In September 2024, the Department of Health and Human Services (HHS) Office of Inspector General (OIG) published a report detailing its recent review of remote patient monitoring (RPM) services furnished to Medicare beneficiaries and recommending additional oversight of RPM services. The OIG’s call for heightened scrutiny in this area is likely an indicator of increased audit activity of providers of these services.
By way of background, remote patient monitoring services typically use digital technologies to collect medical and other forms of health data from a patient in one location and electronically transmit that data to the patient’s healthcare provider in a different location for evaluation and treatment management. In many instances, the data collected is automatically electronically transmitted to providers for review and allows for efficient patient management. In some cases, these technologies can either trigger direct patient engagement or facilitate communication between the patient and provider.
In 2019, the Centers for Medicare & Medicaid Services (CMS) expanded payment for remote patient monitoring services. Shortly thereafter, the availability of Medicare reimbursement for remote monitoring services led to a substantial increase of providers furnishing RPM services. OIG’s report specifically highlights the increase in utilization of RPM services between 2019 and 2022, with Medicare payments for RPM services totaling more than $300 million in 2022, compared to $15 million in 2019.
RPM services generally include the following five CPT codes, which CMS contemplates together comprise the three basic components of RPM services:
- Patient Education and Device Set-Up
- CPT 99453: Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment
- Device Supply
- CPT 99454: Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days
- Treatment Management Services
- CPT 99091: 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 health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days
- CPT 99457: Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes
- CPT 99458: Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; each additional 20 minutes (List separately in addition to code for primary procedure)
Additionally, OIG contends that its review found that about 43% of Medicare beneficiaries who received remote monitoring services did not receive all three of the above components. OIG and CMS claim that Medicare lacks key information for oversight, including information such as who ordered the monitoring for the beneficiary, which has led OIG and CMS to raise concerns about these services. OIG’s report ultimately makes the following five recommendations to CMS in an effort to increase oversight of RPM services:
- Implement additional safeguards to ensure that remote patient monitoring is used and billed appropriately in Medicare.
- Require that remote patient monitoring be ordered and that information about the ordering provider be included on claims and encounter data for remote patient monitoring.
- Develop methods to identify what health data are being monitored.
- Conduct provider education about billing of remote patient monitoring.
- Identify and monitor companies that bill for remote patient monitoring.
The OIG report along with the several recommendations above appear to be a sign of increased audits of providers who furnish remote patient monitoring services to Medicare beneficiaries. Providers who utilize RPM services should take this opportunity to review their documentation and billing procedures and strengthen compliance with the unique requirements applicable to these services. It is also worth noting that CPT coding and Medicare coverage policies for remote services have not always kept pace with advancing technology and capabilities. RPM providers should be aware of the coding and coverage requirements of the services they bill.
For over 35 years, Wachler & Associates has represented healthcare providers and suppliers nationwide in a variety of health law matters, and our attorneys can assist providers and suppliers in understanding new developments in healthcare law and regulation. If you or your healthcare entity has any questions pertaining to Medicare audits or healthcare compliance, please contact an experienced healthcare attorney at 248-544-0888 or wapc@wachler.com.