The Convergence of AI, Telehealth & Billing: What Internal Medicine, Pulmonology & Cardiology Practices Must Know
Internal medicine, pulmonology, and cardiology are specialties at the center of America’s chronic-disease burden — diabetes, COPD, hypertension, obesity, asthma, heart failure, arrhythmias, and more. As patient volume grows and care shifts beyond the clinic walls, three forces are reshaping specialty care:
✅ Telehealth
✅ Remote Patient Monitoring (RPM/RTM)
✅ AI-powered revenue cycle management
This convergence is transforming how practices deliver care and how they get paid. For many groups, these innovations mean new revenue streams — but for others, the rapid changes are creating compliance risks, denials, and revenue leakage.
Everest AR helps specialty practices adopt these technologies while ensuring clean claims, accurate coding, faster payments, and airtight payer compliance.
This article reviews how AI, telehealth, RPM/RTM, and modern billing intersect — and exactly what internal medicine, pulmonology, and cardiology practices should do right now to optimize reimbursement.
1. Telehealth: Core to Modern Specialty Care
Telehealth has evolved from a pandemic necessity to a mainstream care modality.
How Telehealth Impacts These Specialties
Internal Medicine
Chronic disease management (diabetes, hypertension, thyroid disorders)
Medication management
Behavioral health check-ins
Preventive care counseling
Pulmonology
Asthma control follow-ups
COPD symptom monitoring
Sleep medicine check-ins
Post-hospitalization evaluations
Cardiology
Heart-failure follow-ups
Arrhythmia management
Medication titration discussions
Virtual cardiac rehab check-ins
High-Value Telehealth CPT Codes
Common Telehealth E/M Codes
99201–99215 — Office/outpatient telehealth visits
G2012 — Virtual check-in
G2010 — Remote image/video evaluation
Chronic Care & Transitional Care (Often Done Virtually)
99490 — Chronic care management (CCM), 20 minutes
99439 — CCM add-on
99487/99489 — Complex CCM
99495/99496 — Transitional care management (TCM)
Correct Telehealth Modifiers
Modifier 95 — Synchronous telemedicine
Modifier GT — Telehealth via interactive audio-video
Modifier GQ — Asynchronous (rare cases)
Place of Service 10 — Patient at home
Place of Service 02 — Telehealth (other locations)
Errors in modifiers and POS are top causes of telehealth denials.
2. Remote Patient Monitoring (RPM): High-Value for IM, Pulmonology & Cardiology
RPM is one of the fastest-growing revenue streams in these specialties.
Why RPM Matters
Heart failure → weight/BP monitoring
Hypertension → BP monitoring
COPD/asthma → oxygen saturation tracking
Diabetes → glucose monitoring
Post-discharge → vitals surveillance
RPM CPT Codes
Device Setup & Supply
99453 — Device setup
99454 — Device supply + data transmission
Remote Monitoring & Management
99457 — First 20 min of RPM management
99458 — Additional 20 min
Reimbursement Example:
A cardiology group billing 99453 + 99454 + 99457 monthly per patient can generate $140–$170/patient/month.
Documentation Requirements (Common Denial Causes)
Patient consent not documented
Device not FDA-defined
Insufficient data-transmission days (need 16 days)
No management time documentation
Everest AR uses AI-driven audits to catch these issues before claims go out.
3. Remote Therapeutic Monitoring (RTM): Ideal for Pulmonology
RTM focuses on non-physiological data such as medication, therapy adherence, inhaler use, etc.
Best Use Cases
COPD inhaler compliance
Asthma medication adherence
Pulmonary rehab
Activities/exercises tracking
RTM CPT Codes
Device Setup & Supply
98975 — Initial setup
98976 — Supply, respiratory system
98977 — Musculoskeletal device
Management & Monitoring
98980 — First 20 min of RTM management
98981 — Additional 20 min
RTM has fewer day-count requirements compared to RPM — but still requires structured documentation.
4. Chronic Care Management: A Foundational Revenue Stream
Internal medicine & cardiology benefit heavily from CCM.
High-Value CCM Codes
99490 — Basic CCM
99439 — Add-on
99487/99489 — Complex CCM
Why It Matters
Patients with 2+ chronic conditions
Often billed in combination with RPM
Creates predictable recurring revenue
Supports risk-stratified care
5. AI Is Reshaping Billing, Coding & Compliance
AI is no longer hype — it’s a force multiplier for RCM.
