Billing and Revenue RPM

RPM Commercial Reimbursement Eligibility Expansion is Boon for Healthcare Providers

Optimize Health | 29 September 2021
3 minute read

You may think that RPM only applies to Medicare populations, but that is definitely not the case. Spurred by the COVID-19 Public Health Emergency, a number of industry changes have swiftly been implemented in recent times.  Provisions for broader coverage and reimbursement for telemedicine services, including RPM, have been steadily growing state by state. This shift represents a tremendous opportunity to expand service to a broader eligible patient population for healthcare practices across the country. 

Loosening of Federal Restrictions

During the COVID-19 pandemic, demand for telemedicine services, including RPM, grew exponentially. The Centers for Medicare and Medicaid Services (CMS) responded swiftly by declaring a Public Health Emergency (PHE), essentially loosening restrictions on Medicare reimbursement for telemedicine services, including RPM. 

As we look towards a post-pandemic future, the changes made throughout the pandemic have paved the way for broader coverage of RPM services, from Medicare patients to the general population as a whole. 

States Trending With Expanded Commercial Coverage

According to Foley & Lardner LLP, the number of states requiring all commercial payers to reimburse for RPM surged from two in early 2020 to 17 by early 2021. Additionally, 43 states and Washington D.C. offer commercial remote care coverage.

Individual states have set different timelines and have varying approaches for expanding coverage of RPM services. Many state governments are focused on developing telemedicine coverage, particularly among Medicaid programs. The focus would include reduced restrictions on healthcare provider licensing and prescribing. 

Furthermore, many states are officially requiring that private payer plans offer service and payment parity. In other words, they must cover and reimburse for telemedicine services equally to how they would for in-person care. 

Commercial Payers Voluntarily Opting-In

Many commercial and private health insurers have taken a proactive stance when it comes to telemedicine. The COVID-19 pandemic was an essential factor in this sea change.  Healthcare Insurance companies voluntarily addressed telemedicine in their response to COVID-19. By broadening coverage of telemedicine, expanding in-network telemedicine providers, and reducing patient costs, more patients have been able to benefit. 

Increasing Equity and Access for All

The COVID-19 pandemic not only revealed but also magnified the disparate levels of access to healthcare services for marginalized communities. 

Both Medicare and Medicaid’s geographic restrictions on reimbursable telehealth services are decreasing. At the same time, more federally qualified health centers and rural health clinics may benefit from these changes. 

While gaps remain, an increase in service and payment parity for telehealth services across all insurers was one step in helping to reimburse providers and ultimately increase healthcare access for all patients.

Technology has proven to be an essential tool in increasing access to healthcare. When combined with the right program, RPM devices can reduce many of the barriers related to travel and access for communities regardless of their location. 

Furthermore, with telehealth eligibility widening beyond the Medicare population, a greater variety of patients, regardless of age or socioeconomic status, may now be potential candidates for RPM.

Tremendous Growth Opportunity

The healthcare industry has faced seemingly insurmountable challenges in the past two years. Fortunately, both industry and government entities have responded swiftly. 

From small independent practices to larger healthcare systems, a gamut of healthcare providers has quickly brought on new telehealth programs or expanded existing ones. While this can be a considerable investment, the broadening of patient eligibility presents a tremendous opportunity for growth. 

If you’ve been considering RPM services, but are concerned about a possible lack of commercial reimbursement eligibility, now is the time to reach out to an expert who can help you evaluate what the opportunity looks like for your patients and your practice.