presents a webinar… · to make real improvements in how telemedicine programs are designed,...
TRANSCRIPT
Understanding CMS Reimbursement Opportunities for Remote Patient Monitoring
Presents a Webinar…
Presenters
Chris A. OttoSenior Vice President
Jerriene CordovaDirector of Telehealth Programs
Garry CarnealFounder & Strategic Advisor
AGENDA
Welcome …………………………………………………………………… Jerriene Cordova
Telemedicine and RPM Trends and
Accreditation Overview ………………………………………… Garry Carneal
2019 CMS Reimbursement Codes Explained……………… Chris Otto
Top 3 Criteria for Selecting the Right Partners…………… Jerriene Cordova
Q & A………………………………………………………………………… All
Accreditation Overview: The Need for
Telemedicine and RPM Standards
June 12, 2019
Carneal’s Telehealth Related Accreditation Experience
Health Call Center Standards (originally 24-Hour Triage and Health Information Standards) (1998)
Case Management Organization Standards (1999)
Accreditation Program for Online Patient Consultations (2015)
CHQI Telemedicine Accreditation Program (2018)
Remote Patient Monitoring Accreditation (2019)
Graphic Source: http://www.cdwcommunit.com/news/top-news/the-history-of-telemedicine/
History of Telemedicine
10 Reasons: Why Accreditation?
1. Seal of Approval: An accreditation seal provides consumers with an easy-to-identify confirmation of quality.
2. Consumer-Centric: Accreditation promotes patient education and safety and focuses squarely on the consumer.
3. Efficiency: Accreditation provides a cost-effective mechanism to streamline telehealth delivery.
4. Standardization: Accreditation promotes standardized telehealth delivery, allowing for significant improvements in operational efficiency.
5. Professional Oversight: Accreditation encourages professional development standards to be maintained throughout all levels of the organization interfacing with telehealth services.
6. Risk Management: The accreditation process helps organizations identify and mitigate risk to the patient and the organization.
7. Workflow Management: The accreditation process provides an avenue for telemedicine organizations to document their workflows, risk management programs, and quality assurance activities.
8. Innovation: Accreditation guides applicants on how to make real improvements in how telemedicine programs are designed, implemented, maintained, and updated.
9. Transparency: Accreditation utilizes clear benchmarks that provide a navigational roadmap to move the practice of telemedicine forward.
10. Best Practices: Accreditation promotes the use of evidence-based clinical pathways through telemedicine encounters.
ClearHealth Quality Institute
CHQI is the nations largest accreditor of telemedicine provider organizations.
Our volunteer committee system is comprised of more than 125 diverse stakeholders.
The American Telemedicine Association is a strategic partner.
CHQI offers consumers an easy-to-identify confirmation of quality from an independent third-party organization.
CHQI Telemedicine Accreditation Program
Draft Telemedicine Outcome Standards
Draft RPM Standards
Remote Patient Monitoring (RPM) is a service using a form of telecommunications or digital technologies to collect medical
and other forms of health data from individuals in one location and electronically transmit that information securely to health care
providers in a different location for clinical assessment, disease monitoring and analysis for potential clinical intervention with the
patients care team.
P: 410-756-1300
twitter.com/ClearHealthQI
linkedin.com/company/CHQI
Contact Us
Remote Patient Monitoring
How it works
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Vitals Monitoring Devices in the comfort of the patient’s home
Health & Adherence Data is collected on patient population
Notifications of abnormal readings and non-complianceallow clinicians to manage populations by exception
RPM Reimbursement Codes Explained
CMS defines these as “remote monitoring of physiologic parameter(s)”
• Weight• Blood pressure• Pulse oximetry• Blood glucose • Respiratory flow rate
The emphasis is on measuring and reviewing physiological data remotely.
RPM Reimbursement Codes Explained
New for 2019…
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CPT 99453 – initial set-up and patient education on use of equipment
There are three non-face-to-face codes approved for remote patient monitoring (RPM), effective January 1, 2019.
CPT 99454 – Device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days
CPT 99457 – Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time
CPT 99453
1 CPT 99453 – Separate Payment for Initial set-up & education“Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.”
Allows for additional reimbursement for the time spent with a patient for “initial set-up and patient education on use of equipment.”
This sets the foundation for success and supports providers in their effort to implement RPM programs.
CPT 99454
2 CPT code 99454 – Provides for billing for remote monitoring and adds clinical staff to allowed service providers. “Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.”
• Provides reimbursement for the technology• Explicitly adds clinical staff to those who are authorized to bill for service
in addition to physicians/other qualified healthcare professionals.
