Effortlessly Manage the Reimbursement Bill Format for Supervision

Reimbursement bill format for Supervision

good afternoon everyone this is Doreen Cordoba I'm the director of teloth programs for mobile health health care's division I'm on behalf of mobile health I would like to welcome you to today's webinar understanding CMS reimbursement opportunities for remote patient monitoring all attendees have joined in listen-only mode however you can submit questions in writing throughout the webinar in the app we will try to answer all of those questions during our Q&A period at the end of the presentation I would like to inform you that our webinar today is being recorded including a written record of the questions you submit so let's get started our two other speakers today actually three will include Michael Gomez CEO and Gary Carr Neill founder and strategic advisor for Claire health quality Institute and Chris Otto senior vice-president of the mobile health healthcare division we are also joined today by Paula Reisner general counsel for mobile health who will be available during the Q&A to answer any questions you may have one disclaimer while we will be talking about various laws and regulations our experience and advice should not be taken as legal advice if you have specific legal questions regarding your program or participation please consult your attorney I will now hand over the presentation to Michael Gomez and Gary Carr Neill to get us started thank you Thanks thank you my name is Mike Gomez and I'm the CEO of clear health quality Institute CQI was formed a little over two years ago and quickly grown to become the nation's largest accrediting body of telemedicine and telehealth programs our seal of accreditation provides consumers providers payers and regulators with an easy to identify confirmation of quality from an independent third-party organization a patient and consumer benefit that had previously been unavailable for telehealth care in the past our goal is to promote access to safe quality and competent healthcare regardless of the telemedicine model our modality being deployed or the type of clinic services being provided to patients we continue to refine our standards and expand our program offerings to include additional performance and telemedicine delivery and modalities I want to congratulate the team of mobile health who has partnered with ch Qi as an early adopter of our upcoming remote patient monitoring Edition program their efforts to seek accreditation for our newest program is a clear testament to their commitment to their customers and the quality of their products and services now introduce to you Gary Carr Neil Abner och - I will take you through history of telehealth and the value of accreditation while discussing the future of rpm Gary thanks Mike and thanks to mobile health you know when you think about healthcare and all the innovation and we have something like remote patient monitoring that's coming on gaining steam and think about being first bed it's really interesting to see how accreditation can play an important role in terms of us explain in a moment providing contingencies wherever you personally come through so we're all familiar with the history telemedicine obviously a public start around the late 1800 early 1900s when the telephone took off and in fact the first kind of modern telemedicine began in the early 1900's in the Netherlands when there's a transmission of heart rhythms over the telephone and then kind of rotating east in 1940's radiology beginning to take off where there were radiology images sent in Pennsylvania over 24 miles between two townships via telephone line in the first world example of electronic medical record transfer and then you move forward to like 1959 where there was a video communication for medical purposes in the University of Nebraska where there was a two-way television set up to transmit information to medical students across the campus and then DC headed into the 1960s and 70s you had a NASA health and the federal government begin to really develop removed remote patient monitoring applications such as Alan Shepard when he flew in space freedom 7 he was the obvious person in his face in 1961 and actually monitored him for a primitive EKG and a respiration sensor at a microphone a thermometer then later the mercury place a blood pressure monitoring device was used by the accidents among some other remote patient monitoring standards and so if you look and also from the lens of retardation sometimes it takes a while as figure out with virtual terrors to kind of create a framework and so my work I've brought my different vision programs to market and these are some of them on the screen right here or starting back in the late 1990s foreigner standards call center standards and case management a little bit about our work today who sees Qi thanks a lot when you think about accreditation there's really a lot of benefits to accreditation a lot of reasons to do it obviously the other day is about reimbursement and so credits you can promote a quality based standardization not driven health care they can identify mitigate risk to both patients and organizations and empowers the use of evidence-based clinical pathways to promote better clinical outcomes they document maintain enough data were close and encourage streamline healthcare services and it really does set the stage for reimbursement in terms of having people understand kind of what the service is doing this case remote patient monitoring and also for example there may be gaps and create a national standard a next slide please so as I mentioned click on button to do this form several years ago I think the important point here is that we're taking all the bells and whistles of the best