Tag Archives: Telehealth

2021 CPT Codes by the CMS for Medicare Extension Care Management Programs

Chronic Care Management:

The chronic care management program was virtually untouched by the 2021 Final Rule from CMS. There are three main CPT codes and two add-on CPT codes in 2021 that may be billed by primary care providers for CCM services.

C

Requirements for CCM:

Non-Complex CCM:

  • Two or more chronic conditions expected to last at least 12 months (or until the death of the patient)
  • Patient consent (verbal or signed)
  • Personalized care plan in a certified EHR and a copy provided to the patient
  • 24/7 patient access to a member of the care team for urgent needs
  • Enhanced non-face-to-face communication between patient and care team
  • Management of care transitions
  • At least 20 minutes of clinical staff time per calendar month spent on non-face-to-face CCM services directed by a physician or other qualified healthcare professional
  • CCM services provided by a physician or other qualified healthcare professional are reported using CPT code 99491 and require at least 30 minutes of personal time spent in care management activities

Complex CCM:

Shares common required service elements with CCM but has different requirements for:

  • Amount of clinical staff service time provided (at least 60 minutes)
  • The complexity of medical decision-making involved (moderate to high complexity)

CPT Reimbursement Codes for CCM Service:

Non-complex CCM:

  • CPT Code 99490– This code requires that patients must have two or more chronic conditions, as well as documented consent to enroll in the program AND receive at least 20 minutes of CCM services from clinical staff within a given month. A personalized care plan, which shows an assessment of all patient factors and identifies gaps and barriers to be addressed, is also required. Reimbursement Rates – CPT Code 99490 – $42/patient/month.
  • CPT Code 99439 (formerly  G2058) -This code allows providers to bill for each additional 20 minutes spent for Basic CCM services in a given month, up to 2 times. For example, if CCM services were provided for at least 40 minutes with a patient in a given month that was not Complex, 99490 ($42) and 99439 ($38) would be billed together for that month. Reimbursement Rates – CPT Code 99439 (formerly  G2058) – $38/patient/month.

Complex CCM:

  • CPT code 99487– This code has a higher rate of reimbursement than the Basic CCM CPT code. To bill using this code requires moderate or high complexity in medical decision making AND acknowledgment by both patient & provider of an acute exacerbation (generally defined as a sudden worsening of a patient’s condition that necessitates additional time and resources). The patient must receive at least 60 minutes of services from clinical staff within a given month to bill for this code. Reimbursement Rates – CPT Code 99487 – $93/patient/month.
  • CPT code 99489 – The same as with the Basic Chronic Care Management code, the Complex Chronic Care Management code also has an add-on CPT code to cover time spent beyond 60 minutes. It allows for billing for each additional 30 minutes spent for Complex CCM services within a given month. Reimbursement Rates – CPT Code 99489 – $45/patient/month.

Transitional Care Management:

Transitional Care Management (TCM) services address the hand-off period between the inpatient and community settings. After a hospitalization or other inpatient facility stay (e.g., in a skilled nursing facility), the patient may be dealing with a medical crisis, new diagnosis, or change in medication therapy. Family physicians often manage their patients’ transitional care.

medicare reimbursement codes

Requirements for TCM:

  • Contact the beneficiary or caregiver within two business days following a discharge. The contact may be via the telephone, email, or a face-to-face visit. Attempts to communicate should continue after the first two attempts in the required business days until successful.
  • Conduct a follow-up visit within 7 or 14 days of discharge, depending on the complexity of medical decision-making involved. The face-to-face visit is part of the TCM service and should not be reported separately.
  • Medicine reconciliation and management must be furnished no later than the date of the face-to-face visit.
  • Obtain and review discharge information.
  • Review the need for diagnostic tests/treatments and/or follow up on pending diagnostic tests/treatments.
  • Educate the beneficiary, family member, caregiver, and/or guardian.
  • Establish or reestablish referrals with community providers and services, if necessary.
  • Assist in scheduling follow-up visits with providers and services, if necessary.

CPT Reimbursement Codes for TCM Service:

  • CPT code 99495 – moderate medical complexity requiring a face-to-face visit within 14 days of discharge. Reimbursement  rate – $175.76/patient/month.
  • CPT code 99496 – high medical complexity requiring a face-to-face visit within seven days of discharge. Reimbursement  rate – $237.11/patient/month.

Allowed reported services alongside TCM services include,

  • Prolonged services without direct patient contact (99358-99359);
  • Home and outpatient international normalized ratio (INR) monitoring (93792-93793);
  • End-stage renal disease (ESRD) services for patients ages 20 years and older (90960-90962, 90966, or 90970);
  • Interpretation of physiological data (99091); and
  • Care plan oversight (G0181-G0182).

Remote Patient Monitoring:

RPM involves the collection and analysis of patient physiologic data that are used to develop and manage a treatment plan related to a chronic and/or acute health illness or condition.

