Managed Care ACO clinicians can provide remote patient monitoring, telehealth, and virtual care services to patients with acute and chronic conditions and for patients with only one disease.
An estimated 117 million adults have one or more chronic health conditions, and one in four adults have two or more chronic health conditions.
For example, managed care ACO may remote patient monitoring can be used to monitor a patient’s oxygen saturation levels using pulse oximetry.
CMS is allowing physicians to supervise their clinical staff using virtual technologies when appropriate, instead of requiring in-person presence.
These services are not considered “telehealth” services and were never subject to telehealth limitations. They do have other factors that limit how they can be used so make sure you check the definition for the codes.
- 21 state Medicaid programs provide reimbursement for remote patient monitoring (RPM). As is the case for store-and-forward, two Medicaid programs (HI and NJ) have laws requiring Medicaid to reimburse for RPM but at the time the research was conducted, did not have any official Medicaid policy.
The Remote Patient Monitoring questions and answers for managed care ACO posted here are provided for general informational purposes only and were current as of the publication date. Due to the evolving nature of the industry, updated or new guidance and clarifications from the governing agencies and your particular circumstances, your results with insurance billing/reimbursement may vary.
CENSON Health in no way guarantees or warrants any particular result to be obtained from use of the information on this page. You should consult with your billing provider for the latest information, and for additional codes that have become available during the COVID-19 pandemic.
Managed Care Q & A
Yes. Even before the new codes, Medicare already offered separate reimbursement for RPM services billed under CPT code 99091. That service is defined as the “collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified healthcare professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time.”