class accreditation function we're leveraging my 25 years of tradition experience in 88 25 years of clinical experience as a trade association so we really didn't have a good foundation to build our programs next slide so part of this is actually building a typology so as you can see in this slide the cord comas and a crazy scanners that were often taking the 88 initial program last year we have three basic functions a consumer to provider which would include for example position or triage interaction where the consumer calls physician provider to consumers like an ongoing therapeutic relationship between professional location and provider to provider a zippered pocket which would be for example celery obviously special counsel and within each bucket or different service lines this is a huge step toward in terms of technology delegate both public and private payers excited about potentially reimbursing for that remote patient monitoring a next slide but if you carry the ball forward it's important that in terms of today's environment advice based purchasing that you kind of make sure you demonstrate outcomes so part of our work today for developing a four module fell right on top of the existing three modules that actually activated the National Forum outcomes framework that's adopt in August 2017 we're taking their four domains not even fit so basically this is a soup to nuts program demonstrating free service line certain measurements ability to access to care clinical effectiveness experience patient satisfaction financial impact and operations measurements next slide and then finally we routinely work now and actually Chris Otto whose videos is actually on remote patient standards work route so we're actually now in the process of drafting standards as you see the left of the slide and up to the top of the right side you see the core standards actually are the telemedicine equation program so we're kind of left working that kind of core infrastructure we're going to modify the standards and then you can see on the bottom right how to do remote patient models so it really gets the point of you know what are the program goals once the provider and personnel service line capacity what are the clinical procedures let's see end-user Technology proficiency what is the provider patient relations what's a continuity of care what's the patient population served and so on so it's that kind of processing structure assessment that really kind of creature framework for reimbursement and with the reason she invest codes including CPT code nine nine four five seven there's going to become even more important and you'll hear more about those codes in terms of potential opportunity predation to sample is over twenty state Medicaid departments now that reversed at some level for rpm so we look forward to just being the ecology answer any questions but it's a creation typically it's the first step forward in terms of really people understanding what remote patient monitoring is we're hoping to have these specific standards which will be a separate equation program completed by August we'll do the public comment in them and hopefully have it all wrapped up like at the end of the year so I'll stop there and look forward to the rest of the webinar okay great thank you Gary I I think it's really exciting and I appreciate the the overview of the evolution of remote patient monitoring and I think the the establishment of standards is really a testament to the maturity of the space as well as the reimbursement the depth is now offered by CMS so just just as a refresher maybe for those of you that may not be familiar with remote patient monitoring really what we're talking about is technology in a patient home this may include connected connected self testing medical devices like like a blood pressure monitor or a weight scale or some-some hub in the home for communication that allows patients that have a chronic condition to collect data and then transmit that to their to their clinical team that's monitoring that data so clinicians typically can use a software platform that allows them to collect health and adherence data on those on those populations and then to receive notifications of abnormal readings of excuse me of abnormal readings and non-compliance that allows them to prioritize interventions for patience in that population next slide please all right so today we'll be talking about the reimbursement that's now available through CMS there's three codes that we'll be talking about and I'll point out that this is this is really we're talking about today the codes as they are defined for Medicare Part B so today's it's available for Medicare Part B and the way it's defined is remote monitoring of physiological parameters so I think it's interesting to note here that those of us in the industry will often return up sorry well we will often refer to rpm as remote patient monitoring but CMS is very specific in their language to denote remote physiological parameter monitoring and the emphasis is on collecting data associated with some sort of vital sign they provided examples in in in the language of the code that refers to weight blood pressure pulse oximetry respiratory flow rate blood glucose readings but these are not intended to be an exhaustive list of examples it's really up to the physician or the healthcare provider to determine what's medically necessary next slide please so the three I'm not gonna go into detail we have a couple slides that will go into detail so just know that these codes that we'll be covering today the three CPT codes are all effective January 1st 2019 these are not face to face codes so they are approved for remote care and I'll refer to them interchangeably as our p.m. as a remote patient monitoring or a