CMS

Requirements for RPM:

To qualify for CMS reimbursements for utilizing the RPM services efficiently, the service providers and hospitals need to ensure the following:

  • Medicare part B patients are imposed 20% of copayment (renouncing the copayments regularly can trigger penalties under the Federal Civil Monetary Penalties Law and also the Anti-Kickback Statute)
  • Patients must take the remote monitoring services and are required to monitor for a minimum of 16 days to be applicable for a billing period.
  • The RPM services must be ordered by skilled physicians or other qualified healthcare experts.
  • Data must be wirelessly synced for proper evaluation, analysis, and treatment.

CPT Reimbursement Codes for RPM Service:

  • CPT code 99453It is a one-time practice expense reimbursing for the setup and patient education on RPM equipment. This code covers the initial setup of devices, training and education on the use of monitoring equipment, and any services needed to enroll the patient on-site. Reimbursement  rate – $18.77/patient/month.
  • CPT code 99454This code covers the supply and provisioning of devices used for RPM programs, and the code is billable only once in a 30-day billing period. Reimbursement  rate – $64.44/patient/month.
  • CPT code 99457This code covers the direct monthly expense for the remote monitoring of physiologic data as part of the patient’s treatment management services. To receive reimbursement, the physician, QHP or other clinical staff must provide RPM treatment management services for at least 20 minutes per month. Reimbursement  rate – $51.61 (non-facility); $32.84 (facility) /patient/month.
  • CPT code 99458This code is an add-on code for CPT Code 99457 and cannot be billed as a standalone code. This code can be utilized for each additional 20 minutes of remote monitoring and treatment management services provided. Reimbursement  rate – $42.22 (non-facility); $32.84 (facility) /patient/month.

Principal Care Management:

PCM codes are intended to cover services for patients with only one complex chronic condition that requires management by a specialist. Like other chronic care management (CCM) codes (chronic care management, transitional care management), the PCM codes are intended to reimburse physicians for the additional work they do to take care of high-risk, complex patients. This includes the extra time and work required for medication adjustments, creating a care plan, patient follow-up, and more.

Healthcare technology

Requirements for PCM:

  • One complex chronic condition lasting at least 3 months, which is the focus of the care plan,
  • The condition is of sufficient severity to place the patient at risk of hospitalization or has been the cause of recent hospitalization,
  • The condition requires development or revision of a disease-specific care plan,
  • The condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities

CPT Reimbursement Codes for PCM Service:

  • CPT Code G2064 – requires 30 minutes of provider (allergist, NP, PA) time each calendar month to care for the patient. This code can be billed monthly (in addition to appropriate E/M codes) and approximate reimbursement is $52/patient/month.
  • CPT Code G2065 –  requires 30 minutes of clinical staff time directed by a provider each calendar month for patient care. Provider supervision does not require the provider to be onsite while clinical staff performs PCM services. This code can be billed monthly (in addition to appropriate E/M codes) and approximate reimbursement is $22/patient/month.

Annual Wellness Visit:

The Annual Wellness Visit (AWV) is a yearly appointment with your primary care provider (PCP) to create or update a personalized prevention plan. This plan may help prevent illness based on your current health and risk factors. Keep in mind that the AWV is not a head-to-toe physical.

healthcare solutions

Requirements for AWV:

For G0438 (initial visit),

  • Billable for the first AWV only.
    • Patients are eligible after the first 12 months of Medicare coverage.
    • For services within the first 12 months, conduct the Initial Preventive Physical Exam (IPPE), also referred to as the Welcome to Medicare Visit (G0402).
  • The patient must not have received an IPPE within the past 12 months.
  • Administer a Health Risk Assessment (HRA) that includes, at a minimum: demographic data, self-assessment of health status, psychosocial and behavioral risks, and activities of daily living (ADLs), instrumental ADLs including but not limited to shopping, housekeeping, managing own medications, and handling finances.
  • Establish the patient’s medical and family history.
  • Establish a list of current physicians and providers that are regularly involved in the medical care of the patient.
  • Obtain blood pressure, height, weight, body mass index or waist circumference, and other measurements, as deemed appropriate.
  • Assess a patient’s cognitive function.
  • Review risk factors for depression, including current or past experiences with depression or mood disorders.
  • Review patient’s functional ability and safety based on direct observation, or the use of appropriate screening questions.
  • Establish a written screening schedule for the individual, such as a checklist for the next 5 to 10 years based on appropriate recommendations.
  • Establish a list of risk factors and conditions for primary, secondary, or tertiary intervention.
  • Provide personalized health advice to the patient, as appropriate, including referrals to health education or preventive counseling services and programs.
  • At the patient’s discretion, furnish advance care planning services.

For G0439 (subsequent visit),

  • Billable for subsequent AWV.
  • The patient cannot have had a prior AWV in the past 12 months.
  • Update the HRA.
  • Update the patient’s medical and family history.
  • Update the current physicians and providers that are regularly involved in providing the medical care to the patient, as developed during the initial AWV.
  • Obtain blood pressure, weight (or waist circumference, if appropriate), and other measurements, as deemed appropriate.
  • Assess a patient’s cognitive function.
  • Update the written screening schedule checklist established in the initial AWV.
  • Update the list of risk factors and conditions for which primary, secondary, and tertiary interventions are recommended or underway.
  • Provide personalized health advice to the patient, as appropriate, including referrals to health education or preventive counseling services and programs.
  • At the patient’s discretion, the subsequent AWV may also include advance care planning services.

