Remote Patient Monitoring (RPM) quickly has become a valuable asset to healthcare providers. Monitoring patient data remotely, physicians are able to respond earlier, improve care outcomes, and reduce costly hospitalizations. Reimbursement policy usually stands in the way, though. Several providers have said that WellMed is not reimbursing for RPM services, and they are left with rejected claims and added financial stress.
Let’s breaks down why WellMed may not reimburse for RPM, the policies behind these decisions, and what providers can do to respond.
How RPM is Covered Under Medicare Part B
Traditional Medicare (Part B) considers RPM as a standalone billable service. Specific CPT codes (i.e., 99453, 99454, 99457, 99458) provide the rules for billing for setup time, device supply, and monitoring time.
CMS has certain reimbursement requirements, such as:
- Medical necessity documentation
- Minimum of 16 days of patient data within a 30-day period
- Use of FDA-approved devices
Under Part B, RPM has strong reimbursement support, but the same is not always true for Medicare Advantage (Part C).
The Role of Medicare Advantage (Part C) in RPM Reimbursement
CMS Guidelines vs. WellMed Policies
CMS states under 42 CFR §422.100 that Medicare Advantage plans must cover all basic Medicare benefits. However, RPM is not classified as a telehealth service under Medicare’s official telehealth benefit list. This gives WellMed room to argue that RPM is part of overall care rather than a standalone reimbursable service.
Common Reasons for RPM Claim Denials
- Incorrect or Missing Claim Data
- Failure to Meet Medical Necessity
- Improper CPT Coding and Billing Errors
- Overlapping or Bundled Services
- Policy Limitations Under Medicare Advantage
- WellMed’s Interpretation of CMS Rules
Why CMS Needs to Step In
The Case Against Medicare Advantage Restrictions
Medicare Advantage plans like WellMed receive significant federal funding. However, by limiting RPM payments, they can curtail patient care but still profit.
Motivating Providers and Patients to Come Forward
Physicians, clinics, and patients should compel CMS to adopt more equitable reimbursement policies. Patient-centered care is realized by transparency and accountability.
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