Big Win for Home Health Technology: Medicare, Medicaid to Up Reimbursement

Centers for Medicare & Medicaid Services (CMS) presents new policy that helps clinicians get reimbursed for remote patient monitoring and other home health technologies.


Connected healthcare got a nice boost from the Centers for Medicare & Medicaid Services (CMS), which proposed in a final rulemaking to expand reimbursement for remote patient monitoring (RPM). CMS incorporated the new rules into its Merit-based Incentive Payment System (MIPS) after research proved the value of home-health technology:

The study of the potential value and efficacy of telehealth and remote patient monitoring has become more prevalent in recent years as technology has enabled greater utilization of these services. Studies and case studies from health systems have shown value in using telehealth platforms for activities such as e-visits and remote patient monitoring, as well as for higher intensity care through real-time videoconferencing particularly to enable older adults to receive care more rapidly from their homes and with minimal burden. The Next Generation ACO [Accountable Care Organizations ] Model allows ACOs flexibility in utilizing telehealth services to improve access to the most appropriate care for aligned beneficiaries. 

“Beginning in 2018, CMS will support clinicians who leverage remote monitoring tools, such as wearables and smart devices at home, and use patient-generated health data in care coordination and management,” according to an excellent report by mHealth Intelligence, a website covering mobile health.

The Connected Health Initiative lobbied for the new rules. Executive director Morgan Reed said in a statement: “We believe that the use of digital technologies that provide either one-way or two-way data between MIPS eligible clinicians and patients is valuable, including for the purposes of promoting patient self-management, enabling remote monitoring, and detecting early indicators of treatment failure.”

“Beginning in 2018, CMS will support clinicians who leverage remote monitoring tools, such as wearables and smart devices at home ….

— mHealth Intelligence

The new rules, Reed states, would “level the playing field for innovators, giving doctors and patients the chance to take advantage of the best technologies available.”

The rules primarily have to do with the way services are coded by the medical community, separate from “telehealth” services, which are governed by multiple regulations.

The RPM code “will not be subject to any of the restrictions on originating sites or technology that telehealth services are subject to by statute, allowing users of this technology more flexibility,” according to C&M Health Law, which explains in laymen's terms some of the guidelines of the new rules.

In addition to improved patient monitoring in general, the changes will “enhance accessibility to healthcare services for those that need it most: working parents who can't miss a day in the office, chronically ill seniors with mobility issues, economically disenfranchised patients who can't afford ongoing specialist visits, people with disabilities,” according to David Heenan, president of the clincial-research automation firm AcesHealth, quoted in CHI's statement.

The Consumer Technology Association, which represents numerous health, wellness and medical-device providers, chimed in as well.

“The field of medicine is evolving rapidly, led by remarkable innovations in health information technologies and remote health care services,” says CEO Gary Shapiro. “These changes are already disrupting the current models of health care delivery and the established payment framework.”

The new reimbursement program for remote patient monitoring is slated for the 2018 Physician Fee Schedule. 

About the Author

Julie Jacobson
Julie Jacobson:

Julie Jacobson is founding editor of CE Pro, the leading media brand for the home-technology channel. She has covered the smart-home industry since 1994, long before there was much of an Internet, let alone an Internet of things. Currently she studies, speaks, writes and rabble-rouses in the areas of home automation, security, networked A/V, wellness-related technology, biophilic design, and the business of home technology. Julie majored in Economics at the University of Michigan, spent a year abroad at Cambridge University, and earned an MBA from the University of Texas at Austin. She is a recipient of the annual CTA TechHome Leadership Award, and a CEDIA Fellows honoree. A washed-up Ultimate Frisbee player, Julie currently resides in San Antonio, Texas and sometimes St. Paul, Minn. Follow on Twitter: @juliejacobson




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