More than 6 million adults in the United States have congestive heart failure (CHF), according to the most recent data from the Centers for Disease Control and Prevention, with heart failure costing the nation more than $30 billion annually. Both figures are expected to rise in the coming years, fueled by the “silver tsunami” of aging baby boomers, unhealthy lifestyles taking their toll, and chronic medical conditions like obesity, high blood pressure, and diabetes raising the risk of developing CHF. Since CHF is so prevalent, it's more important than ever to find effective treatment solutions that won't break the bank for patients and that help provide better control over our national healthcare spending. Enter remote patient monitoring for congestive heart failure.

There are currently dozens of telehealth bills in Congress. As is the case with most pieces of federal legislation, a majority of these bills will go nowhere. However, some have the potential to become law and significantly reshape or at least affect the rules concerning the delivery and coverage of telehealth services.

The Centers for Medicare & Medicaid Services (CMS) has issued its 2022 Medicare Physician Fee Schedule proposed rule. Within it are some potentially significant developments concerning remote therapeutic monitoring (RTM), which we will discuss below.

Looking to leverage FCC funding to launch or expand a remote patient monitoring program (RPM)? Pylo devices by Prevounce are fully qualified for FCC reimbursement, and the Prevounce platform makes it easy to deliver RPM services and connect to your EMR. Want to learn more? Click here. The Federal Communications Commission (FCC) has announced it will provide $249.5 million in FCC telehealth "grants" for healthcare providers delivering telehealth services. The application window is open from noon ET on Thursday, April 29, through noon ET on Thursday, May 6 (seven calendar days).

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.