When telehealth emerged as a necessity during the pandemic, it revolutionized access to care almost overnight. However, what began as a temporary solution is now a permanent fixture in healthcare delivery. Alongside telehealth, Remote Patient Monitoring (RPM) is gaining traction as practices focus on proactive care management, especially for chronic conditions. While both services enhance patient outcomes and expand practice capabilities, they also introduce billing challenges that can jeopardize revenue if not handled with precision.
Why Telehealth Billing Isn’t As Simple As It Seems?
At first glance, billing telehealth might appear straightforward—submit claims for virtual visits as you would for in-person encounters. However, the reality is far more nuanced. Each payer has distinct requirements regarding:
Modifiers and Codes:
- Using the correct modifier 95, GT, or GQ is crucial. For example, Medicare typically requires modifier 95 for synchronous telehealth visits, but some payers still request GT.
- Failing to append the right modifier often leads to claim rejections or partial payments.
Place of Service (POS) Confusion:
- Should you use POS 02 (telehealth), or POS 11 (office) with a modifier to indicate telehealth delivery? Medicare guidance and commercial payer policies frequently differ, making a one-size-fits-all approach impossible.
- Incorrect POS coding can result in lower reimbursements as telehealth visits may be paid at a non-facility rate if coded incorrectly.
State Licensure and Compliance:
- Cross-state telehealth visits add layers of complexity. Providers must ensure they’re licensed in the state where the patient is located during the visit.
- Some states maintain pandemic-era licensure flexibilities, while others require full active licenses, increasing compliance risks if unchecked.
Coverage Limitations by Payer:
- Not all payers reimburse for telehealth at parity with in-person visits. Knowing payer-specific policies is critical to avoid denials.
For practices without specialized billing support, these differences often translate to increased denials, revenue leakage, and frustrated billing teams.
Remote Patient Monitoring (RPM): Expanding Care, Increasing Complexity
Remote Patient Monitoring has rapidly moved from an innovation to a standard of chronic care management, particularly for patients with hypertension, diabetes, COPD, and heart failure. RPM enables providers to track patient vitals and symptoms in real-time, intervening early to prevent deterioration.
Billing RPM, however, is far from simple. Here’s why:
Code and Documentation Requirements:
- RPM billing involves CPT codes 99453 (setup and education), 99454 (device supply and data transmission), 99457 (20+ minutes of interactive monitoring), and 99458 (each additional 20 minutes).
- Documentation must clearly support time thresholds, data reviewed, and clinical decisions made.
Minimum Time Thresholds:
- For example, 99457 requires a minimum of 20 minutes of interactive communication with the patient per month. Even one minute short can result in claim denials or recoupments upon audit.
Device Eligibility Standards:
- Only devices that meet FDA definitions and automatically transmit patient data qualify for RPM billing. Devices requiring manual entry by patients are excluded.
Patient Consent and Enrollment Requirements:
- Some payers mandate documented patient consent prior to initiating RPM services, while others specify that consent must be written rather than verbal.
- Missing consent documentation can lead to denied claims or repayment demands during audits.
Payer Policy Variability:
- Medicare, Medicaid, and commercial payers each define RPM coverage, frequency, and eligible diagnoses differently, making it crucial to track policy updates continuously.
Why These Complexities Matter More Than Ever
For practices, inaccurate telehealth and RPM billing has far-reaching impacts:
- Revenue Protection – Rejected claims delay cash flow, and underpayments reduce practice profitability.
- Compliance Assurance – Incorrect billing risks audits, fines, and reputational harm.
- Patient Experience – Billing errors often lead to patient frustration over unexpected charges or delayed care continuity.
- Competitive Positioning – As virtual care becomes a patient expectation, practices that can bill efficiently remain sustainable and competitive.
How MediBill Health Partners Simplifies Telehealth and RPM Billing?
At MediBill Health Partners, we understand that your focus should be on delivering care, not deciphering complex billing rules. Here’s how we support practices in telehealth and RPM billing:
- Policy Expertise: Our billing specialists stay updated on every payer guideline change, state licensure requirement, and telehealth billing nuance to keep your practice compliant and profitable.
- Accurate Modifier & POS Application: We ensure each claim is submitted with the correct modifiers and place of service codes to maximize reimbursements.
- Detailed RPM Documentation Review: Our team verifies time logs, device eligibility, and patient consent before claim submission to reduce denials and ensure audit readiness.
- Faster Reimbursements: With clean claim submissions and proactive follow-up, your revenue cycle remains smooth and predictable.
- Dedicated Account Management: We function as an extension of your team, providing regular billing performance updates, denial analyses, and strategy recommendations.
Final Thoughts
Telehealth and RPM are transforming healthcare delivery, but only practices that master their billing complexities will harness their full benefits. As regulations evolve and patient expectations rise, having an expert partner to navigate this landscape is essential.
Ready to streamline your telehealth and RPM billing process? Connect with MediBill Health Partners today and empower your practice to thrive in this new era of digital healthcare.