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Chronic Care Remote Physiological Monitoring (RPM) and its Medicare Reimbursement Codes

Chronic Care Remote Physiological Monitoring (RPM) or Remote Patient Monitoring is a healthcare practice that involves the use of technology to monitor patients in a virtual manner. This practice has gained popularity in recent years and is being utilized with great success in the treatment of chronic care patients. 

how chronic care patients are benefited by rpm

Specifics of RPM

RPM is a form of real-time telehealth that employs the use of technology in the live collection of vital parameters such as heart rate, blood pressure, weight, or any other relevant measure. This information is then sent to health professionals, who can analyze the data and make informed decisions on the patient’s health. Another beneficial factor is RPM devices often notify both patients and care providers if any abnormal vitals are detected.

How do patients benefit from RPM?

An extensive RPM system gives patients increased access to healthcare. New innovations in the health-based tech industry have afforded patients with high-quality devices to track their health progress. Patients with chronic care conditions that require extensive care are able to monitor any changes to their health on a daily basis. The interactive nature of RPM allows patients to be more involved in their care. RPM is also proven to decrease both readmission and emergency situations. The combination of these factors ultimately results in higher patient satisfaction. 

how providers and patients are benefited by rpm

How do providers benefit from RPM?

RPM has given providers an opportunity to stay updated with their patients, even when they cannot physically meet with them. The rapid growth of RPM technologies has also presented care providers with additional streams of revenue. The CMS has recognized this and introduced new codes that provide reimbursement for virtual care related to RPM. RPM also increases the number of patients a clinic can serve as well as the efficiency of care.

RPM and COVID-19

The ongoing Covid-19 pandemic has brought an increased level of attention to RPM practices. Patients and providers with existing RPM infrastructure are greatly benefiting from the ability to monitor health through a virtual platform. Observing a successful model of RPM use during the pandemic will convince many providers to adopt such practices moving forward.  

Different Medicare CPT Codes within RPM

Care Providers can use the following CPT codes to generate revenue from the establishment and monitoring of RPM practices.

CPT 99453

CPT 99453 is an RPM code that is used when establishing RPM technologies and educating the patient about safe practices. In 2020, the average revenue received when issuing this code is $19. It must be noted that this code can only be issued one time when installing the necessary technology. Any additional support related to technology or patient education cannot be issued using this code.

CPT 99454

CPT 99454 is an RPM code that can be used to cover the transmission of biometric recordings and program alerts. ThIn 2020, the average revenue received when issuing this code is $64. The reimbursement cost also covers the cost of the device(s) involved in the care. This code is to be issued every 30 months. In order to issue this code, all RPM devices used in the care process must be FDA approved.

CPT 99457

CPT 99457 is an RPM code that can be issued for any care that is at least 20 minutes per month and is monitored by a qualified health professional. In 2020, the average revenue received when issuing this code is $52. This code covers any non-face-to-face interactions between providers and patients that involve the patient’s RPM progress. Providers must not issue CPT 99457 or any other code for any care that is less than 20 minutes per month.

CPT 99458

CPT 99458 is a new RPM code that addresses care provided by a qualified health professional for every additional 20-minute interval after the first 20 minutes of RPM services, which is currently billed under CPT 99457. This code came into effect on January 1, 2020, and has an estimated reimbursement rate of $42. This code must be used as an add-on to the existing RPM’s CPT 99457 for billing.

Challenges with RPM

Despite the previously mentioned benefits of an RPM scheme, there are still a few challenges that have prevented such programs from being widely accepted. 

challenges in implementing remote patient monitoring

Despite these challenges, RPM technology remains a promising force in the healthcare industry. Its revolutionary nature is reshaping the patient-provider relationship for the better. This care model will help move from reactive care to proactive care. Providing immediate attention will help reduce readmission rates, reduce hospital admissions, etc. thereby helps reduce the overall cost.

Schedule a demo and talk to our RPM solution experts and get your RPM started in a jiffy!

Preventive Care through Remote Patient Monitoring – Power of RPM

Understanding Preventive Care Services

Preventive Care services are to help people stay healthy and to detect or diagnose health-related issues early while there is a higher chance of recovery. Preventive Care Services include periodic health check-ups, patient counseling, and screening to prevent health-related issues.

