reimbursement for Remote Patient MonitoringAmidst the tumbling US stock market, the telehealth world is abuzz with repercussions of clarifications of remote patient monitoring (RPM) services released by the Centers for Medicare and Medicaid Services (CMS) on August 3, 2020. This particular RPM controversy is of relevance to all professionals for three reasons: 1) RPM is one of the fastest-growing areas of telehealth; 2) CMS’ definitions of RPM have repercussions for beneficiaries and providers seeking reimbursement under Medicare. 3) Medicare’s definitions are likely to set the bar for other payers nationwide.

The predicted CMS changes to definitions of RPM are described as part of the annual publication of the CMS proposed 2021 Physician Fee Schedule. This Schedule gives the industry a head’s up on what is likely to be approved in January of the next year. In the case of RPM, CMS clarified its position on how it reads and interprets the requirements for RPM services.  The comments build on RPM guidance issued in previous years for Medicare reimbursement, including CMS’ creation of new RPM codes in 2019 and 2020, followed by regulatory changes allowing RPM to be delivered under general supervision for purposes of incident-to billing.

However, RPM has been a topic of discussion in the telebehavioral health community for several years. While it isn’t as prevalent in behavioral care as in medical care, tremendous growth has been seen in these services since the availability of new CPT codes for reimbursement for remote patient monitoring in 2017. See TBHI articles discussing these issues: Remote Patient Monitoring & Telehealth Reimbursement and 99091: New Telehealth CPT Code for Remote Patient Monitoring.

Why Are the CMS Proposed RPM Changes a Topic of Discussion Now?

The potential repercussions of these changes were initially lost amid the stir created by the concurrent proposed expansion of telehealth coverage and President Trump’s Executive Order, which calls for more telehealth in rural areas. Since then, several stakeholders have voiced concern over fundamental issues that some groups consider to be a hindrance to the expansion of RPM.

Senior counsel at the Foley & Lardner law firm, and a member of its Telemedicine & Digital Health Industry Team, along with colleagues Nathaniel Lacktman and Emily Wein, described the issues in 10 FAQs on their firm’s August 5 Health Care Law Today blog. In the post, they described the CMS announcement and outlined how it purposes to regulate the reimbursement for remote patient monitoring. They explain the repercussions of the definition provided by CMS revolved around the Evaluation and Management (E/M) services that focus on the collection and analysis of patient physiologic data, most often collected in the home setting. The specific Medicare codes under discussion are CPT codes 99091, 99453, 99454, 99457, and 99458.

For the upcoming year, the Foley team outline three significant changes proposed by CMS, each of which “would impose more restrictions (or) burdens on RPM in a significant way.” Readers seeking more information are directed to the 10 FAQs drafted by Ferrante and further discussed by Eric Wicklund in MHealthIntelligence.

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