Remote Patient Monitoring began on January 1, 2019 when the CMS announced that new codes would go into effect.
Then, two bills in Virginia were passed to broaden remote patient monitoring. They also add to the commonwealth's telehealth and telemedicine guidelines. This legislation mandates coverage by payers and Medicaid, giving providers more opportunity to be reimbursed for using the technology.
In November of 2018 CMS announced three new codes for Remote Patient Monitoring that became active on January 1, 2019. Fast-moving providers jumped on this new opportunity to provide Remote Patient Monitoring technologies such as the platform provided by optimize.health to their Medicare patients. Virginia doctors soon have it even better once approved by the Governor.
It's estimated that an average primary care physician could generate up to $200k additional revenue from their Medicare patients alone. This figure could double or triple if Remote Patient Monitoring is also extended to patients on private insurance and Medicaid, as the new laws would mandate.
Both Virginia Bills, House Bill 1970 and Senate Bill 1221, were originally filed on January 9 and were quickly approved. These bills define RPM as “the delivery of home health services using telecommunications technology to enhance the delivery of home health care, including monitoring of clinical patient data such as weight, blood pressure, pulse, pulse oximetry, blood glucose, and other condition-specific data; medication adherence monitoring; and interactive video conferencing with or without digital image upload.”
It is typical for States to follow the lead of CMS in adopting coverage of new CPT codes.
This bill makes economic sense from the standpoint of CMS, which is seeking to stimulate adoption of new technologies that prevent or replace even more expensive home care services and hospitalizations. Finding replacements for these costly services is something that is necessary as the baby boomer population continues to age and to add to Medicare's expanding cost base. Some experts also speculate that this is an effort by CMS to invest in prevention-focused technologies that could help to transition the healthcare system from a labor-intensive fee-for-service system to technology-enabled form of value-based care. Doing so would enable more, higher-quality care to be delivered without requiring an increase in the supply of doctors, nurses and other highly qualified healthcare providers.
The approved bills require Virginia payers, including the commonwealth’s Medicaid program, to reimburse healthcare providers for RPM services “to the full extent that these services are available.” Additionally, these potential laws would allow providers in other states who are in good standing with their medical boards and permitted to use connected care technologies to utilize them with Virginia residents.
Virginia was one of the first states in the nation to mandate private payer parity for telehealth, and in 2015 and 2016 lawmakers enacted legislation expanding commercial insurance coverage and establishing rules and guidelines for those services.
Virginia is clearly on track to establishing itself as a leader in the world of telehealth.
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