Remote patient monitoring is becoming an increasingly popular method of patient care. The technology has long existed, but the recent COVID-19 pandemic brought a new sense of urgency for modernization of payment models. CMS has continued to expand remote patient monitoring (RPM) in its Physician Fee Schedule. It is important to understand how remote patient monitoring works to maximize reimbursement potential. This article will examine the reimbursement process, costs, and regulations.
Reimbursement for remote patient monitoring
The CMS has made significant changes to the way it reimburses hospitals and clinics for telehealth and remote patient monitoring. The changes were implemented through two rules, which take effect on January 1, 2018. These changes are expected to improve clinical practices and technology developers' business models, particularly for companies that participate in advanced alternative payment models. However, some challenges remain. To understand what is happening, it is helpful to examine the proposed changes.
The new CMS fee schedule has made a number of changes to how remote patient monitoring is reimbursed. In general, reimbursement has increased for telehealth programs like chronic care management (CCM), but decreased for others. It is important for providers to understand the new CMS reimbursement rules so that they can continue to provide remote patient monitoring services. Many CPT codes have been updated to reflect the new guidelines. In addition, the CMS has created a new CPT code for remote therapeutic monitoring, which tracks non-physiological data. Check out another blog post from GatewayMD that breaks down the CPT codes here.
Guidelines for remote physiologic monitoring services billed to CPT codes 99453 and 99454
Physiologic data must be electronically collected and automatically uploaded to the secure location where the data can available for analysis and interpretation by the billing practitioner
The device used to collect and transmit the data must meet the definition of a medical device as defined by the FDA
Remote physiologic monitoring data must be collected for at least 16 days out of 30 days. During the public health emergency for COVID-19, if a patient is suspected or diagnosed with COVID-19, data can be collected over as few as two days
Remote physiologic monitoring services must monitor an acute care or chronic condition
The services may be provided by auxiliary personnel under the general supervision of the billing practitioner
Telehealth coding
There are new changes coming to telehealth coding. In the next few years, more devices will be available to monitor conditions such as asthma, diabetes, and allergies. Telehealth codes for these conditions will become more common. And, as the industry becomes more sophisticated, the need for new devices and techniques will increase. Fortunately, there are ways to improve the coding process for these services. Here are three tips for achieving quality and efficient coding.
The Centers for Medicare and Medicaid Services (CMS) has recognized the use of remote patient monitoring (RPM) as a reimbursable service. These new technologies allow health care providers to meet the needs of patient populations from remote locations. In addition, remote patient monitoring can lower the overall cost of healthcare systems by allowing physicians to provide follow-up care for patients at home. In 2017, CMS released new rules and CPT codes to recognize these new technologies. In addition to improving the patient experience, these new codes will also help clinicians get paid for remote care services.
The final rule for remote patient monitoring is important because it advances the ability of healthcare providers to maximize reimbursement and improve patient outcomes. Remote patient monitoring services are covered by Medicare and 23 state Medicaid programs. While there is no official remote patient monitoring policy in the other states, New Jersey and Hawaii have laws mandating that hospitals reimburse remote patient monitoring services. As a result, remote patient monitoring has become a more popular medical service. This will increase patient satisfaction, improve quality of care, and help hospitals and providers get a higher reimbursement rate.
In addition to remote patient monitoring, CPT 99454 captures the time spent by healthcare professionals interpreting data from remote monitoring systems. CPT 99453 covers the time spent by the healthcare providers to educate patients about the new technology. Healthcare providers can bill for the time spent interpreting remote patient monitoring data, communicating with patients, and monitoring patients. A medical professional should also bill for the additional twenty-minutes of communication with the patient.
Regulations
Patients must provide consent, verbal or written, before receiving remote patient monitoring services. The consent is usually obtained from a billing physician or certified healthcare professional. CMS has also made it mandatory for patients to be monitored for a certain period of time before receiving a payment, and the service can be delivered by wireless means. The rule requires that a patient be monitored for at least 16 days in one calendar month. Once the patient consents to RPM services, the data is wirelessly synced for evaluation.
Quality assurance requirements
The latest news from CMS and remote patient monitoring focuses on the RPM quality assurance requirements. This guidance sets forth the "order of events" for RPM programs. This includes the professional work performed, which may include a phone call to the patient, and the post-service phone call, which is covered under the CPT code 99457. This guidance also covers the quality assurance requirements for remote patient monitoring. This is an important area to monitor closely, as any changes to the final rule may have a major impact on the industry.
The latest proposal from CMS outlines several new quality assurance requirements for remote patient monitoring, such as measures of pain levels and medication adherence. This is the lowest-hanging fruit, according to Healthcare IT News, a publication of HIMSS Media. While these requirements are a welcome addition, they should be implemented gradually. However, it is important to note that the new quality assurance requirements are not mandatory. Until such a change is made, CMS will continue to evaluate the use of remote patient monitoring in healthcare.