What is Remote Patient Monitoring?

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Remote Patient Monitoring (RPM) is a subset of telehealth that involves reporting and collection of a patient’s health data and thus the evaluation of a patient’s health. This is done by utilizing mobile devices, smartphone apps, and internet-enabled devices outside of traditional physical medical settings.  Example: Someone with diabetes may have a glucose monitor or someone with high blood pressure may have a blood pressure monitor that sends information to their doctor via an app on their smartphone or device connected to the internet.

This technology allows a practitioner to monitor patients with chronic conditions continually and be able to make medical decisions that enhance the medical care of the patient on an ongoing basis.  This window into the daily vitals of chronic patients helps to reduce hospital admissions and lower healthcare costs.

Types of RPM

There are several types of RPM devices on the market however the most common ones are:

  • Blood Pressure Monitor
  • Weight Monitor
  • Blood Glucose Monitor
  • Pacemaker

These devices allow for real-time information to be sent to a patient’s physician from anywhere at any time.

There are two ways that these devices can be connected and send information. The first is via cellular. This option allows for the RPM device to transmit data from anywhere the service provider has coverage. This type of device may also offer two-way communication depending on what device is being utilized. These devices are easier for patients who may not be comfortable with hi-tech equipment as they are essentially ready to use out of the box. You just add batteries and turn them on.

The second is via Bluetooth. These RPM devices utilize short-range wireless connections to transmit data to an internet-connected device. These devices do not offer two-way communication, however, it does allow for a wider selection of devices that are more readily available online and in stores. They are more cost-effective as they don’t require a cellular data connection.  The downside to these is they can be difficult to set up and may require connections to be established more than once if the device needs to be reformatted or updated.

Benefits of Remote Patient Monitoring

  1. Improves patient outcomes
  2. Ability to monitor patient vital information outside the medical office setting
  3. Reduction of hospital visits and length of stays
  4. Decreases healthcare costs
  5. Improves patient-physician relationship

How Much is RPM Utilized?

In 2019, the Centers for Medicare and Medicaid Services (CMS) issued a final rule on changes to the Medicare Part B Physicians Fee Schedule creating new billing codes for RPM. The following are the codes established and when to use them:

  • 99453 – Initial Set Up and patient education on the use of equipment
  • 99454 – Device(s) supply with daily recording or programmed alert transmission, each 30 days
  • 99457 – 20 minutes of monitoring per month
  • 99458 – Additional 20 minutes per month for monitoring services
  • 99091 – 30 minutes monitoring each 30 days that doesn’t require interactive communication

With the pandemic has come opportunities to utilize RPMs for more than chronic conditions but acute conditions as well. For instance, in the case of patients with COVID 19 who have recovered enough to be sent home.  Those patients can be supplied an oxygen saturation monitor, or spirometer, to continue to evaluate their oxygen levels and lung function; but releasing them to continue to recover at home opens up hospital beds for those who need in-hospital care.

The Future of RPM

According to a study conducted by the Consumer Technology Association, 68% of physicians polled strongly intend to utilize remote patient monitoring technology in the future. This study also showed big benefits of using RPM which included: (49%) improved patient outcomes, (44%) improved compliance rates, and (42%) of patients taking ownership over their health. In addition, researchers observed that among patients, the top three benefits from RPM were (43%) detailed information on personal care, (42%) faster access to health care services, and (38%) stated more influence over their well-being. Interestingly, the survey also showed that over half (52%) of consumers said they would use an RPM as part of their treatment if their doctor recommended it.

The global market for RPM is projected to reach US$117.1 billion by 2025 up from US$23.2 billion in 2020.  That is a CAGR of 38.2%. This is due to the rising geriatric population and the growing need to expand healthcare access.

Miniaturization is the next trend in RPM technology. Technology makers are going to be making their devices smaller and less invasive while partnering with new companies to grow the technology and expand the market share. As this technology advancement continues, it only stands to reason that there will be a positive effect on both the patients and the health care providers who treat them.

 

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Who is Billed Right?

