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Calculating Your Reimbursements

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The Need to Adopt Telehealth

As the nation learns to navigate the realities of a pandemic world, traditional healthcare structures are proving insufficient for the current crisis. Providers are responding to the demands of a quickly spreading virus and an overburdened hospital system by changing the way they interact with patients — not in the office, but virtually.

What Can You Do?

In the field of obstetrics specifically, practices are adapting by revising the prenatal visit schedule, with some reducing in-person visits to as low as five. To stay connected and manage patients in between visits, providers are leveraging technological touch points like video visits, remote patient monitoring, mobile apps, and telephone visits.

What CPT Codes Will You Use?

For the purpose of this analysis, we will be focused on the codes related to remote patient monitoring.

 

First, assess your new prenatal schedule. For those who normally bill a global fee to insurers (CPT code 59400), make sure that the new schedule meets the minimum threshold of visits (minimums can vary by state or plan but often the average is 5 visits). Once you confirm this, you can rest assured that you will still be able to capture the same reimbursement for the physician management of the pregnancy.

 

Then, use the following CPT codes as you work in OB Connect to set up patients and monitor them remotely.

RPM CPT Codes 01

 Note: Be sure to check with your payers directly to understand if they will reimburse and the exact reimbursement rates.

What Does This Look Like in a “Typical” Private Practice and an Integrated Health System?

Below we share two examples. One for a mid-size private practice with 1,000 annual births and one for a large integrated health system with 15,000 annual births. Using the CPT codes above, we calculate the potential additional reimbursement for adopting telehealth through OB Connect.

What Will Your Reimbursement Look Like While Using OB Connect?

This calculator will estimate the amount of reimbursement expected for the number of pregnant patients during the typical 9 month period for maternity care. Be sure to check with your payers directly to understand if they will reimburse and the exact reimbursement rates.

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