For the twelfth time in nearly three years, the U.S. Department of Health & Human Services (HHS) extended the public health emergency (PHE) due to COVID-19. The latest extension is good until April 11, 2023. This article provides updates on the PHE extension and what it means for remote patient monitoring and telehealth now and in the post-pandemic future.
PHE Extends Flexible Guidelines For RPM
Remote patient monitoring (RPM) is a digital health solution that captures and records patient physiologic data outside of a traditional healthcare environment. COVID-19 increased the adoption of remote patient monitoring nationwide, showing that quality healthcare can be accessible, safe, and efficient outside of conventional clinic settings.
Telehealth and remote patient monitoring have their own Medicare reimbursement requirements. The PHE extension provides flexible guidelines that make it easier for health organizations to adopt telehealth and remote patient monitoring, recruit patients, and maintain safety protocols. Though, it’s important to emphasize that PHE changes are temporary and only approved for the duration of the pandemic.
Continued updates to RPM guidelines in response to COVID-19 include the following:
1. Option to Waive Copays
Due to the PHE, one beneficial change to RPM guidelines is that providers may waive patient copays. The 20% copay was a barrier to adopting remote patient monitoring because many patients did not fully understand what RPM was or did not want to pay an additional fee. The update allows clinicians to waive copays to recruit more patients, allowing patients to experience the benefits of remote patient monitoring for themselves. More patients are inclined to opt-in for RPM services if the copay is waived.
2. New Patient In-Person Consult for RPM No Longer Required
Another update to remote patient monitoring requirements during the PHE is that new patients who have not seen their physician within the last 12 months can opt-in remotely.
This is especially helpful for at-risk patients who do not feel safe leaving their homes. Remote opt-in also reduces in-person patient traffic in healthcare settings, which promotes safe social distancing and minimizes wait times.
3. Remote Patient Monitoring for Acute Conditions
Before COVID-19, RPM was often viewed as a way for patients with chronic conditions to manage their symptoms or monitor patients following hospitalization. The reality is that many symptoms and conditions can be tracked with remote patient monitoring. To that end, the pandemic highlighted the fact that RPM assists in the management of acute conditions.
Patients that have or are suspected of having COVID-19 may show mild symptoms yet may not require hospitalization. With RPM, patients can measure vital signs like body temperature, lung capacity, and oxygen saturation levels from home. If a measurement is concerning, the remote patient monitoring platform automatically alerts the clinician for quick action, resulting in reduced hospital traffic. Patients feel more confident knowing that they are being regularly monitored.
4. 2-Days of Monitoring Extended For COVID-19 Patients
During the public health emergency (PHE), CMS requires RPM services to be used for at least 16 days but no less than 2 days. When billing for CPT codes 99453 and 99454 in RPM, it is important to note that it is incorrect to apply the “2-day RPM requirement” to all patients even during the PHE.
CMS states that the 2-day RPM requirement permits providers to deliver and bill for RPM services only when patients have suspected or confirmed cases of COVID-19. Providers must otherwise adhere to the “16-day RPM requirement” when billing for CPT codes 99453 and 99454.
PHE Extends Flexible Guidelines For Telehealth
Telehealth, also known as telemedicine, allows health care providers to offer virtual care for patients without an in-person office visit. Virtual care visits generally occur online via a digital device such as a computer, tablet, or smartphone. According to the CDC, roughly 37% of adults used telemedicine in the past 12 months.
The following flexibilities for telehealth remain in place due to the PHE extension:
- Originating Site: Medicare beneficiaries can receive telehealth services from any geographic location, including their home.
- Expansion of Eligible Practitioners: physical therapists, occupational therapists, speech therapists, and audiologists can provide telehealth services to Medicare beneficiaries.
- Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs): FQHCs and RHCs may provide telehealth services.
- In-Person Requirement for Mental Health: waives the requirement for mental health providers to meet patients in-person before providing behavioral health services through telehealth.
- Audio-Only: Medicare may cover audio-only services when deemed appropriate.
- Acute Hospital Care at Home (AHCaH) Initiative: CMS Medicare acute hospital care at home waivers and flexibilities are extended. Over 260 currently participate in the AHCaH initiative.
- Hospice Recertification: Healthcare providers may use telehealth services to meet hospice face-to-face recertification requirements.
Beyond COVID-Era Telehealth & RPM Proposed Legislation
The COVID-19 public health emergency spotlighted the value of remote patient monitoring and telehealth, accelerating their growth. Though, ending the PHE will end the telehealth excepted benefit status. HHS promises to give healthcare providers 60 days’ notice before the public health emergency ends. What happens after that time is still unknown. The latest PHE extension allows officials more time to define which flexibilities in the extension for telehealth and RPM may become permanent.
Different from the COVID-19 PHE extension, the U.S. House of Representatives passed legislation on July 27, 2022, to extend remote patient monitoring and telehealth billing flexibilities through the end of 2024. The legislation now awaits Senate review before it moves on to President Biden for final approval. If the legislation is passed, it will remove considerable barriers to Medicare telehealth reimbursement, at least through December 2024.
The Advancing Telehealth Beyond COVID-19 Act calls to extend coverage of telehealth services beyond the COVID era. Passage of the Act would ensure patients nationwide benefit from increased access to virtual health care. Telehealth and RPM have earned broad bipartisan support in both governments and among Americans.
Today, telehealth and remote patient monitoring technologies continue growing in need among providers and patients beyond the needs of the PHE. Healthcare organizations and government proponents of telehealth believe it is unlikely that regulations will revert to exactly as they were before the public health emergency.
Tenovi Remote Patient Monitoring
Tenovi works exclusively with companies that would like to offer remote patient monitoring solutions to healthcare providers. The companies we serve include:
- RPM Service Companies
- RPM Software Companies
- Chronic Care Management Companies
- Telehealth Companies
Tenovi is committed to enhancing preventive patient care and simplifying the process of managing patient data. Our easy-to-use FDA-cleared devices help optimize care for patients with chronic care conditions such as heart disease, COPD, diabetes, kidney disease, and hypertension. Schedule your free demo and consultation today.