CPT Reimbursement Codes for AWV Service:

The four CPT codes used to report AWV services are,

  • G0402 Initial Preventive Physical Exam – This code is used for patients visiting within 12 months after enrolling in Medicare.
  • G0438 Initial Visit – This visit is eligible within 11 calendar months from the date of IPPE.
  • G0439 Subsequent Visit – This code is used for every subsequent visit. Patients are eligible for this benefit every year after their Initial AWV.
  • CPT 99497/99498Patients are eligible for an Advance Care Planning (ACP) at any time. But if performed during an AWV, the patient has no copay.

Behavioral Health Integration:

Integrating behavioral health care with primary care (“behavioral health integration” or “BHI”) is an effective strategy for improving outcomes for millions of Americans with behavioral health conditions. Medicare makes separate payments to physicians and non-physician practitioners for BHI services they furnish to beneficiaries over a calendar month service period.

medicare cpt codes

Requirements for BHI:

  •  Any mental or behavioral health condition being treated by the billing practitioner, including substance use disorders, that, in the clinical judgment of the billing practitioner, warrants BHI services.
  • The diagnosis or diagnoses could be either pre-existing or made by the billing practitioner and may be refined over time.

CPT Reimbursement Codes for BHI Service:

The CPT code used to report BHI services is,

  • CPT Code 99494 – Initial or subsequent psychiatric collaborative care management, each additional 30 minutes in a calendar month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified healthcare professional.

References:

https://signallamphealth.com/2021-medicare-cms-chronic-care-management-ccm-cpt-code-updates/

https://www.cms.gov/newsroom/fact-sheets/final-policy-payment-and-quality-provisions-changes-medicare-physician-fee-schedule-calendar-year-1

https://college.acaai.org/new-principal-care-management-cpt-codes/#:~:text=G2064%20requires%2030%20minutes%20of,is%20%2452%2Fpatient%2Fmonth

https://www.aafp.org/family-physician/practice-and-career/getting-paid/coding/transitional-care-management.htm

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

CMS expands Telehealth Services to Deliver Care Safely during COVID-19 and Beyond

During the COVID-19 pandemic, CMS has taken the necessary steps to make it easier to provide quality care through telehealth services. This unprecedented action by CMS has encouraged healthcare providers to adopt and use telehealth as a way to safely provide care to their patients in situations like medication consultation, eye exams, nutrition counseling, behavioral health counseling, and routine health check-ups like annual wellness visits. Past data have shown telehealth to be an effective medium for patients to access healthcare providers especially for managing chronic conditions like diabetes, asthma or to obtain mental health counseling.

Advantages of CMS changes to Telehealth:

telehealth reimbursement codes

Telehealth services made permanent post-COVID-19:

CMS has announced that 60 of the 144 telehealth services that were newly offered during the pandemic will become permanent. This includes services for cognitive assessment, psychological and neuropsychological testing, and custodial care services for established patients.

virtual healthcare

They have also finalized the decision that direct supervision in telehealth visits can be provided with interactive audio and video technology through the end of the year until December 2021. 

 

CPT Code

Services

Description

77427

Radiation management

It is reported once for every five fractions or treatment sessions regardless of the actual time period in which the services are furnished. The services need not be furnished on consecutive days.

90853

Group psychotherapy

Group psychotherapy including interpersonal interactions and support with several patients; typically 45 to 60 minutes in length.

90953

End-stage renal disease, one visit per month, ages 2 and younger

End-stage renal disease (ESRD) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, etc.

90959

End-stage renal disease, one visit per month, ages 12-19

End-stage renal disease (ESRD) related services monthly, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth 

90962

End-stage renal disease, one visit per month, ages 20 and older

With 1 face-to-face physician visit per month

92057

Speech/hearing therapy

Treatment of speech, language, voice, communication, and/or auditory processing disorder, individual

92521

Evaluation of speech fluency

Evaluation of speech fluency (e.g., stuttering, cluttering)

92522

Evaluation speech production

Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria) 

92523

Speech sound language comprehension

Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria)

92524

Behavioral quality voice analysis

Behavioral and qualitative analysis of voice and resonance.

96130

Psychological test Evaluation Phys/qhp 1st

Psychological testing evaluation services by a physician or other qualified healthcare professional, including the integration of patient data, interpretation of standardized test results and clinical data

96131

Psychological test evaluation phys/qhp ea

Providers should now use CPT code 96130 to bill for the first hour of psychological testing evaluation services and 96131 for each additional hour

96132

Neuropsychological testing evaluation phys/qhp 1st

Neuropsychological testing evaluation services by physician or other qualified healthcare professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour

96133

Neuropsychological testing evaluation phys/qhp ea

The first hour of neuropsychological evaluation is billed using 96132 and each additional hour needed to complete the service is billed with code 96133

96136

Psychological and neurological testing phy/qhp 1s

Psychological or neuropsychological test administration/scoring by physician or other qualified healthcare professional, two or more tests, any method; first 30 minutes

96137

Psychological and neurological testing phy/qhp ea

Similar to 96136. This code is used for each additional hour.

