For years, CMS balked at reimbursing physicians for remote patient monitoring (RPM) and other types of non-face-to-facecare, but it seems those days are over. During the past two years, the agency has built on its existing coverage of chronic care management-related RPM services by adding new codes for RPM reimbursement.
Physicians who haven’t yet taken advantage of these new reimbursement codes because of concerns about staffing or implementation may want to consider leveraging mobile-enabled remote patient monitoring (mRPM). This technology is much more efficient and cost-effective than past approaches such as telephonic RPM. Easy to implement, it can provide nearly immediate clinical and financial value for large group practices or solo practices with minimal clinical support staff.
Reimbursement leading the way
On January 1, 2018, physicians were permitted to start billing separately for 99091, a code that is separate from, and can be billed concurrently with, CMS’s Chronic Care Management (CCM) program that reimburses for time spent on patient-generated data collection and interpretation.
As of 2019, CMS also added a new level of CCM management, CPT 99491, and increased the weighting of RPM as a practice improvement option under the Merit-based Incentive Payment System (MIPS).
In September 2018, CMS approved three of the new codes for RPM, 99453, 99454 and 99457. In the 2019 Medicare fee schedule, these codes are for general physiological remote monitoring of chronic conditions. These new reimbursements were long-overdue, because they finally allow practices to bill “incident to” for any clinical staff that implement and manage RPM, instead of just physicians. The new codes also do not make restrictions about where the patient needs to be located, such as a rural area or in a medical facility, for the monitoring.
The new codes followed a two-year study (published in November 2017), of the CCM program that showed millions in cost savings and an increase in patients’ awareness of their chronic conditions. The report’s findings have likely been a major driver of the new RPM codes for CCM, since they are a less costly way for physicians to manage their patients’ chronic conditions when compared with more frequent face-to-face visits.
Adding RPM without the overhead
Physicians who aren’t yet participating in CMS’s CCM program (with RPM as a chronic care management tool) may have shied away because of the expansive requirements of CCM. In addition, reservations may surround a perceived need—and the related costs—to hire additional care team members or outside services to perform the care management interactions.
That’s where mRPM comes in. An automated schedule uses push notifications to prompt patients to enter requested biometric, objective and subjective data (including social determinants of health); patients can then respond at a time and place convenient for them. Once the data has been received, a clinician assesses the information and can decide if there is any need for a face-to-face visit or phone conversation. With a dashboard for the physician practice and a patient-friendly mobile app for check-ins between appointments, mRPM can greatly enhance communication between providers and patients. In addition, patients become more aware and engaged in their own care without overburdening care teams.