RPM Billing

This guide will walk you through the Remote Patient Monitoring (RPM) billing components in the system.

The Basics

There’s a lot that goes into understanding RPM billing, but the basics are as follows:

  1. The government allows clinicians to bill for remotely monitoring patients. The billing codes are based on time it takes to set up a patient and minutes spent monitoring that patient each month
  2. The Monitor keeps track of when a patient has been set up for RPM billing
  3. The clinicians use features within the monitor to record minutes they work with a patient
  4. The Monitor system produces an RPM billing output report each day that reflects billable codes whose rules have been met.
  5. The monitor contains visible controls showing minutes being accrued towards monitoring and dashboard features show monthly views as to what minutes remain to bill for a particular patient

Billable Work

What is billable in the RPM world depends on the rules and regulations for reimbursement determined by the government. Currently, the following billing codes are recognized by and can be generated automatically by the system:

99453 – “Remote Monitoring of Physiologic Parameters – Initial Set Up”.

This code is designed to capture the moment in time when a patient has been enrolled in the system and the physician has completed the “set up” of the patient. Said another way, when enrollment and initial set up is complete, the billing system can generate the 99453 code.

99454 – “Device(s) supplied with daily recording(s) or programmed alert(s) transmission each 30 days

This billing code is designed to recoup the cost of placing biometric equipment into the hands of the patient for purposes of remote patient monitoring.

To qualify for this code, the equipment must be in place, with the patient, for at least 16 days within a 30-day period.  The code can be generated once for each 30-day period.  It should, however, be billed immediately at the first 16-day opportunity for the first 30-day period.

  1. It cannot be generated, if a 99453 has not already been generated for the patient
  2. It cannot be generated, if there are not at least 16 days, within a billing period, that the patient has sent in any measures (it does not matter how the measure was added, i.e., voice, manual entry, device, etc.)

99457 – “Remote Physiologic Monitoring treatment management, first 20 minutes” and 99458 – “Remote Physiologic Monitoring treatment management, additional 20 minutes”

This code is used to document the time a care team spends working on RPM for a particular patient.  To qualify for this code, the doctor + care team must accrue 20 minutes of work with the patient in a 30-day window.  Each 20-minute period after the first 20, causes 99458 to be generated, one 99458 per additional 20-minute period.

Every 30 days after the key date “Program Start”, the system should assess whether or not 99457 and 99458 codes can be generated.  The system will add together the elapsed time of every task executed for a patient, by any member of the care team, for tasks which have the “RPM Time Accumulator” attribute turned on.   If the total time is 20 minutes or more, then 99457 should be billed.  If the time is 40 minutes, then 99457 and one 99458 should be billed.  If the time elapsed is, say, 60 minutes, then 99457 and two 99458s should be billed. Basically, you get one 99458 for every 20-minute block above the first 20 minutes.   

If, however, you had 21 minutes, you only bill 99457, as there is not another block of 20 minutes to reach a 99458.  A block of 45 minutes would bill 99457 and 99458 (the extra 5 minutes is lost).

99457 and 99458 cannot be billed if 99453 and 99454 have not ever been billed for the patient. In other words, the patient has to be actively enrolled and have equipment, before you can bill 99457 and 99458 codes.

Setting up a Patient for RPM Billing

From a monitor user’s perspective, to enable RPM billing for a patient, you would do the following:

RPM Patient Set up Basics

  1. Enroll a patient as normal
  2. The RPM Billing Monitoring Plan associated with all patients in the department will automatically mark a newly enrolled patient as being in Training Mode on the date of enrollment.
  3. When you have completed training and set up for the patient, using the left wing on the demographics tab you indicate that the patient has exited training mode
  4. Upon exit from Training Mode, the RPM Billing Monitoring Plan will create a new appointment on the subject’s calendar indicating the date that they started in the program and when training mode completed
  5. The billing system will use the exit from training mode to determine when it can assess the “Initial Set Up” billing code

Set Up Detail

One might think that the moment a patient is enrolled within the system corresponds to initial set up being completed. Unfortunately, this is not the case. Rather, a patient can be enrolled within the system, but may not have been trained or given the equipment yet that is required to begin being monitored. The 99453 code can only be generated when the patient is truly set up. In the monitor application, we use a couple of different mechanisms to determine when set up has truly been completed.

Enrolling a Patient/Subject in the Monitor

First, when a patient is enrolled in the system, rather than being set to “Active” status, we mark this patient as being in “Training Mode”. We use the moment in time when the patient exits training mode to determine that initial set up has been complete. RPM Monitoring Plans automatically move the patient to Training Mode upon enrollment and then upon exiting enrollment generate the key dates needed to specify the patient’s initial set up is now complete.

Training Mode is Denoted on the Left Wing of the Subject Notebook

When the billing system runs it will record a 99453 for each subject whose Training Completed Date occurred after the last run of the billing system.When a patient deactivates from the program, an alert will fire, and the Monitoring Plan should record an appointment with key date type of Program Exit with the date and time of the exit.

