November 2019 ~

Under the 2020 Physician Fee Schedule (PFS) final rule, hospitals and health systems will see an expanded reimbursement plateau and have greater opportunities to use remote patient monitoring.

These changes come as part of a package of mHealth and telehealth amendments, proposed this past August for the 2020 PFS, which were designed to expand opportunities to use connected health services for came management and coordination.

Originally CMS mandated that RPM services couldn’t be delivered incident to the physician’s service. But later allowed some incident to reimbursement by certain members of the care team under the direct supervision of the physician.

Under the final rule on Chronic Care Remote Physiologic Monitoring (RPM), CMS has expanded the reimbursement plateau for RPM services delivered “incident to” general supervision and has added code 99458 for patients receiving an additional 20 minutes of mHealth services in a given month.

An “incident to” service is defined by CMS as a service performed under the supervision of a qualified healthcare professional and billed to Medicare in the name of that professional, subject to certain requirements. The “incident to” revision aims to expand RPM reimbursement by allowing more providers and business models to use the technology.

Also under the rule, CMS clarified its position that RPM is already included in the all-inclusive rates paid to Rural Health Clinics (RHCs) and Federally-Qualified Health Centers (FQHCs), and that therefore RPM is not separately billable by RHCs and FQHCs.

Source(s): mHealthIntelligence; Foley & Lardner LLP; McDonald Hopkins LLC;