NEWS BRIEF
CMS Finalizes 4.5% Physician Pay Cut Starting 2023
| Medicare’s physician fee schedule final rule, released Nov. 1, will reduce the physician pay conversion factor by 4.48 percent.
| With the 4 percent statutory Pay-As-You-Go sequester, which is an additional pay cut, scheduled to be implemented in 2023 which will total an 8.5 percent physician pay cut for the upcoming calendar year.
| Physicians worry the cut will decrease access to care for patients in the Medicare population.
| The rate cuts would create immediate financial instability in the Medicare physician payment system and threaten patient access to Medicare-participating physicians. Physicians are already challenged by inflation from the Covid-19 pandemic and staff shortages may be facing an insurmountable task in order to maintain vital quality service to their patients.
A Physician’s ANSWER to an Unsustainable Fee Reduction in 2023 is A VIRTUAL ANCILLARY CLINIC at Low Cost and Stable Reimbursement Rates.
Most Americans Find Virtual Care Effective and Appealing
| New survey results show that 79 percent of Americans who engaged in virtual care have allowed them to take charge of their health. Embrace Integrated Health Solutions is partnering with Physicians to provide PREVENTATIVE HEALTH SERVICES via REMOTE PATIENT MONITORING (RPM)
RPM Service Guide
Introduction
In 2018, the Centers for Medicare and Medicaid Services (CMS) began reimbursing providers for remote patient monitoring (RPM) after recognizing the mounting evidence that such monitoring reduces hospitalization rates, enhances care coordination, and improves patient outcomes.
RPM Criteria
- Medicare Beneficiaries
- Medical Necessity
- Medicare Advantage Plan Beneficiaries.
- Chronic Conditions
- Chronic Kidney Disease
- Hypertension
- Cardiovascular Disease, etc.
- Diabetes
- Obesity
Billing for Remote Patient Monitoring
| The vast majority of RPM services will be billed under four CPT codes. Generally, these codes can be split up into two categories: RPM “service codes” and timed RPM “management codes.”
RPM Service Codes: 99453 and 99454
| RPM service codes reimburse for the expense associated with furnishing RPM services, including the cost associated with the device, the initial education and training of the patient, and the transmission of the data to the practice. These codes include:
| CPT 99453 is used to report the setup and patient education on RPM and the use of the device(s). As such, this code is generally billed once per patient on the initiation of RPM services and issuing of RPM devices (blood pressure cuff, pulse oximeter, weight scale, EKG, etc.) Average pay rate ~$18
| CPT 99454 is the monthly code that reimburses for the supply of the device and monitoring of patient data. Supplied with daily recordings or programmed alerts transmission. This code requires that patient readings be performed at least 16 days each month. Average pay rate ~$64
RPM Management Codes: 99457 and 99458
| RPM management codes are monthly time-based codes covering interactive communication with the patient or caregiver to manage treatment with interpretation, care planning, and act on transmitted data. They include:
| CPT 99457 Remote Physiologic Monitoring Treatment Management Services. Clinical staff/physician/ other qualified health care professional spends time in a calendar month conducting interactive communication with the patient/caregiver to manage treatment and the care plan via interpretation of the transmitted data during the month; initial 20 minutes. Average pay rate ~$55
| CPT 99458 Once 99457 has been billed a practice can add up to instances of 99458 at 40 minutes and 60 minutes, respectively. Average pay rate ~$44
As of 2020, CMS has Announced that 99457 and 99458 can be Furnished by Clinical Staff Under the General Supervision of the Billing Provider.
EIHS is your Remote Ancillary Clinical Staff.
Billing RPM in Action
| Putting all four of the above RPM codes into action, the billing for RPM looks something like this:
RPM Billing
First Month
Initial Enrollment
99453: Initial patient setup and enrollment into RPM program. Average $21
Monthly
Base Monthly RPM
99454: Remote monitoring and management of device readings. Averages $62.
Monthly
Care Management (20 min)
99457: 20 minutes of clinical staff time communicating with patient or caregiver. Averages $52
Monthly
Care Management (40 min)
99458: Additional 20 minutes of clinical staff communication with patient or caregiver. Averages $42.
Monthly
Care Management (60 min)
99458: Additional 20 minutes of clinical staff communication with patient or caregiver. Averages $42.
Initial Steps
1. Bill 99453 when you First Initiate RPM Services with a Patient.
2. Bill 99454 for each Month that the Patient Transmits Readings for at least 16 Days.
Bill 99457 for the First 20 minutes of Interpretation and Management In addition to the Monthly 99454 you may also: Bill for the Additional Amount of Time You Spend Managing the Patient within the Program.
Bill 99458 for each Additional 20 minutes, up to a Total of 60 minutes of Management Time.
Conclusion
| The adoption of RPM by Medicare and other insurers holds great promise for lowering hospital admission rates, and emergency room visits and improving outcomes for patients with chronic conditions who require ongoing monitoring to achieve optimum health.
| Embrace Integrated Health Solutions Remote Patient Monitoring is the Physician’s answer to offsetting CMS’s draconian pay cut.
| EIHS is Committed to Helping both Patients and Practices Benefit from Care Management Services such as RPM.