remote physiological monitoring this is the language that CMS uses again this is for Medicare Part B CPT 99.5 three is a one-time code you can go ahead and advance the slide Brenda yes so CPT nine nine four five three is the first code this is a one-time code means it can be billed once for the duration of care for that patient on the can program it is really designed for initial setup and patient education use of the equipment so I've had a lot of partners ask us if that if you know if that education needs to be delivered in person are going to be able to phone on the answer is yes it can be delivered over the phone I will point out that for all of these codes whichever ones you don't necessarily need to need to build for all of these codes but for any of these codes consent is required by the patient so they have to opt into the program they have to have been seen at least once in the past year in office and then they have to opt into the program that consent can be collected in person or over the phone and in this this code is billed one time the next slide please the next code is cpt nine nine four five four this code is intended to cover the device supply with daily recordings and or programmed alerts transmission for the initial thirty day period in each 30-day period so this code is intended to be a recurring can be billed monthly and it's it's essentially designed to cover the cost of the technology in that patients home as well as the software or whatever tools are being used to aggregate that data so we'll talk about this in detail a little bit later how the mobile health solution you know works inside this code but this is really for the technology next slide please and the next code cpt nine nine four five seven is the code that's designed to cover the twenty minutes or more of clinical staff physician qualified healthcare professional time in a calendar month requiring interactive communication with the patient and caregiver during the month so this this code covers the review of the patient data so again for for every patient that's in your practice is participating in the remote patient monitoring program there is a requirement by CMS that you must satisfy 20 minutes of review in that billing period and we'll show you later that we do have software that that demonstrates and automatically will record the time spent towards this requirement but it is a requirement that you have to meet this I would also mention that for for 2019 at least under the current law this this CPT nine nine four five seven must be delivered under direct supervision of the of the billing practitioner in this case so with respect to CMS they have defined this as clinical staff physician or other qualified health care professional time but they didn't they were not specific in the supervision level and the default supervision level for CMS as default is is direct supervision so unlike chronic care management codes if there's some of you that are using those codes today those are there was an exception in the language made so that it was approved for general supervision but at least for today with respect to CPT nine nine four five seven that 20-minute has to be delivered by clinical staff or other qualified health care professional time under the same roof under direct supervision as the as the position all right so just to summarize there are three codes the first one is for the setup in patient education we also talked about the consent that's required to be collected that is not necessarily coupled directly to nine nine four five three so if you choose not to bill for nine nine four five three you still have to collect consent but I think it's generally we sort of associate that with the sort of the patient enrollment tasks get the patient on program that's a $21 reimbursement one-time can be billed one time at the onset of care the next code nine nine four five four is four covers of technology in the delivery of the physiological data that code varies by locale anywhere from fifty five dollars to send me four dollar so please consult your be scheduled for the actual reimbursement rate in your area I've seen a lot of blogs and articles refer to this code as sixty-five or $69 nominally which which is kind of the average but it does vary by locality be aware of that and then the last code is the ninety nine four five seven which covers the clinical oversight the review of the physiological data is captured by the RPM equipment that buries in where from 47:56 again varies by locale so on a monthly basis you have a little bit of a additional reimbursement on the first month but then on on an ongoing basis that reimbursement ranges between 100 to 130 dollars depending on the locale now of course this is subject to the 20% copay for Medicare Part B next slide please so I know everybody everybody's eyes are probably gonna go to this the numbers first but if you would just look at the bottom of the slide and I want to point out that that in as gary alluded to remote patient monitoring has been around for a very long time in the last couple decades it's been widely used and has been it's shown very effective especially with heart failure patients to demonstrate the reduction readmission anywhere from 50 to 60 percent reduction readmissions for patients that have congestive heart failure by using a simple connected wait scale that can monitor their weight in addition is shown to be able to approve improved patient engagement we've received feedback from a lot of practices too that they can they've been able to improve access to access to care for those patients that can't come into an office or it's not practical to come in they've been able to better manage chronic conditions promote skill development for self-management of diseases and also