In 2006, two business partners had a vision of creating holistic services that can help improve medical billing operations. They started by listening to doctors and building a service model around what doctors need the most. As a result, Billed Right’s Revenue Cycle Management (RCM) model was born. The focus continues to be on solving the problem, rather than selling a product, and hence, Billed Right’s advanced RCM model revolves around personalized service in today’s corporate world, while still cutting costs and improving both patient care and practice revenue. No matter what challenges physicians face, we never waiver from our goal to be a strategic partner to promote practice growth.

Contact Billed Right to learn more.

 

 

CMS Medicare Physician Fee Schedule Final Rule CY 2022

Reading Time: 3 minutes

The CY 2022 Medicare Physician Fee Schedule Final Rule was released on November 2, 2021, and with it came some important changes including updates to payment rates for 2022, expanding the use of telehealth for mental health, and allowing PAs to bill Medicare directly.

Conversion Factor Decrease

A significant change was made to the conversion factor which was decreased to $33.59. This is $1.30 lower than the CY 2021 conversion factor.  This decrease accounts for statutory changes to relative value units (RVUs) and the expiration of the 3.75% temporary CY 2021 payment increase that was approved by Congress through pandemic-related legislation.

Telehealth Changes

As telehealth becomes more important in providing healthcare, the rule also eliminates geographic barriers when it comes to utilizing telehealth for behavioral healthcare. The rule allows patients to access telehealth services from their homes versus a qualifying healthcare site for diagnosis, evaluation, and treatment of mental health disorders.

CMS also finalized an extension for services added to the telehealth list originally due to the COVID-19 pandemic. It includes the extension of some cardiac and intensive cardiac rehabilitation codes on the telehealth list through the end of CY 2023.

Additional services added to the Medicare telehealth list are to remain through Dec. 31, 2023, allowing time to evaluate whether the services should be added permanently following the cancelation of the COVID-19 public health emergency (PHE).

Vaccinations

Through this final rule, CMS will support an additional priority from the COVID-19: administration of vaccinations. The final rule addresses a higher Medicare reimbursement rate for the administration of certain vaccines. The rule outlines that Medicare will pay $30 per dose for administering the vaccinations for influenza, pneumococcal, and hepatitis B virus, nearly doubling the amount paid for these vaccines and will continue to pay $40 per dose for the administration of the COVID-19 vaccines.

Direct Billing for PAs

Starting January 1, 2022, physician assistants (PAs) will be able to bill Medicare directly for their professional services along with being able to reassign payment. This only applies to Medicare and does not affect Medicaid reimbursement policies or commercial payers. This will benefit those PAs who want to work as independent contractors or want to own a practice or medical corporation.

One thing to remember is that Medicare regulations defer to state law, so if the state law or regulations prohibit a PA from receiving direct payments then this doesn’t apply unless the state has also updated its regulation.

Split or Shared Evaluation and Management Visits

CMS finalized an update to the definition of split or shared E/M visits provided in a facility setting with a physician and a non-physician practitioner in the same group. The determination is that the visit is to be billed by whichever person provides the substantive portion of the visit.  The substantive portion of the visit is defined as more than half of the time spent with the patient whether it is gathering history, physical exam, or medical decision making.

Other requirements that have to be met are:

  • Physician/NPP must work for the same group;
  • Physician/NPP must see the patent on the same calendar day;
  • Services must be performed in a hospital, facility, or hospital outpatient office;
  • Must have a claims modifier to indicate a split, or shared, service for monitoring purposes by CMS;
  • Documentation must identify the physician and PA or nonphysician provider who performed the visit. And the individual who provides the substantive portion (spends the most time) of the visit must sign and date the medical record as well as bill for the visit.

Statement from CMS

“The COVID-19 pandemic has highlighted the gaps in our current health care system and the need for new solutions to bring treatments to patients, wherever they are,” CMS Administrator Chiquita Brooks-LaSure said in an announcement of the new rule. “This is especially true for people who need behavioral health services, and the improvements we are enacting will give people greater access to telehealth and other care delivery options.”

Click here to read the press release from CMS.

Other Topics

The 2022 PFS Final Rule addresses a wide range of other material topics, besides those listed above including clinical labor practice expense values, changes to the Stark Law Regulations, Medicare diabetes prevention program expanded model, Quality Payment Program Provisions to name a few.

