CPT Codes: Trends towards remote patient monitoring and preventive care
The healthcare industry is currently experiencing the rise of a huge trend: a strong shift of focus towards preventive care and the use of wearable data as a critical component of this approach. However, with every leap forward, we face new challenges. One of them is that the growth of the wearable market has created a multitude of points of contact with patients and, consequently, an overflow of scattered and non-standardized data. This makes turning monitoring services into billable items complicated and time-consuming.
To address this issue, healthcare providers require standardized terminology to classify their services, which is where Current Procedural Terminology (CPT) codes come into play.
CPT codes are a set of numerical codes that determine medical procedures and services in a specific way. By using CPT codes, healthcare providers can report their services more accurately and efficiently, making the billing process more transparent for both patients and insurance companies. CPT codes are divided into three categories, which allow for ease of use and more straightforward handling of all the items related to remote care.
One of the most important aspects of CPTs is that they allow healthcare providers to report and bill their services more effectively and accurately. This is key to a more transparent relationship between patients, healthcare providers, and insurance companies, and overall, an easier exchange of information between all of them.
Thanks to these codes, companies that provide preventive care or even treatment with the aid of data gathered from wearable devices can reimburse those services via insurance, making it easier to apply billable hours or services to their operations.
We cannot overstate the increase in the importance of wearable data in the healthcare industry, particularly in remote patient monitoring and preventive care. The rise of wearables means that healthcare providers have access to a continuous flow of health data from their patients for the first time in history, which helps with earlier intervention and a more efficient flow of information.
That's why healthcare providers and billing professionals need to understand how billable Current Procedural Terminology (CPT) codes relate to remote patient monitoring (RPM). To help with this, we've compiled a concise yet comprehensive list of key points to keep in mind.
1. Code Categories: There are currently 3 categories of CPT codes available for the healthcare provider:
CPT Category I: These are the most commonly used by providers to report their procedures and, consequently, the largest category.
CPT® Category II: These codes are considered supplemental and are used for performance management.
CPT® Category III: These are temporary codes utilized to report emerging and experimental services and procedures.
2. Eligibility Criteria: Some eligibility standards need to be met if you want to use RPM CPT codes. For example, one of the most important is that the patient's condition should require at least 16 days of monitoring within 30 days to be eligible for a billable RPM CPT. As a healthcare provider, you must ensure that you meet the eligibility criteria and use the correct codes in every case.
3. Documentation: Maintaining proper documentation when billing for RPM CPT codes is essential from a business standpoint. Not only does it help you to follow all regulations and guidelines for healthcare providers, but it also allows you to receive the maximum possible reimbursement for your time and services. You will want to keep records of the dates and duration of the monitoring services, take notes of the actions taken during the monitoring window, and obtain the patient's consent in writing.
4. Compliance with regulations: It's crucial to be up to date with CPT codes, especially those that cover remote patient monitoring since those are fairly recent. The American Medical Association is the institution that assigns these codes, and they set the standards and regulations for the healthcare industry. It's a good practice to use their recommended codes to prove adherence to their regulatory requirements and keep your team updated on any code changes or additions.
5. Transparency and Communication: Using the correct CPT codes makes communication easier between all people and institutions involved, from the patients to the different healthcare providers, the billing staff, and the insurance companies. Using standardized codes ensures clarity and consistency in describing the services provided. This, in turn, helps insurance companies accurately process claims and determine reimbursement amounts.
6. Billing and Reimbursement: CPT codes are crucial in the process of billing preventive healthcare services that are based on the gathering and processing of wearable data for remote patient monitoring. They standardize data that otherwise would be scattered and inconsistent because wearable manufacturers don't always coherently present their information. By assigning the appropriate CPT codes to preventive healthcare services, healthcare providers can accurately document and bill for these services, allowing for proper reimbursement from insurance providers and government programs like Medicare and Medicaid.
CPT codes help ensure that preventive care is recognized, valued, and accessible to individuals seeking to maintain and improve their health.
Knowing and using them will ensure that your digital health service will be effective for your users and the health of your cash flow.
