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Hardware bill format for Healthcare

hello everyone and welcome to today's session how to build for a remote patient monitoring services like a pro my name is Ryan Kuroko senior marketing manager here at gluco and we are excited to have you all join us for today's webinar the second in our four-part series for diabetes connected care presenter Marianne hood erlik's besides being a licensed registered dietician nutritionist and a certified diabetes educator Marianne is also certified endocrinology coder and earned her MBA with a concentration in marketing she is a nationally recognized expert in many areas of diabetes care and especially a Medicare managed care and commercial payer reimbursement in this capacity she has worked with hundreds of health care professionals and entities professional membership associations and government agencies across the country we're thrilled to have Mary Ann join us today to share her wealth of knowledge on on remote patient monitoring now without further ado I'll pass it to Mary Ann hello everybody I am so pleased to be with you - objective I'm not going to read all these for the sake of time one other thing I do some of you who are familiar with me I will say sometimes pens up and that means what if she meaning pens up it means that what I'm going to say is not in the slide deck and so you may want to jot it down on paper or make a note of it in your Notes app on your cell phone and it's or it's so important it is in the slide deck but it's so critically important that writing it down or putting it in your phone would be good and again this deck is going to be available to you after today's webinar along with four different handouts that I created two different types of progress notes for remote monitoring and I tried when I designed the two different formats I tried to make those progress notes compliant to the Medicare qualifications rules coverage guidelines and there modifiable they're on their own Microsoft Word so just do whatever you want with them you could take my name off and then I designed a remote monitoring consent form because Medicare beneficiaries one of the rules is from Medicare that they have to sign a consent form and that has to be uploaded into the patient's EMR so this is focusing on the Medicare rules for remote patient monitoring and I'm just going to say our p.m. this is all about Medicare you know with Medicare either love them or hate them I love them because I you know maybe not Medicare for all but or maybe so who knows you know but they have wonderful benefits but their coverage guidelines tend to be all about the fees complex convoluted challenging copious and some time I'm going to say it kind of crazy and like what are they thinking you know like what are they doing over there and they make up some of these rules but you know they serve us a lot of beneficiaries so today we're going to call her beneficiary that's the tainted term for the patient in Medicare is we're going to call her Martha as a Martha Stewart love this woman or hate that woman either way right okay our PM services what are they they include establishing implementing revising and monitoring a patient's treatment plan now I'm not going to read word for word from each slide I won't do that but I'm going to highlight what's really important on each slide the important thing here is a course remote and we have to use an FDA defined digital device we're talking about that later and it's all about the patient's physiological data being collected by Martha and wirelessly transmitted by Martha collected and transmitted wirelessly to dr. Miller and just miss a dr. Miller who's going to be our provider so on we have three actually four different rpm codes now and one of them the first one we're going to review is a actually done can be done live in person and that is that the training and set up but we'll talk about that so this is all outside of an in-office visit which is wonderful for convenience now again CMS that is the that stands for the center from Medicare and Medicaid Services and that's the governing body over Medicare it stands for the Centers for Medicare and Medicaid Services that also includes Medicaid okay so a lot of people say to me oh gee Marianne our private insurances commercial private like United Bluth and state Medicaid programs are they covering this and other guidelines the same the reimbursement guidelines and the answer is I don't know commercial payers do not have to follow Medicare guidelines they can do whatever they want the same with Medicaid programs but in there's 50 of them in the country but they the Medicaid programs still look to CMS as their governing body when they format what benefits are going to pay for and their coverage rules okay so CMS does make a distinction with Medicare now between active technologies and passive the passive platforms and devices they don't virtually transmit the data in real time and so that those kind of platforms cannot be used so it's all about wirelessly and virtually transmitting what they call patient generated health data in order for dr. Miller and his clinical staff our ends are DS pharmacists even medical assistants the people who work for him clinically or even in a hospital outpatient department and it will look at those places of service we're using that patient generated health data to do Martha's assessments her ongoing monitoring of her data and then dr. Miller or Mary Ann the Rd or Barbara the RN can then call Martha on the phone or text or email her once we look at her data coming in into our platform in our office we're looking at her blood glucose data for example and Mary Ann's looking at it as the Rd or dr. Miller's looking at it or Barbara the RN and we call Martha on the phone and say you know Martha we're seeing that your blood sugar is peaking way too high after you eat and so we're going to