96138

Psychological and neurological tech phy/qhp ea

Psychological or neuropsychological test administration/scoring by technician, two or more tests, any method; first 30 minutes

96139

Psychological and neurological testing tech ea

Similar to 96138. 

 97110

Therapeutic exercises

Foundational, occupational therapy exercises that are designed to improve a patient’s strength, range of motion, endurance, or flexibility.

97112

Neuromuscular re-education

Specific exercises or activities performed and for what purpose, neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, and/or posture.

97116

Gait training therapy

Therapeutic procedure, one or more areas, each 15 minutes; gait training (includes stair climbing). 

97161

Physical therapy evaluation 

Physical therapy evaluation of low complexity, 20 min

97162

Physical therapy evaluation 

Physical therapy evaluation moderate complexity, 30 min

97163

Physical therapy evaluation 

Physical therapy evaluation moderate complexity, 30 min

97164

Physical therapy evaluation

Physical therapy re-evaluation establish plan care

97165

Occupational therapy evaluation 

Occupational therapy evaluation low complexity, 30 min

97166

Occupational therapy evaluation 

Occupational therapy evaluation moderate complexity, 45 min

97167

Occupational therapy evaluation 

Occupational therapy evaluation high complexity, 60 min

97168

Occupational therapy 

Occupational therapy re-evaluation establish plan care

97535

Self-care management training

Direct one-on-one supervision and instruction regarding activities of daily living related to the patient’s health and hygiene.

97750

Physical performance test

Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report, each 15 minutes.

97755

Assistive technology assessment

This procedure is used by the provider to assess the suitability and benefits of technological interfaces that will help restore, augment, or compensate for existing functional ability in the patient.

97760

Orthotic management and training 1st en

Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(ies), lower extremity(ies) and/or trunk, initial orthotic(s) encounter, each 15 minutes.

97761

Prosthetic training 1st enc

Prosthetic training, upper and/or lower extremities, initial prosthetic encounter, each 15 minutes

99217

Observation care discharge

This code is used to report all services provided to a patient discharged from outpatient hospital “observation status” if the discharge is on a date other than the initial date of “observation status

99218

Initial observation care

The first visit of the patient’s admission for outpatient hospital observation care by the Admitting/Supervising Physician or Other Qualified Healthcare Professional. Typically, 30 minutes are spent at the bedside and on the patient’s hospital floor or unit.

99219

Initial observation care

Similar to 99218 but, 50 minutes are spent at the bedside and on the patient’s hospital floor or unit.

99220

Initial observation care

Similar to 99218 but, 70  minutes are spent at the bedside and on the patient’s hospital floor or unit.

99221

Initial hospital care

Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician.

99222

Initial hospital care

Similar to 99221

99223

Initial hospital care

Similar to 99221

99234

Observation/hospital same date

Observation or inpatient care, are used when the patient is placed in observation status or admitted to inpatient status and then discharged on the same date.

99235

Observation/hospital same date

Observation or inpatient care is used when the patient is placed in observation status or admitted to inpatient status and then discharged on the same date.

99236

Observation/hospital same date

Observation or inpatient care is used when the patient is placed in observation status or admitted to inpatient status and then discharged on the same date.

99238

Hospital discharge day

Used when time spent is less than 30 minutes on the discharge process in face-to-face evaluation.

99239

Hospital discharge day

Used when time spent is greater than 30 minutes on the discharge process in face-to-face evaluation.

99281

Emergency department visit

Requires these 3 key components: A problem-focused history; A problem-focused examination; and Straightforward medical decision-making. Usually, the presenting problem(s) are self-limited or minor.

99282

Emergency department visit

Requires these 3 key components: An expanded problem-focused history; An expanded problem-focused examination; and Medical decision-making of low complexity. Usually, the presenting problem(s) are of low to moderate severity.

99283

Emergency department visit

Requires these 3 key components: An expanded problem-focused history; An expanded problem-focused examination; and Medical decision-making of moderate complexity. Usually, the presenting problem(s) are of moderate severity.

99284

Emergency department visit

Requires these 3 key components: A detailed history; A detailed examination; and Medical decision-making of moderate complexity. Usually, the presenting problem(s) are of high severity, and require urgent evaluation by the physician but do not pose an immediate significant threat to life or physiologic function.

99285

Emergency department visit

Usually, the presenting problem(s) are of high severity, and require urgent evaluation by the physician but do not pose an immediate significant threat to life or physiologic function.

99291

Critical care first hour

It is used to report the services of a physician providing full attention to a critically ill or critically injured patient from 30-74 minutes on a given date

99292

Critical care additional 30 mins

Code 99292 (critical care, each additional 30 minutes) is used to report additional block(s) of time, of up to 30 minutes each beyond the first 74 minutes of critical care.

99304

Nursing facility care initial

The problem(s) requiring admission are of low severity. Typically, 25 minutes are spent at the bedside and on the patient’s facility floor or unit.

