{"id":4790,"date":"2017-11-06T15:42:35","date_gmt":"2017-11-06T15:42:35","guid":{"rendered":"http:\/\/tele.healthcare\/?p=4790"},"modified":"2017-11-06T15:42:35","modified_gmt":"2017-11-06T15:42:35","slug":"cms-ama-look-for-common-ground-on-remote-patient-monitoring","status":"publish","type":"post","link":"https:\/\/drmiltie.com\/at-home-testing\/cms-ama-look-for-common-ground-on-remote-patient-monitoring\/","title":{"rendered":"CMS, AMA Look for Common Ground on Remote Patient Monitoring"},"content":{"rendered":"<p><strong>Starting in 2018 CMS will support and reimburse providers using telehealth technologies to remotely monitor patients from their homes using digital devices to capture vital signs such as, blood pressure and glucose levels. Additionally included with these changes by CMS is the unbundled payment for CPT code 99091 which will now permit providers to get reimburse for time spent analyzing patient data collected from these remote monitoring devices.<\/strong><\/p>\n<h4>CMS moves to separate remote patient monitoring from telehealth, giving the mHealth technology a better shot at reimbursement. The AMA is also taking a closer look at the digital health platform.<\/h4>\n<p>November 6, 2017 by Eric Wicklund<\/p>\n<p>Fans of remote patient monitoring found a lot to like in new payment rules released last week by the Centers for Medicare &amp; Medicaid Services, continuing what many hope is a trend toward CMS support for mHealth and telehealth technology.<\/p>\n<p>Beginning in 2018, CMS will support clinicians who leverage remote monitoring tools, such as wearables and smart devices at home, and use patient-generated health data in care coordination and management.<\/p>\n<p>The changes are included in CMS\u2019\u00a0<a href=\"https:\/\/s3.amazonaws.com\/public-inspection.federalregister.gov\/2017-24067.pdf#page=367\">Merit-based Incentive Payment System (MIPS) improvements<\/a>, which would enable doctors using \u201cnon-face-to-face chronic care management using remote monitoring and or telehealth technology\u201d to receive\u00a0<a href=\"https:\/\/s3.amazonaws.com\/public-inspection.federalregister.gov\/2017-24067.pdf#page=1622\">Advancing Care Information (ACI) program points<\/a>\u00a0for activities like sending medication reminders, collecting, monitoring and reviewing patient physiological data and prescribing patient education.<\/p>\n<p>The rules drew praise from the Connected Health Initiative, which had lobbied CMS for RPM incentives this past February.<\/p>\n<p>&#8220;These new rules are an important step forward for America\u2019s connected health innovators, doctors and, most importantly, patients,\u201d CHI Executive Director Morgan Reed\u00a0<a href=\"http:\/\/www.connectedhi.com\/blog\/2017\/11\/2\/new-medicare-and-medicaid-rules-open-opportunities-for-connected-health-tech-for-doctors-and-patients\">said in a statement<\/a>. \u201cUntil now, connected health technologies have been effectively locked out of the most important part of America\u2019s healthcare system, Medicare and Medicaid.\u201d<\/p>\n<p class=\"article-read-more\"><strong>READ MORE:<\/strong>\u00a0<a href=\"https:\/\/mhealthintelligence.com\/news\/mhealth-study-remote-monitoring-cuts-costs-hospitalizations\">mHealth Study: Remote Monitoring Cuts Costs, Hospitalizations<\/a><\/p>\n<p>\u201cPrevious CMS rules created serious disincentives for doctors to consider using new technologies,\u201d Reed added. \u201cTogether with our advisory board, CHI pushed for newly enacted rules that finally level the playing field for innovators, giving doctors and patients the chance to take advantage of the best technologies available.\u201d<\/p>\n<p>CMS actually began this change in direction this past July, when it unveiled the 2018 Physician Fee Schedule proposed rule. And it laid the groundwork for an ongoing discussion on RPM that could lead to more coverage in the future.<\/p>\n<p>Included in the PFS was a solicitation for comments on Current Procedural Technology (CPT) codes 99090 and 99091, which cover, respectively, \u201ccollection and interpretation of physiologic data (e.g., 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 (QHCP), qualified by education, training, licensure\/regulation (when applicable) requiring a minimum of 30 minutes of time\u201d and \u201canalysis of clinical data stored in computers (e.g., ECGs, blood pressures, hematologic data).\u201d<\/p>\n<p>The request for comments on those and other codes covering \u201cextensive use of communications technology\u201d signaled to mHealth advocates that CMS was thinking of switching gears on RPM and separating that platform from telehealth and telemedicine \u2013 two heavily regulated platforms that have drawn their own share of criticism for being too restrictive.<\/p>\n<p>\u201cThis is huge,\u201d says Robert Jarrin, Qualcomm\u2019s Director of Wireless Health Public Policy and an expert in the digital health field. \u201cThey have articulated that RPM isn\u2019t defined by telehealth.\u201d<\/p>\n<p class=\"article-read-more\"><strong>READ MORE:<\/strong>\u00a0<a href=\"https:\/\/mhealthintelligence.com\/news\/gao-report-telehealth-troubles-tied-to-reimbursement-barriers\">GAO Report: Telehealth Troubles Tied to Reimbursement Barriers<\/a><\/p>\n<p>According to Jarrin, CMS has long classified RPM under \u201cmiscellaneous services\u201d and included them in bundled payment programs. The technology could be grouped with other services that do have reimbursement codes, but is doesn\u2019t have its own codes.