ValidCare Powers New CMS Reimbursement for Remote Patient Monitoring

Breaking News…..In January 2018, CMS began reimbursing clinicians for Remote Patient Monitoring under CPT Code 99091. For patients that meet the requirement (see below), CMS is paying $59 per patient, per month. 

Since 2015, ValidCare’s HIPAA compliant, patient experience and monitoring platform has been engaging patients for the collection of Patient Generated Health Data and functional outcomes to power value-based payment models for surgical care. ValidCare has already demonstrated multi-millions in savings to the eco-system through appropriate site of service and early identification of potential complications. With the “un-bundling” of CPT 99091, ValidCare is poised to bring more value to our clinician clients. Contact us to learn more.

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Now, the details.

CPT Code 99091:

Collection and interpretation of physiologic data (eg, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time.

Final Policy, Payment & Quality Provisions:

On November 2, 2017, CMS issued a final rule that includes updates to payment policies, payment rates and quality provisions for Remote Patient Monitoring services under the Medicare PFS on or after January 1, 2018.

In the final rule, CMS finalized separate payment for CPT code 99091 for 2018 pending anticipated changes in CPT coding. This code is payable in both non-facility and facility settings.

Key Components:

  • Must be performed by a physician or other qualified health care professional – CPT code 99091 specifies that the electronic data transmitted by the patient must be interpreted by a physician or other qualified health care professional. The American Medical Association defines this as “an individual who is qualified by education, training, licensure/regulation (when applicable) and facility privileging (when applicable) who performs a professional service within his/her scope of practice and independently reports that professional service.” CMS current billing guidelines state that time counted toward CCM services generally refers to time spent by clinical staff furnishing care management services; however, CPT code 99091 refers to time spent by the practitioner.
  • Billable with CCM, TCM & BHI – CMS is allowing CPT code 99091 to be billed once per patient during the same service period as chronic care management (CCM) (CPT codes 99487, 99489, and 99490), Transitional Care Management (TCM) (CPT codes 99495 and 99496), and behavioral health integration (BHI) services (CPT codes 99492, 99493, 99494, and 99484). CPT code 99091 should be billed no more than once every 30 days.
  • Advance beneficiary consent required – CMS is requiring advance consent for remote patient monitoring. This must be documented in the patient health record.
  • 30 Minute Minimum – CPT code 99091 specifies a minimum of 30 minutes of time that should be reported no more than once during a 30-day period. This requirement specifies time involved with data accession, review & interpretation, care plan modifications (including communication to the patient or caregiver) and associated documentation.
  • Initiating Visit – A face-to-face visit is required for new patients or patients not seen by the billing practitioner within one year prior to billing CPT code 99091. This includes Annual Wellness Visits, Initial Preventive Physical Exams and other face-to-face visits performed by the billing practitioner.

How does RPM differ from CCM:

  • No chronic condition requirement
  • No care planning requirement
  • RPM can be billed by separate providers – i.e. Specialists can bill for RPM even if the PCP is billing for CCM. CCM can only be reported by one practitioner per month.

Reimbursement:

As of January 1, 2018, CMS will pay $59 per patient per service period for CPT code 99091. This rate is variable depending on location. It is unclear if commercial payers will also reimburse for remote patient monitoring services. CMS states that changes to reimbursement under CPT code 99091 will be provisional until more specific coding changes are approved for Remote Patient Monitoring, (anticipated for 2019).

Resources:

  1. Centers for Medicare & Medicaid Services. https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM10393.pdf
  2. Federal Register. https://www.federalregister.gov/documents/2017/11/15/2017-23953/medicare-program-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other-revisions

ValidCare, LLC partners with Marcia Friesen & Associates to help hospitals succeed in the New CJR Bundled Payment Program

ValidCare, LLC (Centennial, CO), the industry’s only patient experience network for surgical patients is excited to announce its partnership with Marcia Friesen & Associates, LLC (Chicago, IL), a global healthcare consulting firm specializing in customized orthopedic and healthcare solutions.

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