This post is from a release sent out by our partners, VitalTech Affiliates, LLC
The Centers for Medicare and Medicaid Services (CMS) released its proposed rule for the 2020 Medicare Physician Fee Schedule. These proposals allow for fully outsourced business models for Remote Patient Monitoring (RPM) and creates additional reimbursement opportunities.
2020 Medicare Physician Fee Schedule updates include:
• CPT Code 994X0 which allows reimbursement for an additional 20 minutes of clinical staff, physician, or QHCP time spent above and beyond the initial 20 minutes provided for by CPT Code 99457.
• 6 new reimbursement codes for Online Digital Evaluation Services “e-Visits” described as a telehealth session which would have constituted an in-office visit. Maximum of 7 days per month for: • 5-10 minute session • 11-20 minute session • 21+ minute session • 3 codes apply to non-physician professionals, and 3 codes apply to physicians who bill independently.
• Technical correction issued regarding “Incident To” billing for RPM. “These services may be furnished by auxiliary personnel incident to a practitioner’s professional service.”
• Distance requirements have been removed for telehealth visits with chronic care patients.
• Private payors are covering RPM in many states.
These CMS updates result in better accessibility, quality, affordability, and personal empowerment for your patients to manage their chronic conditions. VitalCare offers the tools for patients to stay connected to your care remotely.
Below are related articles discussing the new updates. https://www.cms.gov/newsroom/fact-sheets/proposed-policy-payment-and-quality-provisionschanges-medicare-physician-fee-schedule-calendar-year-2
These changes when approved take away some of the systems limitations on remote patient monitoring. No longer will the physician must the physician have the QHCP in their office to provide the monitoring phone contact. There is an additional 20 minutes allowed for longer conversations or multiple conversations in the same month.
Removing the distance requirements for telehealth visits will open up this efficient service to urban and suburban patients. Given the home delivery of basic services that are growing, its only natural that people will flock to contacting their physician's office remotely.
In a recent survey in Florida, people were asked "If you had the option to switch to a doctor who provides remote telehealth services via text, email, or video, what would be the main reason why?
42% Ease of access to healthcare provider
21% Time saver
12% Reduced costs
11% Faster service
11% Rx renewals
The Wall Street Journal stated that 150,000,000 health records have been breached since 2009.
Hospitals spent years shoring up their in house internet security. Now they are focusing on medical devices. They are demanding information such as the software that operates medical devices. The device makers consider this proprietary information and are reluctant to share it. On the other side, manufacturers are not always quick to offer software and firmware updates when a flaw is found.
It has gotten to the point where some hospitals have rejected bids and cancelled orders because of the lack of transparency. New York-Presbyterian cancelled an order for infusion pumps made by Smiths Group in 2017. Since then Smiths has updated firmware on their pumps.
Hospitals reported 140 known hacks last year up from 5 in 2009. The situation has lead to the FDA recommending that manufacturers disclose software information to hospitals. It is now common for manufacturers to respond to cybersecurity questionnaires before submitting bids.
Not covered was the role of intermediary software platforms in blocking access. These platforms such as from Thinaer accumulated data from various vital sign devices, display and manage, and transmit data into Electronic Health Records.
The Wall Street Journal article appeared in their May 13. 2019 issue.
Jim Shumate, COO
Jim is a medical device start-up marketing and sales expert. His broad experience in medical devices, pharmaceuticals and medical equipment is unique and highly valuable to Telemedical Partners. He is a certified business coach and business consultant.
He started his career in pharmaceutical sales, progressed through the ranks in product management, sales management, and vice president of sales and marketing. His experience with sales forces covers both direct and independent reps.
He managed the introduction and growth of the first ultraviolet absorbing Intraocular lens (The ORC IOL) to market building a $35M company in just over 4 years. Later he was a key player of an IOL company that raised capital via an IPO.
A serial start-up and turn around executive, he was one of the first Action International (Action Coach) certified business coach and consultants.
Jim graduated from California State University, Fullerton with a degree in Communications. He lettered in Cross Country and Track and Field. He lives in Clearwater Florida with his wife Anne. Their two adult sons live in the Tampa Bay area. Jim devoted over 25 years to coaching and refereeing youth soccer.
Joe Kirkland, Founder and CEO
Joe is a medical device and technology veteran with over 30 years’ experience in managing several distribution and sales organizations to achieve maximum success.
Prior to founding Telemedical Partners, Joe was President and CEO of Kirkland and Associates, one of the top performing marketing and sales groups for medical device companies in the US. During his more than 26 years at the helm of Kirkland and Associates, Joe’s firm was the leading independent sales organization in the country for such companies as Bio-Rad, Allergan, Medennium and TearLab.
Prior to Kirkland and Associates, Joe also spent almost 10 years as Vice President of Sales and Marketing for Surgidev, a pioneer in intraocular lens implants. Joe was also one of the founders and Chief Operating Officer for Biosyntrx, a medically based nutritional supplements company focused on supporting eye health, dry eye and macular degeneration. At Biosyntrx, Joe was primarily responsible for domestic and international sales and marketing. Biosyntrx became the leader in FDA quality eye care nutraceuticals both in the US and internationally.
Joe is a graduate of Virginia Commonwealth University in Business. He and his family live in Lexington, South Carolina.
CMS will be separating the current CPT code (99091) for patient monitoring into 3 codes in 2019. New in 2018, 99091 was reimbursed $58 a month.
The new codes essentially cover initial training on the device (99453 $21 one time); monthly for the device (99454 $69); and a 20-minute monthly call (99457 $54). Managing these codes should produce $123 for monitoring Medicare patients. We do not know what the charges will be for private insurance patients.
The practice can use a "qualified professional" or “auxiliary personnel” under the physician's supervision (in the office but not directly under their control) to contact the patient or caregiver once a month for a 20 minute or longer chat or chats about the patient's care and readings under 99457 ($54).
SensoSCAN as a wellness monitoring device transmits data to a smartphone via Bluetooth and then to a computer, typically monitored by a caregiver or healthcare professional. . It is billed under new CPT code $69 monthly.
Give us a call to ask how we might help your practice at 800-940-7113 or email us. (Updated March 29, 2019)