The pandemic forced the medical community to find new ways to deliver services to vulnerable populations. Social distancing and mask wearing provided a level of protection for patients, but time spent in waiting rooms or riding in public transportation enhanced the risk of being exposed to the virus.

The medical industry responded by reducing in-patient visits whenever possible. Annual physicals and preventive examinations were deferred. Doctors increasingly relied on telehealth technology to deliver services to their patients without requiring an office visit. Telehealth services combine telephone or video interviews with technologies that allow doctors to manage a patient’s healthcare from a distance. 

By April 2020, the number of in-person visits to doctors had declined by 60%. Notwithstanding that decline, studies found that reliance on telehealth improved the delivery of healthcare services to patients during the pandemic. A recent survey confirmed that Medicare patients are among the most frequent recipients of telehealth services.

While the widespread availability of COVID-19 vaccines reduces the risk of in-person visits with doctors, the healthcare community is not ready to abandon telehealth services. Rather, the government has taken steps to encourage the use of technology for remote monitoring of older patients.

Remote Patient Monitoring

Remote patient monitoring is a form of telehealth. Doctors provide patients with medical devices that they can use in their own homes. The patients operate the equipment by themselves or with the help of caregivers. During video conferences with a physician or nurse, the patient transmits data recorded by a device. Medical staff can thus monitor the patient’s condition in real time.

The devices commonly record the patient’s current weight and measure certain vital signs, including:

• pulse rate
• blood pressure
• glucose level
• blood oxygen level
• respiratory flow rate

More sophisticated devices that might require more patient training include:

• portable ECG devices
• anticoagulation blood testing devices 
• devices that monitor apnea while a patient sleeps

Medicare recently started reimbursing physicians and their staffs for remote patient monitoring. While doctors realized during (and even before) the pandemic that the time for remote patient monitoring had arrived, they were understandably reluctant to adopt new treatment methods for which they would not be paid.

Initially, the Centers for Medicare & Medicaid Services (CMS) established billing codes that allow reimbursement for the remote collection of certain data, including blood pressure, pulse oximetry, and respiratory flow rate. Billing codes are the 5-digit numbers that appear after the physician’s description of each service rendered. Physicians only receive Medicare reimbursement for services that have a CMS-approved billing code. 

One billing code governed reimbursement for an initial remote meeting with a patient to explain how to use the equipment. Physicians were authorized to use a second billing code once a month to cover the physician’s cost of acquiring the equipment and the time spent reviewing the results. Patients must record their vital signs and transmit the data at least 16 times each month before the physician can bill CMS. Additional billing codes cover each 20-minute increment of time during which a physician or care manager has a remote meeting with the patient to discuss healthcare management based on the collected data.

Medicare Expands Telehealth Reimbursement in 2022

The remote monitoring program reduces costs for physicians who do not need to meet with patients in person. It also improves the delivery of healthcare by making it easier for patients to meet with doctors and their staff members. Older patients are more likely to monitor symptoms and vital signs if they can do so from the comfort of their homes. Patients who live in rural areas have been particularly likely to take advantage of telehealth services.

Recognizing the success of the remote monitoring program, CMS expanded the remote services for which it will pay physicians. Staring in 2022, CMS began to pay physicians for a broader range of remote therapeutic monitoring. The new rules offer reimbursement for monitoring of respiratory and musculoskeletal conditions. For example, a patient with asthma might use a smart inhaler that records and transmits data about the number of times the patient used the device, the number of puffs or doses administered each time, and environmental conditions (such as pollen count) that exist when the patient uses the device.

The new rules also allow physicians to be reimbursed for time they spend reviewing patient-reported data that can’t be recorded by a device, such as pain levels and reactions to medication. They also broaden the range of staff members (such as nurses and physical therapists) whose time can be included in Medicare reimbursements.

The telehealth trend is shifting billions of dollars spent on healthcare from in-person services to virtual healthcare delivery. As patients become more comfortable with telehealth services, Medicare may expand reimbursement to more services that are not presently eligible for reimbursement, including common conditions (such as skin irritations) that can often be diagnosed without an office visit.