  99305

Nursing facility care initial

The problem(s) requiring admission are of moderate severity. Typically, 35 minutes are spent at the bedside and on the patient’s facility floor or unit.

99306

Nursing facility care initial

The problem(s) requiring admission are of high severity. Typically, 45 minutes are spent at the bedside and on the patient’s facility floor or unit.

99315

Nursing facility discharge day

99315 is for discharge day management 30 minutes or less

99316

Nursing facility discharge day

This code is for discharge day management over 30 minutes

99327

Domiciliary or rest home visit new patient

Domiciliary or rest home visit for the evaluation and management of a new patient. Usually, the presenting problem(s) are of high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family.

99328

Domiciliary or rest home visit new patient

Code used for Evaluation and Management / Domiciliary, rest home (boarding home) or custodial care services. The general guidance for this code is that it is used for new patient assisted living visits, typically 75 minutes. 

99334

Domiciliary or rest home visit established patient

This code 99334 is used to reflect the domiciliary or rest home visit for the E/M of an established patient

99335

Domiciliary or rest home visit established patient

Similar to 99334

99336

Domiciliary or rest home visit established patient

Similar to 99334

99337

Domiciliary or rest home visit established patient

Domiciliary or rest home visit for the evaluation and management of an established patient. Usually, the presenting problem(s) are moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family

99341

Home visit new patient

Home services are provided in a private residence.  A home visit cannot be billed by a physician unless the physician was actually present in the beneficiary’s home. Level 1 new patient home visit.

99342

Home visit new patient

Home services are provided in a private residence.  A home visit cannot be billed by a physician unless the physician was actually present in the beneficiary’s home. Level 2 new patient home visit.

99343

Home visit new patient

Home services are provided in a private residence.  A home visit cannot be billed by a physician unless the physician was actually present in the beneficiary’s home. Level 3 new patient home visit.

99344

Home visit new patient

Home services are provided in a private residence.  A home visit cannot be billed by a physician unless the physician was actually present in the beneficiary’s home. Level 4 new patient home visit.

99345

Home visit new patient

Home services are provided in a private residence.  A home visit cannot be billed by a physician unless the physician was actually present in the beneficiary’s home.Level 5 new patient home visit.

99347

Home visit established patient

Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components.  A problem-focused interval history; a problem-focused examination; and straightforward medical decision making. Typically, 15 minutes are spent face-to-face with the patient and/or family.

99348

Home visit established patient

Similar to CPT Code 99348. Typically, 25 minutes are spent face-to-face with the patient and/or family.

99349

Home visit established patient

Similar to CPT Code 99348. Typically, 40 minutes are spent face-to-face with the patient and/or family.

99350

Home visit established patient

Similar to CPT Code 99348. Typically, 60 minutes are spent face-to-face with the patient and/or family.

99468

Neonatal critical care initial

Services of directing the inpatient care of a critically ill neonate or infant 28 days or younger. 

99469

Neonatal critical care initial

Services of directing the inpatient care of a critically ill neonate or infant 28 days or younger. 

99471

Pediatric critical care initial

Initial inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 29 days through 24 months of age

99472

Pediatric critical care initial

Subsequent inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 29 days through 24 months of age

99473

Self-measurement of blood pressure at home education/training

Code 99473 represents the work of training the patient and calibrating the device,

99475

Pediatric critical care ages 2-5 initial

Initial inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 2 through 5 years of age

99476

Pediatric critical care ages 2-5 subsequent

Subsequent inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 2 through 5 years of age

99477

Initial day of hospital care for neonatal care

Initial hospital care of the neonate (28 days or younger) who is not critically ill but requires intensive observation, frequent interventions, and other intensive care services.

99478

Ic low-birthweight infant

Intensive care, per day, for the evaluation and management of the recovering low or very low birth weight infant( < 1500 gm)

99479

Ic low-birthweight infant < 1500-2500 g subsequent

Intensive care, per day, for the evaluation and management of the recovering low or very low birth weight infant( 1500 gm-2500g)

99480

Ic infant pbw 2501-5000 g subsequent

Intensive care, per day, for the evaluation and management of the recovering low or very low birth weight infant(2501g-5000g)

99483

Assessment and care plan cognitive impairment

Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home

The ongoing pandemic has resulted in an increased workload for healthcare providers across the country. Incorporating telehealth software into an existing practice can allow providers to virtually connect with patients. This can relieve the strain on practice while introducing an additional revenue stream.

HealthViewX Telehealth/Telemedicine Platform helps health systems to align clinical, financial, and operational goals by providing high-quality remote care and enhancing patient-physician collaborations.

References: https://www.beckershospitalreview.com/telehealth/cms-adds-85-more-medicare-services-covered-under-telehealth.html

The Evolution Of The Health Tech: Positive Change Through Interoperable Solutions

The American Healthcare Industry has experienced many large-scale changes in the past few decades. This timeframe has afforded us many drastic reforms in the industry such as the Affordable Care Act (ACA) or the widespread shift towards Value-Based Care. However, the most noteworthy and significant change is the gradual adoption of software solutions into the healthcare industry. The digitization of healthcare has brought numerous benefits to healthcare organizations that are able to streamline their day-to-day operations. More importantly, these solutions have made life easier for care providers and patients by simplifying the delivery of care. In order for these complex systems to operate, they need to display competency in Interoperability. 

