Telehealth and Remote Patient Monitoring
Telehealth, or health delivered remotely, has been around for decades. While the healthcare system has increasingly accepted and relied on remote care, progress and urgency have increased with developments such as the recent COVID-19 pandemic.
Nurse helplines and phone appointments with doctors are among the most familiar and earliest examples of telemedicine. More recent examples include ordering medical supplies and medications online, emailing your doctor, searching for health information on the internet, and, of course, using mobile apps such as Lark to manage chronic conditions.
Remote patient monitoring is an example of a telehealth solution that has so much potential value that the Centers for Medicare and Medicaid (CMS) are now covering it. It has its own CPT (Current Procedural Terminology) code, 99091, so healthcare professionals can bill specifically for time spent on it. With this support, digital solutions such as Lark can be even more valuable for healthcare professionals and patients alike as Lark facilitates remote patient monitoring while driving improved health outcomes.
COVID-19 and Expansion of Telemedicine
Predictions that the healthcare system would be overwhelmed by coronavirus patients led to goals of minimizing visits to hospitals and doctors’ offices. These are two possible ways.
- Improving chronic care management (CCM) so there are fewer complications and visits to hospitals and emergency rooms. Digital solutions, such as Lark for Hypertension and Lark for Diabetes, can support patient self-management of conditions so patients stay as healthy as possible.
- Switching to video appointments and other remote care options for patients who need to talk to a doctor, but who may be able to get the information and help they need by discussing it with a doctor over the internet instead of going into the clinic.
In response to the COVID-19 crisis, President Trump announced expanded Medicare telehealth coverage. Patients can now access care remotely through means such as online portals, email, video chats, and phone calls with doctors.
Introducing a distinct CPT code shows even more how important telemedicine is for the healthcare system now.
Significance of CPT Codes and 99091
The American Medical Association (AMA) establishes CPT codes to facilitate billing for services. The CPT code 99091 has been used since 2002, but only recently has the Current Procedural
Terminology Editorial Panel of the AMA has “unbundled” CPT code 99091 to allow for billing for “remote patient monitoring in the 2018 Medicare physician fee schedule.”
Hours that a doctor spends collecting and analyzing patient data now are reimbursable under CPT code 99091. Now, when doctors and qualified providers receive data from healthcare solutions such as Lark chronic care management programs, there is direct incentive to examine the information and figure out how to help patients.
Qualifying for CPT Code 99091 Reimbursement
As with any CPT code, CPT code 99091 claims must meet certain criteria to qualify for Medicare reimbursement.
- Data must be transmitted in real-time to the provider. Lark, for example, is able to send data such as patient blood glucose and blood pressure as soon as patients take measurements.
- Data must be patient-generated. In Lark, patient-generated data include not only blood pressure or blood sugar measurements, but also any weight measurements, foods, sleep data, and physical activity data that are recorded.
- Data must be digitally stored as health data. Lark is fully set up to comply with health data storage requirements.
- Patients must receive feedback digitally, such as via text message or email. Lark’s text-based interface offers instant feedback when users enter data manually or via automatic syncing from associated devices.
When their patients use Lark, doctors and other healthcare professionals can have access to increased amounts of data, leading both to increased reimbursement as well as the potential for increased understanding of patients’ chronic conditions and ability to manage them.
These are some additional requirements for CPT code 99091 reimbursement. For example, the data analysis must take at least 30 minutes and be done by a doctor or another “qualified health professional.” Patients must have a documented consent beforehand, which is to be maintained in their records. Billing can occur only once per cycle.
Remote Patient Monitoring and Chronic Care Management
“The Centers for Medicaid and Medicare Services (CMS) recognizes Chronic Care Management (CCM) as a critical component of primary care that contributes to better health and care for individuals.” Conditions that qualify include cancer, Alzheimer’s, arthritis, heart disease, and asthma, for example. Lark offers CCM for hypertension and diabetes.
CCM is intended to assist patients in managing their conditions through a comprehensive plan to assist patients. Components of CCM include developing an electronic care plan, coordinating care between providers, and helping connect patients to resources within their communities.
Furthering goals to improve patient self-management of their conditions, Lark programs can include:
- Referring patients to healthcare providers when needed, such as during a hypertensive crisis or during diabetic hyperglycemia.
- 24/7 availability for patients to get support.
- Instant feedback for behaviors such as logging food or activity or taking a blood sugar or blood pressure measurement.
- Personalized goals and coaching for weight loss and other health outcomes.
Remote patient monitoring can be an important asset in chronic care management (CCM). Patients who use Lark, for example, receive coaching in aspects of self-care that are proven to be effective. Elements of Lark coaching for diabetes and hypertension include the following.
- Reminders to measure blood sugar or pressure according to doctor recommendations, and to take medications as prescribed.
- Support for establishing physical activity goals and habits to improve management of diabetes or hypertension.
- Weight loss goal-setting, tracking, and coaching for overweight and obese patients.
- Condition-specific coaching to improve food choices to lower blood sugar (diabetes) or blood pressure (hypertension).
Infinitely Scalable and Proven Results
Lark’s fully digital health coaches have proven results. In one analysis, Lark Diabetes patients lowered glycated hemoglobin (A1C), which is a measure of glycemic control over the past few months, by an average of 1.3% in 3 months. Lark Hypertension patients reduced blood pressure by 8.4 mm Hg systolic and 6.4 mm Hg diastolic over 6 months.
Outcomes such as these have been linked to lower risk for expensive complications and complications, suggesting the possibility of cost savings for providers. Better patient outcomes, together with reimbursement for remote patient monitoring via CPT code 99091, may lead to increased profitability for providers along with improved patient health.
As a fully digital platform powered by artificial intelligence (AI), Lark is infinitely scalable, quickly and at cost. Connected devices gather patient data for real-time intervention and timely escalation, if needed, for continuity in care. Lark integrates into physician workflow to facilitate patient care and personalized care.
Lark can help providers and payers take full advantage of CPT code 99091 and the potential for reimbursement for remote patient care. With infinite scalability and seamless data collection, Lark can support increased personalization of care and additional revenue for providers without interruption.