CPT 99457
3 CPT Code 99457 – 20 min of virtual patient oversight
“Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.”
Physician Reimbursements
Set-up/Patient Education
Technology to deliver RPM Services
Clinical Oversight
Monthly PPPM Reimbursement
$21.00 (One-time)
$55.63 - $74.25 (monthly)
$46.97 - $56.09 (monthly)
First Month: $123.60 – $151.34Ongoing Monthly: $102.60 – $130.34
CPT 99453
CPT 99454
CPT 99457
Physician On-going Patient Monitoring Revenue Model
CONFIDENTIAL, MOBILEHELP 2019 19
Model based on:• Patient Population of 2,500 patients (32% Medicare eligible; 30% participation)• Average CMS reimbursements• 100% collection of co-pays
Other areas of value to you, your organizationand your patients can include:
• Reduced admissions and readmissions• Improved patient engagement• Improved skills of self-management• Improved quality and access to care• Patient prioritization by data• Efficient use of clinical resources• Clinical engagement
Physician Cumulative Revenue
CONFIDENTIAL, MOBILEHELP 2018 20
Model based on:• Patient Population of 2,500 patients (32% Medicare eligible; 20% participation)• Average CMS reimbursements• 100% collection of co-pays
Implementing a Successful Telehealth Program:
The How To’s…
Personnel considerations
Identify patient populations
Plan a successful implementation
https://www.mobilehelp.com/healthcare/white-papers/RPM-made-easy/
Selecting the Right Partners
…is easy to work with; has clear terms
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…offers logistics management
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Three considerations – select a vendor who…
…has a pricing model that works for your organization
Easy to Work with
1. Clear Terms2. Simple Contracting Process3. Customizable programs for CHF, COPD,
hypertension, and diabetes4. Responsive to your needs
Pricing Model that Works
1. Scalable Programs that work for you2. Simplified PPPM lease model3. Free Shipping4. No capital expenditure – no set-up fees5. Step-down to private pay models available6. All-inclusive pricing – beware of low price with
lots of add-ons later
Logistics Management
Launch support: • Template intake forms• Web-based training on RPM dashboard• Easy enrollment options (via dashboard or
via secure FAX, email)• Patient program materials provided
Accessible support team to help clinicians and patients with questions.
Pre-configured kits shipped directly to patient – no inventory to manage
Summary
With an RPM program, you can:
• Deliver high-quality care, more conveniently
• Strengthen clinician-patient relationships/improve retention
• Manage patients with chronic conditions
• Access patient data for informed decisions/timely intervention
• Lower costs, increase efficiency, improve quality
• With new Medicare Reimbursements – it has never been
easier to start than today!
Why MobileHelp?
1. Easy to Work with✓ Simple, streamlined contracting process
2. Clear and Friendly Terms✓ PPPM pricing✓ Little to no Capital Investment✓ Free Shipping✓ No pricing creep – no additional fees✓ Step-down patient pay program
3. Logistics Support✓ Kits delivered directly to patient✓ Staff Training✓ Technical support
Chronic Care Management Kits
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1. Hub selection
A&D UA-651BLE Blood pressure
A&D UC-352BLE Weight scale Nonin 3230 Pulse Oximeter
2. Select a peripheral(s)
3.3
Per Patient Per Month (PPPM) Lease
Kits are shipped
directly to the patient.
CONFIDENTIAL, MOBILEHELP 2019
Glucose meter(includes 50 strips/mo.)
BLOOD PRESSURE
• Medium & Large Cuffs
BLUETOOTH LOW ENERGY (BLE) SELF-MONITORING PERIPHERALS
MOBILEVITALS TOUCH
• Medical alert system w/large, touchscreen user interface, GPS technology; protects customers in and away from the home
• Includes tablet and choice of waterproof help button• Educational content, games, messaging
WEIGHT SCALE
• Digital Display
PULSE OXIMETER
• SpO2 and Pulse
GLUCOSE METER ACCESSORY
• Connects to multiple Blood Glucose Monitor brands
Optional Fall Button
MOBILEVITALS CLINICAL DASHBOARD
MobileVitals® Telehealth Solution MobileHelp® Healthcare offers a comprehensive and easy to adopt remote patient monitoring solution to enhance your model of care with existing patients. We have created an optimized RPM program for physician groups leveraging reimbursement.
Questions?
Chris A. OttoSVP, Healthcare DivisionMobileHelp561.347.6255 Ext [email protected]
Jerriene CordovaDirector of Telehealth [email protected]
Garry CarnealFounder & Strategic AdvisorClearHealth Quality [email protected]
Paul RisnerGeneral CounselMobileHelp