An Ounce of Prevention
Before 2020, remote patient home monitoring, also known as remote patient monitoring or RPM, was starting to generate some buzz. Healthcare providers were increasingly assessing the function that such virtual technology should play in the delivery of care. Pundits generally agreed that virtual care would eventually take on a significant role but that it would require some time before providers, payers, and patients fully embraced the concept. Then COVID-19 arrived, and virtual care became an essential service seemingly overnight. Now virtual care technology, including remote patient home monitoring, is expected to "redefine healthcare and public health," notes Healthcare IT News. This article includes some eye-opening statistics: The consulting firm McKinsey suggests that $250 billion in healthcare spending could shift to virtual care models and FAIR Health data indicates that telehealth claim lines increased more than 4,000% nationally from March 2019 to March 2020, growing from about 0.17% of medical claim lines to more than 7.5% over that period. The author of the column—who oversees a technology consulting firm —believes that 80 to 90% of all outpatient visits could eventually become "virtualized" in some fashion. Suffice it to say, remote patient home monitoring is not only here, but here to stay. Healthcare practices nationwide are exploring how to incorporate remote patient home monitoring into their services. The good news is that it is a great time to launch a remote patient home monitoring program. In 2020, remote patient monitoring CPT codes (99453, 99454, 99457, and 99458) were overhauled. This made RPM one of the most lucrative Medicare care management programs. Commercial payers are increasingly covering remote patient home monitoring (some by choice, some forced by law). And consumers are rapidly embracing virtual care technology and finding tremendous satisfaction with the experience.
Thinking about investing in a remote patient monitoring system (i.e., software and connected patient devices) for your practice? You're like many practices these days. Remote patient monitoring, or RPM, was already gaining popularity before the COVID-19 health crisis. This can be attributed, in part, to the 2020 changes to CPT codes that propelled RPM into the spotlight as the most lucrative Medicare care-management program as well as providers increasingly embracing technology to support the health and wellness of their patients. When the pandemic hit, the value of providing remote patient monitoring services to patients who were expected to reduce travel and direct contact with others became even more apparent. The federal government recognized this as well, which is why it permanently expanded Medicare coverage of RPM services from just those with chronic conditions to those with chronic and/or acute conditions, among other changes that supported the expanded use of RPM. The future of virtual health services like remote patient monitoring is brighter than ever. Federal and commercial payers are supporting them, and patients are looking for them. Now it's up to practices to meet the demand. With the RPM industry growing, practices have an increasing number of remote patient monitoring system options to choose from. Making an informed decision on which remote patient monitoring system to invest in may prove the difference between whether an RPM program, which includes the software and services provided using it, successfully meets patient and practice needs or if the investment is one that a practice regrets. Before choosing a remote patient monitoring system, answer these five questions.
The COVID-19 pandemic has placed a spotlight on the value of digital health and its ability to effectively engage patients and deliver care. The widespread adoption of digital health is likely to change the way healthcare is delivered here in the United States after the health crisis is behind us. While not a new concept, one of the most exciting changes is the increasing usage of new remote patient monitoring (RPM) technologies. In an effort to keep the most vulnerable patients healthy amidst social distancing guidelines, practitioners and insurers like Medicare are finding that RPM technology offers a good solution to keeping patients with chronic health conditions home and safe while still effectively monitoring their disease progression.
The documentation requirements for the Medicare annual wellness visit (AWV) serve multiple purposes. Most importantly, documentation is critical to maximizing the value of the Medicare AWV to patients. As AARP notes, the Medicare AWV is "… designed to promote the use of preventive care, identify health risks, and plan for future healthcare needs." In addition, the Medicare AWV is an opportunity for patients to meet with providers who can also deliver or schedule preventive services, such as vaccinations and cancer screenings.
Little good has come out of the COVID-19 pandemic, but there are some silver linings. One is the increased adoption of virtual healthcare services and delivery systems. This includes remote patient monitoring, or RPM. Remote patient monitoring was a concept foreign to most individuals before the health crisis, but that is slowly changing as providers increasingly adopt the service and order it for their patients. Yet many people still lack a firm understanding of remote patient monitoring, so we thought it would be helpful to dedicate a blog that focuses on the RPM definition, including providing an RPM meaning in medical terms and contrasting the concept of remote patient monitoring with other terms often associated with it.
Over the past decade, remote patient monitoring, or RPM, has been slowly gaining momentum. 2020 was already expected to be a big year for RPM, but “big year” turned out to be an understatement. The COVID-19 pandemic has spurred RPM into the spotlight, positioning it to become an essential health-care delivery service, embraced by providers, payers, and patients. Even with all the publicity, there has been a bit of confusion about what types of care fall into RPM. Depending on the article you read, “Remote patient monitoring” can be used as a general term, a CPT coded service, or as a term of art. We wrote this fact sheet to help clarify things for both providers and patients alike.
When you conduct an online search for information about the Medicare annual wellness visit or AWV, one of the first resources you will find is an independent reference tool called Medicare Interactive. Its description of the AWV is as follows: "The annual wellness visit (AWV) is a yearly appointment with your primary care provider (PCP) to create or update a personalized prevention plan." Going by this definition, one might believe that the answer to the question "Who can perform the Medicare annual wellness visit?" is a PCP. End of story, right? Far from it.
An essential element of the Medicare annual wellness visit (AWV) is the personalized prevention plan, sometimes referred to as the personalized prevention plan of service or PPPS. During the annual wellness visit, you are expected to create or update the patient's Medicare personalized prevention plan. This requirement is clearly stated, both in the regulations and AWV HCPCS codes descriptors, and yet it is often neglected. When the PPPS is overlooked, the potential ramifications are significant. Providers run the risk of experiencing claims denials, needing to return payments if shortcomings are discovered during audits, and reducing the value of the AWV and PPPS to patients.
Anyone who works with Medicare on a regular basis understands how often the Centers for Medicare & Medicaid Services (CMS) seemingly changes its rules. Keeping up with new and ever-evolving policies can be challenging, but there are a few simple ways to stay current. Look for updates quarterly on the CMS website and follow the Prevounce blog for important and timely coverage of Medicare topics, especially those that matter the most to you, your practice, and your patients.
A Kaiser Health News (KHN) article tells the story of Medicare beneficiary Beverly Dunn. She scheduled her annual physical exam, believing that Medicare would cover the checkup. Then Dunn received the bill and quickly learned the shocking piece of information many patients discover: Medicare does not cover annual physical exams.