How to Enhance Patient Care and Practice Revenue with Virtual Care Services

The healthcare landscape is undergoing a transformative shift, driven by advancements in technology and an increasing demand for accessible, patient-centered care. Virtual care services have emerged as a game-changer, providing healthcare providers with innovative tools to enhance patient care and increase practice revenue. With an estimated 133 million Americans suffering from one or more chronic health condition, Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) have garnered significant attention for their ability to bridge the gap between patients and healthcare providers, offering continuous care and improved health outcomes.

CCM and RPM leverage the power of digital connectivity, enabling healthcare professionals to remotely monitor and engage with their patients in a more proactive and personalized manner. These services have the potential to revolutionize the way chronic conditions are managed, while simultaneously generating additional revenue streams for healthcare practices. By understanding the capabilities and advantages of these virtual care services, healthcare providers, like yourself, can harness the potential to deliver better care experiences and improve financial sustainability.

Chronic Care Management (CCM)

What is CCM?

CCM involves a comprehensive and coordinated approach to managing the care of patients with chronic conditions, such as diabetes, hypertension, heart disease, and Alzheimer’s. These diseases typically require ongoing care and attention to ensure that patients remain healthy and avoid complications. This involves a healthcare team working together to develop and implement a care plan that addresses the patient’s medical, social, and behavioral needs. Our CCM services aim to provide this care in a proactive and coordinated manner, utilizing technology to improve patient outcomes and reduce healthcare costs. These services can help your patients better manage their conditions, prevent complications, and improve their overall quality of life.

CCM Services

The goal of Chronic Care Management is to provide your patients with a team of dedicated health care professionals who can help them plan and stay on track for good health. At DAS, our CCM services include:

• Dedicated Care Team engaging with patients and explaining the CCM program in detail
• Consistent Care Plans integrated into EHR
• Accelerated Patient Enrollment
• Bi-lingual Care Coordinators (Spanish and Vietnamese)
• Protection from CMS Audits by meticulous time tracking, documentation, and reporting to ensure all services are fully compliant

Remote Patient Monitoring (RPM)

What is RPM?

Remote Patient Monitoring (RPM) involves the use of technology to monitor patients’ health remotely, often from their homes. RPM allows healthcare providers to monitor patients outside the clinical setting, which is significant for chronic disease management, improving healthcare access for elderly, rural areas, or patients with mobility issues. It can help patients stay connected with their healthcare team and receive timely interventions to prevent complications. This innovative approach to care has been growing in popularity in recent years, with a wide range of benefits for patients and healthcare providers alike.

Why RPM?

You may ask yourself, why Remote Patient Monitoring? It is estimated that 30 million US patients will use remote care tools by 2024. By providing continuous monitoring, real-time feedback, and personalized care, RPM can improve patient outcomes, reduce healthcare costs, and enhance the overall quality of care. As the healthcare industry continues to evolve, RPM is likely to become an increasingly critical component of patient-centered care.

Together, CCM and RPM can provide a more holistic approach to managing chronic conditions. By combining ongoing care management with remote monitoring, healthcare providers can identify potential issues early, adjust treatment plans as needed, and provide more personalized care for patients. This can lead to better outcomes and improved quality of life for patients with chronic conditions.

Billing with CCM and RPM

The costs of CCM and RPM are very clear when working with DAS. The processes for CCM and RPM billing are established seamlessly to work best with your practice’s needs.

CCM Billing Restrictions

• One patient, one provider
  • One practitioner per patient per month may bill for the service
  • This practitioner must only report either complex or non-complex CCM for a given patient for the month (not both)
• Program Overlap
  • Cannot bill for CCM services that overlap with other programs, such as CPC+
• Skilled nursing facilities
  • Cannot bill for services provided to SNF patients or hospital patients in Medicare Part A

Billing Codes

• 99490: Chronic care management services, at least 20 minutes of clinical staff time directed by a physician or other qualified health care professional
  • Most common billing code and can be used every month
  • As required by this code, a CCP for managing conditions is developed (establishing/monitoring/revising/implementing care for the first time)
  • Approximate reimbursement of $64
• G0506: Comprehensive Assessment and Care Planning
  • Patient enrollment in person by the practice
  • Systematic assessment and care planning personally performed by the billing provider
  • Billable one time per enrolled patient
  • Approximate reimbursement of $60

RPM Medicare Rules

• Medicare rules for RPM billing are challenging, but these rules should not be viewed as a barrier to provide important RPM services to patients
  • Practitioners should be familiar with and structure their service delivery models to meet Medicare’s requirements
• Medicare reimbursement for RPM shows great promise for improving patient care/outcomes that require continuous monitoring
• Since CMS introduced RPM, other payers (outside of Medicare and Medicare Advantage Plans) have begun to reimburse RPM services
  • Hence why now is an excellent time to register patients for RPM services

Billing Codes

• 99453: Remote Monitoring of physiologic parameters (weight, BP, pulse oximetry) initial; set-up and patient education on use of equipment
  • Billable one time per patient, set up and 16 days of data delivered on the first 30-day period
  • Approximate reimbursement of $19
• 99454: Remote Monitoring of physiologic parameters (weight, BP, pulse oximetry), patient device(s) supply with 16 days of data transmission each 30 days
  • Device supply with daily recording and alerts
  • Billed each 30 days, minimum of 16 days of monitoring
  • Approximate reimbursement of $55
• 99457: 20 minutes of monitoring and treatment management that includes interactive communication with the patient/caregiver during the calendar month
  • Billed each calendar month
  • Approximate reimbursement of $50

Both CCM and RPM aim to improve patient outcomes, reduce healthcare costs, and increase practice revenue by providing continuous, personalized care. These approaches can be integrated into existing healthcare systems and workflows to support the management of chronic conditions and promote proactive healthcare delivery. At DAS, our top priority is the success of your practice and your patients. If you are looking to add CCM and RPM systems in your practice, DAS can help with a seamless integration. Contact us today for a free consultation.