Does Private Insurance Cover Remote Patient Monitoring(RPM)?

As the use of remote patient monitoring grows increasingly common, it can be difficult to ascertain who is qualified to receive it and who is responsible for the associated costs (RPM). The vast majority of insurance companies will cover RPM, with a few notable exclusions. People who are qualified for RPM telecare must adhere to a number of requirements. In order to start providing patients with care that is immediately more personalized and effective, medical practices that have patients who are eligible for remote patient monitoring should immediately enroll in the RPM program.

Does private insurance cover remote patient monitoring?

Patients covered by private insurance are one of the key patient populations that stand to gain from RPM’s implementation. These patients encourage doctors to use RPM in order to give effective and preventative therapy, for which they will compensate practitioners for billable services. In return, these patients will reimburse practitioners for billable services. Because certain businesses offer reimbursement for remote care, remote patient monitoring is covered by a subset of the private insurance plans that are available.

Does Medicare cover remote patient monitoring?

As a result of recent changes that were implemented by the Centers for Medicare & Medicaid Services (CMS) in response to the COVID-19 public health emergency, Medicare will now fund telehealth services with a patient’s home designated as the origin rather than a typical physician’s office. This change was made possible as a result of the COVID-19 public health emergency. Because of this adjustment, patients can now receive care via remote access, eliminating the need for them to ever set foot inside an office.

Patients who already have Medicare coverage have access to a variety of electronic platforms, such as the telephone, video conferencing, and imaging, through which they can communicate with their practitioners. Medicare will provide coverage for this kind of virtual check-in, allowing patients to maintain communication with their physicians regardless of whether they are feeling well or where they are located. This will help patients avoid unnecessary trips to the doctor.

Do nursing home or rural patients qualify? Patients with either acute or chronic conditions qualify.

Patients residing in nursing homes and those living in rural areas qualify for remote patient monitoring. The growth of telehealth during the COVID-19 health crisis made remote patient monitoring accessible to patients in remote locations and medical facilities such as nursing homes. Patients in rural locations greatly benefit from RPM services, as it can be more difficult to obtain practitioners in remote places, particularly when frequent visits are required for chronic diseases. These services include standard check-ins in addition to emergency calls, therapeutic sessions, and critical care services. As remote care expands, more patients will qualify for RPM services.

Previously, telehealth and remote patient monitoring services were restricted to patients with chronic diseases requiring more constant monitoring. As of 2021, the Centers for Medicare & Medicaid Services (CMS) confirmed that RPM services may be applicable and medically necessary for both acute and chronic patients. Chronic disorders that frequently benefit from RPM include hypertension, diabetes, congestive heart failure, and obesity, whereas acute conditions include more transient or minor illnesses such as asthma, nausea, or the common cold.

Do both new and established patients qualify?

Yes, both new and established patients can qualify for remote patient monitoring. As a result of the extensions and enhancements made during the 2020 public health emergency, both new and existing patients are now eligible for virtual communication services and equipment. It is possible, however, that this regulation will not be prolonged through the public health emergency and into 2021. Medicare-covered telehealth services continue to include billing codes for new patients, despite the CMS 2021 Final Rule requiring that services be limited to established patients only. As a result of this final regulation, the CMS has also failed to provide guidance on new telehealth patient services. Ultimately, new patient services may defer to state legislation addressing clinical standards of care and physician-patient relationships. Currently, all state statutes allow physicians to establish new patient relationships for RPM services.