Using Tasks to track RPM Activity

Currently, one of the billing codes that can be generated for RPM billing has to do with the amount of time you spend working with a patent remotely and in performing reviews of patient data. The RPM billing system relies on the monitor’s task system to keep track of RPM work and to help the system decide which pieces of work can be billed. Minutes accrued toward RPM based tasks accumulate in minutes towards the RPM billing codes recognized by the system.

RPM Task Tracking Basics

  1. When you complete tasks using the monitor, minutes to complete the task are automatically accrued for RPM billing.
  2. The type of task determines whether a task accrues minutes towards billing.
  3. The system displays a visible timer for any work-in-progress RPM task running for the signed on user when inside the patient’s notebook
  4. The system displays information to indicate whether or not you have any open RPM tasks running at the top of the monitor display
  5. If you forget to close a running RPM task, the system will close it for you.

Tasks Overview

Within the monitoring application, Tasks are used to keep track of the work you have performed. A task:

  • Describes the kind of work you’ve performed
  • Keeps track of when the work was started and completed
  • Tracks who completed the work
  • Can optionally link the work to a patient
  • Tracks information you gather to complete the task

Many times, tasks are generated and assigned to a individual by the monitor’s alert system. The alert system detects a key event and then determines who should follow up on the event and then assigns a task to that person to track the work being done to resolve the issue associated with the key event.

Tasks are not limited to being created by the alert system. You may create a task yourself to track work that you are doing. You do so by navigating to the Task List and clicking the “New” button. Once you’ve done so, the system will ask you to tell it what kind of task you are performing and will then provide you with the tools you need in order to do the task at hand. You record information about the task in the task notebook.

When you are working on a task, it is very common to have that task require you to fill out a check list of items indicating what you’ve done on the part of your work in the task. You use the task notebook to complete task based work.

Task Notebook Details View

Each task tracked by the monitor always has a “Details” page associated with it. On this page, you can update the time it took to complete the task and mark the task as completed.

Commonly other tabs are displayed as well to help you capture the data required to complete the task. The other pages on the Task Menu are displayed to the left of the Details page as blue links. Clicking on these links lets you navigate the task and provide the data necessary to complete the task.

Task Notebook- Check List

The task notebook often is used with a check list and the check list can group work that you are to do into categories in order to complete the task. Sometimes the check marks must be checked before the task is allowed to complete (depending on the settings in your department).

Logging Phone Calls with a Patient

The monitor application tracks the amount of time you spend on the phone with a patient. From within the patient’s notebook, on the demographics page, you will see a “Phone” icon on the top right. When you click that icon, the “Start or Log Phone Call” dialog displays as follows:

Start or Log Phone Call Dialog

From this dialog, you can either start a new phone call by clicking on one of the listed phone numbers for the patient, or you may record a previous phone call. To start a phone call, simple click the phone number you are wanting to call. When you do so, the monitor will create a new task of the type specified at the top of the display. It will start that task as well and assign the work to the signed on user.

When the call is started, you can indicate when it is finished by clicking the “Stop” button on the “Start or Log Phone Call” dialog.

Start or Log phone call – Click Stop to stop call

When you click the Stop button, the task that is tracking the work is automatically completed for you. When you click Stop, the logging dialog hides upon completing the task.

Some tasks require you to work within the task notebook to, say, check off the check list of actions you are required to complete for that task. To view the running task associated with the phone call, click the hyperlink next to the “Task ID” field and you will be taken to the task notebook where you can work within the task to record information about the call.

You can record a call that was done outside of the system using the “Start or Log Phone Call” button as well. When the dialog displays, click the “Record Previous Call” button

After clicking “Record Previous Call” you can then log the dates and time of the previous call. The system will automatically created and complete the task of the selected type for that phone call.

Logging Non-Phone Call RPM Activity

RPM Billing allows for you to track time associated with chart review and consideration of data submitted by the patient. This billing code requires the system to track the minutes of this monitoring type of activity. The monitor tracks these minutes through the Task system much like with the Phone Call tracker, but with a bit more flexibility in what tasks are tracked.

To start a non-phone call RPM task, click on the “Hour Glass” icon on the patient demographics screen. When you do so, the system will display a dialog where you can indicate the type of task you wish to perform. Simply select the RPM task from the drop down and click the Start button.

When you click Start, the monitor will create a task of the specified task type for you and assign the work to you. You can then do the work using the task notebook.

When you start the task, a task timer displays and counts the time it takes you to complete the task. The minutes logged here will be considered part o the RPM billable minutes for this patient. You can complete the task by clicking the red button to the right of the time shown under the task timer.

The task timer displays for you when you are inside of the patient’s notebook. But, what happens if you were to leave that patient’s notebook? The system reminds you of the ongoing task by displaying the time and the patient in the top of the monitor web page. To return to the patient’s notebook you can click on this red banner.

Automatically Terminating Tasks

It’s possible to forget to close out the work you were doing using the monitor. To ensure that they timer does not keep running for a task, the system contains an automatic termination mechanism. If the system detects that you have not done anything with the monitor for 20 minutes, and there is a timed task running, the monitor will automatically complete the task for you at the point in time it detects you’ve forgotten to complete the task.

NOTE: Please try to remember to complete running tasks to improve the accuracy of the billing system.