Reimbursement rules make remote monitoring feasible for patients with rheumatic diseases
New reimbursement rules may allow rheumatologists to use digital tools and remote monitoring to improve patient care, according to a presenter at the 2023 AWIR annual conference.
“This is, of course, the most overhyped thing that we have in medicine these days — artificial intelligence, with machine learning being one of the forms of AI,” Jeffrey Curtis, MD, MS, MPH, of the University of Alabama at Birmingham, told attendees during the hybrid meeting. “It is going to solve the world, it’s magic, but let’s motivate. Why do we need any of this stuff?”
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To give an example of the potential uses of AI in medicine, Curtis recounted an anecdote in which a patient with rheumatoid arthritis failed to receive the prescribed therapy. The patient did not tell Curtis or his colleagues, and no disease management progress could be made until that patient’s next appointment — 3 months later.
“This is a failure for me,” Curtis said. “I did not help him in the way I was hoping to help him, and whether it was this drug or something else, we have basically done a repeat and we have lost ground, or at the very least we have not made any advancements, and now 3 or 4 months have gone by.”
According to Curtis digital tools and applications of AI technology could potentially prevent situations like this from occurring.
“Failure to launch” has occurred approximately 33% of the time in patients receiving care through Medicare, he said. Among commercially insured patients, patients “failed to launch” about 41% of the time.
However, establishing digital remote monitoring technology for patients has the potential to improve patient outcomes, according to Curtis. In addition, practices that take advantage of digital monitoring rules from CMS have an opportunity to increase revenue.
“The notion was that people could wear a device, and you, as the health care provider — or, more appropriately, your staff — can monitor that device and you will be able to take care of them between visits,” Curtis said.
In cases where a wearable device might not be particularly useful, a smartphone app patients can use to answer regular questions could be helpful, he added. CMS codes allowing this practice were introduced in 2022.
According to Curtis, the new CPT codes removed the need to use specialized biosensors. For patients in rheumatology, regular check ins with a digital app will suffice, he said.
As a result, there are five CPT codes physicians can use to receive reimbursement from insurance companies regarding remote monitoring through the use of an app. The codes follow:
- 98975 for the initial technology set-up and patient education.
- 98977 for supplying the device with recordings every 30 days for patients with musculoskeletal diseases, and 98976 for those with respiratory conditions.
- 98980 for remote monitoring of patients using the technology.
- 98981 for each additional 20 minutes spent on these projects, billable twice per month.
“The nice thing is that most of us are already taking care of patients in many of these ways already — we just don’t get reimbursed for it,” Curtis said. “This is now a pathway for reimbursement, mostly for things you are doing already — you’re just not getting paid for it.”
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Curtis J. Systemic Onset Juvenile Idiopathic Arthritis (SoJIA). Presented at: Association of Women in Rheumatology annual conference; Aug. 10-13, 2023; Orlando, Florida (hybrid meeting).