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CMS Proposes Amending Billing Regulations to Medicare Remote Patient Monitoring

By | Center for Connected Health Policy

The Centers for Medicare & Medicaid Services (CMS) has released a proposal rule which would provide a definition to remote patient monitoring (RPM) and amend regulations to allow home health associations (HHAs) to report RPM in administrative costs.  CMS’ logic in interpreting its various statutory obligations for payment that allows them to make this change are detailed in the rule.   They acknowledge from the outset that Medicare is prohibited from making payment for services furnished via a telecommunications system if the services could substitute for an in-person home health service.  However, no prohibition exists for furnishing payment if the service merely augments care, rather than substitutes for an in-person visit.  Furthermore, CMS explains that while a telecommunications system is defined under provisions of the Social Security Act that pertains to telehealth reimbursement as “two-way, real-time interactive communication”, no definition is provided as it relates to the provision of home health care.  Additionally, remote patient monitoring is not considered a Medicare telehealth service as currently defined by Medicare, as CMS has begun reimbursing for RPM code 99091 without applying the limitations and restrictions telehealth services are subject to in Medicare.  Therefore, CMS utilizes a similar definition of RPM as the one included for CPT code 99091 “the collection of physiologic data digitally stored and/or transmitted by the patient and/or caregiver to the HHA”.  Under this definition, RPM is not replacing but instead augmenting in-person care nor do the limitations to reimbursement for telehealth apply.  This interpretation allows CMS to accept RPM services as an administrative cost for HHAs, which can be factored into the costs per visit.

CMS is seeking comments on this and other proposed regulation as well as additional utilization of telecommunication technologies for future rulemaking by August 31, 2018.

For further details, the full document can be accessed in the Federal Register.