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Better Reimbursement Definitions Set to Drive Connected Health Services

December 13, 2018
Meredith Wagner

One of the biggest deterrents to the adoption of connected health technologies is getting buy-in from both patients and physicians.  On the patient side, it can be a question of awareness and acceptance of connected health.  For physicians, there are deeper challenges, including increased workload due to the current physician shortage, and lack of effective regulation around reimbursement for connected health services.

 

 

The latter is particularly important today, with the Baby Boomer generation representing the largest population group in the United States.  Not only are its older members reaching their 70s, this is a generation that is generally less healthy than previous generations, Baby Boomers exhibit much lower rates of reported “excellent health,” higher rates of obesity and chronic disease, and significantly less physical activity.  The result will be an increased strain on the healthcare system.

 

 

There is a light at the end of the tunnel, however.  Remote Patient Monitoring (RPM) can help relieve the strain on the healthcare system, while also delivering better and more convenient care for many conditions.  That’s why the decision a year ago by the Centers for Medicare and Medicaid Services (CMS) to unbundle CPT code 99091 was seen widely as a positive step.  The decision allowed physicians using RPM to be reimbursed specifically and separately for time spent accessing, reviewing or interpreting patient data generated and collected by RPM devices, along with communication with the patient and/or caregiver.

 

 

For the coming year, CMS has made additional adjustments to its CPT code schedule that further underscore a commitment to driving modern healthcare and better outcomes for more patients, including revising code 99091 to apply to clinical staff and other qualified professionals (as opposed to just physicians), but also creating three new codes to expand providers’ ability to get reimbursed for RPM services.

 

 

The new codes allow doctors to now be paid separately for chronic care physiologic monitoring of ECG, respiratory rate and volume, body temperature, weight, blood pressure, etc., and including initial setup, patient education, and monitoring and management by not only physicians, but other qualified clinical staff as well.

 

  • 99453 (new) Initial set-up and patient education of RPM equipment and services; a one-time payment.

 

  • 99454 (new) RPM devices for monitoring, recording, transmission of physiologic data; recurring payment every 30 days.

 

  • 99457 (new) Remote physiologic monitoring treatment management services requiring 20 minutes or more per month of time from clinical staff, physicians, or other qualified healthcare professionals.

 

  • 99091 (revised) – Collection and interpretation of physiologic data digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days.

 

 

With nearly 57 million Medicare beneficiaries, physicians’ ability to extend RPM services to them with the confidence they will be paid is significant progress towards more efficient and better healthcare using the latest technologies.  If half of them were to leverage RPM services, the total revenue stream would be more than $3 billion, while freeing up physicians’ time to attend to other patients.

 

 

To learn more about how you can benefit from RPM and other connected health services, visit us here.