change this in your meal plan or we're going to change this medication or change this info and that's what we mean by that one way care plan guidance telephone email and text but of course we have to get the patients Martha's permission to do that on a consent form and you were able to receive the consent form that I developed from different references I use online so let's jump right into the codes now the CPT procedure codes I'm just going to say procedure codes and the first one is nine nine four five three now these codes are paid under Medicare Part B which is where all the outpatient benefits are housed Medicare Part A houses all of the inpatient benefits and some others and Medicare Part B is really outpatient so we've got the first code nine nine four five three and basically what what that is it's the supplying the patient with the device it's called device supply it's giving Martha the blood glucose meter that has that specialized meter that has the ability to wirelessly transmit her blood glucose data from her meter right to dr. Miller's office or you give her a halter monitor like just a month ago all transparency I had to wear a halter monitor for 24 hours so that that's considered a medical device that they loaned me for 24 hours and I had to return it okay so with this particular code in order if you think about it in order to build this code the device that you loan to Martha or you give to Martha to use during the remote monitoring period you basically have to own that device you have to have paid for it because the essence of reimbursement the core concept of reimbursement is that you're billing Medicare to get money back you've incurred an expense and you're billing Medicare to get your money back and so if you got a whole case of free blood glucose you didn't pay for them and there's a specialized meters that allow that wireless transmission but you got them free and then you give one to Martha technically you can't have bill for this code because you incurred no expense but if if you did purchase it and you give it to her or loan it to her either way because you've incurred the expense you can build this code and it says each 30 days so that means if Martha has it all the month of April and May for the month of April and the month of May one time in April and one time in May you can build this code but look at the bottom right these are again Medicare rules you can only build this code if Martha has been doing the monitoring for 16 or more days in that calendar month for 16 or more days in that calendar month so that's why tracking minutes you'll see that in some codes weary tracking minutes but tracking these days in your progress note or your EMR template is going to be important so you're billing legitimately and accurately okay so again - but the device itself has to be defined as a medical device defined by the the FDA and these words are they all mean something each word means something a medical device defined by the FDA okay and we talked about that wireless transmission now what is the date of service on the claim to build this device supply code it's the it's the date in which the device is given or delivered to the patient or caregiver but because the patient has to do the monitoring for 16 days or more okay I would in my opinion I would wait for that 16th or 17th day before I actually build this code now at the bottom you can see that CMS is still to give us guidance and what type of technologies can be used for this device kind of thing they were not really granular with their first publication of these first initial reimbursement rulz and that's unfortunate because there's been hundreds and hundreds of comments and questions that have gone into CMS about what devices are used like you know fitbit's and watches and that kind of thing that that records physiological data this is not just red blood glucose this is there any kind of physiological data so we'll talk about more about that in a minute so this is a practice expense only code and that means physician work is not required you're supplying the device to Martha but again you have to own it and you're loaning it out or giving it you've incurred an expense that's really important so that's what this slide speaks to if you've gotten these devices free like when I wear the halter monitor obviously I don't think my hospital got that free they had to pay for that halter monitor and I had to return it and that's why they were able to bill okay now when we talk about the type of technology required for that particular code it says FDA defined that's on Medicare the language they've used and they said they'll give us further guidance but we do have some guidance already okay so software applications that can be integrated into into Martha's smartphone the answer is yes those are now considered a medical device by the FDA I have another slide on that coming up but like healthcare monitors are we know that fitbit's we're not so sure about that and like the Apple watch I'm not trying to be brand specific and I'm not being paid by any company to mention a brand name but we have to be careful because we don't have a lot of precise guidance from CMS at at this point okay but CMS did say that they're going to issue guidance in the near future to help people with this benefit so the best way to keep up to date ladies and gentlemen about that future guidance when they speak when Medicare speaks is to sign up for what's called the CMS Medicare Learning Network and you see it here this is I just clipped it out of the CMS website and you see the URL the link down at the bottom anyone can sign up for this this mln newsletter and you get it into any inbox email that you give them and you don't have to be a Medicare provider my son is a restaurant manager could sign up for this and that's how I keep updated for the work I do and the changes that Medicare makes to any of their benefits okay and you'll