RPM – Getting Better But CMS Still Needs a Nudge

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On March 15 CMS posted via the Federal Register a technical correction on the Chronic Care Remote Physiologic Monitoring CPT Code 99457, stating CPT code 99457 may be furnished by auxiliary personnel, incident to the billing practitioner’s professional services.

On March 15 CMS posted via the Federal Register a technical correction on the Chronic Care Remote Physiologic Monitoring CPT Code 99457, stating

CPT code 99457 may be furnished by auxiliary personnel, incident to the billing practitioner’s professional services.

Since CMS did not specify “general supervision”, and simply stated “the billing practitioner’s professional services”, the expert opinions we have received state that the default is to Direct Supervision*, requiring the monitoring to occur in the same facility as the billing provider; but allows auxiliary personnel to do the interactive patient care.

If CMS will make this change, it will greatly expand the opportunity for physicians to improve patient outcomes and engagement for those patients with chronic conditions.

Below is the exact language from the Federal Register notice, page 11, #2.

https://www.federalregister.gov/documents/2019/03/15/2019-04803/medicare-program-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other-revisions

On page 59575, column 3, 3rd full paragraph, we incorrectly stated that CPT code 99457 could not be furnished by auxiliary personnel, and instead must be performed by the billing practitioner. CPT code 99457 may be furnished by auxiliary personnel, incident to the billing practitioner’s professional services.

On page 59575, column 3, 3rdfull paragraph we are removing the sentence, “We note that CPT code 99457 describes professional time and therefore cannot be furnished by auxiliary personnel incident to a practitioner’s professional services.” and adding in its place, “We thank commenters and confirm that these services may be furnished by auxiliary personnel incident to a practitioner’s professional service.”

Below is the definition of Auxiliary personnel from 2002, and definition of Direct Supervision, which still exists.

Auxiliary personnel means any individual who is acting under the supervision of a physician, regardless of whether the individual is an employee, leased employee, or independent contractor of the physician, or of the legal entity that employs or contracts with the physician.

Medicare – CMS.gov

CMS made an update in 2015 that further explains this language:

 Additionally, we are amending § 410.26(b)(5) by revising the final sentence to make clear that the physician (or other practitioner) directly supervising the auxiliary personnel need not be the same physician (or other practitioner) that is treating the patient more broadly, and adding a sentence to specify that only the physician (or other practitioner) that supervises the auxiliary personnel that provide incident to services may bill Medicare Part B for those incident to services.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R3423CP.pdf

Policy experts we have consulted with believe that this technical correction may be the last from CMS on this issue until the Physician Fee Schedule proposed rule for 2020, followed by the Physician Fee Schedule Final Rule expected in Nov. 2019, with effect taking place January 1, 2020.

For a more rapid change We urge you to contact CMS, and your legislators, industry groups, trade organizations and other influencers to advocate for an immediate additional change:

CPT code 99457 may be furnished by auxiliary personnel, incident to the general supervision of the billing practitioner’s professional services.

Below are talking points compiled by several RPM experts, and we urge you to utilize them:

Advocacy for General Supervision Model for RPM Code 99457

1.          Thank you for issuing the technical correction authorizing auxiliary personnel and “incident to” billing for RPM CPT code 99457 under the 2019 Physician Fee Schedule.

2.          Of note, the technical correction does not address requirements for supervision (i.e. general versus direct supervision).

3.          Without this clarifying language, RPM services will be held to the default requirement for direct supervision.

4.          Requiring direct supervision will inhibit many organizations (clinics and hospital-based programs) from adopting and expanding RPM programs because in many cases the supervising/billing healthcare practitioner and clinical staff will not be co-located. 

5.          Therefore, the direct supervision model will create disincentives to adopt RPM because these organizations will not be able to bill using CPT code 99457, negating the significant opportunities for patients to benefit.

6.          Furthermore, a direct supervision model for RPM has never been required over the 22-year history of RPM (first implemented under home health) nor is direct supervision needed for this care delivery model.

7.          With RPM, there are physiologic data sets and/or alert parameters that are set by the clinic’s physician and workflows for validating alerts, conducting a nursing assessment and escalating validated useful, actionable data to the provider to determine the need for medical intervention.

8.           Clinical models utilizing RNs and other auxiliary staff do not need to be in the same location as the billing provider to effectively monitor and escalate a medical situation when required.

9.           We respectfully request CMS clarify that CPT code 99457 is allowed to be billed incident to the general supervision of the billing provider.  This policy will create incentives to adopt RPM, bringing better patient care to the Medicare population.

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FTInsights: 2018 – Takeoff time for Remote Patient Monitoring?

Everyone buys the promise of remote patient monitoring. But healthcare providers keep asking, who’s going to pay for it? Increasingly, we’re seeing the answer: insurers, starting with CMS, the big daddy of them all. Eric Rock, founder and CEO of Vivify Health, one of the largest remote care platforms, and I talk about the evolving payment structures, what they mean for RPM and overall health. And why 2018 could be a breakout year for RPM.

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Vivify Health is transforming healthcare with the market’s most comprehensive patient-centered connected care platform, spanning from remote monitoring of high-risk patients and patient activation to population and employee health. Vivify’s platform is the digital pathway to collaborative care on demand — with a focus on ease of use for employees, members, patients and providers.

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