Prevounce Blog

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. 

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.

The annual wellness visit (AWV) is an important tool for providers to track and help manage the health and wellbeing of their Medicare patients. Social distancing is crucial to combat our current health crisis, but so is maintaining continuity of care with your most vulnerable patients. Fortunately, Medicare understands the importance of the AWV, and included it in it's initial §1135 waiver so that it can be performed entirely via telehealth on any Medicare beneficiary. As of 4/30/20, Medicare further waived restrictions, and now allows Annual Wellness Visits to be conducted via audio-only telehealth (i.e. over the telephone) for the duration of the waiver.