Click here to read the entire rule.

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Who is Billed Right?

In 2006, two business partners had a vision of creating holistic services that can help improve medical billing operations. They started by listening to doctors and building a service model around what doctors need the most. As a result, Billed Right’s Revenue Cycle Management (RCM) model was born. The focus continues to be on solving the problem, rather than selling a product, and hence, Billed Right’s advanced RCM model revolves around personalized service in today’s corporate world, while still cutting costs and improving both patient care and practice revenue. No matter what challenges physicians face, we never waiver from our goal to be a partner in strategy to promote practice growth.

 

Contact Billed Right to learn more.

What is Telehealth vs Telemedicine?

Reading Time: 3 minutes

We all have witnessed how the COVID 19 Pandemic has brought on new, little-known terminology to the healthcare forefront. Terms like telehealth and telemedicine have now become more mainstream in the healthcare community and not many are aware of the subtle differences in definition.

 

What is Telehealth?

Telehealth is defined as the broader method of delivery of health-related services (clinical or non-clinical) including provider and patient education, medical care, health information services, and self-care via telecommunications and digital communications technologies.

Although telehealth and telemedicine often are used interchangeably, telehealth has become the overarching term for the broader array of digital healthcare activities and services.

 

What is Telemedicine?

Telemedicine is defined as the remote diagnosis and treatment of patients utilizing telecommunications technology for clinical services  This means that telemedicine is more around the utilization of technologies and telecommunication systems in administering healthcare to patients such as cell phones, video calling, and internet-connected computers in clinical, vs. Non-clinical services

COVID 19 made this opportunity more relevant as a way to allow patients medical care without running the risk associated with having to go into the doctor’s office.

 

Telehealth Applications and Services

The internet and mobile devices have become commonplace in our lives and it is only natural that we would want to be able to leverage that technology for convenience, improved care, and promotion of access to healthcare.

Some of the things that telehealth can help with are:

  • Addressing physician shortages
  • Providing access to specialists in less-resourced hospitals
  • Education and training both of patients and practitioners
  • Patient engagement
  • Better communication between providers for treatment collaboration

The Future of Telehealth/Telemedicine

To get a better idea of the future of telehealth MGMA did a Stat Pol in February 2021 asking healthcare leaders what they expected to happen to their organization’s telehealth utilization in 2021. The results where 2 out of 3 expected their telehealth utilization to change – 31% said they thought it would increase, 35% said they thought it would decrease and 34% saw no change. Among those who saw an increase, they stated that patient demand and the convenience of it would be the driving factors. For those that said they saw a decrease moving forward, they expressed coverage concerns, expecting payers to discontinue current reimbursement levels. They also noted their patients and/or practitioners preferred in-person visits.

Since the start of the pandemic, Medicare telehealth usage has increased exponentially due to the increased flexibilities brought about by congressional and regulatory action. But most of the flexibilities hinged upon the COVID-19 public health emergency (PHE) remaining in effect.

The question everyone is looking to have an answer to is “what happens to the expanded access to Medicare telehealth once the PHE expires?” Some flexibilities can only be modified by Congress. There are efforts underway to permanently repeal statutory restrictions that, previous to COVID-19, served as roadblocks.  The challenges in making these waivers permanent are the lack of cost data to the Medicare program and quality outcomes. However, incremental steps have been made by Congress recently in expanding Medicare telehealth by allowing for greater flexibilities for specific services.

Only time will tell how much the COVID-19 pandemic has impacted the way telehealth is viewed and if lawmakers will see the benefits once the PHE is over.

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Who is Billed Right?

In 2006, two business partners had a vision of creating holistic services that can help improve medical billing operations. They started by listening to doctors and building a service model around what doctors need the most. As a result, Billed Right’s Revenue Cycle Management (RCM) model was born. The focus continues to be on solving the problem, rather than selling a product, and hence, Billed Right’s advanced RCM model revolves around personalized service in today’s corporate world, while still cutting costs and improving both patient care and practice revenue. No matter what challenges physicians face, we never waiver from our goal to be a partner in strategy to promote practice growth.

 

Contact Billed Right to learn more.