New codes create reimbursement opportunities in remote therapeutic monitoring (RTM).

Digital health tools are transforming healthcare, making it more affordable and accessible for those who need it. The Centers for Medicare and Medicaid Services (CMS) recently approved reimbursements for remote therapeutic monitoring, which is catapulting telehealth services forward starting Jan. 1, 2022.

But not only is there financial backing for expanded digital care to help members monitor their health, but new studies show that these services offer incredible value in improving health outcomes and member engagement. 

Remote therapeutic monitoring (RTM) empowers clinicians to provide greater care and oversight of members than ever before because it allows members to self-report data about how and when they take medication, what therapies they are engaging with, how they are feeling and more. This allows room for telehealth services for mental health, chronic care management, diabetes, and much more. 

Learn more about what RTM is, how it differs from remote physiological monitoring, the benefits of RTM, and how to get started treating members and billing for RTM. 

What Are Some Use Cases for RTM?
RTM expands digital care options and helps members manage the day-to-day needs of their healthcare. For example, it allows for members to record and narrate how they are taking medications, such as an inhaler to treat asthma. Now doctors can monitor not just adherence to a medication schedule, but adherence to proper use and administering the medication to reduce errors.

Telehealth and diabetes management are nothing new. But before RTM, clinicians only saw daily glucose readings with no background information on what might be driving those numbers. With member self-reporting data like exercise and mental health, clinicians can see the behaviors that lead to those numbers.

RTM expands the options for digital care to additional treatments, such as:

  • Monitoring and improving medication adherence
  • Virtual physical therapy
  • Closer diabetes management
  • Capturing mood related to mental health treatment
  • Pain management
  • Respiratory care

RTM versus RPM 
Remote care for ongoing conditions and treatments is still fairly new. In 2019, CMS approved remote physiologic monitoring (RPM) reimbursements to pay for clinicians’ time in reviewing medical device reports and readings for a member’s temperature, blood pressure, glucose, etc. These readings would help care providers know whether a member was following a care plan and managing their conditions accordingly. 

Ultimately, RPM is focused on specific aspects of member care and doesn’t account for care of the whole person, including mental health, adherence to plans, taking medication, etc. 

Remote therapeutic monitoring aims to change that and expand the care that a clinician can provide remotely, which can improve relationships between the member and the care provider as well as reducing hospital readmissions.

Instead of focusing on physiological data, RTM provides greater flexibility in remote care, allowing members to provide additional information, including self-reported data. Now members can show when and how they took a medication or report that they completed physical therapy exercises. 

members can share their perception of how they are feeling in relation to their treatment plans. After taking medication, they can state pain levels to help a doctor adjust medication to meet member needs. 

Remote Therapeutic Monitoring Benefits
The benefits of RTM are numerous and impactful for the member, clinician and the healthcare system as a whole. Here’s a look at what you might experience when adding RTM to your care options.

  • Higher member engagement: members can now get answers to questions quickly and receive feedback on how well they are caring for their health. For example, instead of blindly doing exercises with poor technique, telehealth physical therapy engages the member and ensures they complete the activities with greater accuracy.
  • Improved member outcomes: New England Health Institute found that RTM can prevent approximately 460,000 to 627,000 heart-failure-related hospital admissions per year.
  • Reduction in medical costs: Improving care and offering members more oversight between visits is helping reduce hospital admissions and prevent severe health events. It could equate to cost savings of $6.4 billion annually.
  • Greater quality in care: Because healthcare providers oversee a member’s care more often than twice-a-year office visits, they can better assess and diagnose the member’s conditions.
  • Increases access to care, especially in underserved populations: Due to clinician shortages, about 120 million Americans live in areas where they have limited access to the healthcare they need. Allowing for more telehealth services offers care for those in underserved populations.

CMS Digital Health Reimbursement Guidance
One of the greatest strengths of RTM is the fact that more healthcare professionals can now bill for digital services since RTM codes fall under general medicine unlike RPM codes, which were categorized as evaluation and management codes.

In addition to physicians, practitioners and physicians assistants, the following healthcare providers can bill using the new RTM codes and monitor members remotely.

  • Licensed clinical social workers
  • Nutrition professionals
  • Occupational therapists
  • Physical therapists
  • Psychologists
  • And more

Take some time to familiarize yourself with the new codes and their uses as you look to engage members using RTM. 

Start building communication bridges between you and your members with AMC Health as your partner. Our telehealth tools help you monitor and care for members at a distance to continue providing care and improving outcomes. Schedule a time with our experts today to see how easy the tools and technology are to use for both you and your members.

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