Misconceptions about billing, coverage and implementation are hampering technology's growth
Patients, providers and payers got a first-hand look at the benefits of remote patient monitoring (RPM) after the COVID-19 pandemic accelerated use of these tools and services.
But as demand has grown for RPM, so have the misconceptions about what’s covered, how to bill for it and the ways in which providers can implement RPM among their patients.
Before digging into these misconceptions about RPM, let’s consider how we’ve gotten to where we are now. Until recently, providers had been slow to adopt RPM, even after the Centers for Medicare & Medicaid Services first added RPM reimbursement codes in 2018.
However, COVID-19 brought it to the mainstream. With the inability to see patients regularly in person, RPM became a valuable tool for overseeing patient care, particularly for those with chronic diseases, such as diabetes, heart disease and obesity. RPM helped providers track blood pressure, blood sugar, and blood oxygen, and respond proactively to changes that could impact a patient's health – all while the patient remained in the comfort of their own home.
Managing these chronic conditions remotely helped prevent complications and greater expenses related to the diseases. A KLAS Research report noted that more than one-third of healthcare organizations saw fewer readmissions when using RPM for chronic care management, and 17% said they achieved cost reductions.
Results like these are encouraging more practices to adopt RPM. But only about half of practices surveyed by Sage Growth Partners are currently using RPM. The good news is that number is expected to grow in the next year, reaching about 76% by January 2024. And within two years, it is expected that more than 70 million U.S. patients – 26.2% of the population – will benefit from some kind of RPM.
Despite the projected growth, there are some misconceptions swirling around that may discourage providers from adding, or growing, RPM within their practices.
Let’s take a look at the top three and clear up the misunderstandings.
1. The 20 minutes required in CPT 99457 has to be a live interaction with a patient.
There had been much confusion around the requirement for live interaction for a while, as well as criticism from those advocating for asynchronous options. In January 2021, CMS clarified that interactive communication must contribute to the 20 minutes.
However, live interaction is not the only activity that could be included in the total time calculation. Providers could also spend time reviewing and analyzing patient RPM data, and determining which changes to care management were necessary. Additionally, since this can be billed under general supervision, a third-party care management team can be the ones interacting with patients, or conducting review and/or analysis.
2. The devices are not covered by insurance, so I cannot afford to offer remote patient monitoring.
In order to remotely monitor patients, the data must transmit from the device to the software used in the clinic. Many providers have found that cellular-enabled medical devices like blood pressure cuffs, glucometers, and scales are preferable to Bluetooth-enabled devices, because the data can be transmitted without downloading a new app to the patient’s smartphone or frustrating syncing or pairing for the patient.
However, many of these cellular-enabled devicesare not currently covered by insurance and they can be more expensive than Bluetooth-enabled devices. All of that said, you can afford to offer these devices to your patients and will get better engagement resulting in a more successful program because of them. Given the average device costs just over $100 and reimbursement for activities in the first month of RPM can total $133 on average, the practice has covered the cost of the device in month one.
Therefore, many providers see both the economic and clinical benefits of rolling the costs of these devices into their program, knowing it will drive long-term success through better engagement and data reliability. In other cases, insurers now cover more sophisticated devices, like continuous glucose monitors (CGMs), that are used in RPM programs.
3. Remote patient monitoring programs must use expensive kits.
Providers who are new to RPM often express concern about having to follow a kit-based model in which they provide patients a bundle of remote monitoring devices. This approach is both dated and daunting because of the expense of the devices, and the fact that RPM reimbursements do not offset the cost of paying for multiple devices upfront.
Additionally, since the devices are expensive, practices may loan them to patients, then have to retrieve them once the patient has completed the program – which adds even more administrative burden to the process.
Further, most patients have one primary health challenge that would most benefit from intensive remote management, so all of the devices in a kit are not clinically necessary and just add cost to delivering RPM.
Practices should focus on providing the right device for the patient and their condition, rather than taking the blanket kit-based approach. By having a targeted focus, device costs can be offset by reimbursement in the first month, like illustrated above, and providers will be able to deliver a more personalized approach that has better chances of improving patient outcomes.
As the healthcare industry continues to evolve, the use of RPM in practices will continue to evolve, and so will reimbursements and willingness of insurers to cover the cost of devices as there is more evidence to the efficacy of RPM. It’s important to understand reimbursements and coverage, and take the steps to ensure that your practice can cost-effectively leverage RPM to help patients manage their chronic conditions and lead healthier lives.
Looking ahead, understanding options within the reimbursement landscape will also be critical when it comes to implementing an RPM program. For additional RPM policies and reimbursements information, see the 2023 Medicare Physician Fee Schedule Final Rule.
Lucienne Marie Ide, M.D., PH.D., is the founder and chief executive officer of Rimidi.