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    2018 payment outlook shows new opportunities, old challenges


    Remote monitoring

    The code for monitoring data from remote devices (CPT code 99091) is important for its link to chronic care management services, explains Gary Capistrant, MA, chief policy officer for the American Telemedicine Association. The inability to bill separately for analyzing data tied to chronic conditions such as blood pressure and glucose levels discouraged doctors from using the chronic care management code CMS created in 2015.

    “Now that they’re covering the monitoring part, it really makes the management code a lot more attractive,” Capistrant says. “If you team them up, you end up with about $100 per month for caring for a chronic care patient, and that’s without any kind of patient services being rendered or an office visit.

    “It’s a huge deal particularly with the number of Medicare beneficiaries with one or more chronic conditions,” he adds. “It will enable a lot more chronic care services to be rendered.”

    The new Rule also includes codes allowing doctors to bill several services provided via telemedicine that previously they could only bill for in face-to-face encounters, including health risk assessments, psychotherapy for patients in crisis situations, and determining a patient’s eligibility for low-dose computed tomography. 

    The codes are part of the agency’s growing recognition of telehealth’s potential for improving healthcare delivery, says Matthew Kremke, MBA, vice president for the American Osteopathic Information Association, the information technology and advocacy subsidiary of the American Osteopathic Association. 


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    “I think what they’re doing is understanding where the market is going and the need for telemedicine, especially when you’re looking at a senior population or patients who don’t have the ability to get to a physician’s office quickly,” Kremke says.


    Diabetes prevention

    Another possible source of additional revenue comes from the Rule’s implementation of the Medicare Diabetes Prevention Program (MDPP), which CMS describes as “a structured intervention with the goal of preventing progression to type 2 diabetes in individuals with an indication of pre-diabetes.” 

    The two-year MDPP consists of 16 intensive group training sessions over six months in dietary and behavioral change for weight control, followed by monthly maintenance sessions extending over 18 months, with the goal of participants achieving at least 5% weight loss.  can earn $645 for each patient who completes the program and achieves 5% weight loss, or $670 if the patient achieves 9% weight loss. (See box, “Payment fee schedule for Medicare Diabetes Prevention Program.”) The program takes effect April 1. 

    Kremke explains that MDPP is designed to encourage doctors to identify patients who are at risk for, or in the early stages of type 2 diabetes. “If you can diagnose a patient as being pre-diabetic or in the early stages of the disease and get them into the system early, the long-term outcomes are much better,” he says. The program will also reimburse suppliers—although at a lesser rate—for patients who attend the training sessions but are unable to achieve their weight loss goals. 

    Kremke adds that the MDPP addresses a long-standing complaint among doctors regarding a lack of sites to which they could refer diabetic patients for dietary and lifestyle education. And even where such services exist, insurance often doesn’t cover them. “By CMS authorizing this program they’re giving doctors a way to address the needs of such patients,” he says. 

    Next: MIPS reporting and reviewing payer contracts


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