Electronic Health Reporter

By Jared Lisenby, chief sales officer, Azalea Health.

Telehealth services have become more popular, particularly after the COVID-19 pandemic highlighted its importance as a necessary solution for rural health clinics (RHCs).

RHCs face distinct business challenges, including serving patients at higher risk of chronic illnesses, limited resources, workforce shortages, and geographical isolation. These challenges require innovative solutions, and telehealth is one such solution.

Also known as telemedicine, telehealth empowers healthcare providers to care for patients without an office visit, saving time and money and allowing providers to see more patients. Care options require internet access and a computer, tablet, or smartphone, including phone or video consultations, secure messaging, email and file exchange.

Telehealth and the adoption of electronic health records (EHRs) have allowed healthcare to extend beyond clinical settings into patients’ homes.

RPM device use is expected to increase

New solutions and offerings make Remote Patient Monitoring (RPM) possible. This technology allows providers to manage acute and chronic conditions, gather vital signs and inform healthcare providers about a patient’s progress while reducing travel costs and infection risk.

Doing so allows providers to make real-time decisions and course-correct care as needed, potentially reducing patient costs in the long run and leading to better healthcare outcomes.

Remote patient monitoring is useful in conjunction with telehealth, particularly for patients who require consistent monitoring for certain health conditions, including high blood pressure, diabetes, and heart conditions. It can also help prevent complications in patients who have difficulty traveling.

RPM devices can include meters and monitors for glucose, heart rate, and blood oxygen levels. Patients with some of these chronic conditions are usually eligible for RPM devices and services.

According to Insider Intelligence, about 30 million Americans will be using one this year.

Regulatory changes will ensure continued RPM adoption

Before the COVID-19 Public Health Emergency (PHE), the Centers for Medicare & Medicaid Services (CMS) launched billing codes and extended RPM coverage. At the start of the PHE, CMS introduced additional flexibilities and waivers, allowing RHCs to provide telehealth services and remotely enroll patients into care management programs.

This waiver helped clinics provide services to many more patients throughout the pandemic. It alleviated the pressure on the healthcare system, allowing clinics and hospitals to focus on those needing help.

While the initial waiver expired at the end of the PHE in May 2023, CMS made the waiver permanent starting in 2024. This new rule and coverage expansion for RPM services will now increase access to remote care programs.

Cost —whether the platform itself or reimbursements that didn’t cover the entire visit cost — was one of the biggest impediments to telehealth adoption.

In 2024, Medicare will reimburse Federally Qualified Health Centers (FQHCs), including RHCs, for RPM and Remote Therapeutic Monitoring (RTM). Providers can bill for two RPM services under the general care management code at $71.68 per month per patient.

While patient quotas are not a specific requirement, RHCs must meet certain productivity standards as part of their policies and procedures. RHCs can benefit from a comprehensive EHR platform to ensure compliance with all requirements.

CMS has also made significant progress in distinguishing Chronic Care Management (CCM) services, which go hand in hand with RPM.

Integrating RPM with CCM programs, whether new or existing, addresses billing’s limitations and promotes patient engagement.

RHCs and RPM can collaborate to improve the patient experience and maximize benefits. This integration can be done with existing work and increases annual revenue, making it feasible for RHCs.

The platform is key to RPM’s success

While RPM has already grown in popularity, it will continue to gain prominence this year. The cost-effectiveness of RPM varies depending on the type of monitoring, the disease being monitored, and the monitoring setting.

Such a platform enables RHCs to document all requirements and provides valuable insights through analytics for operational excellence. Providers must process paperwork correctly and submit timely claims, as there is a risk of losing revenue. In addition, payers and insurance companies have strict requirements regarding claims submission deadlines.

It also empowers them to manage their revenue properly.

The situation may seem confusing from a biller’s perspective, but it is simple. If claims do not go out on time, providers risk losing revenue, making paperwork processing a critical matter for many. Payers and insurance companies also have strict requirements and deadlines for claim submissions.

Modern EHR systems collect data from RPM devices and automatically update the patient’s chart. Analytics will then alert clinicians and implement the best care plans for each patient.

The right tools and technology empower providers to overcome challenges in keeping their doors open, running on tight margins, and barely covering costs. With technology, providers can deliver the next level of patient care, whether major urban providers or rural clinics focused on underserved populations.