to be able to allocate precious in clinic time for those patients from higher acuity that they need that time in the clinic so there's a lot of benefits what's new for 2019 is the reimbursement so now while the the outcomes and the benefits have been pretty well documented we're really really excited - has really embraced the value of remote patient monitoring and they're now making that available in a big way so that providers can deploy this and get reimbursement to do so so the numbers you see on the screen are just just an example it would vary by practice but we we assumed a 2500 patient population we assumed that 32 percent of them were eligible for the programming and we're on Medicare Part B so this will obviously vary widely by practice and then we assumed that 30 percent of that practice would participate so these are I think pretty conservative numbers so you can see here month 1 through 12 we show 28 twenty patients on-boarded per month or 20 patients enrolled in the program for a month with the total of 240 patients on program by the end of the year and you can see some of the numbers just in terms of what the reimbursement actually provides on a monthly basis and how that adds up over time again I'll point out that this is assuming that that 100 percent collection of co-pays we we know of course that you are required by law to build for that copay but we're just pointing that out as a caveat because I know in practice it's not always as easy to collect 100 percent of code base so it will again that'll vary by practice so we just highlighted that here so you can be aware that I later in the webinar will talk about the actual prices I will just say that the mobile health rpm solution is designed to be a per patient per month model there's no upfront expenses and it's designed to fit inside the unit economics of 99.5 for the technology reimbursement so you can see how that this revenue accumulates over time over that 12 month period $30,000 and fees sorry sorry in reimbursement for this example population the red line that you see on the screen is what is the reimbursement without the copay so you know depending on what your own history and success is on collecting co-pays for patients we would expect that that would probably be a sinner similar collection rate so just be cognizant of that as you're building and programming and we do the right along here to denote the where the co-pays were okay the Hal twos implement is implementing a successful telehealth program we do have some resources on our website and we are very collaborative with providers that we work with so everything that we do is very collaborative we we create a we have program plans in place to define remote patient monitoring and we will customize those and tailor those during a typical typical onboarding phase for practice and we'll talk a little bit more about that we do have some white papers on our website as well so feel free to visit our website and you can these are freely available to you we we cover some of the considerations to putting a successful remote patient monitoring or telehealth program in place personnel considerations identifying the inclusion criteria what populations you want to focus on and you're defining what outcome you're seeking to achieve I will point out through this this white paper in particular was originally originally written with a focus on home health I did see a number of home health agencies enrolled in today's webinar so you especially may want to visit our website and I'm access this resource but I think it's a good resource for anybody starting an RPM program okay selecting the right partners I'm actually gonna hand over the stage to Doreen Cordova dream do you mind taking over here yeah absolutely I'm happy to talk about selecting a good vendor partner there's a lot of considerations when you're selecting a vendor partner to support your remote patient monitoring program and the first and foremost is that this is a long-term relationship we walk through the process with you in terms of planning your program implementation launch and what type of supportive features you need to have built-in in for the long haul post implementation we're looking at adoption for patients so it does take a good partner to support your program next slide first and foremost you want to select a vendor partner who's easy to work with it's one that will supply you with a simple contracting process and clear transparent terms customizable programs meaning you might have an idea for your rpm program today but plan to make changes in the future because you may want to expand beyond your initial populations you might start out with congestive heart failure COPD hypertension diabetes and down the road you may include other populations or change direction you want a partner that can be flexible and meet your needs when you have change also responsiveness it's about communication between yourself and your vendor partner you want to make sure that you have multiple check points to determine whether or not the program is successfully on track or if at any point you need to create a change to address something that occurs along the way so definitely communication and responsiveness are important nextslide pricing pricing is an interesting discussion because you really have to be thoughtful about what is included in your upfront pricing inclusive pricing especially if it's if it's a bundled rate a per patient per month lease model it allows you to be aware of what's included in that pricing if the software is included the hardware shipping to the patient definitely you want to know all the details upfront and not be surprised by any cost of add-ons later on so be aware of your pricing model next slide in terms of the overall program