get it into your inbox so it's a really good thing to do so I'm going to go through these examples and then if I'm going to ask Ryan if there's been any questions input it into the chat box we go through these examples and the equipment so on this equipment the device supply hardware devices such as cellular enabled blood glucose meters the this would count this would count because those at the meter has this ability to transfer that data wirelessly and it is an FDA defined medical device and so these another example is these applications or apps that we on smartphones and oh gosh we have a lot of those to transmit a lot of different types of physiological data matches blood glucose which were used to but even virtual body weights and virtual blood-pressure all of those kind of apps exist for different types of martha's physiological data so these apps now that are they're transmitted medical data for the care and assessing and monitoring and treatment planning based on medical data those apps are now FDA defined as a medical device and this is where I dropped in this information for the FDA you can see at the bottom apps can be considered medical devices if they are intended for use in the diagnosis of the cure mitigation treatment or prevention of the disease or to affect the structure or any function of the body so that's really good that's really really really really good on these apps and the same thing for software so maybe Martha doesn't have the smartphone you know she's 79 years old but she has a tablet she has software where she's collecting the data pushes a button and the tablet transmits her blood glucose data to dr. Miller that software is is also considered that if it's medically orientated a medical it's a medical device defined by the FDA so that's really really good and that's what this example shows it's the software again related to medical decision-making for diagnosis cure and treatment of medical illnesses so if you go to the I gave you the URL here at the bottom for the FDA references on software and apps so I hope that's helpful to you okay I'm going to skip that one let's you know what actually I'm going to cover these these codes and then we'll open it up to questions okay the next code nine nine four five four this is for the initial setup and the patient education and the use of the equipment so you sit down with Martha and this is typically done face-to-face this is typically not done remotely this is the one that's usually done face-to-face where you sit down with Martha and dr. Miller's office or in the hospital outpatient department and show her how to use the blood glucose meter or the halter monitor and that's exactly what happened to me when I had the monitor and they sat down in the hospital outpatient department and put it on me and taught me how to use it clip the little monitor receiver and it was all good but here again physician work is not required clinical staff can do this but again you can see on the right that the patient has to do the remote monitoring for greater than sixteen days in the month in order to bill for this now the frequency we can only bill for this code one time we can only do that initial training in education one time the device supply the nine nine four five three where we supplied her with the meter that you paid for we can bill that every thirty days once every third days as long as she's remotely monitoring and using the device on the education and setup and training that can only be done one time per patient but Martha has to be monitoring for at least 16 days in their calendar month the third of the four codes is nine nine four five seven and this is the actual monitoring by dr. Miller and its clinical staff of Martha's data and I'm just going to say blood glucose data because I'm in the diabetes world but again it could be blood pressure it could be her body weight could be all sorts of physiological data and I'm sure there's people on this call that monitor other physiological information so this is dr. Miller and the RN and the Rd and the pharmacists are in the office outpatient department and we're looking at our data on software that's been loaded into our computers by the the medical device company or manufacturer or the software data management review software has been integrated into our EMR and we're looking at it as it's coming in and we call Martha on the phone and say change this do that I have a question or we text her or we email her again those three ways to communicate telephone email and text we would have to get her permission for any or all of those communication methods on that consent form which we have to do anyway to start this benefit so in the course of the month if this is a month now and this is really good that they defined it as a month once you reach that twenty minutes threshold then you can build this code so maybe you spent one minute on April 14th and two minutes on April 20th and another minute on April 28th so April 28th you've got your 20 minutes then you can build this code you don't have to wait until April 30th so it is one time on frequency for each calendar month so you had 20 minutes or more thrush old in April you still have her doing the monitoring in May and she gets another you get another twenty minutes in May so it's one time for each calendar month when you meet that 20 minute threshold now if if Martha is already on CGM you know you start around remote monitoring for this these functions what we're talking about this modality this benefit but in addition in addition you have our uncie GM and your billing you want to build with C GM codes ninety five to forty nine five oh and five one you cannot build both at the same time for Martha because they're both remote or virtual monitoring of physiological data they're very very similar and so medicare in their initial first round of reimbursement guidelines said they actually stated in this first