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How Medicare’s New Telehealth-Friendly Billing Codes Can Increase Revenue for Healthcare Businesses

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Author: Mike Walsh | CEO
How Medicare’s New Telehealth-Friendly Billing Codes Can Increase Revenue for Healthcare Businesses

Is your healthcare business utilizing Medicare’s updated billing codes to maximize revenue?  Whether you’re ahead or behind the curve with your telehealth strategy, new codes may make it worth the investment in new technology.

Telehealth technologies are already helping many healthcare facilities lower costs by:

  • Reducing hospital readmissions
  • Improving staff workflows
  • Optimizing remote patient monitoring for rural populations, patients with chronic conditions and long-term care patients

But some of those facilities may not be capturing all their revenue potential.

Many physicians — and their patients — are unaware that the Centers for Medicare and Medicaid Services (CMS) deployed three new Remote Patient Monitoring (RPM) billing codes as of January 1, 2019. These telehealth-friendly billing codes can make a difference to your bottom line.

The best part? RPM isn’t considered a Medicare telehealth service. In fact, RPM is considered equivalent to in-person physical services.

Medicare has offered reimbursement for RPM services under CPT code 99091 since the beginning of 2018. This code covered the collection, storage and interpretation of physiological data by a qualified medical professional requiring a minimum of 30 minutes of time — but it fails to address current methods and technology. CPT code 99091 is more than 16 years old.

The three new codes more accurately reflect the services rendered by modern telehealth technology, including timeframes and personnel who are actually administering these services. While all three cover essentially the same aspects of telehealth services covered by CPT code 00909 — remote monitoring of physiological parameters — CPT code 99453 refers specifically to the initial set up of and patient education on the use of equipment.

CPT code 99454 covers device supply and daily recording or transmission of data, and CPT code 99457 covers time spent by qualified medical professionals to manage treatment by interacting with the patient.

How do these new codes translate to revenue? By addressing modern usage of these covered services, the new codes allow for better reimbursement for care provided. Medicare will reimburse you for the setup of equipment, and not only for rural areas. In-home setups are covered, too. Because RPM is considered complementary to Chronic Care Management (CCM), CPT 99457 and CPT 99490 can be billed in the same month as long as the time requirements are met for individual services. By unbundling the aspects of the previous CPT code, Medicare’s new telehealth friendly billing codes can help your healthcare business bring in reimbursements that might have gone unbilled in the past.

Curious about maximizing the impact of Medicare’s new CPT billing codes?  DGI knows telehealth, from the equipment to the technology and most importantly the support. Want to learn more? Let’s chat about how DGI can drive more revenue and better patient outcomes for your practice.

– CPT code 99453: “Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.”

– CPT code 99454: “Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.”

– CPT code 99457: “Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.”

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Mike Walsh | CEO

Mike Walsh is a 15+ year veteran in the audio visual industry, bringing extensive knowledge of AV design, implementation, service and sales to DGI. Mike is high energy, providing leadership and driving innovation for the diverse divisions that make up our company. He’s also led a team that was recognized as the top integration firm serving educational markets in the country two years running.

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