Remote Patient Monitoring (RPM): A New Opportunity for Root Cause Practices

Coding Advantage, LLC www.codingadvantage.com

With Sonda Kunzi, CEO of Coding Advantage and Jim Eischen, Esq. of the Eischen Law Office

Agenda for Today

• Overview• Recap from last week• Quantifying the value of RPM in the 12-month diabetic care

path• Operational considerations• RPM vs CCM (chronic care management): Should you

consider both?• Reengaging the payer system• Next steps and preview of next week

Who is this session for?

• Billing eligible providers seeking to quantify income potential through third party payers

• Providers and practice managers investigating the potential costs and benefits of RPM

• Allied practitioners seeking avenues to monetize their work inside payer participating root cause medicine practices

RecapFive key changes that make root cause medicine financially feasible for practices and patients within the payer system.

1. Bill for time spent prepping for and documenting visits (on the same calendar day of the visit) including prolonged visits (beyond 99215) in15-minute increments

2. Code on the basis of time OR medical decision making (MDM) – rewarding root cause providers for work with more complex patients

3. Parity in the value of telehealth and in-person visits – including virtual group visits

4. Utilize health coaches in combination with a tech platform for RPM5. Dramatic reduction in note-taking requirements for providers to bill

higher level E/M codes

Recap: 12 Month Care PathNew patient w diabetes & hypertension

Recap: Care Path Economics

2020 values• Total provider time: 5.65 hours/ patient• Net revenue/ patient (net of coaching cost): $1,067.61• Net revenue/ hour: $188.962021 Values• Net revenue/ patient (net of coaching cost): $1,610.12• Net revenue/ hour: $284.98An increase of $96.02/ hour (51%)

Recap: Cohort Economics

Why Consider RPM?

Achieving the Triple Aim of Healthcare

Achieving the Triple Aim of Healthcare

• Improves health by: Driving patient adherence, engagement in care paths, self-management, and overall health outcomes

• Improves the patient experience by: Providing daily interactions and making healthcare infinitely more convenient and accessible

• Reduces cost by: • Fewer hospital admissions• Reduction in unnecessary visits• Improved patient communications• Optimizing time spent with patients

RPM Study for Type 2 Diabetes:• 97% satisfaction with nurse availability

• 100% satisfaction with the quality of the nurse’s care

• 97% satisfaction with the patients' ability to improve and manage their own healthcare needs

• 100% overall satisfaction rate with the RPM service

• (GE Aviation Telehealth Study for Patients with Diabetes Mellitus)

Extremely High Patient Satisfaction

Strong Economic Argument for Practices• Reimbursement is set to cover resources, equipment and time as

well as management and interactive communication• Practice expense reimbursement

99453 Remote monitoring of physiologic parameter(s) initial; set-up and patient education on use of equipment

BILLED ONE TIME

99454Remote monitoring of physiologic parameter(s) initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days

BILLED EVERY 30 DAYS

$20

$63

Strong Economic Argument for Practices• Reimbursement is set to cover resources, equipment and time as

well as management and interactive communication• Management and interactive communication

99457 RPM management services, clinical staff, physician other QHP time in a calendar month interactive communication with patient/caregiver; first 20 minutes

99458 RPM management services, CS, physician or QHP time in a calendar month interactive communication with patient/caregiver; each additional 20 minutes

$51

$41

Strong Economic Argument for PracticesSummary for diabetic patient example

Blood Glucose Monitoring

Month 1 - $134.00 per patientRecurring during RPM service $114.00 per patient12-month total: $1,388

Description of Service Billed Code $$

Set up and patient education Once 99453 20.00

Practice cost associated with providing RPM (equip/transmission)

Monthly 99454 63.00

Management and interactive communication Monthly 99457 51.00

$41 each add’l 20 min mgmt. per month

Who is eligible for RPM?• Medicare and many Commercial and Medicaid patients• Practitioners may provide RPM services to patients with

acute or chronic conditions• Captured data should be directly relevant to managing patient’s

condition(s)• RPM services are eligible for established patients

• Note: During PHE providers may provide RPM without first conducting a new patient E/M service.

• Recommend established patient-provider relationships due to this ending after the PHE waiver expires

• Blood pressure:• 2 readings (within 1 minute) twice daily • Min. 12 readings per 30-day period

• Glucose:• 1 reading per day • Min. 16 days per 30-day period w/discrete measurements

• Weight:• 1 reading per day • Min. 16 days per 30-day period w/discrete measurements

• Other vitals:• See appropriate CMS documentation

Minimum Adherence Requirements for Billing

Documentation for Billing• Physician, CNP or PA order for services• Patient consent form• Documentation of device provided• Documentation of providing education to patient for initiation• Actual recordings/data transmissions over the 30-day period• Interventions during the month. Both interactive and other.

• Note: Medicare clarification: “interactive communication” element contributes to the total time, but is not the only activity that can be included when calculating the 20 minutes per month

Costs to the Patient• Always understand and be transparent with patient’s liability• Deductibles and copays do apply

• Go through the effort of validating coverage and communicate expected cost per month to the patient openly

• Get buy in with patient’s understanding of the benefit of monitoring and value of health coach or other’s intervention and oversight during the month.

• Unexpected cost will result in non-compliance and loss of engagement!