Remote Patient Monitoring and Its Acceptance

Remote Patient Monitoring is a method of healthcare delivery that is a part of Telehealth technology to gather patient data outside the traditional care settings. It is the use of specific technology to simplify the interaction between providers and patients at a remote location (home, nursing care facility, remote area or anywhere outside of conventional clinical settings. Remote patient monitoring is one of the tools that can bridge the current gap in patient engagement.

Currently, 88% of hospitals are investing or considering to invest in remote patient monitoring. In fact, 68 percent of physicians “strongly intend” to use remote monitoring technology in the future, according to a new study by the Consumer Technology Association (CTA).

how Remote Patient Monitoring help patients and payers?

How does Remote Patient Monitoring help providers?

Providers can use remote patient monitoring to manage the health of high-risk patients, patients at-risk for hospital readmissions, monitor patients with chronic conditions, track patients post-discharge, check on senior patients, and to increase value-based care adoption. Remote Patient Monitoring helps providers detect any changes in patients before it shows visible symptoms.

Related Article: The Role of Referral Management in Value-Based Health Care

How does Remote Patient Monitoring help patients?

Patient participation in the remote monitoring program helps patients avoid unnecessary clinic visits and potential emergency department visits(ER Visits). Remote patient monitoring provides monitoring and support at home to help patients reach their healthcare goals.

How does Remote Patient Monitoring help payers?

Remote patient monitoring connects all involved in the care cycle - providers, patients, and payers. Communication and exchange of information is much quicker and transparent which can help prevent emergencies, hospitalization, reduce readmissions, and mainly reduce costs. According to the KLAS Research report that surveying 25 healthcare organizations found 38% of healthcare organizations running RPM programs focused on chronic disease reported reduced admissions, and 17% cited cost reductions.

With such benefits it’s quite easy to understand why remote patient monitoring is burgeoning. As the RPM technology adoption continues to expand, it helps to have a positive effect on patients, providers, and the payers.

Adoption of various healthcare technology solutions are driven by various underlying factors like increasing healthcare costs, rise in baby boomer population, chronic conditions, and many more. Out of which chronic conditions are considered to be one of the main factors that need attention. More than 133 million Americans representing 45% of the U.S. population have at least one chronic disease. Chronic diseases are responsible for seven out of every 10 deaths in the United States, killing more than 1.7 million Americans every year.

Are you planning for Remote Patient Monitoring, Chronic Care Management, Telehealth, Care Management, Referral Management, or other similar solutions? Schedule a demo today! We are here to help you get started!

Provide uninterrupted care for your chronic patients during a pandemic outbreak

The COVID-19 outbreak has placed an unprecedented demand on health systems. Health systems and health workers on the front line are swamped by a plethora of activities related to the pandemic like identifying and isolating infected patients, providing care to them, ensuring it doesn’t spread to other patients, and themselves. Due to this, the delivery of essential health services which communities expect from providers is at high risk.

Focusing on a pandemic contingency plan and providing continued care for other essential health services are equally important. This will not only help gain people’s trust in the health systems but also reduce mortality from other health conditions.

Related Article: Learn how the COVID-19 pandemic is transforming healthcare with technology

Why shift to Preventive Care?

Preventable hospital readmissions are estimated to account for more than $17 billion in Medicare expenditures each year, and some of those Medicare costs are passed on to hospitals in the form of penalties. High medicare costs are a direct consequence of low patient engagement. During this time of the COVID-19 crisis, it is more important than ever to manage patients with chronic conditions to reduce costs.

One of the key strategies for providers to help their chronic patients is extending chronic care management to their homes. Providers should take a more proactive role in keeping their patients engaged in the process of care to manage their chronic conditions in a better way.

In a survey conducted by West, only 39% of respondents admitted they were only somewhat knowledgeable, at best, about how to effectively manage their condition. There is a serious gap among patients when it comes to managing their chronic conditions. Patients may not know how to check their vitals, how to follow a specific diet for their medical condition, health alert threshold, might not know their care plan, etc. Getting patients to understand certain metrics is important for reducing complications of their condition.

