Senior Counsel Thomas Ferrante was quoted in the mHealth Intelligence
article, “CMS Proposes Significant Changes to Remote Patient Monitoring Coverage
,” which discussed how the Centers for Medicare & Medicaid Services has clarified how providers can use telehealth to establish and run remote patient monitoring programs, with changes that some feel could hinder care at home.
The were part of CMS’ proposed 2021 Physician Fee Schedule
released in August 2020 could alter a connected health platform that’s becoming popular with care providers looking to push care out of the hospital, clinic or doctor’s office and into the home, where they can continually monitor a patient’s care and make care management changes based on real-time information collected from the patient.
According to Ferrante, the changes clarify how CMS will regulate and reimburse for RPM, which is defined as Evaluation and Management (E/M) services that focus on the collection and analysis of patient physiologic data, most often collected in the home setting, for the purpose of creating a care management plan related to a chronic or acute health condition. CMS created new codes for RPM services in 2019 and 2020 and has tweaked its guidelines for services delivered under general supervision for purposes of incident to billing.
For the upcoming year, Ferrante says CMS has made three significant changes, each of which “would impose more restrictions (or) burdens on RPM in a significant way.”
Differentiating between new and established patients
. According to Ferrante and an August 5 Health Care Law Today blog
penned by Ferrante and colleagues Nathaniel Lacktman and Emily Wein, CMS had expanded RPM coverage to both new and established patients during the COVID-19 public health emergency. The emergency rule was designed to give providers more leeway to treat patients – especially those infected by the virus – through virtual care channels, to contain the virus and avoid infecting the care team.
That will change, however, when the emergency ends, and CMS reverts to RPM coverage only for established patients. According to Ferrante, CMS hasn’t clarified whether providers can use telehealth – specifically, a real-time audio-visual telemedicine platform – to onboard new patients into an RPM program.
“The RPM industry should keep watch on this concept to see if CMS clarifies in the final rule that a provider-patient relationship can be established and a patient can be enrolled into an RPM program virtually using telehealth,” he says. “Allowing patients to enroll into RPM programs pursuant to a telehealth visit would open the doors to innovative business models unhampered by an in-person, physical exam pre-requisite to RPM services.”
Identifying the technology
. CMS has clarified that the “interactive communication” requirement in CPT code 99457 includes not only gathering, analyzing and using the data, but also spending at least 20 minutes on a video platform or the phone with the patient. Many providers have assumed that the 20 minutes covers both data gathering and conversation.
“This is the first time CMS provided published guidance on the interactive communication requirement in the context of RPM and is not how most of the industry has, to date, viewed the requirement, is not consistent with clinical need, nor is it consistent with the way the code is valued,” Ferrante says. “We anticipate (and encourage) significant industry stakeholder push back on this in the public comments requesting that 99457 and 99458 can be billed for the time spent during the calendar month both reviewing the data and communicating with the patient about the data, short of an actual patient visit.”
“It may be helpful for the AMA and its Digital Medicine Payment Advisory Group
(the group of experts who helped create the RPM codes in the first place) to offer clarification on whether it actually intended the RPM codes to require a practitioner to spend at least 20 minutes per month of time communicating via audio or video with the patient,” Ferrante and his colleagues noted in their blog. “A more reasonable reading of the code descriptor and intent is that the interactive communication with the patient is part of the 20 minute minimum, but the practitioner can also include time spent reviewing and analyzing the patient’s RPM data and determining how to change the care management accordingly.”
Using multiple devices
. CMS has clarified that providers can only bill once under CPT codes 99453 and 99454 per patient during a 30-day period no matter how many devices a patient uses. This would hinder providers looking to gather data from different devices, such as a weight scale, blood pressure cuff and blood- glucose monitor.
“For example, a diabetes patient who uses a wireless scale to help with weight monitoring who may also have chronic heart failure and needs a blood pressure monitoring device would only be able to bill the codes once despite having multiple and separate conditions requiring additional devices and setup,” Ferrante points out. “RPM companies likely will advocate in the public comments that CMS clarify that the codes be limited to being billed once per physiological condition but that additional codes can be billed for monitoring of additional physiological conditions, as clinically appropriate.”