The healthcare industry often evolves at a snail’s pace, but the year 2024 promises a groundbreaking change for RHCs that will disrupt the status quo. It marks the recognition of Remote Patient Monitoring (RPM) as not merely a service but a vital component of care delivery.
The eagerly awaited Proposed Rule from Centers for Medicare and Medicaid Services (CMS) ushers in this pivotal shift toward equitable access, while also raising several questions for providers to address. In a recent panel discussion, MD Revolution’s Paul Huffman and Azalea Health’s Doug Swords dissected the implications of this proposed change, tackled the challenges, and unearthed innovative strategies to help RHCs navigate this uncharted territory.
“Four out of ten rural hospitals are operating at a loss, so we’re constantly exploring ways to boost revenue and cut costs. But maximizing reimbursement is just one part of the puzzle. The bigger question is how to achieve better outcomes, enhance the quality of care, and increase profitability. That’s what we’re here to discuss.”Doug Swords, Co-Founder & SVP of Revenue Cycle Management at Azalea Health
The Remote Care Management Revolution: A Necessity with Benefits
The sustained use of telehealth following the pandemic underscores the imperative for RHCs to embrace remote care solutions as a norm and a necessity. However, RHCs face unique challenges in the healthcare landscape, such as sicker patient populations, limited resources, workforce shortages, and geographic isolation demands innovative solutions. While CMS has made significant progress in distinguishing Chronic Care Management (CCM) services, issues related to equitable access persist. Notably, RHCs are unable to bill for RPM codes. Presently, these services are considered part of the comprehensive rate, encompassing the offerings of these facilities’ programs, and limited to billing one G0511 code each month, regardless of the number of care management services provided.
CMS’s Proposed Rule: A Glimpse into the Future
The Proposed Rule for 2024 sheds light on the integration of RPM into the existing remote care framework. Under the proposed changes, the G0511 code for 2024 is set to cover various services, including Chronic Care Management (CCM), Principal Care Management (PCM), Behavioral Health Integration (BHI), Chronic Pain Management (CPM), Remote Therapeutic Monitoring (RTM), and Remote Physiological Monitoring (RPM). Although this expansion is promising, it’s worth noting that CMS suggests a slight decrease in the current reimbursement rate for G0511, which currently stands at $77.94.
With a reduced rate of $72.98, the implications are significant. While the primary driver for a provider’s decision-making should be medical necessity rather than financial constraints, this proposal places RHCs in a delicate position if they can’t provide the appropriate bundle of services under G0511. Unlike non-RHC counterparts, RHCs must balance financial viability with the delivery of high-quality care.
Synergizing Innovation: Combining RPM and CCM
In response to these challenges, RHCs must adopt innovative solutions. One strategic approach is to integrate RPM with existing or newly established CCM programs. This blend not only addresses billing limitations but also encourages meaningful patient engagement. By offering comprehensive support, including clinical health coaching and connected devices, RHCs can improve patient interactions, resulting in higher adoption rates. Enrolling in both programs streamlines the process, maximizing the benefits of both CCM and RPM. This harmonious integration not only captures existing work but also significantly boosts annual revenue, making it a financially viable option for RHCs.
Empowering Through Technology: Streamlined Workflows and Tailored Solutions
In the face of clinician shortages, streamlined systems are indispensable. Integrated workflows and tailored technological solutions are vital for successful remote care programs. Azalea Health, for instance, provides tailored EHR, RCM, and telehealth solutions designed for rural health providers. Azalea Health’s EHR supports RHCs with split claim functionality, simplified cost reporting, and accurate tracking of RHC qualified visits. This not only helps avoid penalties but also ensures maximum reimbursement.
MD Revolution’s care management programs offer intuitive, integrated workflows that guide clinicians through remote care delivery, enabling efficient documentation and billing within the EHR environment.
These solutions, designed with features tailored to clinics’ needs, such as simplified digital record management and AI-assisted pathways, free up more time for patient care. These streamlined workflows optimize billing through enhanced compliance and identifying opportunities for maximum reimbursement.
Navigating Ambiguity: Strategic Adaptation for RHCs
As RHCs stand on the brink of change, the 2024 Proposed Rule introduces unique nuances for rural health. For example, under this new proposal, both codes tied to a calendar month (e.g., CCM) and those associated with a rolling 30-day period (e.g., RPM device) would fall under the single-unit-per-month G0511 code. The convergence of billing codes presents a strategic dilemma: should RHCs prioritize device readings or care management time? This decision hinges on understanding the needs of the patient population and requires adaptability, proactive strategies, and ongoing advocacy.
Proactively navigating this ambiguity is crucial to harness the full potential of remote care solutions for RHCs, paving the way for a more connected and patient-centric healthcare system. Fortunately, rural health providers have access to partners well-versed in rural healthcare, ready to support the conversation.
About MD Revolution + Azalea Health
As a valued partner, MD Revolution offers strategically integrated Chronic Care Management and Remote Patient Monitoring solutions. These seamlessly blend with Azalea’s electronic health records, revenue cycle management, data insights, and telehealth solutions specifically tailored for rural and community practices and hospitals. Our solutions are quick to deploy and user-friendly, ensuring improved care coordination and communication. This not only leads to better outcomes but also provides a significant competitive edge.
Learn more at https://mdrevolution.com/partner/azalea/