Coach Monthly Activities

• Monitoring RPM patient compliance for measurement requirements and alert protocols set by provider

• Interactive communication with patient throughout the month• Engagement/ adherence• Re-direction/ behavior modification• Success feedback• Discussing care path and upcoming actions

Adding RPM to the Diabetic Care Path

Recurring during RPM service $114.00 per patient• Potential # of patients per month (single cohort) = 10• X $114 per month X 12 months = $13,680

Chronic Care ManagementWhat about CCM?

• 2015: Chronic Care Management billing codes introduced by Centers for Medicare and Medicaid Services (CMS) for eligibles with two or more chronic connections PPPM

• THE THEORY: Detaching from “fee for service” and creating reimbursement for ongoing data-drive care connection; evolving from awaiting disease and increased intervention costs toward pre-condition detection and prevention to decrease fee for service misalignment

• Very large eligible population: 2020: 61,212,247 Medicare Beneficiaries —CMS estimates 2/3 of Medicare eligibles qualify for CCM; but the reality: maybe 90% qualify with obesity, mental health/addiction, and cardiovascular/stroke risk as qualifying conditions

• Very low/slow adoption to date

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CCM Summary: What and Why

The CCM Patient Experience/ Benefits

Telehealth visits can be used for:• Behavioral healthcare• Check-in visits to manage compliance with care plans, physicals, wellness checks,

inoculations, tests, etc.• Oversight of patient progress• Other telemedicine visits as needed

CCM can be performed by the practice (licensed provider or nurse) or can be outsourced.

CCM can be performed and billed in addition to RPM

Practice Considerations

• Practice considerations:• Time requirements to implement and proceed?• Compensation?• Outsourced or not?

The Economics of CCM: Codes & Payment

• 99490: 20 mins of out of office electronic care coordination communication w/ care plan for 2 or more chonic condition eligible=approx $40-$50/month per patient

• 99490 plus 99439: 40 mins=each 99439 adds approx $30-$40/month=approx $70-$90/month PP

• 99490 plus 99439 2x: 60 mins plus=approx $120 month PP

CCM Initiation & Management

• Initiate with AWV, IPPE, E&M• Verbal consent works & create care plan for care coordination

support• With aligned medical practice/enterprise like Precise

Telehealth, PT handles all of the above & pays provider approx. $20 PPPM to review/note plan updates and offloads the time/admin/expense of CCM, handles complex chronic condition patients via medical practice/nursing staff expect at CCM

Operationalizing RPM

RPM Implementation

Workflow:

• Hire a qualified health coach or other auxiliary staff

• Define protocols and alert thresholds

• Select devices (FDA cleared, wireless)

• Identify eligible patients• Insurance and qualifying conditions

• Obtain patient consent

• Assist patients with device connectivity

• Ongoing monitoring and engagement

• Monthly billing

Getting Started with RPM

• Blood pressure:• Withings• iHealth• Qardio (coming

soon)

• Glucometer:• Keto-Mojo• iHealth

Heads Up Supported Devices

• CGM:• Dexcom• Libre

• Blood oxygen:• iHealth

• Weight / Body fat• Withings• FitBit

Patient Dashboard

Provider Dashboard

Reports & Trends

Notes & Templates

Recap

Next week: Implementing Private Pay Services as an Insurance Participating Practice

• Does your decision to participate with payers prevent you from offering private-pay memberships/ subscriptions or from selling bundled programs?

• How can these models compliantly co-exist?

Certification course for health coaches

• RPM basics

• Device selection and setup• Client onboarding• Billing thresholds• Patient engagement

Pre-register at: headsuphealth.com/remote-patient-monitoring-course

Coming Soon – Health Coach RPM Training

Reengaging the Payers

Reengaging With the Payers

Opportunity during PHE to take advantage of waiver 1135 • Allowing opted-out physicians and NPPs to terminate their opt-out status

early and enroll in Medicare• Medicare temporarily waiving the following to become re-enrolled:

• Application fees• Background checks• Site visits

Coding Advantage, LLC www.codingadvantage.com

Reengaging with the payers

Commercial payers may have special contracting in place. • This will be a payer-by-payer decision on how credentialing will be handled and if new

policies are in place to facilitate contracting• COVID-19 related services are generally paid similarly with or without regard to in

network status during the PHE.

Examples of healthcare payer information on expediting credentialing process:• UnitedHealthcare is temporarily updating credentialing policies to implement provisional

credentialing for out-of-network providers who are licensed independent practitioners and want to participate in UHC networks. https://www.uhcprovider.com/en/resource-library/news/Novel-Coronavirus-COVID-19/covid19-credentialing-updates.html

• Some of the BCBS companies at the state level have addressed the PHE in the credentialing process. BCBS of Massachusetts has a PHE credentialing application. https://provider.bluecrossma.com/ProviderHome/wcm/connect/e4ac3e24-aab3-4b90-b91a-28aff0d5a2eb/Public_Health_Emergency_Credentialing_Application_MPC_030620-1N.pdf?MOD=AJPERES

Coding Advantage, LLC www.codingadvantage.com

Next Steps

• Complete a simple 10 question survey to arrange a free consultation with the Coding Advantage team to explore the opportunity to reengage the payer system.

• Join us next week to for how to implement RPM in your practice.