Remote patient monitoring reimbursement: Recent changes from CMS

RPM Reimbursement CMS Changes

On April 6, 2020, the Centers for Medicare and Medicaid Services (CMS) released an Interim Final Rule, giving providers that serve Medicare beneficiaries additional flexibility to meet the needs of patients during the COVID-19 pandemic. One of the changes aims to increase access to remote care, including remote patient monitoring, to avoid exposure risks to healthcare providers, patients, and the community.

How RPM reimbursement is changing

Remote physiologic monitoring (RPM) is considered a Communication Technology-Based Services (CTBS) and usually is only billable for established patients. During the COVID-19 pandemic, CMS is allowing physicians to bill for providing these services to new patients as well as established patients. The aim is to increase access to necessary care and reduce exposures and the utilization of medical resources.

How to obtain consent

CMS has also clarified how physicians should obtain consent when initiating RPM services. Prior to the COVID-19 outbreak, CMS required verbal consent from a beneficiary in order to bill for the services, to avoid scenarios where a patient receives an unexpected copay for RPM services. 

The new interim rule would allow physicians to receive consent annually, including at the time the service is furnished, for the duration of the COVID-19 national emergency. CMS recommends that for new and established patients, physicians obtain verbal consent and document it in the patient’s chart. Due to COVID-19, the OIG has also temporarily allowed physicians to waive copays for remote monitoring and other telehealth services, so physicians can offer these services at no cost to the patient.

Acute vs. chronic condition monitoring

Lastly, CMS has clarified that RPM codes may be used for monitoring patients with acute conditions as well as chronic conditions. While these codes are mostly used for monitoring chronic conditions like COPD or asthma, they may also be applicable for a patient with an acute respiratory virus.

The Interim Final Rule is open to comment from the public until June 1, 2020. Submit your comments here.

The Propeller team is monitoring these regulations closely and will keep our Clinical Blog updated with new information relevant to HCPs. If you have questions about how to monitor patients with respiratory conditions remotely, send us a note at [email protected]