Effective January 1, 2023, the Centers for Medicare & Medicaid Services (CMS) implemented the new G-codes for home health agencies to report remote patient monitoring (RPM) services. These codes are informational only and will not be reimbursed by CMS. However, they will be mandatory for all home health agency (HHA) RPM programs starting July 1, 2023.
The three new home health G-codes for telehealth services are:
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Home Health Agency G-Codes |
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G0320 |
Video visits with patients to discuss their care plan |
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G0321 |
Audio communications with patients to discuss their care plan |
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G0322 |
Collection of physiological data that is stored and transmitted |
These codes should be reported monthly, and we recommend that you start submitting test claims prior to the deadline of July 1, 2023. This ensures that you use the correct codes and that your claims are processed correctly.
Collecting this data allows CMS to analyze the characteristics of patients using services provided remotely, helping them understand the social determinants that affect who benefits most from these services and the potential barriers preventing certain subsets of patients from using them.
Learn more about the home health G-codes in this 90-second video clip where Charika Wilcox-Lee, Vice President of Revenue Cycle Management at HRS explores the latest telehealth reimbursement advancements.
Can Home Health Agencies Bill for Telehealth?
The answer is: Yes!
To qualify for a home health benefit from CMS, consider the type of services your HHA provides to patients. Medicare home health reimbursements encompass two categories of services, split into Part A and Part B.
- Part A Services
Your HHA is eligible to apply for Part A benefits if patients under your care are homebound. “Homebound” is defined as patients suffering from an impediment that necessitates special assistance from another person to leave their home. Other necessary criteria needed for Part A qualifications are in-person patient visits by medical professionals, a plan of care prepared by a certified physician, or a need for intermittent therapy over time.
An example of some services listed under Part A could be skilled nursing, physical therapy, and home health aides.
- Part B Services
If the criteria in Part A are unmet, they can still be reimbursed under the Part B benefit through the Medical Physician Fee Schedule. Services and supplies necessary for treatment, as well as preventive services for early detection of illnesses, can still be covered.
Although the new G-Codes are non-reimbursable, home health agencies can bill for chronic care management, remote patient monitoring, and remote therapeutic monitoring using designated CPT codes. Check out our telehealth reimbursement codes cheat sheet for more information on these codes and how to use them.
In addition to CMS reimbursement, there are other telehealth reimbursement models that home health agencies should consider to generate revenue from their telehealth & RPM services.
Home Health & RPM: How It Works
The CMS defines remote patient monitoring (RPM) as a "collection of physiological data gathered through electrocardiogram, blood pressure, or glucose monitoring, which is digitally stored or transmitted from the patient or caregiver to the HHA." HHAs were early adopters of RPM, utilizing it as a solution to help monitor patients in their homes and decrease the need for in-person visits from nurses and caregivers.
MaineHealth Care at Home (MHCAH) was one of those early adopters. According to the US Census, Maine has the oldest population in the country, a fact that compounds healthcare challenges alongside other factors such as significant levels of poverty, adverse trends in chronic disease, as well as the predominantly rural landscape of the state.
Back in 2015, MHCAH transitioned to Health Recovery Solutions (HRS) remote patient monitoring services and experienced a 75% reduction in overall 30-day hospital readmissions in their first year with HRS. Following this, MHCAH expanded its telehealth efforts and reported:
- 30-day hospital admissions in the range of 0.07% to 5% per quarter for telehealth patients, as opposed to 17% for non-telehealth patients
- 85% average daily adherence for patients taking biometrics
- Patient satisfaction scores in the range of 3.35 to 4.0 (with 4.0 being the highest possible score)
There are more such success stories of RPM helping patients achieve better outcomes. Find out more in this patient success story from Colorado, where a patient with hypertension finds renewed freedom and comfort through home health RPM services.
How HRS Helps Home Health Agencies
HRS has solutions for HHAs that help them support patients with telehealth and RPM throughout their home health journey. With an easy-to-use platform that allows for real-time monitoring of patients, HRS allows HHAs to observe high-risk patients from their homes while increasing patient engagement in the treatment process. Through patient education and engagement, patients can understand their own condition and take active steps toward staying on track for treatment.
Going back to the subject of reimbursement, HRS’ reimbursement experts make it easier for providers to comply with this new G-code reporting requirement by populating the necessary codes on reimbursement reports. HRS does the heavy lifting by putting the information that our home health clients need to submit these claims to CMS in their hands. Not only that, HRS provides invaluable insights that empower HHAs to make data-driven decisions.
Request a demo to learn more about how we help home health agencies with remote patient monitoring and reimbursement.
