Remote Patient Monitoring: Key Takeaways in the Proposed 2021 Physician Fee Schedule

The Centers for Medicare and Medicaid Services (CMS) recently released its proposed 2021 Medicare Physician Fee Schedule (PFS), addressing some questions about the status of temporary policy changes surrounding telehealth--including Remote Patient Monitoring-- that were made in light of the COVID-19 Public Health Emergency (PHE). CMS is soliciting public comments on the proposed rules until October 5, 2020.

Earlier this year, CMS issued an Interim Final Rule that granted broad flexibilities for payment and furnishing of telehealth services, with big wins for Remote Patient Monitoring. To recap, the interim final rule:

• Waived patient copays for RPM. During the PHE, the Office of the Inspector General (OIG) said that they would not penalize doctors for not collecting patient copays for telehealth services--including RPM.
• Enabled healthcare providers to offer RPM to new patients, not just established patients.
• Allowed for consent to be obtained at the time RPM services were furnished and allowed virtual patient consent--rather than face-to-face--for these services.
• Clarified that practitioners could furnish RPM services to patients with acute conditions as well as chronic conditions.
• Reduced from 16/30 to 2/30 minimum days per month that data must be collected and transmitted to meet billing requirements for CPT codes 99453 and 99454.

Which Temporary Flexibilities for Remote Patient Monitoring are Proposed as Permanent in the 2021 PFS?

In the proposed PFS for 2021, CMS is proposing which temporary flexibilities will remain permanent after the Public Health Emergency (PHE). Looking specifically at the list above, here’s what we know:

• Copays: It is unclear beyond the PHE whether doctors will be subject to penalties for not collecting copays for RPM services. It will likely take an act of Congress to permanently waive patient copays for telehealth services and cannot be addressed in the PFS.
• New and established patients: Following the PHE, CMS will again require that RPM only be furnished to established patients, rather than new ones.
• Patient consent: CMS is proposing that consent can be obtained at the time RPM services are furnished, even after the PHE.
• Acute and Chronic Conditions: CMS is clarifying that RPM services can be furnished both for patients with chronic conditions and acute conditions. This was a clarification not a temporary measure tied to the PHE.
• Minimum Days of Data Collection: CMS is proposing that following the PHE, data must again be collected and transmitted a minimum of 16/30 days per month, but are seeking comments on what other clinical situations might require shorter periods of data collection (i.e. temperature checks after surgery).

Additionally, CMS is proposing to make permanent that auxiliary personnel, including contractors, can furnish CPT codes 99453 and 99454 services under a physician’s supervision permanently. Finally, CMS is clarifying that “interactive communication” for purposes of CPT codes 99457 and 99458 involves, at a minimum, a real-time synchronous, two-way audio interaction that is capable of being enhanced with video or other kinds of data transmission.

Advocating for Better Healthcare Means Advocating For Better Healthcare Policy

At Rimidi, we know that proactive, continuous, virtual models of care like Remote Patient Monitoring are crucial for patients with chronic conditions -- especially the most vulnerable populations with barriers to in-person care beyond the COVID-19 pandemic. As members of the Connected Health Initiative, we will continue to advocate for policies that promote these models, including more value-based initiatives for Rural Health Centers and Federally Qualified Health Centers and permanently waiving cost-sharing for patients.