How Interoperability Ties It All Together

Interoperability in the context of healthcare refers to the use of many complex systems and information technology (IT) to exchange and interpret health-based data. As many software systems were designed for specific tasks, the transfer of data between different systems emerged as a significant challenge. Interoperability allowed for different computer systems that operate on different platforms to interact with each other. This gave health organizations the ability to employ multiple systems for their varying needs. At the foundational level, interoperability is present in roughly 75% of health systems in the US. The incorporation of more advanced levels allows organizations to expand the scale of their services.

How Technology is Combatting COVID-19

The COVID-19 Pandemic has proved to be a challenging obstacle for the healthcare industry. While the pandemic continues to test the industry’s existing abilities, the prevalence of computer systems currently in use have helped in the fight to control COVID-19. The use of virtual health services has skyrocketed since the outbreak as clinics across the country shift their focus to COVID-19. Patients are able to access health services like routine check-ups from their tablet or computer. The significance of this service is that it ensures patients with chronic conditions can receive medical services without the risk of being infected with COVID-19. It also helps clinics establish stable cash flow and make up for revenue shortfall due to the pandemic. 

Examples of Interoperable Health Tech Solutions:

Telehealth

Interoperable Health Tech Solutions

Telehealth involves the transfer of healthcare services through a telecommunications platform. While the primary use of telehealth is for virtual conferencing between patients and physicians, it is also used for monitoring and educating patients. The most popular form of telehealth is video conferencing where patients and physicians can perform most tasks required in a typical check-up. According to the American Hospital Organization (AHA), 3 out of every 4 hospitals offer some form of telehealth service. Telehealth has proven to be a valuable tool in the fight against COVID-19, while also eliminating long wait times and nonessential clinical visits. Telehealth must be interoperable with other platforms in order to share Electronic Health Records (EMR). Reviewing these records is crucial for physicians who are deciding the next course of action for a patient. 

Remote Patient Monitoring

Remote Physiological Monitoring (RPM) uses real-time technology to collect vital parameters such as heart rate, blood pressure, weight, or any other relevant health-based measure. These devices are worn by patients to track the parameters of their health while simultaneously sending the results to a qualified health professional. This professional can analyze the information and intervene if there is any abnormal data. These gadgets have been extremely helpful for chronic care patients who can avoid the hassle of regular clinical visits. Clinics who effectively use these devices can significantly reduce the number of readmissions, which costs the industry over $41 billion a year. Interoperability is crucial in the RPM care delivery as data must be transferred from the patient’s device to the health system without any errors. 

Workflow and Referral Management

Remote Patient Monitoring

The goal of Workflow Management is to streamline the patient workflow by eliminating inefficiencies in the process. Tech solutions such as Smart Rooming help nurses room the patient and transfer the responsibility of care in a time-efficient manner. Referral Management is also an extremely crucial part of clinical operations. Referral Leakage, which occurs when a patient’s Referral loop is not closed, costs the industry millions of dollars a year. Interoperable platforms would transfer information from the physician to the specialist in a timely manner and without any gaps. 

Artificial Intelligence and Machine Learning

Primary Benefits of healthcare technology

While still extremely developmental in nature Artificial Intelligence (AI) and Machine Learning (ML) provide a glimpse into the future of healthcare. AI and ML both use machines to perform human activities such as comprehension, interpretation, and analysis. Despite a limited role, they are both currently used for routine activities like streamlining workflows, patient education, diagnosis, and predictive analysis. AI/ML can help health tech innovators attain interoperability by assisting computer systems in receiving and analyzing data. 

Primary Benefits

The influx of interoperable systems has revolutionized the healthcare industry. Listed below are the main benefits of these solutions. 

 

  • Improved Patient Experience: One of the main focuses of these innovative software solutions was to improve the overall experience of patients. The introduction of Telehealth and RPM increases access to healthcare for all patients. Tools such as AI and ML are life-saving as they quickly and accurately diagnose conditions. 
  • Simplifying the Care Journey: In the traditional Care Journey, patients may have to spend an entire day in a clinic while physicians shuttle back and forth to tend to them. Software Solutions have streamlined this process by assisting clinics with scheduling, rooming, and diagnosis. Nurses, Physicians, and Clinical staff can allocate their time more efficiently, resulting in a smoother Care Journey for patients. 
  • Optimal Operational Efficiency: Health Organizations are able to maximize the use of their resources thanks to health tech solutions. Using tools like Referral Management and Care Orchestration allows organizations to streamline patient workflows. This helps them serve more patients without having to expand or increase costs. 

 

Increased Profit: Perhaps the greatest benefit for organizations is the ability to increase clinical profits. Efficient software solutions help organizations identify and eliminate inefficient practices. At the same time, solutions like RPM provide additional revenue streams for clinics with little additional cost. While Interoperable solutions may incur an initial cost, effective development and use of the product will have a positive impact in the long run.

Talk to us to understand more about the advancements in the healthcare industry and we will guide you to achieve our common goal “Quality Care for All” seamlessly.

