables providers to extend their services outside traditional clinical settings, monitoring patients’ health conditions and recommending interventions in real-time. Insider Intelligence’s estimates suggest that nearly 70.6 million American patients will use RPM tools by 2025. That is a whopping 26.2% of the population.

As the adoption of RPM and connected devices grows, clinics should integrate them to stay relevant and competitive. However, understanding the reimbursement landscape is vital to ensure the sustainable implementation of these solutions. The last thing you want as a provider is to struggle for proper payment because the insurer raises doubts about RPM.

This article highlights a few proven reimbursement best practices to address key considerations to optimize financial outcomes.

Understand Reimbursement Policies

According to the US Health and Human Services Department, billing and reimbursement terms for remote patient monitoring vary for Medicare, Medicaid, and private insurers. They may also depend on the location because terms differ for states. Additionally, providers must follow certain regulations to ensure successful remote patient monitoring reimbursement.

Successful RPM implementation for your healthcare organization requires an understanding of reimbursement policies, relevant healthcare regulations, coding requirements, and payer guidelines. Since each payer may have distinct rules, you must stay informed about updates and changes. Regularly check for the latest policies to ensure compliance and maximize reimbursement opportunities.

Ensure Accurate Coding and Documentation

Proper reimbursement depends on accurate medical coding. Check the Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes relevant to remote patient monitoring. CoachCare notes that RPM reimbursement rates can be higher than chronic care management and telehealth, provided codes are adhered to.

Besides selecting the appropriate codes for the services provided, you must ensure documentation supporting the medical necessity of the RPM services. It includes evidence of patient eligibility, device setup, and ongoing monitoring. Accurate coding and precise documentation strengthen claims and mitigate the risk of denials.

Verify Patient Eligibility

In a recent survey, 30% of healthcare leaders expressed concern over the increasing rate (10 to 15%) of claims denials in the country. Even worse, most of them are avoidable because they happen due to human oversight. Missing out on patient eligibility verification is the top reason for the denial issue. The problem often begins during registration or pre-registration when inaccurate or incomplete information is collected.

Simple errors like patients misspelling their names or the registration staff selecting Medicaid instead of Medicaid Managed Care as the payer can lead to a denial. With RPM, the chances of such errors are even higher.  Going the extra mile with the verification process can be a savior.  Verify that patients meet the reimbursement condition, such as having chronic conditions requiring continuous monitoring.

Also, set up efficient eligibility verification processes before initiating RPM services. You can also enhance compliance with clear communication with patients about their eligibility status and associated costs.

Establish Strong Partnerships with Payers

Healthcare providers and payers follow a shared goal of ensuring the highest quality of patient care at lower costs. According to a survey, 92% of providers seek better collaboration with health plans as they believe this will lead to better patient outcomes with reduced cost of care. Building collaborative relationships with payers can optimize RPM reimbursement, just as in the traditional treatment model.

Prioritize open communication with payers to understand their requirements, expectations, and changes in reimbursement policies. Foster a collaborative approach by addressing any concerns or questions. Strong payer partnerships can also lead to better negotiation opportunities and expedited claims processing.

Utilize Technology for Billing and Reporting

Another best practice to streamline remote patient monitoring insurance claims is to utilize technology solutions for billing processes and reporting. For example, electronic health record (EHR) systems can reduce errors and improve the efficiency of the billing process. They also streamline patient data verification for organizations serving hundreds of patients.

You can implement automation through tools for coding accuracy, claims submission, and tracking reimbursement status. Beyond integrating these solutions, you should audit billing processes to identify weak spots and ensure compliance with payer requirements. No matter how complicated RPM reimbursement sounds, these tools can help you overcome its challenges and maximize payments.

In conclusion, remote patient monitoring is here to stay, and being ready to adopt it requires staying ahead of the reimbursement processes.  Navigating the RPM reimbursement landscape is easier than you imagine, provided you take a proactive and informed approach. Understand the reimbursement policies from the outset and create your RPM plan around them. Also, work closely with payers to ensure long-term success in the evolving industry.

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