Setting Up RPM Billing

This tutorial walks you through the complete RPM billing configuration — from understanding CPT codes and reimbursement rates to configuring payers, enabling automated device billing, reviewing billing entries, generating claims, and running revenue reports. By the end, your Vantrexia instance will be capturing all billable RPM activities automatically.

Step 1: Understand RPM CPT Codes

Remote Patient Monitoring uses four primary CPT codes recognized by CMS. Understanding each code's requirements is essential for proper billing configuration:

Step 2: Configure Payers

Before billing can be generated, you must register the insurance payers your practice works with. Navigate to Admin → Billing → Payers or use the API:

curl -X POST https://app.vantrexia.com/api/v1/billing/payers/ \
  -H "Authorization: Bearer $ACCESS_TOKEN" \
  -H "Content-Type: application/json" \
  -d '{
    "name": "Medicare",
    "payer_id": "CMS",
    "type": "government",
    "address": {
      "street": "7500 Security Blvd",
      "city": "Baltimore",
      "state": "MD",
      "zip_code": "21244"
    },
    "contact_phone": "+18007721213",
    "electronic_payer_id": "00882",
    "accepts_electronic_claims": true
  }'

Repeat for each payer your practice bills — common payers include Medicare, Medicaid (state-specific), Blue Cross Blue Shield, Aetna, UnitedHealthcare, and Cigna.

Step 3: Set Payer Rates per CPT Code

Reimbursement rates vary by payer and locality. After creating each payer, configure the rates for each CPT code:

1. Navigate to Admin → Billing → Payers, then click on the payer name (e.g., "Medicare").
2. Click the Rate Schedule tab.
3. Enter the contracted rate for each CPT code:

4. Click Save Rate Schedule. These rates will be used when generating billing records for patients covered by this payer.

Step 4: Verify Automatic Device Billing

Vantrexia includes a Celery background task that automatically generates CPT 99454 billing records. This task runs daily at 2:00 AM and evaluates every active patient's device transmission compliance.

1. Verify Celery Beat is running by checking the logs:
   Shell Copy

   docker compose logs celery-beat | grep "generate_device_billing"

   You should see scheduled entries like:
   Output Copy

   celery-beat | Scheduler: Sending due task generate-device-billing (billing.generate_device_billing)
   celery-beat | [2026-02-06 02:00:00,001: INFO] Task billing.generate_device_billing sent.

2. The task evaluates each patient's 30-day billing period:
   • Counts distinct days with at least one device transmission
   • If ≥ 16 days → creates a CPT 99454 billing record with status pending_review
   • If < 16 days and period is complete → logs a missed billing opportunity
3. Navigate to Billing → Pending Review to see auto-generated records after the task runs.

Step 5: Enter Manual Billing for Clinical Time

CPT 99457 and 99458 require documented clinician time. While Vantrexia's time tracker automatically logs clinical interactions, you can also enter time manually:

1. Navigate to the patient's detail page and click the Billing tab.
2. Click + Add Time Entry.
3. Fill out the form:
   • Date: The date the clinical interaction occurred
   • Duration: Time spent in minutes (e.g., 12 minutes)
   • Type: Select "Interactive Communication" for 99457/99458 eligibility
   • Notes: Describe the interaction (e.g., "Called patient to review elevated BP readings from last 3 days. Patient reports dizziness. Advised medication adjustment and scheduled follow-up.")
4. Click Save Time Entry. The system accumulates time entries for each billing period.
5. When total interactive time reaches 20 minutes within a billing period, a CPT 99457 billing record is automatically generated. Each subsequent 20-minute block generates a CPT 99458 record.

Step 6: Review Billing Entries

All billing records go through a review workflow before they can be submitted as claims. Navigate to Billing → All Entries to manage the lifecycle:

1. Navigate to Billing → Pending Review to see all records awaiting review.
2. Click on a billing record to see its details: patient, CPT code, service date, amount, billing period, transmission days (for 99454), and clinical time (for 99457/99458).
3. Verify the record is accurate, then click Approve. The status changes to reviewed.
4. To bulk-approve, select multiple records using the checkboxes and click Bulk Approve.

Step 7: Generate Claims Export

1. Navigate to Billing → Claims Export.
2. Select the date range and payer(s) to include in this batch.
3. Click Generate Export. Vantrexia creates an 837P (Professional) electronic claim file in ANSI X12 format, ready for your clearinghouse.
4. Download the file or send it directly to your configured clearinghouse integration.
5. All included billing records are updated to submitted status with the batch ID and submission timestamp.

curl -X GET "https://app.vantrexia.com/api/v1/billing/claims/export/?start_date=2026-01-01&end_date=2026-01-31&payer=CMS&format=837p" \
  -H "Authorization: Bearer $ACCESS_TOKEN" \
  -o claims_january_2026.edi

Step 8: Run Revenue Reports

Vantrexia provides comprehensive revenue analytics. Navigate to Billing → Reports to access:

1. Revenue Summary: Total revenue by CPT code, payer, and time period. View monthly, quarterly, or annual breakdowns.
2. Billing Compliance: Percentage of patients meeting the 16-day transmission requirement for 99454. Identify patients at risk of non-compliance.
3. Clinical Time Utilization: Total clinician time logged per patient, with breakdown by interactive vs. non-interactive. Identifies opportunities for 99457/99458 billing.
4. Denial Analysis: Breakdown of denied claims by denial reason, payer, and CPT code. Track denial rate trends over time.
5. Revenue Projection: Forecasts monthly revenue based on current patient census, compliance rates, and payer mix.

curl -X GET "https://app.vantrexia.com/api/v1/billing/reports/revenue-summary/?period=2026-01" \
  -H "Authorization: Bearer $ACCESS_TOKEN"

{
  "period": "2026-01",
  "total_revenue": 41304.75,
  "by_cpt_code": {
    "99453": { "count": 25, "revenue": 493.25 },
    "99454": { "count": 425, "revenue": 18283.50 },
    "99457": { "count": 350, "revenue": 16754.50 },
    "99458": { "count": 150, "revenue": 5773.50 }
  },
  "by_status": {
    "paid": 38500.00,
    "submitted": 2104.75,
    "denied": 700.00
  },
  "compliance_rate": 0.85,
  "active_patients": 500
}