Chronic care management is necessary for patients because chronic patients contribute to 75% of hospital visits. In one of the articles, it is said that patients enrolled in Chronic Care Management Programs had significantly fewer hospital readmissions than routine care patients had.

How CCM benefit patients?

Patients involved in CCM services are healthier and happier. Patients get involved and engage in the management of the day-to-day activities in their care. Even during this time of crisis, they feel cared and see their care coordinators as a supporter, and they don’t feel alone.

How does CCM help your practice?

By offering CCM practices will not only see improved quality metrics but also high returns. It is great to get paid for something that is already being performed by clinical staff. Chronic Care Management helps increase your practice’s revenue as the CCM program directly translates into higher revenue. The more patients enroll the more the revenue.

Apart from increased revenue Chronic Care Management has several successful outcomes like

  • Better patient satisfaction and outcomes
  • Increased patients' compliance with medication therapy
  • Reduced hospitalizations and emergency department visits
  • Improved clinical quality and metrics
  • Reduced clinical staff time

Enrolling more patients in CCM programs is just perfect for providers to take care of their chronic patients during this time of crisis.

Are you looking for Chronic Care Management for your patients?

Partner with HealthViewX to provide Chronic Care management. HealthViewX CCM offers both the solution and end-to-end service.

HealthViewX Chronic Care Solution Alone

Automates and streamlines the entire process, and makes it easier for your staff to provide CCM services seamlessly.

HealthViewX Chronic Care Management Full Service

HealthViewX also provides end-to-end CCM services through our network of seasoned RNs and CMAs that enable you to increase your monthly reimbursements without incurring any additional cost of hiring additional staff or investing in technology solutions.

Interested in learning more? Schedule a demo and talk to our solution experts. Our experts will help you implement the solution or service, and get your practice started in a jiffy to provide uninterrupted care for your patients!

Related Article: Learn how the COVID-19 pandemic is transforming healthcare with technology

Earn from Medicare’s Chronic Care Management Program! CCM made simple!

Chronic Care Management Services are delivered to Medicare beneficiaries with two or more chronic conditions with a goal of improving health and quality of care for high-need patients. As population ages, FQHCs, RHCs, ACOs, Hospitals, individual practitioners, etc. face the daunting challenge of improving quality of care for chronically ill patients while containing costs.

The Centers for Medicare and Medicaid Services (CMS) says about 93% of total Medicare spending is on beneficiaries with multiple chronic conditions. Research has shown that highly fragmented care for Medicare beneficiaries with multiple chronic conditions are more likely to present in emergency rooms, and be admitted than others.

In spite of the need for proactive care for Chronic Care Management Patients, a lot of the providers are still underutilizing this benefit. There are several reasons why providers like FQHCs, RHCs, ACOs, Hospitals, individual practitioners, etc. have chosen to leave it on the table.

Complicated Process:

There are several rules physicians and practices have to follow in order to qualify for CCM reimbursement. CMS has set rules right from enrolling Medicare patients up to the necessary documents that have to be furnished for CCM reimbursement. Other mandatory requirements include providers offering CCM service, should have access to patient’s health records, provide 24/7 access to care, provide care plans, and patients be able to reach providers to meet urgent care needs.

Time Consuming and involves additional costs:

Many providers feel offering CCM service is a time-consuming effort, and requires additional staffing. They find it difficult to document each of these and also provide quality care for their patients. Providers feel there is an increased administrative burden to managing and tracking CCM services, and it also involves additional cost.

Patients Consent:

Providers must identify Medicare eligible patients, explain CCM services and get consent to enroll the patient and start the service. Providers must explain the required information in detail where the patient can either accept or decline the service. 

Wait and See Approach:

Providers  want to first see if the approach is effective before deciding to opt for it. Many providers and physicians wait to see if other providers who opted to provide the service have success with reimbursement before committing to participation in the program.

HealthViewX makes Chronic Care Management process easier with the below features and makes reimbursement simple:

Automated Documentation for CMS Auditing

HealthViewX automates and streamlines the end-to-end CCM process. Integrates with softphones to accurately record the time spent on each call. It easily helps generate reports as per CMS requirements. 

