CMS to Begin to Pay for Remote Patient Monitoring in 2015

It’s about time and the way that CMS is going to pay for Remote Patient Monitoring is, essentially, like this…..

Services to be covered when provided by telehealth:

Chronic Care Management


CMS is proposing reimbursement criteria for non-face-to-face chronic care management (CCM) services, defined as a unique, covered service designed to pay separately for non-face-to-face care coordination services furnished to Medicare beneficiaries with two or more chronic conditions. CMS discussed this new policy in 2013 but did not include a specific reimbursement proposal.

The specific code for this service (tentatively called GXXXI) is defined as:

“Chronic care management services furnished to patients with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; 20 minutes or more; per 30 days”

A payment rate of $41.92 could be billed no more frequently than once per month per qualified patient.

Eligible CCM services MUST be furnished with the use of an electronic health record or other health IT or health information exchange platform which includes an electronic care plan that is accessible to all providers within the practice, including being accessible to those who are furnishing care outside of normal business hours and is available to be shared electronically with care team members outside of the practice.

The mTelehealth Remote Patient Monitoring Solution’s clinical platform meets or exceeds all of the above conditions.  Any accounts that have physicians or eligible Part B providers that use the mTelehealth Remote Patient Monitoring Solution platform for chronic care management of patients meeting the criteria listed can bill Medicare $41.92 per user/subscriber on a monthly basis, offsetting the monthly service cost. This is a clear and direct ability for providers to get paid for using our mTelehealth platform.

Since this new code GXXXI is covered when provided by telehealth for non face-to-face management and carries its own set of unique criteria, it is a separately identifiable service from 99339, or 99374 (NOT considered “telehealth” or “telemedicine” by CMS) and can be billed separately for qualifying patients.

Another example of this is examined in the following article:

Neil Versel, Contributor

After July ended with what I called a “big week for telemedicine and telehealth,” August started with at least one telehealth company — maybe more “digital health,” but let’s not split hairs here — getting some national TV coverage to discuss an important development in the field.

Bill Smith, president of ALR Technologies, Richmond, Va., appeared Monday on Fox Business Channel’s “Opening Bell With Maria Bartiromo” (though Sandra Smith was in for Bartiromo that day) to discuss something I left out of my post: Medicare reimbursement for telehealth services.  ALR makes devices and offers remote monitoring services for people with diabetes.

The proposed 2015 Medicare physician fee schedule, released in early July, would expand the number and types of services eligible for reimbursement when care is delivered remotely. The Centers for Medicare and Medicaid Services has proposed paying physicians for annual wellness visits, psychoanalysis, psychotherapy and “prolonged evaluation and management services.” The latter, for which CMS would pay physicians $41.92 for each remote consultation involving a Medicare fee-for-service enrollee, means care for people with two or more chronic diseases

This is where ALR comes in, as this video illustrates.

Bill Smith shot down Sandra Smith’s worry that there would be more mistakes made simply because the patient is not physically present in front of the remote physician. “You may cut down on mistakes,” Bill Smith said. “A doctor can remotely see a patient’s blood glucose. A lot of doctors don’t know what’s going on, for example, with a diabetes patient between office visits. With remote technology, you have the potential to actually bring real data to the table.”

ALR pulls data from glucose meters, uploads it to a secure website, where clinical professionals working for the vendor look for trends that could indicate the need for medical intervention. “It’s essentially a system for managing and monitoring chronic care, which is what this rule is about,” he explained.

Playing to its audience of people who invest in the stock market, Fox Business listed a handful of large publicly traded medical device companies that stand to benefit from this proposed rule change, but plenty of the action will be among startups and small companies such as Smith’s. ALR is a penny stock, currently valued at 2.7 cents per share in over-the-counter trading.

Expect the final 2015 physician fee schedule to appear in the fall.