Telemedicine tracking can be reimbursed – here’s what you need to know

Since CMS released new CPT codes for telemedicine tracking last year, health systems have been eager to use them, but uncertain about the criteria. Providers are recognized for the time they spend connecting with patients outside of the office.

With the new CPT code, providers can be reimbursed for:

  • Teach patients how to use the remote care management platform.

  • Monitor platform alerts and patient usage of distance education.

  • Direct messaging to patients/providers within the platform.

  • Collect data through the platform, i.e. collect patient feedback on pain level, activity and movement.

To be eligible for a returnable RTM, providers need to use software that is considered a medical device by the FDA. Force Therapeutics, a provider of a digital care management platform, has just received such a title for its software.

We interviewed Bronwyn Spira, CEO and co-founder of Force Therapeutics, to learn about RTM and CPT codes to help healthcare organization CIOs and health IT leaders others understand this new way to get reimbursed for the cost of care.

Q. Providers can now be reimbursed for teaching patients how to use remote care management platforms. How do health care providers conduct this education?

ONE. A trend that has persisted in the wake of the pandemic is that healthcare providers and payers are finally adopting telemedicine. By releasing new CPT codes for telemedicine monitoring, CMS is trying to drive the behavioral changes it wants to see.

The ability to manage evidence-based, results-driven home care while enabling personalized and tailored care journeys for each patient – ​​rather than a one-size-fits-all approach fits all – is a game changer for service providers and patients.

And it makes high-quality, evidence-based care more accessible to all patients, including previously underserved populations due to barriers to access. care, such as income, insurance, language, mobility, transportation, and other factors.

When it comes to patient education and using musculoskeletal care (MSK) as an example, the traditional way to provide patient education for the entire phase of care, especially postoperative care , very discrete.

Usually, the care team will go through the instructions and give the patient a large pre-printed package. At discharge, the patient may be on medication, overwhelmed and anxious – not ideal for absorbing complex information. Now that telemedicine is an accepted and reimbursed method, healthcare providers have more tools to educate patients and track progress. their own effectively.

The use of a digital care management platform not only qualifies as software as a medical device (SAMD) but also provides seamless patient interaction and flexible care management capabilities. activity, is crucial for effective and efficient patient education.

This allows patients to access provider-assigned resources to them anytime, anywhere, and as often as they like. Educational content can be presented in a variety of ways to suit different learning styles and interests, making information easy to understand, understand and share with a spouse or partner other care at home.

Provide education in small pieces, using gamification techniques and integrating quizzes, all of which help patients absorb the information they need to fully participate in their own care plan, and achieve the best results.

Q. Now, tracking platform alerts and patient distance education usage is also on the cards. How do healthcare providers conduct this monitoring?

ONE. An important underlying point is that, from the CMS point of view, it is not enough just to provide knowledge and to-do lists to patients using the technology platform. It is important that the platform engages patients in their provider-assigned care plan to help patients achieve the same or better outcomes at home than in-person care. continue tradition.

Therefore, there must be a measurable, protective audit trail for all interactions with the plan of care. Medicare and other payers will ask for that proof, both to track outcome data and to prevent misuse of the new reimbursement codes.

Another important factor is that technology-based care management shouldn’t create extra work for providers – it needs to be well integrated into their workflow. Traditionally, remote monitoring has been done by phone calls and face-to-face meetings.

In virtual care, interactions still need to be meaningful, measurable, and well documented. With parameters for meaningful touchpoints defined by CMS, vendors can work with their platform to configure efficient workflows and even incorporate automation for manual task.

From a patient perspective, a digital care management platform should be easy to use and convenient as it tracks and measures patient engagement. When patients log in, the platform automatically tracks the time they spend, the activities they participate in, the tasks and assignments they complete, as well as their answers to questions about pain, severity, and pain. operation, range of motion, etc.

As the data returns to the provider, they can be alerted if patients go astray or report pain or other symptoms that need attention. All these factors are combined to deliver better patient outcomes and higher patient satisfaction.

Virtual care has been shown in numerous studies to achieve similar – or better – care outcomes. For example, a one-year retrospective analysis of a health system that implemented the full MSK digital care management platform showed readmission rates for all arthroplasty, not dependent on the change of surgeon, has decreased by more than 26% year-over-year.

Q. Up to reimbursement: direct messaging to patients/providers in one platform. How do vendor organizations handle this message?

ONE. Two things are important when texting patient-providers. First, all messages should be between the patient and their own care team. Health information is not generic, can be used immediately or outsourced to the call center.

Each patient has different needs, different comorbidities, and different support structures at home, so the message regarding diagnosis, surgery, and follow-up care should be individualized by their provider. individualized for each patient.

Second, messaging operations must be consistent with the provider’s workflow. In today’s environment with labor shortages and clinician burnout, providers simply cannot find time for new operations.

Instead, we need to scale up care delivery, making it easier and more affordable for clinicians. A digital care management platform needs to help communicate with patients effectively and efficiently, so each member of the care team contributes appropriately to guiding the patient to the best outcome. .

For example, a platform can be configured to accommodate the workflows of different clinicians, such as physicians, physiotherapists, nurses, care navigators, The platform can intelligently alert the appropriate care team member if an intervention is needed, such as if they report unexpected pain or symptoms of infection.

Additionally, by providing prior education to patients, patients have a better understanding of what to expect during their recovery and when to contact their provider if things don’t work out. normal. This level of ongoing interaction benefits both the patient and the provider in achieving the desired outcome.

Q. Data collection through a platform – which collects patient feedback on pain levels, activity and movement – ​​is also reimbursed. How do service providers manage this type of collection?

ONE. As I mentioned, to be eligible for an RTM refund, the platform a supplier uses must be deemed SAMD by the Food and Drug Administration. With many devices commonly used today to monitor patients remotely, such as watches and fitness trackers, it is unrealistic to expect all patients to have the same device or to ask for a home. provides multi-port access to view patient data based on the device they are using.

Therefore, a digital care management platform needs to combine all pertinent data points (activity, pain, affective, functional outcomes) to create a holistic view of the patient and their stages of care.

Digital patient engagement and care management platforms must use a multi-channel approach, gathering information from emails, secure messages, text messages, and voice response calls. work to be effective.

The digital care guide needs to be accessible to all patients, regardless of their device or access to a computer, so that they can actively participate in the recovery process by reporting their progress and complete patient-reported outcome assessments, creating a clear understanding of their activity level, pain, medication use, swelling, and potential complications.

Clinicians can use real-time status updates to monitor patient progress and identify patients in need of intervention or support. Additionally, digital care management platforms provide a means for patients to interact directly with their care team instead of seeking care elsewhere or going to the emergency room.

Combining lots of patient data with ongoing interaction creates a continuous feedback loop so care teams can tailor care plans to meet patient needs at each step. Some patients will need very little personal help, leaving time for patients who may need more help.

As we move into this new year, the ability to be reimbursed for elements of telecare delivery will encourage the use of digital care management technology. Providers will be able to provide personalized care to a wider range of patients, and more patients will have access to the care they need to improve their health.

Follow Bill’s HIT coverage on LinkedIn: Bill Siwicki
Email the writer: [email protected]
Healthcare IT News is a publication of HIMSS Media.


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