round of guidelines for remote monitoring that billing both reminded remote monitoring and CGM at the same time for the same patient is not allowed and we don't want to bill also the remote monitoring this code nine nine four five seven with the chronic care management codes same patient same period of time like the month of April because chronic care management is a separate benefit within Medicare that is about virtual care it is virtual care the guidelines are different in chronic care management the beneficiary has to have two or more chronic diseases that are going to get worse over time or could lead to death or course severe morbidity so there are different rules but we can't bill CGM or chronic care management codes at the same time for the same patient with nine nine four five seven so because we have to meet that 20-minute threshold for nine nine four five seven that's why I designed these progress notes our p.m. progress notes and they're two different formats to kind of give you an idea of how to be tracking those minutes as you go through the month and then what type of activities like what talking to Martha on the phone what type of activities really fall under remote monitoring so I did a lot of research and benchmarking there's not a lot out there for forms and templates I did the best I can I'm not saying they're the cat's meow but maybe it will help jumpstart so you can build for this like a pro like we talked about in our title now on these three codes you can see here on the right-hand side that Martha does have a 20% copay and that's 20% of the geographically adjusted reimbursement rate that Medicare is going to pay you it's not the national rate when you look up the rates you you can see the national rates and the geographically adjusted and you're always going to pay be paid geographically adjusted and she's responsible for 20% and the deductible is going to be applied also to these codes okay now it's really funny about this and then I'm going to open it up for questions is that you do not need to build the setup and training code nine nine four five four you don't need to build that one to build the 20 minutes of monitoring say that the patient already had the device they already had the FDA defined device to do the monitoring they got that from you know a year ago and they still have it so you don't have to do the setup in training but you start to do the 20 minutes of monitoring then you can build a nine nine four five seven and then at the bottom it's the reverse you if you do the training and education for nine nine four five four but then she doesn't do any monitoring then there is no nine nine four five seven twenty minutes to build but if you did that hook up in training and education you can build that nine nine four five four even though she did not go on to do any monitoring so again this is the Medicare rules that hit we have gotten so far okay when Medicare comes up with new benefits and they roll out their first initial reimbursement rules or guidelines it's up there always not complete and a lot of them too are what I call fuzzy wuzzy you have to interpret what they're saying they're not really clear so the incomplete rules the fuzzy wuzzy Nisour the rules and early on there was a lot of negativity negative comments going to CMS we need more guidance and the thing about direct supervision and general supervision you can see here effective in 2020 the when the initial rollout of these codes came in nineteen twenty nineteen it said that these codes had to be furnished under direct supervision they have changed that because of all the complaints that have gone into CMS Medicare from practitioners just like you so the bottom line is pens up you can change the mind of Medicare by submitting enough concerns complaint directly by calling your Mac or emailing Medicare they have an email address on the CMS site CMS gov you can change the mind of Medicare this is a clear example so they changed it from direct supervision to general supervision and that means that dr. Miller does not have to be in the same building at all when his clinical staff are furnishing any of these codes he doesn't have to be there he could be making his rounds at the hospital he could be on the golf course he could be at home because he's sick as long as he's in communication electronically through a phone or pager you're good so this is really really excellent okay that's one of the best changes they have ever made I get goosebumps when I think about that change because it really opens up this benefit to be used comprehensively and holistically in real honest-to-goodness practice settings with real patients in real time okay that the fourth code we have which is new in 2020 this is exciting I got goose bumps about this one nine nine four five eight this is a new one that's been added and this is for in additional twenty minutes we had the first twenty minutes in a calendar month with nine nine four five seven so let's say you hit those first twenty minutes on April 15 for Martha and then between April 16 and April 28th she has another 20 minutes because she's there's a lot of things going on with her diabetes and she's using one of those wirelessly enabled blood glucose specialised meters so you give her another twenty minutes in the same month of April then you build this code ninety nine four five eight and on the frequency limits what I looked up and this is hard to find but being a certified endocrinology coder I know my way around the CMS different publications and tables and benefit manuals and the frequency limits you can build this code two times in each calendar month so that's really good which means we have an extra forty minutes actually in that calendar month above and beyond the first twenty initially that we give Martha now the consent yes we have to get a beneficiary's written signed consent for thee this is in the statutory language for these