Where AI Makes the Biggest Impact
✅ Pre-submission audits — catching missing documentation
✅ Modifier accuracy — ensuring correct telehealth usage
✅ RPM/RTM compliance — detecting missing time, missing days
✅ Predictive denial analysis — preventing rejections before they occur
✅ Automated coding guidance — reducing coder dependency
✅ Smart charge capture — identifying underbilled services
Everest AR’s AI Enhancements
Flags missing telehealth consent
Detects incorrect RPM device codes
Ensures POS/modifier alignment
Identifies insufficient time for CCM/RPM/RTM
Predicts payer-specific telehealth denial patterns
This is critical because specialty practices are now dealing with hybrid documentation (in-clinic + virtual + device logs).
6. Specialty-Specific Impacts & Opportunities
Below is a breakdown by specialty.
✅ Internal Medicine
Top Opportunities
Diabetes RPM
Hypertension RPM
Chronic Care (CCM)
Behavioral Health Integration (BHI)
High-Value Codes
99212–99215 — Virtual visits
99490/99439 — CCM
99457/99458 — RPM
G2012, G2010 — Brief telehealth services
Common Revenue Risks
Missing chronic condition documentation
Insufficient 20-minute CCM/RPM logs
Not documenting patient consent
Everest AR prevents these errors using AI-based alerts.
✅ Pulmonology
Top Opportunities
Respiratory RTM (98976/98980)
Asthma & COPD management via telehealth
O₂ saturation monitoring via RPM
Sleep-medicine follow-ups
High-Value Codes
98975–98981 — RTM respiratory
99453–99458 — RPM
95250/95251 — Continuous glucose monitoring (when applicable)
G0406–G0408 — Telehealth follow-ups
Common Revenue Risks
Billing RTM without valid device data
Incorrect respiratory RTM device code
Telehealth modifier errors
✅ Cardiology
Top Opportunities
Heart-failure RPM
Weight & blood pressure monitoring
Arrhythmia telehealth follow-ups
Remote EKG monitoring (when applicable)
High-Value Codes
RPM
99453–99458
Cardiology-Specific
93228/93229 — Remote arrhythmia monitoring
93294/93295 — Pulse generator/device surveillance
93750 — Heart failure monitoring
Telehealth
99212–99215, G2012, G2010
Common Revenue Risks
Device data not meeting payer thresholds
Missing documentation of interactive communication
Wrong POS for telehealth
7. Why Practices Must Act Now
The digital care model is here — insurers are adjusting policies weekly, and compliance requirements are tightening.
Without the right RCM systems, practices face:
❌ Denials for telehealth modifier errors
❌ RPM claims rejected for missing 16-day data
❌ RTM claims denied for lack of documented “therapeutic relationship”
❌ Missed revenue from underbilled chronic care
❌ Increased AR days
❌ Lost income from hybrid virtual care
8. How Everest AR Helps Providers Maximize Revenue
Everest AR integrates AI, telehealth workflows, RPM/RTM data, and billing intelligence into a unified revenue cycle engine.
Our Core Capabilities
✅ AI-Powered Telehealth Compliance
✅ RPM/RTM Workflow Integration
✅ Specialty-Optimized Coding
✅ Predictive Denial Management
✅ 100% Audited Claims Before Submission
✅ EHR-Integrated Charge Capture
✅ AR Acceleration & Denial Resolution
What This Means for Your Practice
Higher clean-claim rate
Faster payments
Lower denial rate
Increased reimbursement (10–35% lift seen across specialties)
Full compliance with CMS & payer rules
Significant new recurring revenue streams (RPM, RTM, CCM)
Everest AR ensures your virtual-care services are properly captured, coded, and reimbursed.
Conclusion
Telehealth, AI, RPM, RTM, and modern billing are merging into a single care-delivery ecosystem. Internal medicine, pulmonology, and cardiology practices that embrace this convergence will unlock:
✅ Higher reimbursement
✅ More efficient workflows
✅ Better patient outcomes
✅ Stronger long-term financial performance
The future belongs to practices that integrate AI-enabled revenue cycle intelligence today — and Everest AR is the partner that makes this transition seamless, compliant, and profitable.
