Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) can improve patient outcomes and provides revenue for providers. The first CPT Code for Chronic Care Management 99490 was approved by the Center of Medicare Services (CMS) for the Physician Fee Schedule CY2015. Remote Patient Monitoring CPT code 99091 followed; approved in 2017. Additional CPT codes were later adopted and made available in 2019, expanding the financial incentives for practices and healthcare systems to conduct CCM and RPM programs.

The 2019 Physician Fee Schedule (PFS) from the Centers for Medicare Services (CMS) enables practicing physicians, hospitals, and health systems to adopt, implement, and bill for care delivered via Remote Patient Monitoring (RPM) technologies. Earlier in 2018, CMS had unbundled CPT 99091 as a first step in support of care delivery via Remote Patient Monitoring technology.

In the 2019 PFS Final Rule CMS-approved 3 new CPT Codes that expand support for Remote Patient Monitoring:

  • CPT Code 99453 Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; setup, and patient education on the use of equipment.
  • CPT Code 99454 Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, every 30 days.
  • CPT Code 99457 covers Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with a health care provider.

The 2019 RPM codes indicate growing CMS support for patient-centric, preventative care models. The 2019 PFS represents progressive action by CMS to modernize healthcare by embracing the intelligent use of technology to improve quality of life for patients while reducing healthcare cost associated with hospital stays and rationalize the use of emergency services.

eCare21 generates new income streams for physicians and provider organizations by clearly documenting non-face-to-face clinical activity throughout the billing cycle. With our solution, a medical practice with 300 Medicare-eligible patients can generate more than $15K-$20K of new monthly revenue. Furthermore, Remote Patient Monitoring enables practices to generate an additional $125 per qualified Medicare patient each month.

At its core, eCare21 is a remote clinical documentation software application, uniquely designed to simplify the rigorous Medicare requirements to bill for Chronic Care Management (CCM: CPT 99490, 99487, 99489) and Remote Patient Monitoring (RPM: CPT Codes 99091, 99453, 99454, 99457. eCare21 helps Medical Practices and Healthcare Organizations effectively monitor & manage health status trending, care plans, medication adherence, and coding & reimbursement for remote clinical encounters.

Remote Patient Monitoring (RPM) is an effective method for physicians and Healthcare Systems to care for an increasing patient population with a decreasing clinical workforce. Remote monitoring collects and trends patient-generated health-data (PGHD). By delivering patient-generated data on a near real-time basis, providers can effectively provide prompt and efficient care to control costs and improve clinical outcomes. Monitoring physiological data on a frequent or continuous basis permits healthcare providers and caregivers to track health trends, resulting in timely, effective interventions. Furthermore, traveling to doctor appointments is a common barrier to care in both urban and rural locations. By delivering “care-in- place,” eCare21 improves access to vital healthcare services.

eCare21 is device-agnostic, ensuring providers and patients options to engage in multiple monitoring device vendors. Monitoring device brands can be selected based on efficacy, cost, and user preference. eCare21 recommends using FDA-certified devices with proven reliability. Our system can leverage hundreds of tools and many relevant data points to support remote care for chronic and post-acute conditions.

eCare21 promotes positive patient engagement. Our App, available for both Apple & Android devices, offers patients 24-hour access to their health data and care plan. Communication through the eCare21 App allows members of the care team to send the patient reminders and encouragement, allowing patients to become an active member of their healthcare team. The patient can set goals with all members of the team and monitor their own progress towards attaining these goals.

The Community of Care helps chronic health patients achieve a positive outcome. A strong family and friend support system is an active co-factor in achieving positive outcomes. In addition to healthcare providers, the Community of Care may include friends, family, neighbors, and other social support networks. Patients control who and when to invite people into their personal Community of Care. Authorized members of the Community of Care can monitor patients progress and send messages of encouragement and reminders as needed.

eCare21 is designed to work in compliance with CMS requirements for these programs. Data is collected remotely and transmitted directly to the eCare21 clinical website for analysis by the care team. Care coordination activity based on patient data is accurately documented and securely communicated via eCare21, which begins the chain of documentation of Orders/Actions/Outcomes.

eCare21 maintains clean, compliant documentation of all care coordination activities performed on behalf of a patient – who, did what, when, and how. Orders begin with the creation of a “to-do” list action item, which is assigned to a specified care team member of the clinical staff. As the appropriate care team member completes each action item on the “to-do” list, the action and results are automatically recorded, and the “to-do” list is updated.

Follow-up activities can be conveniently scheduled as required and assigned to the Physician, a Nurse or another member of the care team. eCare21 is easy to implement, adapts to the existing practice workflow, and interoperates with the current EMR’s. eCare21 maintains a comprehensive audit trail and keeps a tally of the accumulated time spent on each patient eligible for CCM or RPM (CCM requires 20 minutes of clinical activity per patient per month, while RPM requires 30 minutes).

When the required threshold of clinical activity is attained for each patient, eCare21 marks the series of events as complete and prepares a clean, CMS compliant bill. eCare21 is designed to record non-face-to- face activities and used as an intra-office communications documentation tool.

Orders that previously required a face-to-face interaction between the physician and staff can be readily entered into eCare21 by any authorized care team member from any location via a secure browser.

Here is what some of eCare21’s customers are saying:

  1. “Simple to use.”
  2. “More efficient and secure than note pads, post-it notes, text messages, and emails.
  3. “Improves communications and drives more accountability within the practice”
  4. “Clear, compliant documentation.”
  5. “Very easy to implement.”
  6. “No software to purchase, download, or install.
  7. “It’s helping my practice improve our Star rating.”

Key Facts:

  • Medicare is unsustainable
  • $700B Budget
  • 56.8M Beneficiaries
  • 10,000 new beneficiaries every day for 20 years
  • 15% of patients use 65% of the Budget
  • $50B Incentive Market Established to reduce cost
  • $17B/yr Chronic Care Management (CCM)
  • $35B/yr Remote

In 2015 less than 5% of physicians submitted CCM claims to Medicare, while current claims are estimated to increase only 10% or less by the end of 2019. Many physicians and healthcare organizations have been reluctant to adopt RPM programs due to the lack of understanding of billing the new codes and limited staff resources to support additional programs. The eCare21 solution is compliant with Medicare billing requirements. eCare21 offers additional resources for practices and healthcare systems requesting to outsource CCM and RPM.