In November, 2018 CMS officially approved three new billing codes for Remote Patient Monitoring (RPM). Most telehealth industry experts agree that this is the biggest financial incentive to date in the history of digital medicine. (The average primary care physician could end up generating over $400,000 of additional revenue per physician per year). Still, most physicians, patients and even healthcare executives are either unaware or unclear of what this could mean to them.
The Opportunity for Physicians
Starting on January 1, 2019, there are three new CPT codes that cover remote patient monitoring equipment, setup and monitoring services:
Moreover, these codes can be combined with chronic care managements services (CCM), which have been active for a few years. The combined utilization of these codes provides a mechanism that family medicine providers can use to monitor and engage with patients, and to help them more efficiently manage their chronic conditions, while getting reimbursed, providing a new mechanism that innovative and savvy physician practices may be able to use to increase their quality metrics while also increase the near term profitability of their practices.
The average primary care physician could end up generating over $400,000 of additional revenue per physician per year. This assumes that the physician extends these services to about 20% of their Medicare-covered patients. Contact us for a more detailed explanation of the numbers used in this assumption.
So, What’s Required?
In order to properly bill to these codes you must meet the following requirements:
While this program may seem too good to be true for primary care physicians who are used to being underpaid relative to their specialist peers, this actually makes a lot of sense from a macro level and may actually do a lot to protect the solvency of our nation. Policy makers with AMA and CMS have seen rapid growth in Medicare and Medicaid spending, totaling almost $1.3 trillion in 2017, up substantially since 2007, that is continuing to rise without some form of rapid technology-based innovation, these expenditures will continue to grow as the baby boomers continue to age, and will pile on even more to an already out-of-control national debt. CMS knows that affordable new wireless remote monitoring technologies exist that can help keep stay in their homes longer and stay out of the hospital more and initial results have been promising. These technologies have just not had enough reimbursement attached to them to make financial sense for most physicians - until now. The leaders at CMS should be commended in this case for supporting and driving innovation. While this new mechanism creates an enormous new financial opportunity for certain types of providers (e.g. primary care providers) it is expected help to reduce overall medical spending as a whole. Furthermore, innovation in this field will now accelerate even faster with more direct financial support by CMS that will drive more rapid adoption by physicians as well as more investment by technology providers.
Where do I Get the Equipment and Software?
Because this code is still very new, there are still not many options for software and equipment that can be used to meet the requirements that also fit into the workflow of primary care practices and hospitals alike. Fortunately, Pillsy has developed software that meets these needs, as we’ve been following the evolution of these codes carefully, engaging both with legal and billing experts in this field as well as directly with CMS.
We can provide you with the remote monitoring equipment, software, workflow, and expertise to get your remote monitoring program up and rolling in days or weeks. Our system works with a variety of workflows for primary care practices and hospital systems alike.
For patients, available components of our remote monitoring kits include:
The healthcare provider team gets access to web-based software that includes the following capabilities and more