Babyscripts Virtual Care Resource Center

Calculating new reimbursements for your practice

Mar 31, 2020 10:50:32 AM / by The Babyscripts Team

As the nation learns to navigate the realities of a pandemic world, traditional healthcare structures are proving insufficient for the current crisis. Providers are responding to the demands of a quickly spreading virus and an overburdened hospital system by changing the way they interact with patients — not in the office, but virtually.

In the field of obstetrics specifically, practices are adapting by completely revising the prenatal visit schedule, with some reducing in-person visits to as low as five. [For more on this, read New Prenatal Schedule enhanced with technology to deal with COVID-19: Best Practices from Cone Health]. To stay connected and manage patients in between visits, providers are leveraging technological touch points like video visits, remote patient monitoring, mobile apps, and telephone visits. 

Additionally, there have been changes in reimbursements to respond to these necessary changes.

For many, it’s a foreign game with a totally different playbook, and the learning curve is steep. To help, we’ve compiled a guide on the financial implications of investing in technological tools like Babyscripts.

 

Let’s start with the codes.

 

[For the purpose of this analysis, we will be focused on the codes related to remote patient monitoring (RPM). If you are interested in the codes for other technological interactions, like video visits, telephone calls, etc., the American College of Physicians has put together a comprehensive and easy to understand overview of COVID-19 Telehealth Coding and Billing Practice Management Tips]

CMS just authorized RPM as they expand access to telemedicine services in response to COVID-19.

Two codes (99453 and 99454) are relevant to programs like Babyscripts, and we encourage you to check with your coding and billing department to confirm the charges are available for your staff when they order Babyscripts’ Schedule Optimization.

Here is the latest update from CMS:

 

Code

Description

Medicare Rate

99453

Remote monitoring of physiological parameter(s), initial; set-up and patient education on use of equipment. One time code. 

$18.77

99454

Remote monitoring of physiological parameter(s) (e.g., weight, BP, pulse oximetry) initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days

$62.44

Note: Be sure to check with your payers directly to understand if they will reimburse and the exact reimbursement rates.

 

What does this mean for your practice? Let’s do the math. 

 

First, assess your new prenatal schedule. For those who normally bill a global fee to insurers (59400), make sure that the new schedule meets the minimum threshold of visits (minimums can vary by state or plan but often the average is 5 visits). Once you confirm this, you can rest assured that you will still be able to capture the same reimbursement for the physician management of the pregnancy. 

Next, let’s look at the impact of adding RPM reimbursement to the revenue of the practice. On top of billing for the visits (say the 59400 global), you can bill: 

  • 99453 for setup
  • 99454 for each month of monitoring (likely at least 6 months)

 

That results in the following equation:

 

(# Annual Births x $18 for setup) + (# Annual Births x $60 for monthly management x 6 months ) = Additional reimbursement to practice

 

RPM Reimbursement calculations (2)

 

In our visual above, we have depicted two examples of what the additional revenue could look like for a large integrated health system and a mid-sized private practice. As you can see, either scenario has a huge impact on the financial health of the organization, and will more than cover the expenses of an RPM solution, like Babyscripts. 

These new codes are a response to the growing crisis — as a validation of the benefits of virtual models, they also might provide insight into the landscape of a post-pandemic world.  When the threat of COVID-19 passes, as it eventually will, we are going to see virtual care remain an attainable option, if not the standard of care.

 


 

Are you interested in understanding how Babyscripts can meet your needs in this crisis and get a tailored pricing proposal? Reach out to us by clicking here! 

 

 

Tags: Reimbursement, COVID-19