Getting started

Single vendors are like the conglomerates of old. When a single company offers all the varied software and services themselves, they lose the advantage of being solely focused on delivering one core product or service. Single company solutions try to do it all in house and in the process cannot provide the excellence inherent in a best of breed solution. They may provide a “best of breed” excellence in one part of their offering, but very few companies outside of Apple can provide a single integrated solution of adequate excellence. For example - Does your existing EHR provide best in class functionality and service for all aspects of clinical, administrative, billing etc.? C24 provides the best of both worlds, with individual best of breed solutions that are pre-integrated to work seamlessly for the end customer.

Customers have been piecing together best of breed products and services to fill in specific gaps in all aspects of healthcare for decades. The challenge with this approach is that it is up to the customer to bridge the technical and workflow gaps between each best of breed product and service. This is a time consuming, expensive and frustrating process, both from the vendor, customer and end user perspective. We see a similar result in the EHR marketplace. With limited choices, customers are forced to adopt a single solution from a single vendor, as the lesser of two evils. Sacrificing best of breed functionality for removing the challenges inherent with disconnected vendors. C24 provides a better solution, by retaining the inherent value of best of breed by pre-integrating these solutions and providing a single federated solution for customers.

Telemedicine is more narrowly defined than telehealth. Telemedicine is the remote diagnosis and treatment of patients by means of telecommunications technology. An example of which would be the use of virtual video visits to diagnose and interact with a patient. Telehealth is a broader term that encompasses traditional telemedicine video visits and expands beyond “remote diagnosis and treatment” and into the broader “provision of healthcare remotely”. Traditional telemedicine technology like virtual video visits is a component of telehealth, but it also includes Remote Patient Monitoring (RPM), Chronic Care Management (CCM), Transitional Care Management (TCM), Medication Management, Personal Emergency Response, etc.?

○ A variety of healthcare providers can bill Medicare, Medicaid and/or Private Insurance depending on their roles. Some examples include: ■ Remote Patient Monitoring (RPM) Medicare - the usual provider physician can bill Medicare under four codes and under direct supervision for RPM. The patient must be diagnosed with at least one chronic disease. ■ Remote Patient Monitoring (RPM) Medicaid - this will vary from State to State, with some reimbursing and others working towards reimbursement. Each State will have different restrictions on providers, eligible chronic conditions covered, number of Medicaid patients covered, etc. The gold standard for Medicaid coverage is Texas. In Texas, both the referred home care agency and the usual provider physician can bill the state for monitoring the same diabetic and/or hypertensive patient. ■ Chronic Care Management (CCM) Medicare - a patient must have been diagnosed with two or more chronic conditions and a physician, clinical nurse specialist or nurse practitioner can bill for a variety of CCM or complex CCM codes.

Remote Patient Monitoring

CPT Code 99457 allows for reimbursement for time spent by the billing physician, a qualified healthcare professional (“QHCP”), or clinical staff. All practitioners must practice in accordance with applicable state law and scope of practice laws.

The code requires the physician, QHCP, or clinical staff to spend at least 20 minutes per calendar month providing RPM services to a particular patient in order to receive reimbursement.

Approximate reimbursement amounts for each of the codes are as follows: 99453: $18.77 one time per episode of care* 99454: $62.44 every month 99457: $51.61 every month 99458: $42.22 every month if applicable *NOTE: Amounts listed are approximate values only; reimbursement varies among MAC localities. Contact your local MAC to determine reimbursement amounts in your region.

The Remote Patient monitoring codes are not subject to the same restrictions that currently govern reimbursement of telehealth services under Medicare. Specifically, reimbursement for RPM services is not limited by geography to rural or medically underserved areas, nor is there any “originating site” requirement for RPM services. RPM services can be provided anywhere the patient is located, including at the patient’s home, or while out and about.

Private payers may reimburse for RPM services; however, they are not required to do so. It is important to note that private payers that do reimburse for RPM services may have different requirements for billing. Practitioners should check with the commercial payers in their region to determine whether services are reimbursable and what requirements must be met for billing.

Yes, for Medicare beneficiaries. As with other Medicare Part B services, RPM services are statutorily subject to a 20% beneficiary copay. With very limited exceptions, practices may not choose to waive the Medicare copay. Private payers may establish their own copays or may choose not to require a patient copay.

No. Practices should simply ensure that all requirements for each code are met (e.g. documenting patient consent for RPM services) and follow their current standard billing practices in submitting claims.

No. A practitioner may recommend RPM services for any patient whom s/he deems may benefit from some form of remote patient monitoring through improvements in care planning and treatments.

CPT Codes 99457 and 99091 are similar, but they differ in some important ways. CPT Code 99091 requires an aggregate of 30 minutes of time by a physician or QHCP during a 30-day time period, while CPT Code 99457 requires an aggregate of 20 minutes of time spent by clinical staff, physicians, or QHCPs during a calendar month. In addition, CPT Code 99457 requires live, interactive communication between the individual performing the services and the patient. A billing practitioner should carefully review the requirements for each and use his/her professional judgment to determine which code the provided services should fall under.

No. According to the CPT Code Manual, CPT Codes 99091 and 99457 cannot be billed for the same patient within 30 days of each other.

CMS does not set forth in the Final Rule a specific list of practitioners that are considered “Qualified Health Care Professionals” for purposes of these codes. The code descriptor for CPT Code 99091 references a qualified health care professional as “qualified by education, training, licensure/regulation (when applicable),” and this is the definition included in the American Medical Association’s CPT Manual. The AMA has indicated that the definition is drafted as intentionally broad so as to allow flexibility between payers, providers and regulatory agencies alike to determine the appropriate policies. When in doubt, consult your local Medicare Administrative Contractor (“MAC”).

CPT Code 99454 can only be billed once per patient each 30 days, regardless of whether the patient is using one device or multiple devices. Therefore, if a glucometer, a weight scale, and a blood pressure cuff are all provided to.

Chronic Care Management

The four CPT codes used to report CCM services are: 99490 non-complex CCM is a 20-minute timed service provided by clinical staff to coordinate care across providers and support patient accountability. 99487 complex CCM is a 60-minute timed services provided by clinical staff to substantially revise or establish comprehensive care plan that involves moderate- to high-complexity medical decision making. 99489 is each additional 30 minutes (cannot be billed with CPT code 99490) 99491 CCM services provided personally by a physician or other qualified health care professional for 30 minutes.

Physician Clinical nurse specialist (CNS) Nurse practitioner (NP) Physician assistant (PA) Certified nurse midwife Non-physicians must legally be authorized and qualified to provide CCM in the state in which the services are furnished.

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