management you want a vendor partner who can support you in either a branded program that might require some marketing tools patient onboarding you may require foundational tools such as intake forms consent forms dis enrollment forms and you want to make sure that that enrollment process is easily and you can expedite quickly if you've identified a patient to participate in your program you want to know that within a few days that patient will have their kid in their hand and be ready to start taking readings pre-configured kits are also helpful if the kits are already paired before they leave a warehouse shipped directly to the patients and if they're plug-and-play then patients are able to launch into their program quickly also support support is critical to the success of your program if there's any point at which there's a challenge with dataflow connectivity or devices you want to be able to pinpoint exactly where the system's breaking down and you want your clinicians and your patients to have access to a support team that cares and is able to walk them through the process of identifying problems and fixing those problems next slide so in summary with an RPM program really what you're trying to do is improve your quality of care it's an enhancement to your current model of care we want to give you a program that will strengthen your clinician patient relationships improve your retention you will tools that will help you better manage your patients with chronic conditions to date you've all been doing activities that are between clinical visits to help those patients with chronic conditions now you can get paid for that so in short we really want to provide a program that helps to lower the healthcare costs improve efficiencies and improve quality overall so with Medicare reimbursements it's really easier than ever next slide so in short why work with mobile health well we're easy to work with we've removed all the barriers to adopting and launching a program we've made it simple for your team to be able to provide remote patient monitoring to their patient populations without a lot of hiccups we offer clear and friendly terms meaning we do not require a capital investment you do not have to purchase hardware and devices to inventory on your own we provide a per patient per month lease pricing and we ship freely to the patient so there's no cost in shipping directly to the patient and again it's plug and play technology we also offer step down private pay options meaning at the end of your patience program they're able to access a private paid program and you can support durability of benefits so all the logistics are included in the technical support and I see that we are toward the end of our time and we do have a few questions so in short if you select a kit option you can select from two different hubs simplistic up an engaging tablet hub and a variety of peripherals for any program needs next slide if you have any questions you have contact information for any of the participants on today's panel and I would like to hand over a couple of questions if Carrie I'm gonna shoot a question your direction first is accreditation required to participate in our p.m. reimbursement that's a great question you know it's interesting we look at an application like mobile health you know it's embedded into in terms of clinical pathways and and there are other types of remote patient monitoring devices like visit which really doesn't qualify so what purchasers are looking for is really some sort of sign and signal that it's a company that's really well structured that they know what they're doing so certainly accreditation is recommended for our pin reimbursement but technically it's not mandated at this point but to be aware for examples one of the largest art piece in the country right now issued by evaluate of the National line for healthcare our purchasers about your weight actually does ask for telemedicine accreditation whether they're accredited and they will be asking for remote patient monitoring but for example in some cases CMS actually will mandate accreditation you actually need an act of Congress typically for some ready for you guys but for example for big exciting off-site imaging if you want to if your imaging provider you want to get paid for Medicare beneficiaries you actually do need an accreditation pursuant to the memo program so today it's recommended but not a mandatory but it could be mandatory in the future great thank you this one is directed at Chris Otto is this reimbursement available to home health agencies unfortunately the the CMS codes that we're describing today are intended for a billion practitioner providing direct for the physician providing care for that patient so next year for 2020 there's been a lot of discussion about reimbursement for home health and certainly PD GM has been a big hot topic for home health agencies and I know there are some home health agencies that are planning to deploy rpm under PD GM is sort of a you know an operational cost savings to deliver better care but unfortunately no these do not apply directly to home health great thank you Chris another one directed towards you what are the big challenges that people are facing with regards to starting an RPM program oh well that's a good question I think those those the physicians that the practices that we worked with that have struggled the most are those that have attempted to provide their own technology and sort of deliver a bring your own device meaning bring a smartphone or your own tablet and you're you know you're collecting the data yourself and I think this has been a nightmare and it works on small scale you know 10 to 20 patients but if you try to go beyond that certainly a hundred patients or more it