Reimbursement Based Solution

Remote Patient Monitoring (RPM)

Program Overview

RPM allows healthcare providers to monitor patient vitals remotely using connected devices. This is especially beneficial for managing chronic or acute conditions that require ongoing attention.

CPT Codes:

99453: Covers the one-time setup and patient education for RPM equipment.

99454: Monthly billing for supplying devices and transmitting data from patient to provider.

99457: 20 minutes of clinical staff time spent on RPM management, including patient interaction.

99458: Additional 20 minutes of RPM management beyond the initial 20 minutes.

Benefits:

Early Detection: Continuous monitoring allows for early identification of potential health issues, preventing complications.

Reduced Hospital Visits: Regular monitoring decreases the need for emergency care and hospitalizations.

Financial Incentives: RPM is reimbursable under Medicare, providing a new revenue stream for healthcare providers.

Cellular Devices

SmartHub enabled Bluetooth Device for Patient does not have proper cellular connectivity or at Facilities

Chronic Care Management (CCM)

Program Overview

CCM offers comprehensive care coordination for patients with two or more chronic conditions, facilitating continuous, personalized management to improve health outcomes.

CPT Codes:

99490: Covers 20 minutes of non-complex CCM, focused on ongoing care coordination.

99439: Additional 20 minutes of CCM services, used alongside 99490 for extended care.

99487: Complex CCM, requiring 60 minutes of clinical staff time with moderate to high complexity medical decision-making.

99489: Additional 30 minutes of complex CCM services, billed with 99487 for more extensive care.

Benefits:

Holistic Care Management: Ensures consistent and coordinated management of chronic conditions, improving patient outcomes.

Prevention of Complications: Regular follow-ups and care adjustments reduce the likelihood of disease progression and hospital readmissions.

Enhanced Patient Engagement: Encourages patients to take an active role in managing their health, leading to better adherence to treatment plans.

Medication Therapy Management (MTM)

Program Overview

MTM optimizes the medication regimens of patients with complex drug needs, ensuring proper use, adherence, and preventing medication-related complications.

CPT Codes:

99605: Initial 15-minute medication therapy review for new patients, focusing on a comprehensive evaluation of the patient’s medication regimen.

99606: Follow-up 15-minute review for established patients, assessing the effectiveness and safety of the ongoing therapy.

99607: Each additional 15 minutes of MTM beyond the initial or follow-up session, used to provide more in-depth reviews or adjustments.

Benefits:

Improved Medication Adherence: Ensures that patients correctly follow their medication regimens, reducing the risk of adverse drug events.

Risk Reduction: Prevents complications from drug interactions or incorrect usage.

Enhanced Patient Safety: Promotes the safe and effective use of medications, particularly in patients with complex medical needs.

Transitional Care Management (TCM)

Program Overview

TCM supports patients transitioning from an inpatient setting, such as a hospital, back to their home or another community setting, ensuring continuity of care and reducing the risk of readmission.

CPT Codes:

99495: Moderate complexity TCM, requiring interactive contact with the patient or caregiver within 2 business days of discharge, and a face-to-face visit within 14 days.

99496: High complexity TCM, requiring similar contact within 2 business days, with a face-to-face visit within 7 days.

Benefits:

Reduced Readmissions: Ensures that patients receive timely follow-up care, significantly lowering the risk of hospital readmission.

Smoother Recovery: Facilitates a seamless transition from hospital to home, enhancing patient outcomes and satisfaction.

Cost Efficiency: Reduces overall healthcare costs by minimizing the chances of complications that can lead to further hospitalizations.

Summary Table

Service	Eligible Providers	Supervision Level	Patient Criteria
RPM	Physicians, NPs, PAs, CNSs	General Supervision	Patients with acute or chronic conditions requiring regular monitoring
CCM	Physicians, NPs, PAs, CNSs	Direct Supervision	Patients with ≥2 chronic conditions expected to last ≥12 months
MTM	Pharmacists, Physicians, NPs, PAs	Varies by Setting	Patients with multiple chronic conditions and complex medication regimens
TCM	Physicians, NPs, PAs, CNSs	General Supervision	Patients transitioning from inpatient to community settings

Key Points

Supervision Levels:

Documentation:

InstaMD Platform Features and Benefits

Platform Feature	Benefits
🏠 Support for any Care Setting	RPM Adaptations for homes and facilities
📱 Wide range of Device Support	Depends on Connectivity option i.e., cellular and Wi-Fi
📞 Integrated Phone System	Replicates Practice Caller ID for easy recognition by patients
💳 Over 1950 Payers Integrated	Automated eligibility and monthly tracking optimizes revenue; HMO patients automatically flagged
🔔 Multi-level Alerts	Customized device notifications aligned with practice guidelines for timely intervention
🧠 AI-Enabled	Improved clinical reading trends, clinical summaries for physician and patient communication
⚠️ Patient Risk Scoring	Evaluations for patient conditions such as LACE, ASCVD, Stroke, etc. for prioritized care
📝 Personalized Care Plan	Tracking and outcomes assessment for patient engagement and self-care promotion
🌐 Multi-lingual Patient Support	Leads to high retention and program compliance
📈 Vitals Data Access	Easy access to vitals readings by patients without needing an app. Physicians and care teams receive real-time alerts without any app setup.
✉️ Patient Reminder	Personalized automated messages in various languages
💲 Revenue Cycle Management	RPM only revenue cycle management support available (optional add-on)
🔗 EHR Integration	Platform supports various integration options such as HL7 and APIs; enables seamless EHR integration for claims and reports
📜 Audit Ready	Any integration with patients (calls, SMS, data review) is recorded into the system for future audit review