The Centers for Medicare and Medicaid Services suggested a set of CPT codes for remote therapeutic monitoring for the first time in the most recent Medicare Physician Fee Schedule. According to the idea, these codes will be used to determine the efficacy of a recommended therapy as well as the patient’s response to it. CMS specifically states that these numbers can be used to track drug adherence.
- Expenses: According to National Institutes of Health studies, avoidable hospitalizations and emergency department visits due to pharmaceutical non-adherence cost the United States more than $300 billion every year. Over the last five years, CMS has made it possible for clinicians to be reimbursed for non-traditional patient contacts in which the patient is physically separated from the physician.
- Adherences: As a result, CMS’ proposed RTM codes for medication adherence programs offer a significant step forward in addressing one of healthcare’s most pressing issues. These codes are also one of the most recent breakthroughs in digital health reimbursement.
- Compensation: Nonetheless, new compensation categories for digital health are becoming more apparent. The new RTM codes are similar to those used for remote physiological monitoring, which reimburses providers for reviewing physiological data that is sent to them automatically through a device (for example, heart rate).
- Novelties: Because of the novelty of the technologies and the unpredictability of their use, these attempts have proved perplexing. People frequently pay copays for things that are invoiced to them, limiting the number of patients who are willing to participate.
- Urgent notion: While digital health and telehealth technologies have been around for a while, the current COVID-19 pandemic has added urgency to the modernization of virtual care payment structures. The inclusion of RTM codes in the 2022 Physician Fee Schedule implies that the digital health policy changes made in response to COVID-19 are starting to take hold.