Optimize Revenue Cycle Management with FairPath
Your expert guide to healthcare financial success through streamlined RCM in 2025.
Your Financial Foundation
What Is Revenue Cycle Management?
Revenue Cycle Management (RCM) is the backbone of financial health in healthcare, encompassing all administrative and clinical processes to capture, manage, and collect revenue from patient services. From patient registration to final payment, RCM ensures timely reimbursements, reduces claim denials, and maintains cash flow.
In 2025, as healthcare shifts toward value-based care and digital innovation, mastering RCM is critical. FairPath integrates its proven expertise in Remote Patient Monitoring (RPM), Remote Therapeutic Monitoring (RTM), and Chronic Care Management (CCM) to deliver tailored RCM solutions that maximize revenue while enhancing patient outcomes.
Why Choose FairPath?
FairPath: Your RCM Advantage
FairPath transforms RCM with a comprehensive, technology-driven approach:
Seamless Integration
Syncs RPM, RTM, and CCM workflows into your RCM process, capturing every billable service (e.g., CPT 99454 for RPM, 98980 for RTM, 99490 for CCM).
Revenue Maximization
Reduces denials by ensuring accurate coding and compliance—e.g., logging 16+ days for RTM device codes or 20+ minutes for CCM billing.
Efficiency Boost
Automates eligibility verification, charge capture, and claims submission, cutting administrative time by up to 30%.
Data-Driven Insights
Leverages analytics to track KPIs (e.g., denial rates, days in AR), identifying revenue leaks and opportunities.
Patient-Centric Billing
Enhances satisfaction with transparent billing tied to RPM/RTM/CCM care plans.
Common Question: "How does FairPath differ?" Unlike generic RCM tools, FairPath specializes in remote care, aligning financial and clinical goals.
Mastering the Cycle
How RCM Works
RCM spans the patient journey:
Pre-Encounter:
Registration, insurance verification, and pre-authorization ensure accurate data upfront.
Encounter:
Charge capture and coding translate services into billable claims (e.g., RPM's 99457, RTM's 98977).
Post-Encounter:
Claims submission, payment posting, denial management, and patient collections complete the cycle.
FairPath's Edge:
Integrates RPM/RTM/CCM data into each step, ensuring no revenue slips through—e.g., syncing device usage logs for RTM's 16-day rule.
Common Question: "Why track every step?" Missed steps lead to 14% claim denial rates industry-wide; FairPath prevents this.
Real Results, Real Impact
Optimizing RPM, RTM, and CCM with FairPath
FairPath bridges clinical care and financial success:
RPM
Tracks physiologic data (e.g., blood pressure) for CPT 99453–99458, ensuring 16+ days of readings and accurate management time logs (~$50–$120/month per patient).
RTM
Captures therapy data (e.g., exercise adherence) for CPT 98975–98981, automating 16-day compliance and 20-minute management billing (~$40–$90/month).
CCM
Coordinates chronic care (e.g., diabetes) for CPT 99490–99489, streamlining 20+ minute thresholds and care plan updates (~$60–$130/month).
Common Question: "Can I afford this?" FairPath's ROI—fewer denials, faster payments—pays off quickly.
Tech-Powered RCM
FairPath's RCM Technology
Integrated Platforms
Syncs EHRs with RPM/RTM/CCM data for real-time charge capture.
Automation
Handles eligibility checks, coding, and claims, reducing errors by 20%.
Analytics Dashboards
Monitors KPIs (e.g., clean claim rate, net collection rate) for proactive optimization.
Compliance Tools
Ensures adherence to Medicare's 16-day RTM rule or CCM's supervision guidelines.
Common Question: "Is it secure?" FairPath meets HIPAA standards, safeguarding patient data.
Navigating the Landscape
RCM Compliance and Pitfalls
Regulatory Risks
OIG audits target overbilling (e.g., $1.8M RPM overpayments, 2015–2016); FairPath ensures accuracy.
Common Challenges
Billing errors (14% denial rate), staffing shortages (40% turnover), and payer variability.
FairPath's Solution
Audits logs, trains staff, and adapts to payer policies (e.g., Medicare vs. Aetna).
Common Question: "What if I'm audited?" FairPath's documentation withstands scrutiny—e.g., "3/15: 20-min RTM call, 16 days logged."
Maximizing Reimbursements
RCM Across Payers
Medicare
Covers RPM/RTM/CCM with strict rules (e.g., 16-day RTM threshold); FairPath ensures compliance.
Private Payers
Aetna aligns with Medicare; Cigna lags—FairPath verifies coverage.
Medicaid
State-specific (e.g., Virginia pays ~$30 for 98980); FairPath tracks policies.
Common Question: "Will my payer pay?" FairPath's real-time verification confirms eligibility.
Future-Proof Your RCM
RCM in 2025
Digital Shift
AI predicts denial trends; FairPath leverages this for RPM/RTM/CCM.
Policy Updates
Proposed 16-day rule relaxation (2026); FairPath prepares you now.
Value-Based Care
Ties revenue to outcomes—FairPath aligns RCM accordingly.
Common Question: "How do I stay ahead?" FairPath's analytics keep you proactive.
Optimizing Revenue
Best Practices for Billing RPM Under Capitated Plans
FairPath streamlines RPM in capitated settings:
Verify Plan Type
Check MA enrollment upfront to avoid CO-24 denials.
Review Contracts
Identify carve-outs—FairPath confirms if RPM is payable.
Avoid Unnecessary Claims
Skip billing if bundled; document for quality reporting.
Bill Correctly
Use proper POS (e.g., 11, not telehealth 02); meet CMS rules.
Engage Plans
FairPath negotiates with payers for clarity or future carve-outs.
Common Question: "How do I get paid?" FairPath finds billable paths or value-based incentives.
Turning Denials into Opportunities
Handling CO-24 Denials and Appeals
CO-24 denials signal capitation—FairPath guides you:
Confirm Eligibility
Ensure billing targets the right payer (MA, not Medicare).
Assess Contracts
Appeal if RPM is outside capitation (e.g., specialist billing).
Appeal Wisely
Use contract evidence; medical necessity rarely overturns.
FairPath's Edge
Analyzes denials, appeals when viable, and prevents repeats.
Common Question: "Can I win an appeal?" Yes, if misapplied—FairPath builds your case.
Maximizing Value
Alternative Billing Strategies for RPM
When RPM isn't separately payable, FairPath offers alternatives:
CCM
Bill 99490 (~$60) for chronic care coordination; stackable with RPM if distinct.
TCM
Use 99495/99496 post-discharge (~$150–$200); not with 99457 same month.
PCM
Bill 99424 for single-condition management (~$80).
AWV
G0438/G0439 (~$170) captures setup time annually.
Value-Based Incentives
FairPath tracks RPM outcomes for bonuses (e.g., $50 PMPM).
Common Question: "What if RPM is bundled?" FairPath shifts to payable codes or negotiations.
Launch Your RCM Success
Optimize RCM with FairPath
Ready to streamline revenue and focus on care? FairPath offers:
- Expert guidance on RPM/RTM/CCM billing.
- Tools to cut denials and boost cash flow.
- Compliance assurance for 2025 regulations.
Expand Your Expertise
Dive Deeper with FairPath's Knowledge Hub
Ready to Transform Your RCM Strategy?
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