Nixon Gwilt Law’s Managing Partner, Carrie Nixon, was quoted in an article appearing in mHealth Intelligence discussing the recent changes to Telehealth and Remote Patient Monitoring with the new 2021 Medicare Physician Fee Schedule (learn about our take here and here).

In her analysis of the 2021 PFS, Carrie Nixon, co-founder and managing partner of the Nixon Gwilt law firm, faulted CMS for failing to extend stand-alone reimbursement for federally qualified health centers (FQHCs) and rural health clinics (RHCs), two locations that have seen a lot of telehealth use during the pandemic.

“CMS contends that reimbursement for these care management services is encompassed in the All-Inclusive Rate for RHCs and the Prospective Payment System for FQHCs, ignoring and contradicting the fact that other care management services like CCM have been deemed eligible for standalone reimbursement,” she said.

Nixon also panned the lack of RPM reimbursement for therapists.

“CMS declined to eliminate a barrier to services for patients undergoing physical, occupational, or behavioral health therapy, failing to address comments by numerous stakeholders requesting that such therapists be permitted to order RPM for patients using 'sometimes therapy' codes similar to those created for therapists to bill e-visits and virtual check-ins,” she said. “Instead, CMS reiterated that RPM services may only be ordered and billed by physicians, nurse practitioners, or physician assistants.”

As well, CMS is allowing data to be gathered by wireless devices from the home but it won't take data submitted by patients. 

“In doing so, it ignored comments by stakeholders pointing out that such an interpretation would eliminate relevant physiologic metrics that are typically self-reported, such as pain and mood, from use in managing a patient’s care,” she said. “CMS also failed to consider the lack of access to certain types of devices in “connected” form that became especially apparent during the COVID-19 PHE, when we experienced a global shortage of these devices.”

Finally, Nixon questioned the decision by CMS to require at least 16 days of data over a 30-day time period for an RPM program. 

“Numerous stakeholders responded with clinical examples of such conditions that could readily be managed with fewer data transmissions, and even some instances in which requiring 16 separate transmission can be damaging to patients – for example, transmission of a patient’s weight in managing obesity,” she wrote. “Despite these specific examples, CMS stated in the Final 2021 MPFS that 'although we received general support for a reduction in the number of days of data collection required to bill for CPT codes 99453 and 99454, we did not receive specific clinical examples…we are not extending the interim policy to permit billing for CPT codes 99453 and 99454 for fewer than 16 days in a 30-day period.' Notably, the Final 2021 MPFS does not appear to prohibit billing CPT codes 99457 and 99458 when 20 minutes of care management services time has accrued during a calendar month, regardless of whether or not 16 days of transmissions have occurred during that time.”

Read more here.