Over the past several years, the stars have aligned for remote patient monitoring (RPM). An overhaul of the RPM CPT codes (99453, 99454, 99457, and 99458) made RPM into a lucrative Medicare management program. Medicare is making it easier for organizations to provide RPM services, and private-payer coverage of RPM is growing. The COVID-19 pandemic helped drive the adoption and use of remote patient monitoring devices in healthcare. Finally, a rapidly growing number of patients are interested in virtual care services like RPM, their interest largely fueled by the public health emergency. These factors and others make it an optimal time to consider launching or growing RPM programs — especially when RPM is included in a more comprehensive care management program. Another motivating factor for organizations is they now have many choices of remote patient monitoring medical devices to offer patients and include in their programs. From these options, organizations can select the devices that will best meet the short- and long-term care needs of their patients and maximize RPM programs’ revenue potential.
If you've come to read this blog post, you're presumably looking for the rules you should be following to perform proper chronic care management (CCM) billing and coding. That's good. While the federal government has been increasingly supportive of care management programs, they are also more closely scrutinizing CCM reimbursement by auditing instances and causes of overpayment associated with incorrect billing of the service.
Over the last few years, remote patient monitoring (RPM), also referred to as remote physiologic monitoring, became one of the more lucrative Medicare care management programs. Using average 2023 RPM reimbursement rates, if 100 patients are enrolled in an RPM program and each receives the minimum care management services each month, that will generate annual reimbursement exceeding $115,000. We can largely thank the overhaul of RPM CPT codes in 2020 for such generous reimbursement.
It's no secret that technology has vastly improved healthcare. In just the past few years, we've seen telehealth essentially transform the delivery of care. From increased access and improved patient outcomes to reductions in care costs, telehealth technology like remote patient monitoring (RPM) is driving healthcare evolution, helping practitioners improve the ways in which we interact with patients every day. Thanks to the ingenuity and creativity of technology thought leaders and innovators, we can now reach more people than ever before, including previously difficult to access rural patients, and do so more effectively and efficiently.
Right before Christmas, the U.S. Congress approved the Consolidated Appropriations Act of 2023. Within this $1.7 trillion omnibus appropriations bill are a few significant developments affecting telehealth. Here are three things to know about the telehealth-related laws included in the bill.
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.
Arthritis is probably one of the most bothersome health issues patients face. Classified as both degenerative and chronic, arthritis not only produces pain, but it can also increase symptoms of anxiety and depression, impact independence, contribute to sleep problems, and lead to a host of other chronic health issues due to neglectful self-management of the disorder. Fortunately, those with the two most common types of arthritis — osteoarthritis and rheumatoid arthritis — are eligible for participation in both chronic care management (CCM) and remote patient monitoring (RPM) services. These services can be quality-of-life difference-makers for those with osteoarthritis and rheumatoid arthritis. With the wraparound care provided via the CCM and RPM care models, arthritis patients will receive the connected support they need to better manage symptoms and slow disease progression. Specifically, participation in these types of programs will help patients improve their self-management and coping skills. This can lead to decreased pain and physical harm, helping arthritis patients maintain — or even increase — activity levels and better preserve their independent lifestyle.
There were a number of significant changes affecting the delivery and billing of remote care management in the 2023 Medicare Physician Fee Schedule (PFS) final rule, as we covered in this webinar. One of them was the Centers for Medicare & Medicaid Services (CMS) finalizing the coverage for chronic pain management and treatment services (CPM) — new services that were introduced in the 2023 Medicare PFS proposed rule.
Medicare's annual wellness visit (AWV) has had a rocky ride since its introduction in 2010 and started in 2011 as part of the Affordable Care Act. As with many big healthcare changes, the new service was met with resistance and steeped in confusion, leading to terribly slow uptake and obstacles that still unjustly plague the service more than a decade later. When Medicare beneficiaries do not receive their AWV, this is not only a disservice to these patients, but practices and the healthcare system as a whole lose out on important and impactful benefits.
Q&A With Dr. Arun Chandra Earlier in the year, Arun Chandra, MD, joined Prevounce as the company's clinical lead. In this interview, he explains why he is passionate about chronic care management and healthcare technology, the role he believes healthcare technology should be playing in supporting patients with chronic conditions, and why he welcomed the opportunity to join Prevounce.