Comprehensive Care Plan

Structured care plans are essential to help organize coordination of actions for proper patient progression and self-management. The solution helps create condition-specific, personalized and comprehensive care plans for each patient including tasks and goals for both the patient and care coordinator track for better care coordination. Simplifies and streamlines workflow to guide tele-nurses in creating care plans. 

HIPAA Compliant

HealthViewX CCM follows HIPAA compliance requirements and guidelines. The solution lets you define the access, have user-specific access conditions, and provides secure access to patient records.

Analytics and Dashboard

Gives detailed actionable insights for better care coordination. Data can be visually represented and users can gather detailed information by clicking the desired data. The dashboard also displays the follow-up reminders that can be set-up by the user against each patient.

Take this simple step to improve health outcomes and reduce costs for patients with multiple chronic care conditions.

Schedule a demo and talk to HealthViewX Solution experts today to discuss the CCM solution. Or simply outsource your CCM services. HealthViewX also provides end-to-end CCM services through our network of seasoned RNs and CMAs that enable you to increase your monthly reimbursements without incurring any additional cost of hiring additional staff or investing in technology solutions.

Understanding the scope of Chronic Care Management and what is required to make it profitable

Approximately 71% of the total healthcare spend in the United States is associated with care for Americans with more than one chronic condition. Among Medicare fee-for-service beneficiaries, people with multiple chronic conditions account for 93% of total Medicare spending.

It is said that a large percentage of these expenses are associated with acute care and emergency visits that could be prevented by earlier intervention. Patients who have multiple chronic conditions require ongoing medical attention. Putting further emphasis on health programs with an eye towards preventing and controlling chronic disease is one of the ways to address such costs.

The Centers for Medicare & Medicaid Services (CMS) recognizes Chronic Care Management (CCM) as a critical component of primary care that contributes to better health and care for individuals.

What Physicians need to understand?

Medicare’s Chronic Care Management program has a primary clinical goal which is improving the health of Medicare patients with two or more chronic conditions expected to last at least 12 months or until the death of the patient, and who are at significant risk of death, acute exacerbation/decompensation, or functional decline. In addition to understanding the service-level parameters, pay levels, CCM codes.

PCP’s and other health organizations who provide CCM services need to understand how to effectively bill for CCM in order to profitably achieve that goal.

Some of the basic preconditions that providers must satisfy are:

  • the provider is required to complete an initial face-to-face visit
  • obtain verbal or written consent from the patient, and  develop a comprehensive care plan in the electronic health record
  • provide 24/7 access to care
  • use a certified EHR to aggregate all patient health information
  • establish continuity through a designated care team member who works with the patient to implement a dynamic plan that spells out the patient’s key prevention and treatment goals and strategies

Who all can provide CCM services?

Additionally to physician offices, Chronic Care Management Services can be provided by

  • Federally Qualified Health Centers
  • Rural Health Clinics
  • Critical Access Hospitals

And the following healthcare professionals can bill for CCM services

  • Physicians
  • Physician Assistants
  • Nurse Practitioners
  • Certified Nurse-Midwives
  • Clinical Nurse Specialists

Non-physicians must legally be authorized and qualified to provide CCM in the state in which the services are furnished.

Why provide Chronic Care Management Services?

It benefits both providers and patients. Patients will receive better-coordinated care thereby preventing hospitalization and re-admissions. Providers will not only receive payments for providing care but also improve practice efficiency, compliance, patient satisfaction, and health outcomes. Practices, large providers, and health systems can add net new recurring monthly revenue. 

How do physicians and other providers document the CCM services that are provided?

Some practices do the tracking manually, while some of the practices have CCM documentation built into their EHR’s. Other practices implement specialized CCM software to track time and ensure all the CCM requirements are met. Some of the CCM software has the ability to track not only the documentation but also send reminders or notifications to the patient, provider and other healthcare professionals involved in patient care. 

How to make CCM profitable?

Chronic care management requires 24/7 access to care. Practices take different approaches to meet this requirement to provide better care coordination. Some practices hire additional staff and some opt for a solution to automate the end-to-end process to cut down on additional staff expenses. Considering healthcare IT will not only cut down on additional expenses but will also make CCM more effective and efficient.

