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Who Qualifies and Pays for Remote Patient Monitoring?

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With the expansion of remote care, it can be difficult to tell who qualifies for, and who pays for, remote patient monitoring (RPM). There are a few rules that apply when it comes to those who can receive remote care for RPM. These span age, the patient’s condition, their location, and whether they are a new or established patient with their practitioner. Practices with patients who are eligible for remote monitoring enroll in a RPM program immediately to start giving their patients more personalized and effective care today.

Qualification will vary depending on patient coverage. To determine whether your patient is eligible for RPM, we’ve answered some frequently asked questions:,

Does Medicare cover remote patient monitoring?

Medicare patients are one of the main groups of patients who can benefit from RPM. Medicare encourages practices to start RPM for the efficient and preventive care of Medicare patients for which they will reimburse practitioners for billable services. Remote monitoring is covered for Medicare patients as remote care is reimbursed by Medicare.

In some of the Centers for Medicare & Medicaid Services’ (CMS) more recent changes, in part due to the COVID-19 public health emergency, Medicare will now reimburse for telehealth services with patients’ homes listed as the origin, rather than a traditional physicians office. This change allows patients to receive remote care without ever having to step foot in a physical office.

Medicare patients who are already established are permitted to communicate with practitioners through a variety of technological platforms such as telephone calls, video conferencing, or imaging. Medicare will pay for these virtual check-ins so that patients can continue to communicate with their physicians regardless of condition or location and avoid unnecessary doctor visits.

Do nursing home or rural patients qualify?

Both nursing home patients and rural patients qualify for remote monitoring. The expansion of telehealth during the COVID-19 health crisis allowed patients in rural areas and in medical facilities such as nursing homes to have access to RPM. Patients in rural areas benefit greatly from RPM services as it can be more difficult to access practitioners from isolated areas, especially if common visits are required by chronic conditions. These services consist of traditional check-ins as well as emergency calls, therapy services, and critical care services. As remote care grows, more and more patients will qualify for RPM services.

Do patients with either acute or chronic conditions qualify?

In the past, telehealth and remote monitoring services have been limited to patients with chronic conditions that require more continuous monitoring. As of 2021, CMS clarified that RPM services may apply to and be medically necessary for both patients with acute conditions and chronic conditions. Some chronic conditions that commonly benefit from RPM include hypertension, diabetes, congestive heart failure, and obesity while acute conditions may consist of more fleeting or mild illnesses such as asthma, nausea, or the common cold.

Do both new and established patients qualify?

Yes, both new and established patients qualify for RPM. As of expansions and additions made during the 2020 public health emergency, both new and established patients are eligible to receive virtual communication services and devices. It is possible, however, that this rule is not extended past the public health emergency and into 2021. While the 2021 Final Rule from CMS stated that services be limited to established patients, new patient billing codes continue to be listed among the Medicare-covered telehealth services. Following this final rule the CMS has also failed to issue guidance on new patient services via telehealth. Ultimately, new patient services may defer to state laws regarding clinical standards of care and doctor-patient relationships. As of now, any state laws allow doctors to create new patient relationships for RPM services.

Who pays for remote patient monitoring?

RPM is most commonly paid for by patient insurance coverage and by government healthcare such as Medicare. For Medicare patients, practitioners bill Medicare to be reimbursed for RPM services. Practitioners can bill Medicare by submitting CPT codes for various services. RPM services should come at no cost to Medicare patients and provide small to medium size practices with additional revenue while simultaneously alleviating the strain of in-person visits. Medicaid patients may also be eligible for RPM reimbursement. For non-Medicare patients, RPM coverage may vary from provider to provider. With the help of an RPM company, patient care and billing codes are made easy so that practitioners can focus on getting patients the personalized, in-home care they deserve.

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