rpm services and we have to have that in the beneficiary's EMR so scanned it in you have her sign it scan it into your EMR because in an audit an auditor may ask you to see that and I gave you I created one and I benchmarked it against some other consent forms I found online but again it's I gave it gluco was good enough to upload it for you today and you can download it and if you want to make any changes changes to it please feel free believe me it's not copyrighted by myself or gluco and you know you can brand it and do whatever you want with it another one of those rules is that the beneficiary if Martha have not seen dr. Miller within one year has not been in the office within one year then dr. Miller is going to have to conduct a face-to-face visit with Martha before he can start the remote monitoring because in India to order the remote monitoring by the way to all Medicare benefits have to have an order okay that's that's just a given for all benefits so we have to have a face to face with the beneficiary for from dr. Miller or a nurse practitioner in the office or clinical nurse specialist it can be they can take the form of an annual wellness visit and if enm pens up stands for evaluation and management which is a typical physician or a mid-level medical visit evaluation and management in transitional care management visit any one of these would count as that face to face visit if Martha has not been in dr. Miller's office or in the outpatient hospital department where she's getting services for one year or more and of course dr. Miller or the outpatient department can bill for that face-to-face visit that billing is separate and distinct from the remote monitoring codes okay now there are these qualifying visit codes again for Martha's not been in the office for or the practice setting for a year or more there's certain initiating visits that don't qualify as face-to-face like telephone and online services that Medicare doesn't pay for so but they're traditional the annual wellness visit and evaluation and management visits would qualify okay now again the language of reimbursement some of this language is probably new to you it's called places of service and entitlement if it's like going to France and having to learn to speak French right you don't know how to say coffee and French and eyeglass the line in French because you know it's all foreign the language of reimbursement doesn't roll off our tongue real easy unless you're into it like I am so a place of service where's Martha coming with all the Medicare benefits ladies and gentlemen all of them Medicare will always say these are the approved places of service for the particular benefit and if it's not on that short list of approved places then it's not an approved place that's pretty much it and so you can see here on the Left we have hospital outpatient clinic physician practice federally qualified health clinic rural health clinic home health in a community residence and the beneficiary can be at home for this now entitlement that's from the beneficiary perspective the Martha has to have Part B insurance and you say well don't all Medicare money at Part B not necessarily about 90 percent of them when they turn 65 they will opt into Part B and it is an opt-in that's where your outpatient benefits are housed about 90 percent of them will say I want to have Part B but about 10 percent of them declined that and if you do opt into it and that's your choice you do pay a monthly premium you do pay an extra monthly premium to get that Part B insurance so it's always a good idea to check with your beneficiary F to see her Medicare enrollment card in her wallet or his wallet to see a Part B is listed on that card so when you're submitting a claim your place of service is submitting a claim and you're like what place of service code do I put on the claim the place say you're doing it in the patient's home so you're saying well is there a code for patients home but the statutory language says that we use the place of service code where the billing provider maintains his or her practice the the practice were that the billing provider does all of his or her medical services so if you're going in a community residence or the the beneficiary's home but dr. Miller maintains his office on Harlem Avenue in Palos Heights Illinois the place of service would be the practice on Harlem Avenue in Palos Heights Illinois not the beneficiary's home now remember the two biggest rules of for health insurance billing and I dropped in these slides ladies and gentlemen not to and believe me I have so much respect for all of you on the phone oh gosh I wish we were live in person I wouldn't be giving you a hug because of the virus that I'd give be giving you high fives for all the work the great work you're doing but I get questions a lot about a lot of Medicare benefits about billing and the one question I got a couple days ago I was kind of surprised this person said to me well Mary Ann for the obesity benefit if a doctor orders the Medicare obesity benefit then just because he ordered that he can bill for it right and I'm like no just because you know if he ordered it that doesn't mean he incurred any expense to deliver it I mean it has to be delivered by one of his employees and that's the incurred in expense and it gives them the right to bill so Nancy actually in and this is it's not really on this slide but I'm dressing this the billing provider has to incur an expense in order to bill I know that doesn't say this on the slide but this is really important so just because a billing provider orders the benefit but no expense has been incurred because his clinical employee staff has furnished nothing all he's done is order it that doesn't mean he can bill for it an expense has to be incurred the other rule of thumb is you have to choose the procedure code that's the closest clinical match to the service furnished so if you