CMS Launches Payment for “Virtual Check-Ins” and Boosts Payment for Remote Patient Monitoring

July 26, 2018

Earlier this month, the Centers for Medicare and Medicaid Services (CMS) introduced its 2019 Medicare Physician Fee Schedule and Quality Payment Program, with several amendments designed to accelerate the use of patient engagement and remote patient monitoring (RPM) in the market.

CMS’ explanation of its bold, new proposal:

“Under this proposal, Medicare will start paying for virtual check-ins, meaning patients can connect with their doctor by phone or video chat," said Seema Verma, CMS Administrator. "Many times this type of check-in will resolve patient concerns in a convenient manner that gets them the care that they need and avoids unnecessary cost to the system. This is a big issue for our elderly and disabled populations where transportation can be a burden to care as well as to caregivers. We’re not intending to replace office visits but rather to augment them and provide new access points for patients."

What’s Changing?

The highlights of the proposed 2019 Medicare Physician Fee Schedule and Quality Payment Program with respect to remote patient monitoring include: 

  1. Virtual Check-In Appointments: CMS proposed adding a new payment code (HCPCS code GVCI1) to the physician fee schedule for “Brief Communication Technology-Based Services.” Under this rule, providers could bill for the technology that facilitates virtual check-in appointments to assess whether the patient’s condition necessitates an office visit. The proposed payment code recognizes that patients and providers alike are leveraging technology for effective check-ins that mitigate the need for potentially unnecessary office visits.
  1. Asynchronous Video and Image Review: The second new code (HCPCS GRAS1) would reimburse for a provider’s asynchronous review of video and/or images submitted by a patient in order to evaluate the patient’s condition.
  2. Clinical Staff Allowed: Under CPT code 99901, only “physicians and qualified health care professionals” may deliver remote patient monitoring services. For some physicians, this is too resource-intensive to justify the reimbursement rate of $58.68 for 30 minutes per 30-day period. The new code, CPT 994X9, allows RPM services to be performed by clinical staff, including registered nurses and medical assistants.
  3. Separate Payment for Initial Set-up and Patient Education: CMS is considering reimbursement to physician organizations for the time spent enrolling patients on a remote patient monitoring platform. This will help further incentivize providers to begin using these technologies with patients.
  4. Interprofessional Internet Consultation: CMS is proposing six new CPT codes to compensate asynchronous communications between provider organizations. These codes offer different time-based models for electronic communications for consults between professional groups to encourage greater coordination between providers.  

Incentivizing Broader Adoption of Patient Engagement & Remote Patient Monitoring

We are encouraged that CMS recognizes the promise of these connected health tools and is committed to driving more convenient access to care, which will benefit patients, providers, and connected health innovators alike. Incentives for physicians using remote patient monitoring technologies have been improving in recent years. With CMS’ proposed rule, these incentives are about to get much stronger.

We’re eager to see clinicians we work with every day get even greater compensation for the high quality services they’re delivering to patients. Further, now that CMS will reimburse providers for the use of these technologies, we expect to see an acceleration of these tools reaching the marketplace, which will lead to better care.

The public comment period is open until Sept. 10. We will be working with our partners to make some recommendations to CMS on the details of payment to ensure remote patient monitoring use is accurately incentivized when the final rule comes out in November. 

Meaningful Patient Engagement Delivers Big Results

Consumers and providers alike have grown increasingly comfortable using telemedicine technology to deliver lower cost, highly convenient healthcare services. At GetWell Loop, we continue to see very high patient satisfaction ratings, with 92 percent of patients stating that they are “Extremely Likely to Recommend” their provider to a friend or colleague.

With respect to cost savings and resource conservation, GetWell Loop has had a major impact on reducing in person clinic visits and inbound call volume. And a recent patient engagement study conducted by Anthem found that patients who underwent total joint replacement and who were enrolled on HealthLoop cost an average of $656.00 less per case than patients who were not enrolled on the platform. 

By including new payment codes for remote patient monitoring, virtual check-ins, and asynchronous image and video review, the proposed rule exemplifies CMS’ belief that these are important and clinically valid tools through which providers can deliver superior medical care. We hope and expect commercial insurance carriers to follow suit, because all patients deserve access to remote monitoring technology innovations.

 

Categories: Revenue and Reimbursement, CMS

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