Tech-enabled healthcare solutions are providing new reimbursement opportunities under Medicare

Any healthcare provider is familiar with current procedural terminology (CPT) codes, the numbers the industry uses to classify diagnostic services for Medicare. These codes permeate the medical field because they impact how providers are reimbursed for their patient care.

CPT codes come from the Centers for Medicare & Medicaid Services (CMS), which oversees Medicare reimbursement in the United States. This means all healthcare solutions and providers must work within the bounds of these codes to secure proper reimbursement.

Any provider that codes its services improperly without meeting CMS standards risks ruining the business and falling out of favor with the U.S. government. Service coding failures are considered a violation of the provider agreement with Medicare

Is your facility completely up-to-date on the latest Medicare coding changes? Below is a closer look at how to code remote patient monitoring properly, plus important tips for approaching the new rules regarding CPT coding and Medicare.

Asynchronous Care and Remote Patient Monitoring

Generally speaking, CPT codes for remote patient monitoring involve asynchronous care, which is care that occurs over a period of time and doesn’t necessarily occur in a traditional office setting. When remote patient monitoring uses tech-enabled devices, it almost certainly falls under the umbrella of asynchronous care.

This is an aspect of healthcare that’s currently changing quite dramatically. During the COVID-19 pandemic, there was an enormous rise in the use of remote patient monitoring as a healthcare solution. Companies that are providing cutting-edge virtual care solutions are growing their customer bases rapidly, not to mention saving lives.

For healthcare providers, it’s important to track how Medicare integrates with virtual patient care because it can so strongly impact a provider’s ability to secure reimbursement. Next, we’ll take a closer look at the current state of remote patient monitoring as it relates to CPT codes and Medicare payments.

Broadening What Qualifies for Medicare Reimbursement

The main factor that changed recently is a final rule from the CMS in the Physician Fee Schedule which lays out the addition of new CPT codes and the expansion of existing CPT codes for remote patient monitoring reimbursement. This broadens the use cases for Medicare reimbursement of remote monitoring significantly, which is a huge opportunity for healthcare providers.

Previously, there were some CPT codes related to remote patient monitoring, but they were somewhat limited and old-fashioned. They didn’t always take into account the modern state of healthcare because they couldn’t adequately capture how people realistically receive treatment. This has been particularly true in the COVID era when people have urgently needed world-class healthcare from a distance.

Now, the newly-adjusted CPT codes are helping healthcare providers drive recurring revenue while also improving patient engagement and outcomes. These codes allow the expansion of remote patient monitoring while modernizing billing for digital healthcare and preserving providers’ ability to seek adequate reimbursement.

Steps Providers Can Take to Secure New Billing Opportunities

Ensure that your healthcare organization is using CPT codes in a way that supports the best possible virtual care billing by accomplishing the following tasks.

  • Know the codes. Remote patient monitoring primarily uses the codes 99453, 99454, 99457, and 99458. Ensure everyone in your facility has a clear understanding of these codes and the differences among them.
  • Code properly. Track down the sources of improper coding and resolve them swiftly. For example, codes 99458 and 99457 are sometimes confused because both relate to billing in increments. Employees should receive extensive training on the details of applying these codes.
  • Monitor adherence. Codes may need to be added or changed over time depending on patient adherence to treatment regimens and medication schedules.
  • Stay current on new developments. This is an evolving and expanding aspect of healthcare. This means some questions still remain about how to properly code and bill CPT codes for virtual care, so it’s important to stay informed about the latest changes.
  • Select reputable providers. When choosing a remote patient monitoring healthcare solution, opt for a technology provider with a solid reputation for facilitating proper billing and enhancing the overall quality of patient care.

This is a new frontier in remote patient monitoring and Medicare billing. If your healthcare organization is experiencing challenges and encountering concerns about implementing the right technology for your patients and providers, please connect with AMC Health.

For More Information About Coding and Healthcare Solutions

AMC Health is at the forefront of the revolution in remote patient monitoring that’s optimizing patient care through innovative new healthcare solutions. Our suite of virtual care monitoring solutions is empowering patients, maximizing resource management for providers, and improving the state of global healthcare. 

Please schedule a demo to learn more about CPT codes and reimbursement for remote patient care.


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