How This Early Adopter Leverages, Bills for Remote Therapeutic Monitoring

Amid the staggering rise of virtual care during the COVID-19 pandemic, federal agencies were tasked with classifying these new care modalities to ensure adequate reimbursement. In its 2022 Physician Fee Schedule, the Centers for Medicare & Medicaid Services (CMS) included a new category of CPT codes for remote therapeutic monitoring (RTM) services. While adding these codes has enabled wider adoption of remote care tools, getting paid for these services can be complex.

RTM generally refers to monitoring and collecting non-physiological data, as opposed to remote patient monitoring (RPM), which is used to monitor and collect physiologic data.

 According to CMS, RTM codes differ from RPM codes in a few ways, including "the nature of the data to be collected and how the data are collected." Examples of the data RTM can be used to monitor include musculoskeletal system status, respiratory system status, and therapy adherence and response.

Not only that, but RTM also requires higher levels of patient input than RPM, according to Ahmed Siddiqi, DO, a member of the Orthopedic Institute Brielle Orthopedics in New Jersey and an early adopter of RTM.

"RPM is more physiologic, so if [patients] have a Fitbit, they have an Apple Watch, it kind of collects their heart rate. It doesn't really require patient input," he said in a phone interview. "[With] RTM, they have to be completely engaged in their care. So, when they exercise, they log in [their activities], they log their pain scores, they watch videos. They're following their care plan. There's this input on their end, which kind of quantifies how much time they're spending."

Siddiqi implemented RTM services into his orthopedics practice about two years ago, enabling his team to more closely monitor patients and personalize their care. But a learning curve is associated with implementing and getting reimbursed for RTM services.

USING RTM IN AN ORTHOPEDICS PRACTICE

In Siddiqi's orthopedics practice, RTM occurs through an application that provides various preoperative and postoperative exercises.

Through the app, patients complete surveys and report outcomes post-exercise, which enables the care team to assess their pain and function levels before and after surgery. Patients also complete mental health surveys to determine their mental state pre-and post-procedures.

"All the things that we really care about after surgery and before surgery, we're able to quantify [through RTM]," Siddiqi said.

The app is accessible on a laptop, tablet, or smartphone. It also allows patients to connect virtually with the care team. Patients can send pictures, as well as video and group chat with their care team if they have questions.

Since RTM involves patient input and the use of new technology, Siddiqi offers patient education through classes.

"This whole encompassing package is what RTM is all about because what it really does is it basically makes patients and the care team really engage on a two-way street," he said.

Thus far, the RTM platform has proved its value. According to Siddiqi, it has not only boosted patient satisfaction but also increased patient volume.

KEY CONSIDERATIONS FOR RTM REIMBURSEMENT

With RTM reimbursement, the devil is in the details.

CMS has specific requirements for billing for RTM, including regulations around the number of days per month patients must use a specific platform for the service to be reimbursable. Thus, providers must first familiarize themselves with the RTM codes and their descriptions.

Siddiqi uses CMS' website to understand the codes and match the service provided to the correct code. He also adds information about the platform being used.

Initially, he and his team kept all this billing information in Excel file formats.

"But now, a lot of these platforms, they kind of collect that data and that time spent on the back end of it," he said. "So, it's a lot easier. They may just give you reports for this month [and tell you that] X, Y, and Z patients are eligible for the billing."

While this has made the process of getting reimbursed for RTM much easier, Siddiqi has learned some critical lessons over the years. These include ensuring patients receiving RTM services are eligible and having supporting documentation on hand.

"When we do bill it out, I do put in information about what platform I use and what information it is collecting," he said. "So, there's a lot of information on the front end that we're submitting. It's not like we're just sending these codes blindly without any supporting documents."

Following Medicare's lead, many commercial health insurance plans are also reimbursing for RTM services. But while Medicare pays for 100 percent of the services, commercial payers "reimburse whatever they feel is necessary or if they see fit," Siddiqi said.

While Siddiqi hasn't had many denials from payers, among the few he has experienced were a request for more information and a commercial payer saying the services are too experimental.

"But I honestly haven't had many denials — a lot more pending, more than anything else. So, I think the next level is to do a deeper dive in terms of these denials," he said.  

WHAT'S AHEAD FOR RTM

Siddiqi believes that RTM's popularity will grow, in part because it enables clinicians to give patients their undivided attention while virtually managing them, which could boost volumes.

"I think a lot of it is intangible," he said. "I think surgeons will realize as they have their team and their teams are evolving, they'll be able to use this platform, or any platform for that matter, to manage patients a little bit better, which will indirectly increase the number of patients they're able to see in the office."

Siddiqi also noted that more payers will get on board once the benefits of RTM become apparent. RTM can reduce overall expenditures in the postoperative period, as it can help patients avoid readmissions, unplanned emergency room visits, or urgent care visits, he stated. So, as providers increasingly offer and bill for RTM services, payers may see those cost savings reflected.

Thus, as the clinical and reimbursement model is proven out, Siddiqi expects to see the adoption of RTM grow.  

"Being on the early adopter side of things, I think this is very exciting because I can see in five years most of our society and our conferences are going to focus on different ways to maximize this," he said. "So, I think this is the wave of the future, and getting a glimpse of this early on is just definitely special."