start your your beneficiary and CGM and you're really doing CGM with the the Dexcom six and again i'm not promoting a brand name for any financial incentive here but you put them on the decks con specifically for CGM that's then what you're billing your billing CGM codes because it's the closest clinical match the other thing to bear in mind is you can't add double count you can add double count time so if martha is getting chronic care management and at the same time same month you're doing remote monitoring and you you want to count three minutes of chronic care management which is kind based and you want to count those same three minutes for remote monitoring code nine nine four five seven that same three minutes ten to 1003 in the morning you cannot do that okay that's double counting they won't allow you to do that okay and the same with again these different codes remote non chronic care management and remote monitoring billing again double counting the same time for two different codes okay and that's what this guideline says also right here okay now it says do not count any time during a day this may be one of the questions that comes through do not count any time during the day toward remote monitoring ninety nine four five seven that's that 20 minutes per calendar month when dr. Miller bills on the same day an evaluation and management visit or a dam of ciliary rest home visit with those codes or a home services visit what the codes listed so translation doctor Miller does an E&M evaluation and management visit live in person on April 3rd with Martha and he spends however much time to build one of those levels of codes you cannot then also count their time toward nine nine four five seven you know he spent twenty minutes doing the enn visit with Martha face to face and he discussed the RPM so you say well I'm going to count that twenty minutes into nine nine four five seven you can't do that dr. Miller is going to build the evaluation and management visit that live is it with Martha and that the time does not go into nine nine four five seven okay so again as I mentioned before a great way to keep up with the new guidelines that Medicare will not if but they will be publishing refined guidelines for these remote monitoring codes I know they will because again their initial round of reimbursement guidelines are not comprehensive there's a lot complaints about that and the guidelines themselves that have been published I call it fuzzy wuzzy they're open to interpretation especially like these medical devices like people are saying does the Fitbit or an Apple watch count we don't know that yet because CMS has not given a specific guidance okay so billing providers because we had a question about the Rd so you can see your on the left would the first round of guidelines that Medicare has given us these are the billing providers who can bill for these these codes and you can see here that nine facilities and facilities can also bill and you're saying this is all outpatient would G Marianne what does that mean I'm going to explain that in a couple of minutes between nine facilities and facilities rendering providers who can render the services defined by these codes the same individuals who can bill and the same individuals who can order okay so billing rendering and ordering that subset is all the same but in the middle column under rendering look at auxilary clinical staff employed by the billing provider and this was a change in 20/20 this is terrific because the initial set of reimbursement rules ladies and gentlemen I got goosebumps telling you this one the initial set of rules said only the billing providers can render these codes and everyone went literally ballistic I know that's not a real professional word to say but I feel I'm one with you and I can talk to you for real everyone really went nuts about that that only doctors and NPS pas and CNSs could furnish so they changed it with all those complaints you can change the mind of Medicare and they said now it's auxilary clinical staff but they have to be employed by you're under contract with those billing providers why because the billing provider has to incur and expense in order to bill because they want to get their money back so here's kind of a funny situation say that dr. Miller actually he was my doctor before he retired and at one point he had his daughter working in his office now whether his daughter was employed or not I don't know so if she was working there free because she wanted to learn about medical services I don't know he wasn't paying her and she was sitting down with me teaching me how to use my specialized blood glucose meter if he wasn't paying her then he can't have bill for their code because he has incurred no expense so I I hope that helps you a little bit now I'm not going to go through a lot of detail about facilities and non facilities because you're getting this deck after today's webinar and you can go to your favorite reading room and go through these slides that I'm doing a cursory overview I'd have to tell you a little something funny my favorite reading room when I go through decks or I diabeetus journals my favorite reading room has a toilet in it so I'm going to let you picture that okay and the answer I love to do my reading it may be your family room your bedroom your living room but then you can read through these slides facilities are what you would imagine you know larger places of service hospitals particularly skilled nursing fa Q's RHCs their kind of thing and then non facilities pharmacies dr. Miller's office walk-in clinics urgent care facilities the thing about facilities and non facilities Medicare gives them a place of service code and you can look those up like an office like dr. Miller's office the place of service is code 11 a pharmacy is o1 and so those place of service codes have to be inputted on the professional 1,500 claim form so Medicare