Emerging Technologies that will shape the Future of the Healthcare Industry

The Healthcare Industry has witnessed a great deal of innovation over the past few centuries. Some pioneering breakthroughs include the discovery of vaccines, antibiotics, and insulin. Developments such as these have drastically increased the overall quality of life for billions of people across the planet. These substantial improvements over the past two centuries have led to the emergence of recent tech-based health innovations.  

How the move to Value-Based Care affects Innovation

The Healthcare industry has witnessed a shift towards “Value-Based Care” over the past few decades. This model focuses on the patient outcome more than any other factor. This has influenced technological innovations to be patient-centric rather than purely profit-focused. 

RPM Devices

how remote patient monitoring helps to achieve value based care

Remote Physiological Monitoring (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. These compact gadgets track and send these parameters to qualified health professionals who can analyze the results. RPM devices give patients the opportunity to monitor their condition on a daily basis without constant clinical visits. These devices have allowed providers to remain updated with their patients when a physical visit is not possible. Effective use of these devices is proven to decrease the number of readmissions, which costs the industry over $41 billion a year. The RPM market is expected to grow to $2.7 billion by 2020, per a projection by Research and Markets. If RPM devices can prove their value in a competitive health tech market, they may become an integral part of human life. Their compact nature can allow them to become as ubiquitous as a wristwatch, especially for aging populations. 

Telehealth

what are new advancements in telehealth

Telehealth involves the transfer of healthcare services through a telecommunications platform. While it includes monitoring and education, it is most commonly used as a tool for virtual appointments between providers and patients. Commonly used Telehealth platforms involve the use of a video/audio system with the ability to send EHR/EMRs or other health records by message. Telehealth acts as an added revenue stream as the CMS reimburses providers who employ telehealth services. For patients, telehealth means they can access high-quality healthcare from the comfort of their homes. The use of telehealth has rapidly grown over the past decade as 75% of hospitals utilized a telehealth platform in 2017 as opposed to 35% in 2010. In the long run, telehealth can help eliminate nonessential patient visits which waste both time and resources. With technological advances, telehealth might soon adopt a “virtual reality” based format. This can increase patient-provider interaction while enhancing the quality of care.  

Artificial Intelligence

how Artificial Intelligence hep in healthcare industry

Artificial Intelligence (AI) involves the use of machines to perform human activities such as comprehension and analysis. In a healthcare setting, it can be used to make an advanced interpretation of health-based data. The amount of investment in health-based AI is projected to grow from $600 million to $6.6 billion between 2014 and 2021. AI can make patient-specific care plans by accounting for millions of variables involving the patient’s health condition and trajectory. AI could potentially open the door for “Precision Medicine,” which could be a landmark development in modern medicine. While this method is still highly experimental and embroiled in controversy, the prospects of an effective model remains promising.  

The Impact of COVID-19 on Health Tech Innovations

The COVID-19 Pandemic has placed a heightened focus on the current capabilities of the Healthcare industry. The pandemic has offered both challenges and opportunities for technological innovation. One of the primary flaws of the industry that COVID-19 has highlighted is the prevalence of unnecessary and inconvenient patient visits. As health centers across the country have been focused on tackling the pandemic, patients with other conditions have been encouraged to stay home and receive virtual care. Many patients are able to mitigate their existing conditions without time-consuming visits to a clinic. At the same time, this provides an opportunity for a widespread adoption of telehealth services. Many providers have experienced the efficiency of virtual health services and will continue to invest in these solutions. Clinics without such platforms will likely adopt telehealth to address their lack of virtual care services. The pandemic will no doubt leave an enduring mark on the healthcare industry. The lessons learned from the pandemic will surely shift the focus of innovations towards virtual health solutions. 

Talk to us to understand more about Value-Based Care and we will guide you to achieve our common goal “Quality Care for All” seamlessly.

Remote Patient Monitoring helps achieve Healthcare’s Triple Aim

What is Triple Aim?

Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance.

  • Improving the patient experience of care (including quality and satisfaction)
  • Improving the health of the populations
  • Reducing the per capita cost of health care

The Centers for Medicare and Medicaid Services (CMS) has emphasized the significance of achieving the “Triple Aim” objectives. Therefore, the entire healthcare industry is working to harness the Triple Aim concept to enhance overall outcomes.

Achieving the Triple Aim goals is quite challenging. Improving access to care is one of the prime drivers in achieving Triple Aim, which fundamentally helps improve patient experience of care, treatment outcomes of the population and reduce the per capita cost.


how Aging Baby Boomers related to triple aim

Aging Baby Boomers Drain Financial Systems

There are roughly 77 million Baby Boomers in the U.S. (born between 1946 and 1964). Of that group, about 10,000 are reaching age 65 every single day, and that trend is expected to continue into the 2030s.

It is a fact that the Centers for Medicare and Medicaid Services (CMS) cannot afford this increased cost of medical care for this large aging population. The new payment model i.e. the shift from fee-for-service to value-based reimbursement is intended to inspire and reward for providing quality care across the care continuum at a reduced cost. This also helps improve patient health outcomes, patient experience, and reduce readmission rates.


triple aim and remote patient monitoring

How Does Remote Patient Monitoring (RPM) help in Achieving Triple Aim?

