What the End of the Public Health Emergency Means for Remote Patient Monitoring Companies

  • Sr. Product Marketing Manager, XiFin

The COVID-19 Declaration of a Public Health Emergency (“the PHE”) ended on May 11, 2023. As a result, some of the virtual care flexibilities allowed by the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) during the PHE also expire. Remote Patient Monitoring companies are one of the many groups that must consider how the end of the PHE may impact their business.  

A recent article published by Nixon Gwilt Law, “The End of the Public Health Emergency: What It Means for Telehealth, Virtual Care, and Remote Patient Monitoring Companies,” provides an overview of these changes. Below, Remote Patient Monitoring leaders will find a summary of the changes, based on the expiration of the PHE, which are most relevant to their businesses.  

Telehealth services were one of the healthcare areas most affected by the flexibility granted due to the PHE. Prior to the PHE, these services were only available to Medicare patients in rural or under-served communities. The PHE waiver for Telehealth services authorized Medicare patients’ homes as “originating sites” for telehealth services and eliminated the requirements for the patient to be located in a designated rural or underserved area. The PHE waiver also extended the types of providers eligible to offer telehealth services to all providers eligible to bill Medicare. 

Congress has extended both of these elements of the waiver―patient location and provider type―through December 31, 2024. Advocates anticipate that legislation will be passed to make telehealth permanently available to all Medicare patients and are supporting the permanent addition of provider types, such as physical therapists, occupational therapists, audiologists, and speech therapists to be added as eligible providers of telehealth services. 

Changes to Remote Physiologic Monitoring (“RPM”) and Virtual Care Management Services Post-PHE 

Prior to the PHE, RPM patients were required to electronically transmit 16 days of physiologic data during each 30-day period in order for the billing organization to receive reimbursement for a device used during that time period. During the PHE, an Interim CMS Rule reduced the required number of data transmissions to 2 days each 30-day period, but ONLY for the diagnosis of suspected COVID or treatment of COVID. This waiver expired on May 11, 2023. 

RPM for Established Patients Only 

Prior to the PHE, CMS required that RPM services could only be ordered for a provider’s existing patients. An initiating visit was required for patients who had not been seen in the prior twelve months. The PHE waiver removed this requirement. CMS waived the requirement, allowing RPM services to be ordered for new patients without an initiating visit. This waiver expired on May 11, 2023, and a separate, initiating visit is once again required for new patients (not seen within the past year). 

Part B Co-Pays for Virtual Care Management Services 

Prior to the PHE, Medicare providers were required to collect a 20% copay for Part B services, including Remote Physiologic Monitoring services and other Virtual Care Management services. The Office of Inspector General (OIG) announced it would not enforce Part B copay requirements for telehealth and virtual care management services including RPM and Chronic Care Management (CCM) during the PHE.  

As of May 11, 2023, the OIG will again enforce the requirement for Medicare providers to collect a 20% Part B beneficiary copay. Members of Congress have introduced legislation aimed at eliminating the 20% Part B co-pay for services including CCM. 

Key Takeaways 

As of May 11, 2023, Remote Patient Monitoring and Virtual Care Management vendors and providers must establish a relationship with a patient prior to ordering RPM. In addition, patients must once again transmit at least 16 days of data in every 30-day period. Providers of RPM and other virtual care management services must also resume collecting the required copays if they were waived during the PHE.  

Learn more about how XiFin revenue cycle management solutions and services can help medical device and remote patient monitoring companies improve commercialization as well as ongoing operational and financial results here

Published by XiFin
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