An Ounce of Prevention
CMS recently released its 2023 Medicare physician fee schedule proposed rule. There are some noteworthy, proposed additions and changes that, if approved, would significantly affect the delivery, coding, and billing of preventive services, remote care management — including remote therapeutic monitoring (RTM) — and telehealth.
The Office of Inspector General (OIG) recently announced it had completed an audit of payments for chronic care management (CCM) services. The results of this audit have short- and long-term implications for providers of CCM services and for the vendors of CCM software that support those providers.
It's been about a month since the Centers for Medicare & Medicaid Services (CMS) published its 2022 Medicare Physician Fee Schedule proposed payment rule. Now that we've had some time to digest the document, we wanted to share thoughts on what we feel are some of the most significant proposed changes concerning telehealth and preventive services (e.g., remote patient monitoring, chronic care management). When the final rule is published, we'll be taking a deeper dive into the approved changes for 2022, including hosting a webinar on the topic. Make sure you join our telehealth regulatory update email list so you don't miss when registration for this program opens.
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.
Update: The 2022 Medicare Physician Fee Schedule (PFS) final rule further defined remote therapeutic monitoring (RTM), including finalizing five RTM CPT general medicine codes, but left many questions unanswered while also limiting coverage for these codes. You can learn more about the current state of RTM in this Physicians Practice column discussing the 2022 final rule written by Prevounce Co-Founder Daniel Tashnek.We anticipate receiving more information and clarification concerning RTM in the 2023 PFS proposed and final rules. * * * 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, 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 to schedule a meeting. 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.