Remote Patient Monitoring

Continuous Care Delivery

Closing the Gaps in Care: Extending care from the brick-n-mortar to the home

A survey suggests 70% of those practices, adopting Remote Patient Monitoring (RPM) reports improvements in patient engagement, satisfaction and increased revenue associated with ability to create capacity for higher intensity office visits. Sixty percent of all respondents see RPM becoming a new standard of care over the next two years.

Adoption of the GenieMD RPM module within our virtual care platform allows clients to extend care into the home – providing a continuous care model. Ultimately being able to achieve the tenant of value-based care without taking on risk.

The factors that most influence the structure of an RPM program is:

The identification of qualifying patients
Does their health insurance reimburse for RPM, RTM and CCM?
Which physiological data is required to best monitor a patient’s state of wellness – this greatly influences which medical device is selected?
Willingness of the patient to participate in such a program

GenieMD RPM services takes on these factors and more to offload these monitoring services from the physician needing to look at every alert and only escalate to the designated provider (per patient) when deemed necessary. If billed to its fullest capacity, per the 2022 Physician Fee Schedule below, a Provider can drive a maximum of $183 per patient per month (PPPM) in additional revenue.

How many qualified patients do you have in your office?

RPM Reimbursement Codes:

CPT 99453 ($22 - billed once)

Used to report the initial setup, as well as, patient education on RPM and use of the device(s). As such, this code is generally billed once per patient on the initiation of RPM services.

CPT 99454 ($49/month)

Monthly remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate); reimburses for the supply of the device and monitoring of patient data. This code requires that patient readings be performed at least 16 days each month.

CPT 99457 ($52/month) & CPT 99458 ($41/month)

RPM management codes are monthly time-based codes covering interactive communication with the patient (or caregiver) to manage treatment or the care plan or interpreting and acting on transmitted data. As such, for the first 20 minutes of logged management time each month a practice can bill 99457. Once 99457 has been billed, a practice can add up to two instances of 99458 at 40 minutes and 60 minutes, respectively. CMS has stated that 99457 and 99458 can be furnished by clinical staff under the general supervision of the billing provider.

CPT 99091

99091 was the original way to bill for RPM. The 2021 final rule changed the frequency that CPT 99091 is reported. CMS now permits billing the code concurrently with the newer codes. Providers can bill for “complex” RPM management when the provider must spend significant time managing the patient and their RPM care plan. CMS also stated that 99091 can be billed each 30 days whenever such complex provider management occurs without affecting the practice’s ability to bill clinical staff time via CPT 99457 each calendar month.

Monthly Practice Revenue:

99454 criteria NOT achieved: $0
99454 and 99457 criteria IS achieved: $101/patient
99454, 99457 and 99458 is achieved: $142/patient
99454, 99457, 99458 (40 Minutes) achieved: $183/patient
99091 ($57/month)

Note:

1. When addressing patients escalated to the physician, they can bill 99091, $56.41 – 30 minutes to perform data analysis & interpretation each month.

2. One cost factor that can influence your virtual care adoption financial model is the selected medical device to capture physiological data. While we would collaborate with each client on this point; the cost factor could influence a change in PPPM investments.

Medical Device Utilization

GenieMD integrates with over 400 different medical devices. As such we enjoy a collaborative partnership with some of the industry leading manufactures, such as:

AliveCor: 1L and 6L ECG
Apple Watch: ECG, Heart Rate, Fall Detection
BioMetric: Wellness data including Blood Oxygen Levels, continuous Heart Rate, Skin Temperature, Sleep Stages, ECG (1L) and Blood Pressure
BodyTrace: Blood Pressure and Scale via cellular
Google Fitbit: Wellness Device
Hero Health: Pill Dispensing
iHealthLabs: Multiple devices (ie. Blood Pressure, Oxygen Saturation, Heart Rate, Temperature, Scale, and Blood Glucose)
Omron: Blood Pressure and Scale
PMI Health: PC303 (Blood Pressure, Oxygen Saturation, Heart Rate, Temperature, ECG, and Blood Glucose); Spirometer (Spirolink)
Smart Meter: Cellular connected Glucose, Blood Pressure, and PulseOx
VoCare: Vitals 360 (Blood Pressure, Scale, Oxygen Saturation, Heart Rate, Temperature, and ECG)