Today, to treat patients remotely healthcare organizations are getting the entire patient data into their systems to get them in front of their physicians and specialists. Innovations and improvements in healthcare technology have allowed patients to survive diseases and get immediate medical attention when most needed. Remote Patient Monitoring is one of the solutions that play a crucial role in helping the baby boomers population, and help healthcare providers to get closer to attaining Triple Aim.


how Remote patient monitoring helps in improving Patient Experience, Population Health, Reduce Costs

Remote patient monitoring can help providers in value-based repayments through a proactive focus on disease prevention, early involvement, care management, chronic care management, and patient monitoring. This optimized management of care to a greater extent has helped the manner in which physicians provide care and how patients manage their own health.

Improves Patient Experience

Remote patient monitoring along with other Telehealth solutions allow patients to get involved in their treatment by monitoring/updating their vitals, following care plans, diet, etc. This improves patients’ self-awareness of their medical condition and also helps them connect with their provider when needed. The care model allows patients to engage in their care on a day-to-day basis and drives patient adherence, self-involvement, and better health outcomes which means improved patient experience.

Improves Population Health

At times, elderly patients in rural/remote areas find it difficult to reach the providers when in urgent need. There may be several reasons like lack of specialties, distance, etc. In such cases remote patient monitoring can help to a very great extent facilitating medical attention at doorsteps, eliminating long-distance travel, etc. Providing medical care to people of all ages of the especially aging population will help improve the health of the population.

Helps Reduce Costs

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.

To treat patients remotely, healthcare organizations should adopt and use technologies that help them enhance care experience, improve patient health outcomes, and reduce overall cost.

Schedule a demo and talk to HealthViewX RPM Solution experts and get your RPM started in a jiffy!

Understand the importance, value and use of Telehealth during this pandemic

Understanding Preventive Care Services

Telehealth has become increasingly important and has seen a striking evolution during this COVID 19 pandemic and is especially capable of having a huge effect on how patients communicate with providers and receive care.

Telehealth refers to a broader scope of remote healthcare services. According to the World Health Organization, Telehealth encompasses, “Surveillance, health promotion, and public health functions.”

The National Consortium of Telehealth Resource Centers has published a video on “Telehealth Policy in a Post-COVID-19 World.” In this video, Center For Connected Health Policy (CCHP) tells what temporary policy changes might remain Post-COVID-19 and what could be issues that policymakers may think merit future action. This will help policymakers, practitioners, payers, and the public understand how to accurately discuss “Telehealth” and its key components.

Related Article: Telehealth to Ensure Care and Business Continuity Amid COVID- 19


telehealth and remote patient monitoring

Understanding the dynamics of Telehealth

Telehealth is presently delivered in 2 major ways:

Video Conferencing (VC) - This is used for real-time provider-patient consultations, PCP-Specialist/ Provider – Provider.

  • No special software downloads for patients to connect, just click the HIPAA secure link to join the video call, share videos, file, photos, messages, etc.
  • Patients and providers can connect from anywhere, improved access for remote patients
  • Easy text or email reminders, easy reschedules, patient self-scheduling.

Remote Patient Monitoring (RPM) - This is used to provide appropriate support for patient self-management and helps in gathering patient data outside of traditional healthcare settings or helps transmit patient health information to health care providers.

RPM Benefits for patients:

  • No travel expenses and spending time on travel as the in-person visit is not required
  • Less interference with personal responsibilities like childcare, elder care, etc
  • No exposure to other potentially contagious patients

RPM Benefits for Providers:

  • Increased efficiency and revenue
  • Better patient care and improved health outcomes
  • Fewer circumstances that lead to no-shows

Importance, benefits, and use of Telehealth

Telehealth provides valuable features that help providers achieve health care’s triple aim – access to care, improved patient outcomes, and reduce cost to the provider. Telehealth removes obstructions of time, distance, and specialty lack. This includes remote, rural, and medically underserved urban communities.

  • It helps reduce readmissions, stops unnecessary hospitalizations, and ER visits.
  • It provides peace of mind to patients' family members as they know the patient is receiving the proactive care they need.
  • It incessantly captures and analyses real-time data and integrates alert algorithms, and helps identify patients who are at risk of emergency department visits (ER Visits) or hospitalization.
  • It is more reliable, enhances the quality of care, care coordination, saves costs, and time for both the provider and the patient.

Related Article: Role of Telehealth In Chronic Care

How to implement Telehealth:

Implement Telehealth into your existing operation and it has to be designed to complement your standard practices and workflows.

  • Plan a workflow analysis to reveal how this has to fit in with standard clinical practice.
  • Consider this technology as another tool for the delivery of normal services with the only difference of the patient being at a remote location.
  • Keep it simple.

Implementing sustainable Telehealth is the need of the hour. Talk to HealthViewX solution experts to understand how to instantly launch a Telehealth Program into your practice. Schedule a demo today, get up and run quickly, get started in a jiffy irrespective of the size of the operation.