According to the CMS in the proposed PFS for 2022 the CMS proposes to expand coverage for remote patient monitoring


Despite the fact that the Centers for Medicare and Medicaid Services (CMS) has included coverage for remote therapeutic monitoring services in its proposed Physician Fee Schedule for 2022, there are still some questions about reimbursement for health-care organizations that have implemente

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Despite the fact that the Centers for Medicare and Medicaid Services (CMS) has included coverage for remote therapeutic monitoring services in its proposed Physician Fee Schedule for 2022, there are still some questions about reimbursement for health-care organizations that have implemented remote patient monitoring programs, according to a recent report.

According to the Centers for Medicare and Medicaid Services, remote bedside patient monitor is becoming increasingly popular among health-care organizations across the country, but Medicare reimbursement for this service is still in its early stages.

The addition of new codes, according to connected health advocates, not only expands coverage for some new services in addition to the remote physiological monitoring codes that were introduced in 2019, but it also raises an array of new questions that will need to be addressed when the final draft is published.

As a result of the RPM codes, which were introduced earlier this year by the Centers for Medicare and Medicaid Services (CMS), health care providers will have greater reimbursement opportunities for remote portable patient monitor programs. According to the experts who have looked into the proposed codes, they are far from being complete in their current form and should be revised as a result of their findings and recommendations.

 


The document CMS Bypasses Telehealth Coverage in Medicare Diabetes Prevention Programs (PDF), which contains additional information, can be found here.

Specifically, they point out that this proposal recognizes the importance of remote monitoring while continuing to encourage the use of digital health tools in order to provide clinicians with a more comprehensive data set about the health conditions of their patient monitors.

As an illustration:To treat asthma, a patient may be prescribed an inhaler as well as a mobile health device. Once the non-physiologic data has been gathered, the provider can use it to track medication adherence and make adjustments to the care management plan, if any are required.

Moreover, according to Nixon, restricting reimbursement to specific device types ignores Software as a Medical Device (SaMD) and other devices that patient monitors use to collect important non-physiologic data such as pain, mood, adherence, and other variables, among others.

RTM codes are modeled after RPM codes, according to Nixon, Lacktman, and Ferrante, in order to be billed as an incident to services – which can't be billed by some providers, such as physical therapists – rather than as incident to services in and of themselves, as some providers do.

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