Chronic disease has been quietly waging war on American lives throughout the entire 21st century, quickly rising to the top of the most common causes of death in the United States. Some of the major chronic diseases, such as heart disease, chronic lung disease, and type 2 diabetes, are preventable, yet 6 out of 10 American adults still have at least one chronic disease and 4 out of 10 suffer from two or more chronic diseases. Furthermore, the prevalence of chronic diseases crushes our healthcare system with a confounding $3.8 trillion in annual healthcare costs, leading chronic disease to act as a tremendous drain on both staffing and financial resources.

Just saying the word "audit" is a surefire way to make a practitioner's heart skip a beat. So, while we apologize for including the word in our title, we're glad to have grabbed your attention. It was only a matter of time before remote patient monitoring (RPM) received federal scrutiny. That’s why it wasn’t surprising to see RPM included in a January 2021 announcement by the Office of Inspector General that the Centers for Medicare & Medicaid Services (CMS) would be conducting a series of audits of Medicare Part B telehealth services in two phases (with RPM part of the second phase).

Chronic care management (CCM) made its debut in 2015 when it was rolled out by the Centers for Medicare and Medicaid Services (CMS) as a separately paid service under the Medicare fee schedule. The rationale behind its inception was to offer an avenue of compensation for practitioners who provided care to their patients outside of the normal confines of the average office visit. The introduction of CCM coincidentally led to a more efficient means of care teams proactively engaging and managing patients with problematic chronic diseases, in turn improving outcomes and reducing treatment costs.

The use of telemedicine and telehealth, fueled by the pandemic, are quickly solidifying its place as a permanent facet of modern healthcare. Within telehealth, some of the most positive — and exciting — developments are occurring with the use of remote patient monitoring (RPM). The expanding usage of RPM, also referred to as remote physiological monitoring, is improving patient health outcomes, reducing the overall cost of healthcare, and improving the quality of life for many patients with chronic diseases. One of the most beneficial uses of RPM is for those suffering from heart failure. Outpatient care techniques that leverage home monitoring for heart failure management are proactively working to reduce the rates of acute exacerbation, keeping heart failure patients out of the hospital and healthier for longer than ever before.

In an unusual development — albeit a welcomed one — the Centers for Medicare & Medicaid Services (CMS) has issued a correction to the 2021 Medicare physician fee schedule final rule that clarifies several areas of confusion concerning the billing requirements for remote patient monitoring (i.e., remote physiological management). 

The story below provides a brief overview of this breaking news. If you are interested in a more in-depth discussion and analysis, register for our upcoming webinar here.

Whether your practice is already delivering or is planning to deliver RPM services to Medicare and/or Medicaid patients this year, you must understand the CMS rules for remote patient monitoring services in 2020. Without this knowledge, you run the risk of not getting paid appropriately for remote patient monitoring by CMS (Centers for Medicare & Medicaid Services) and possibly running afoul of requirements that can jeopardize your reimbursement and lead to regulatory headaches. To help ensure you receive appropriate and timely payments for remote patient monitoring from CMS and avoid legal scrutiny for RPM services, here are three key things to know. 

Is your practice looking to help your patients stay healthy and reduce their expenses while generating consistent revenue? Then you're going to want to strongly consider providing remote patient monitoring services. Remote patient monitoring, or RPM, is a form of virtual care technology that is receiving tremendous attention and increased adoption during the COVID-19 pandemic, and rightfully so. Remote patient monitoring allows healthcare providers to monitor and electronically capture medical and other health data from patients for assessment, recommendations, and instructions. As a virtual care technology, this collection of health data, which can include blood pressure, vital signs, weight, heart rate, and blood sugar levels, can occur anywhere but the practice. As long as patients are not in a shared space with the healthcare provider delivering the remote patient monitoring services, they can receive these services. This means a patient can be in their home, in an office, on vacation, in a skilled nursing facility, or any other location. Remote patient monitoring is lucrative for practices, being embraced by patients and payers, and likely to play a significant role in the delivery of healthcare going forward — something these RPM, virtual care, and telehealth stats prove all too well. Note: We’ll be regularly adding new statistics to this resource, so bookmark the page and check back regularly!

In a recent Medical Economics column, I shared some of the most significant updates concerning remote patient monitoring (RPM). Among them: Remote patient monitoring is now one of the more lucrative Medicare care management programs, thanks to an overhaul of the RPM CPT codes (99453, 99454, 99457, and 99458). Medicare is making it easier for practices to provide RPM services, and private payer coverage of RPM is growing. The COVID-19 pandemic has helped drive adoption and use of remote patient monitoring devices in healthcare. A rapidly growing number of patients are interested in virtual care services like RPM, their interest fueled by the health crisis. The column concluded by asserting that the stars have aligned for remote patient monitoring, and it is an optimal time to consider launching or growing RPM programs. Another motivating factor for practices is that they now have several choices of remote patient monitoring medical devices to offer patients and include in their programs. From these options, practices can select the devices that will best meet the short- and long-term care needs of their patients and maximize RPM programs’ revenue potential.

Healthcare providers have found themselves under immense pressure to maintain continuity of care during the COVID-19 crisis, but many aspects of the U.S. health system were not designed to support such an effort. To help providers more effectively deliver care that will not only keep patients healthy but also in their homes and away from hospitals, which are largely focused on treating COVID-19 patients, government agencies, commercial payers, and other healthcare organizations have worked to change the system. Approaches taken include the creation of new and expansion of existing telehealth and remote tools and support, including remote patient monitoring (RPM). For example, we have seen federal waivers and revised state regulations that greatly expand the ability for healthcare providers to deliver telehealth and remote services; commercial payers revising their policies to pay for these services, and healthcare companies offering resources to help providers more effectively leverage telehealth and remote services during the crisis. If your practice is considering launching or growing an existing telehealth and/or remote services program during the pandemic, here are five things you should know.