InSights 

Remote Patient Monitoring on the March: More than a Remote Possibility

We open with a piece on remote patient monitoring (RPM) because, according to a new report by the Peterson Center on Healthcare/the Peterson Health Technology Institute, it’s a growing facet of healthcare. 

The report shows a significant rise in RPM use by Medicare beneficiaries from 2019 to 2023. What’s “significant?” How about a tenfold increase from 44,500 traditional Medicare patients using RPM in 2019 to 451,000 in 2023! And Medicare Advantage patients also account for an increase, from 20,400 in 2019 to over 160,000 in 2021.

If you’re surprised, don’t be, because RPM makes it easy for patients to have an array of vitals monitored without them having to travel to their physicians’ offices to do so. Of course, that’s especially appealing to Medicare patients who may have a variety of mobility issues. Truth be told, RPM is great even for patients who don’t have mobility issues because it’s also extremely convenient when their vitals can be monitored from home or any remote location.

Your resources aren’t taxed either when RPM is made available and utilized. It eliminates patients in the reception area, and the in-house staff typically needs to accommodate those patients from intake to encounter to exit.

Medicare and a growing number of commercial payers pay for remote vitals readings, assuming you or your RCM company know how to create and code those claims correctly.

Quite possibly, RPM is the ultimate offering for patient engagement, perhaps followed only by telehealth. When combining RPM with telehealth, consider how you’d be able to conduct virtual encounters and monitor patients’ vitals, all without them needing to come to you, and with you being paid for both.

Either capability can help you be accessible to your patients. Both will increase your accessibility and patient engagement exponentially.

Based on the numbers, deploying an RPM option would make things easier for your patients and you.

(ADSRCM supports an RPM option at no cost to you or your patients for the hardware, training, or support, as well as our Medics telehealth app for virtual encounters. Beyond that, our team is experienced in RPM and telehealth claims and reimbursements. If in-house automation is preferred, the RPM option and telemedicine app are also available with the MedicsCloud Suite from ADS.)

Click here for the Peterson report.

Digital Health in Underserved Counties

Reinforcing the previous article about RPM and telemedicine, JAMA has issued a report on a recent survey showing that the use of digital health services was higher in US counties with more social vulnerability, which portends positively for underserved populations.

Using rounded-up numbers, of the almost 5,500 participants surveyed, 53% were female, 15% were Black, 15% were Hispanic or Latino, and 65% were White. About half said they used telehealth (defined as an appointment with a clinician by video or phone); about 30% used telemedicine (defined as receiving remote counseling or remotely supervised training or therapy from a clinician online or by telephone), and 16% used telemonitoring (RPM) described as being remotely monitored by a clinician via a device.

Click here for the JAMA report.

Prior Authorizations

Payers seek prior authorizations (PAs) to ensure that whatever procedures or services are requested or performed are medically necessary. If you want to say “fair enough,” that's fine. But have PAs now become an excuse not to pay (deny) reimbursements? Let’s say that sentiment is out there.

Regardless of validity, PAs remain the bane of virtually any healthcare setting. In fact, Kaiser Family Foundation (KFF) reported as recently as this past January that essentially all (99%) Medicare Advantage Plan (MAP) enrollees are required to obtain PAs for higher-cost services such as inpatient hospital and skilled nursing stays and chemotherapy.

What does 99% mean? The report noted that MAPs made almost 50 million PA determinations in 2023, up from 42 million in 2022 and 37 million in 2021. Stating the obvious, PAs “trending up” might be great for MAPS but not for you and your patients.

The news is a bit better regarding traditional Medicare, which often only requires PAs for certain outpatient services, non-emergency ambulance transport, and DME.

Click here for the KFF report with sub-links to details and specific procedures requiring PAs for Medicare and MAPs.

(Your time-consuming efforts to obtain PAs can be virtually eliminated with our automated PA option. Combined with (1) eligibility verifications on scheduling appointments and up to four times prior to arrivals, (2) pre-appointment out-of-network alerts, and (3) with access to our patient responsibility estimator, you’ll be “waterproofed” financially to the best extent possible by protecting your revenue in advance!)

Fraud-of-the-Month

April must go to one of the most famous names in pharmacies which has agreed to pay as much as $350 million for illegally filling unlawful opioid prescriptions and for submitting false claims to the federal government as investigated by the Justice Department, DEA, and HHS.

The complaint states that from 2012 to 2023, the entity knowingly filled millions of prescriptions for controlled substances despite their pharmacists seeing “red flags” indicating the prescriptions were invalid since they lacked legitimate medical purpose or “weren’t issued in the usual course of professional practice.” It was alleged that the company pressured its pharmacists to fill prescriptions quickly without ensuring their validity.

Click here for the Justice Department press release and details.

Advanced Practice Practitioners and Indirect Billing

They might sound like strange bedfellows, but advanced practice practitioners (APPs) and indirect billing are a thing.

We will explain but first, who are APPs? They’re nurse practitioners (NPs), physician assistants (PAs), certified nurse midwives (CNMs), certified registered nurse anesthetists (CRNAs). In short, within their specialties, APPs can/do very much play a role in patient care, supplementing the care provided by MDs and DOs, especially now as we experience a clinician shortage problem. APPs may also be referred to as advanced practice clinicians (APCs).

How does indirect billing fit in? Indirect billing vis-a-vis Medicare is common for office-based encounters. In a recent JAMA report, indirect APP/APC billing was billed, and 39% of all office encounters were indirectly billed, which indicates services provided by an APP/APC rather than an MD or a DO.

APPs/APCs can bill Medicare directly with their own NPIs or indirectly as incidental to an MD or DO. When billed indirectly, Medicare typically reimburses 85% vs. reimbursing an MD/DO directly. The report shows that APPs/APCs are increasingly providing patient care.

Click here for more on the topic from AMN Healthcare.

(Regardless of whether your claims involve APPs/APCs, MDs, DOs, or DPMs, the ADSRCM team knows how to maximize those claims for their highest possible reimbursement value!)