can become a logistical nightmare you're you're out of the business of providing medical care now you're providing technical support so train you you actually looted to this when you talked about selecting a good vendor partner is identifying a partner that can do all this for you so we we take pride in some logistics management and the the preparing of kids I mean we really make things simple so that the practices we work with can focus on delivering quality medical care quality medical care and not supporting the RPM technology concerns great thank you another question and I will direct this towards Chris first and then Chris you may want to share this one there were several questions I came in and they were praised in different ways but pertaining to consent exactly what are the requirements for obtaining consent and how do organizations need to maintain a record of consent yeah good question the first is that first I'll just say I'm not an attorney but so maybe Paul you can jump in here but the the consent does not have to be collected in person so I think that much is clear it can be collected over the phone I believe it has to be documented in some way Paul correct me if I'm Nam and I think memorialized is the language I've heard you used to you know just to document that and memorialize that in the AMR some way yes Krishna this is Paul and I would agree with that that the the consent just has to be in the record somehow and if it's contemporaneously memorialized patient tells the recorder whoever's taking the information and it goes into the record that's how most of the electronic medical records are set up now and the there's not a voice recording of the consent so I think that would be sufficient thank you great thank you another question is around the adoption of RPM since the release of the codes Chris can you expand a little bit on the experience that mobile health has had in the marketplace recently since the introduction of the 2019 CMS codes yes it's definitely created you know a driver for the market I mean this is this has been big so we we I was at the ATA conference in New Orleans maybe a month ago and and the session that was on this topic specifically rpm reimbursement was standing room only it there was and most of most of the audience in the room where providers looking to deploy this and we're actively deploying a number of programs as we speak so I expect that the the market adoption will be very similar to two chronic care when it rolls rolled out in 2015 and we expect our p.m. will kind of follow a similar adoption great thank you who specifically can build for CPT code 994 five seven and Chris I think that you can tackle that one yeah I'll tell you I mean I'll take a stab at that it's it's it's it has to be a physician it has to be a billing practitioner so this is somebody that's provided and again because direct supervision is the requirement today nine nine four five seven you have to be providing that twenty minutes a review you know under the same roof so to speak is the direct supervision requirement but it does not necessarily have to be primary care physician it can be you know it can be an internist or a specialty group but you know I think the spirit of the law is that that code is intended to provide the reimbursement for any practitioner any any physician that's providing that care for the chronic condition so so you know if it's diabetic patient it may not listen you know maybe a specialist that's providing that care on an ongoing basis are mid-levels or maybe nurse practitioners pas are they also considered billable oh that's a good question I may defer to Paul to help me on this one but I do yes that varies by state but if I think if you are billing practitioner so if in your state the nurse practitioner can bill Medicare I believe that is possible Paul can you found it yeah I can confirm that yeah but if they're able to bill for other procedures then this is one they would be able to bill for as well otherwise the billing number is assigned to a physician or another healthcare practitioner who has the ability to bill it has to be billed under that number and they have to bill it great thank you and then one last question we have time for with to building an RPM program and pulling together the hard work it is BYOD program an option I'll be happy to take that one and I sort of alluded to that on the the challenges question it's the first of all is it is an option I mean it would qualify with respect to the CMS codes that were discussing but I would strongly caution against it and the reason is is for the reasons I mentioned before is is we there are a myriad of devices out there smartphone devices different operating systems Android devices different iPhone devices and and trying to manage that and a you know heterogeneous patient population and trying to support that is is a daunting task so I would really caution against that I would recommend that you find a good technology vendor an RPM vendor such as mobile help or some other for that matter and and rely on your partner to manage the technology so so I guess the answer is yes but I would caution against it yeah and I think I'd piggyback on that but I like the idea of a standardized program and one that you can manage the technology and and the support and it's cohesive program in terms of outcomes to you so I think that I I feel the same way and I think that that's all we have time for today and I want to thank everyone for joining us and for your questions we'll follow up with any additional questions that were not able to get to you on this call and we'll send an email with a link of a today's recorded webinar so be on the lookout for that and thank you this concludes our webinar for today have a great rest of your day