Remote Patient Monitoring: An Opportunity for Consultant Pharmacists?

Effective January 1st, 2018, the Centers for Medicare and Medicaid Services will begin reimbursing for remote patient monitoring (RPM).

So, what is RPM?

For starters, NOT telehealth services, which is actually a good thing. While telehealth services do exist, they have several specifications that can make widespread use a little tricky.

So what about RPM?

RPM is the use of digital technology to collect health data from a patient that is then transmitted electronically and securely to a healthcare provider in another location for assessment and recommendation.

CMS is now going to reimburse providers for that assessment and recommendation portion, if it constitutes at least 30 minutes of provider time per month, using CPT 99091.

This means for those patients participating in home glucose or blood pressure monitoring, INR, and even potentially genetic reports, the provider now has the opportunity to receive approximately $60 per month for their time spent reviewing, assessing, and making recommendations regarding the patient’s care plan.

So what are the specifications?

Most notable is that CMS stated the service must be provided by the practitioner, not clinical staff.

For now, using this code means utilizing incident to billing.

Consent must be obtained and documented from the patient, and for all new patients or those that have not been seen within the last 12 months, they must have an initial visit.

The code can be billed once per month for each patient as long as the practitioner is receiving information electronically that impacts the patient’s care.

This opens another potential revenue stream for savvy Pharmapreneurs.

For pharmacists partnering with physicians to offer MTM or consulting services who meet the criteria for incident to billing, this is another service you can offer to your providers.

If you are already spending time reviewing medications and/or making adjustments to medications, most likely this service is an extension of what you are already doing.

​Before making a recommendation or an adjustment to a patient’s insulin regimen, you probably want to see the patient’s blood sugar logs.

If the patient is able to send them electronically, there’s an opportunity to utilize RPM.

If you are already using the chronic care management codes (CPT codes 99487, 99489, and 99490), RPM can be billed in conjunction with these.

As CMS moves towards innovation and expanded integration of technology, this means big opportunities to be on the forefront of this move forward.

Remote Patient Care Monitoring is the use of digital technology to collect health data from a patient that is then transmitted electronically and securely to a healthcare provider in another location for assessment and recommendation.

CPT Code 99091

The Center for Medicare and Medicaid Services (CMS) reimburses providers for that assessment and recommendation portion, if it constitutes at least 30 minutes of provider time per month.

Billing Criteria

The service must be provided by the practitioner, not clinical staff. So for now, using this code means utilizing incident to billing.

Consent must be obtained and documented from the patient, and for all new patients or those that have not been seen within the last 12 months, they must have an initial visit.

The code can be billed once per month for each patient as long as the practitioner is receiving information electronically that impacts the patient’s care. Information transmitted electronically must be transmitted in a protected manner.

Opportunities for Consultant Pharmacists

For pharmacists partnering with physicians to offer MTM or consulting services who meet the criteria for incident to billing, this is another service you can offer to your providers.

If you’re thinking diabetes management the first thing you should think of is blood sugar monitoring. Home blood sugar monitoring is necessary for most patients and something we ask for often.

This information could be transmitted electronically and the time you spend reviewing the information billed for using this code.

Additionally, if you partner with a provider to offer a diabetes prevention program or diabetes self-management training, electronic transmission of items such as patient weight and physical activity could also qualify for remote patient monitoring, giving you more bang for your time.

The next opportunity we’ll discuss is remote patient monitoring.

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