<\/p>\n<p>Beginning next year,\u00a0CMS has unbundled CPT code 99091.<\/p>\n<p>&#8220;Providers will soon be able to get reimbursed separately for time spent on collection and interpretation of health data that is generated by a patient remotely, digitally stored and transmitted to the provider, at a minimum of 30 minutes of time,&#8221; Jodi G. Daniel and Maya Uppaluru, attorneys for the law firm of Crowell &amp; Moring,\u00a0<a href=\"https:\/\/www.cmhealthlaw.com\/2017\/11\/new-reimbursement-for-remote-patient-monitoring-and-telemedicine\/\">wrote in a Nov. 3 blog<\/a>.<\/p>\n<p>Jarrin called both 99090 and 99091 \u201cpromising, but imperfect at best\u201d\u00a0<a href=\"https:\/\/www.qualcomm.com\/news\/onq\/2017\/08\/25\/medicare-and-remote-patient-monitoring\">in an August 2017 blo<\/a>g, and said he expects CMS to continue looking at ways to separate RPM from telehealth andf provide new avenues for reimbursement.<\/p>\n<p>In addition, CMS iis adding several new telehealth services in 2018: counseling visit for lung cancer screening (HCPCS code G0296), psychotherapy for crisis (CPT codes 90839 and 90840), interactive complexity (CPT code 90785), patient- and caregiver-focused health risk assessment (CPT codes 96160 and 96161), and chronic care management services including assessment and care planning (HCPCS code G0506).<\/p>\n<p class=\"article-read-more\"><strong>READ MORE:<\/strong>\u00a0<a href=\"https:\/\/mhealthintelligence.com\/news\/medicare-spending-on-telehealth-increases-but-barriers-remain\">Medicare Spending on Telehealth Increases, But Barriers Remain<\/a><\/p>\n<p>&#8220;These policy updates signal that CMS is moving quickly to incentivize the integration of innovative technologies as it pushes for the transition to value-based care,&#8221; Daniel\u00a0and Uppaluru wrote..&#8221;Health technologists can seize the opportunity to help hospital and clinician customers to meet their regulatory incentives by ensuring that digital health products conform to the requirements set out in these rules.<\/p>\n<p>At the same time, the American Medical Association,\u00a0<a href=\"https:\/\/www.ama-assn.org\/practice-management\/cpt-current-procedural-terminology\">which maintains and copyrights CPT codes<\/a>, has signaled interest in developing RPM-friendly codes as well. That issue is currently being discussed by the AMA\u2019s Telehealth Services Workgroup, which was launched in 2014, and the more recent Digital Medicine Payment Advisory Group (DMPAG).<\/p>\n<p>That both CMS and the AMA are signaling an interest in RPM \u201creally demonstrates how timely RPM is,\u201d says Jarrin, who\u2019s been a member of the DMPAG since its inception. \u201cThat acknowledges that this is a legitimate service.\u201d<\/p>\n<p>\u201cA top priority for the DMPAG has been identifying pathways to clinical integration of digital medicine, specifically remote patient monitoring coding, valuation, coverage and program integrity,\u201d Jarrin wrote in his blog. \u201cAs a result, several formal coding applications requesting the additions of new codes for physiologic monitoring and management have been submitted by the DMPAG to the CPT Editorial Panel for consideration during its upcoming September 2017 meeting. These applications include two for physiologic monitoring and management. One application requests the addition of a code to report the physician\/provider services of chronic care monitoring\/management of a patient using remote monitoring technology, the other addresses the technical component and set up.\u201d<\/p>\n<p>Jarrin says the AMA likely won\u2019t reveal its direction until sometime next year, and any new codes won\u2019t go live until 2019.<\/p>\n<p>\u201cThere is no guarantee they will be approved by the CPT Editorial Panel, but digital medicine will not move forward unless it\u2019s represented in the foundational medical nomenclature code set,\u201d he wrote in his blog. \u201cCPT\u2019s partnership and understanding of the evolution of medical practice and current services are crucial. Should these codes gain approval, it doesn\u2019t mean CMS will begin automatically covering or paying them. But the process of creating codes is methodical and requires thorough assessments of medical practice and procedures based on validated evidence, scientific backing from medical societies, the involvement of the medical community, well defined criteria, and clinical expertise.\u201d<\/p>\n<p>According to the Personal Connected Health Alliance, the issue now goes before the AMA\u2019s Relative Value Scale Update Committee (RUC), which will work with medical specialty societies to develop accurate valuations and utilization figures for these services.<\/p>\n<p>\u201cIn addition, the RUC makes recommendations to CMS on valuation of the codes for Medicare,\u201d the PCHA reported.\u00a0 \u201cThis is a lengthy and rigorous process in which providers share data and information on the resources and clinical time associated with the delivery of the three defined components to remote patient monitoring for those with chronic conditions.\u00a0 The data on costs and clinical time associated with delivery of remote patient monitoring will be crucial.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Starting in 2018 CMS will support and reimburse providers using telehealth technologies to remotely monitor 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