The pandemic didn’t create remote care, but it has greatly accelerated the adoption of telehealth and remote care. The Centers for Medicare and Medicaid Services (CMS) continues to provide new reimbursement options for remote care services. And commercial payers are following their lead. Trends are pushing in the same direction – more healthcare delivered at home with the potential for $250 billion – or 20 percent of all total outpatient, office and home health to be delivered virtually.
Patients’ habits and expectations about remote care are also changing. Studies show, 25 percent of people would switch providers for better remote care options. Offering high-quality remote care programs is no longer a nice-to-have. They are a must-have for practices to stay competitive.
Remote Patient Care Program Options
So, with all of these different remote programs available, how do you know which one(s) are right for your patients? Let’s start with the acronyms:
- RPM – Remote Patient Monitoring
- RTM – Remote Therapeutic Monitoring
- CCM – Chronic Care Management
- PCM – Principal Care Management
PCM and CCM are also closely related care management services for treating complex conditions.. Patients may qualify for one or the other based on the number of and severity of their diagnosed chronic conditions.
RPM/RTM can be a complement to CCM/PCM. RPM/RTM services include collecting and monitoring specific patient data. This data can be a great asset in providing care for patients with complex conditions that are part of a CCM or PCM program.
What are the Differences Between these Remote Care Programs?
|Objective||Monitoring of specific physiological parameters between office visits||Monitoring of specific therapeutic or non-physiological (including self-reported data), parameters between office visits||Chronic care management and coordination for patients with two or more complex conditions between regular office visits||Chronic care management and coordination for patients with one complex condition between regular office visits|
|Device and Reading Requirements||Requires use of FDA-defined device with a minimum 16 of days of readings per 30 days||Requires use of FDA-defined device with a minimum 16 of days of readings per 30 days||None||None|
|Diagnosis Requirement||No specific diagnosis requirement but RPM must be medically necessary||No specific diagnosis requirement but RTM must be medically necessary||Multiple chronic conditions (2+) lasting 12+ months||Single high-risk disease lasting 3+ months|
|Ordered by:||Physician or Qualified Health Care Professional (QHCP), who can bill for E/M services||Physician or Qualified Health Care Professional (QHCP), who can bill general medicine codes, including PTs, OTs, dieticians, psychologists.||Physician or Qualified Health Care Professional (QHCP)||Physician or Qualified Health Care Professional (QHCP)|
|Clinical Care Team Requirement||Requires minimum of 20 minutes by clinical staff per month||Requires minimum of 20 minutes by clinical staff per month||Requires minimum of 20 minutes by clinical staff per month
Requires minimum of 30 minutes personally by the physician or QHCP
|Requires minimum of 30 minutes by clinical staff, physician or QHCPper month|
|Monitoring Provided Incident to the Billing Practitioner||QHCP or clinical staff, including nurses under the general supervision of the billing practitioner||QHCP or clinical staff under the direct supervision of the billing practitioner||QHCP or clinical staff under the general supervision of the billing practitioner||QHCP or clinical staff under the general supervision of the billing practitioner|
|CPT® Codes||CPT® Codes 99453/99454/99457/ 99458||CPT® Codes 98975/98976/98977/ 98980/98981||CPT® Codes 99490/99491/99439/99437||CPT® Codes 99424/99425/ 99426/99427|
Can I Bill for Multiple Remote Programs for the Same Patient?
A patient can be eligible for both a monitoring program (either RPM or RTM) and a chronic care management program (either CCM or PCM). However, the same minutes spent providing care cannot apply to both. The time requirements for each code must be met separately and no time can be double-counted.
Which Clinicians Qualify as “Clinical Staff”?
The type of personnel that qualifies as “clinical staff” for any of these programs will vary by state law and providers should look at the scope of practice laws in the patient’s state to determine who can provide care. CCM and PCM patients often have more complex needs that require care from providers with a higher-level education and scope of practice than RPM and RTM services.
Still Have Questions? Ready to Learn More?
For more details, download our complete Optimize Health 2022 RPM Billing and Coding Guide (includes CCM and PCM codes) and the Optimize Health 2022 Remote Therapeutic Monitoring (RTM) Billing and Coding Guide. Or set up a time to talk with one of our RPM experts. We are happy to answer billing questions and even help you conduct a financial analysis to determine which of these remote programs may be right for your practice.
Share This: Back to Blog