Talk to HealthViewX solution experts to understand more about HealthViewX CCM solution and make your CCM profitable. 

What’s New with CCM? Medicare Reimbursement 2020 Code Changes Explained!

First, let’s have a quick look at what were the codes in 2019.

Beginning January 1, 2019, the CCM codes were as below

CPT 99490 (Non-complex)

Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month.

CPT 99491

Chronic care management services, provided personally by a physician or nurse practitioner for at least 30 minutes, per calendar month to high-risk patients. Codes 99490 and 99491 cannot be billed in the same month for the same patient so practices will need to decide if this new code is a good use of their doctors’ time and which patients would benefit from it.

CPT 99487 (Complex)

 Complex chronic care management services, with at least 60 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month

CPT 99489 (Add-on for CPT 99487)

Each additional 30 minutes of clinical staff time directed by a physician or other qualified healthcare professional, per calendar month (List separately in addition to code for primary procedure).

Complex CCM services of less than 60 minutes in duration, in a calendar month, are not reported separately. Report 99489 in conjunction with 99487. Do not report 99489 for care management services of less than 30 minutes in addition to the first 60 minutes of complex CCM services during a calendar month.

The billing practitioner cannot report both complex and regular (non-complex) CCM for a given patient for a given calendar month. In other words, a given patient receives either complex or non-complex CCM during a given service period, not both. Do not report 99491 in the same calendar month as 99487, 99489, 99490.

What’s New?

On Nov 15, 2019, Centers for Medicare and Medicaid Services (CMS) finalized the CY 2020 Medicare Fee Schedule (MFS). It has revised the current chronic care management reimbursement program and has created a new care management reimbursement program.

Here’s a quick look at 2020 Medicare Reimbursement Codes for Chronic Care Management:

99487, 99489*, 99490, G2058*, 99491

CMS has created an add-on code, HCPCS Code G2058 for non-complex CCM effective Jan 01, 2020.

G2058 Specifications:

A medical practitioner can bill CPT 99490 for the first 20 minutes of clinical staff time spent performing CCM activities (educating the patient or caregiver about the patient’s condition, care plan, and prognosis, etc.) in a given calendar month and can charge HCPCS code G2058 for the second and third 20-minute additions (additional staff time respectively). Use G2058 in conjunction with 99490. Do not report 99490, G2058 in the same calendar month as 99487, 99489, 99491. These CPT codes are tailored toward primary care physicians but can be billed by any physician or by any skilled healthcare professional and get the reimbursement by fulfilling the code requirements.

Payment or reimbursement for the CPT code 99490 is $42.23 while the add-on code G2058 (up to two) pays $37.89. Therefore, total reimbursement for an hour or more of non-complex CCM services is $118.01.  

** Add-on codes are bundled and cannot be billed separately from their base code.

CCM Patient Eligibility

Patients with multiple (two or more) chronic conditions expected to last at least 12 months or until the death of the patient, and that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline, are eligible for CCM services.

How does the scope for CCM look like in 2020?

Qualified healthcare professionals have been billing Medicare for providing CCM services like maintaining care plans, handling care transitions between providers to Medicare patients with two or more chronic conditions. Even today CCM continues to be underused.

The epidemic of chronic disease continues to grow and has reached global epidemic proportions. This condition is exerting considerable demand for health systems to adopt an IT solution to provide better care for their chronic patients. This increased demand has become a major concern today. Adapting new technology or operating models is vital for the health systems to provide care differently, more efficiently, and with better patient outcomes.

HealthViewX CCM platform helps individual physicians, practices, billing companies, etc. to provide CCM services seamlessly to their enrolled Medicare patients. The simplified and automated process makes it easy to meet the criteria for CMS billing and reimbursement.

Power your entire system – simplify your workflow, create patient-specific care plans, automate documentation, generate detailed reports, and improve overall efficiency. Hosted in cloud servers, HealthViewX CCM solution is extremely scalable to meet requirements of any operative size and our pricing model keeps overhead cost minimal and manageable.

Schedule a demo and talk to our solution experts today!


Ref: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ChronicCareManagement.pdf