knows what place of service that the service was rendered in but facilities like a hospital they use a completely different type of claim form they use a ubo for so when Medicare gets a ubo for claim they know it's from a facility hospital critical access hospital and so they don't have to use a place of service code because the claim form that you Leo for is specifically for hospitals so with that said all these other things explain that okay one more thing I want to say and then we're going to look at the reimbursement rates FQHCs and RHCs okay those are considered facilities even though their clinics all the other independent clinics are considered non facilities but you know medicare I set up or sometime their rules are a little bit crazy and outside of what we normally think so even though FQHCs are quote clinics and RHCs are clinics they're designated as facilities in the Medicare world go figure right anyway what's my point in the statutory language right now that we have from CMS FQHCs and RHCs cannot bill separately for the RPM codes but wait a minute it doesn't mean what you think FQHCs and RHCs will still get money from Medicare for doing rendering these rpm codes they will still get money what this means is they're not going to get a separate distinct payment from Medicare the way dr. Miller's office will and why is that because RHCs get paid with a bundled all-inclusive rate for all services furnished to the Bene on one day and FQHCs get paid a bundled rate for all services to Martha on the same day under a different type of bundled payment system called the perspective payment system so you will get paid for our p.m. in FQHCs and RHCs through these bundled reimbursement methodologies but you won't get paid separately with the reimbursement rate for each separate code that I'm going to show you now and that's going to be we're going to wrap up the webinar them okay so what I did I clipped this out with my sniping snipping tool and these are the rates for 2020 and you for all of these four codes and you can see on the right it's nine facility and facility in our facility for most of you on the phone is going to be hospital outpatient department critical access hospital outpatient skilled nursing facility non-facility is going to be a physician's office [Music] an independent clinic that's going to be non-facility so code nine nine four five three now these rates you see on the right are unadjusted they're not adjusted geographically these are the national payment rates that are unadjusted for geography nine nine four five four okay remember that code nine nine four five four that is for the set up in the education and here's your non facility and facility price the rates you're going to again this is national national rates nine nine four five seven four that twenty-minute threshold in a calendar month you see the rates on the far bottom right and they're their difference between hospitals and everyone else and then your extra twenty minutes above and beyond the first twenty minutes nine nine four five eight we have different reimbursement rates between facility and non facility so you can see here that non facility the rates are always higher if they do separate the rates because in a facility there's more departments just spread over the expense so the rates are always going to be a little lower so why move on rpm some of you who know me I'm the queen of acronyms and two of my remote monitoring progress note forums different formats that I sent you today I have some acronyms in there I have an RPM care plan which is an acronym so why move on rpm more reimbursement for you modernize your practice to meet your patients expectations for virtual care right maximize patient engagement in their own care without overburdening your care teams get them more involved in their own care because they're doing this in their own home collecting and transmitting their data and you're calling them in the comfort of their own home or emailing them on their tablet outcomes improvement the more care you give them virtually the better their outcomes are going to be particularly in diabetes and cardiovascular disorders and our PM dates that the patients expect more personalized and convenient services as consumers it validates that you're you're aware of what they want and need and you're catering to them it looks great and it for clinical people on this call that you're going to be rendering these services jump in and do this promote those RDS RN pharmacists because it's going to expand your clinical staff roles and responsibilities so if you're working in a physician's office you're working in a codependent clinic an FQHC and RHC hospital outpatient department and you're doing a very limited amount of services because you're an RD and you're doing MNT and DSM t and CGM and that's it getting into remote monitoring is really going to expand your your clinical staff roles and responsibilities you will be more valuable and then you know what this is what I would do I would ask for a raise that's what I would do anyway okay so again please check out my two different types of our p.m. records and progress notes feel free to remove my name modify however you want if you do modify and make it like you think better I would love to get a copy if you want to send it to me my email address is on the second slide or yeah third slide in this deck I would love to see what you've done with them it would be a lot of fun here's just a little snippet of what they look like but you're going to have the actual word decks so with that said again I want to thank gluco and Brian we've done a lot of commiserating this last month he's been wonderful Thank You Marion and thank you all for joining us today for our second webinar in glucose four-part diabetes connected care webinar series thank you all and have a great day thank you everybody it was my pleasure hope to talk to you soon hope to see