Educational Webinar: A New Era for Community Health Centers and Remote Patient Monitoring

Good afternoon. Thank you for joining us today. My name is Brandon Martin here at mckesson Medical Surgical and I'm so excited to welcome you to today's Clinical Connections presentation, a new era for community health centers and remote patient monitoring, presented by Rameric Health and Corona Health. Before we get started, I'd like to direct you uh to our disclaimer while you're reviewing that information. I will remind you that today's presentation is being recorded and within a day or two, you can expect to receive a link to the recording of the presentation. If you have a question, feel free to enter it into the Q and A panel at the bottom left corner of your webinar window at any time. And we will do our best to answer. At the end of today's presentation. We have multiple speakers today. Uh Before I introduce you to them, I do want to uh share uh their disclaim the Ro Meric disclaimer with you. And I will go ahead and introduce you to our speakers today. We have Rebecca Russell, Director of Program Management at Rameric Health. Rebecca has been in health care for the past 11 years. Her close collaboration with physician groups, community health centers, hospitals and home health agencies has been instrumental in helping these organizations meet quality metrics, reduce health care costs and improve patient outcomes. Through the integration of home monitoring devices and clinical care management services. We also have Erin Walsh Pinkos with us, Vice President of Client Partnerships at Corona Health where she provides revenue cycle analytics and technical support. With 12 years of experience, she recognizes the importance of maximizing patient services revenue to support and grow each FQHC. Once again, thank you all for joining us today. I'm so excited about this presentation. Uh Rebecca, I will hand it over to you. OK, great. Thank you so much, Brandon. Uh Thank you to everybody out there today. Looks like we've got a pretty good crowd, uh which is wonderful. Uh We appreciate you so much, taking some time out of your day, which I'm sure is a busy day to spend with us. Um And we're really, really excited to be here and to announce to you about uh the new physician fee schedule um that does now allow community health centers to receive reimbursements for remote patient monitoring. Um Until recently, uh Medicare was not reimbursing uh CH CS for remote patient monitoring, um which is, you know, very much a shame. Um It's remote patient monitoring reimbursements have been out outside of community health centers now for the last uh 10 years. And so it's been a long time. Waiting and anticipating and, and lobbying and changes in legislation that needed to happen and it's finally here. Um We're gonna share some of the latest information with you today. Uh Just last Thursday night is when the final physician fee schedule was released. Um And this is the final rule now. So starting in January 1 of 2024 there will be reimbursements available under go 511. Um Just to share some of our learning objectives with you today, we're gonna talk and Erin especially is gonna go over um this policy um and the comprehensive details related to reimbursement. Um We are gonna talk about how community health centers can leverage this change uh in this legislation to reduce cost to improve overall patient outcomes. Um and also to generate new revenue. Um We'll talk about some strategies and best practices, whether you have a remote patient monitoring program currently uh or you've had one in the past. Um Or you've never had one, we're gonna talk about how you can best optimize the program. Um We've been doing this for a long time. Uh We've been providing remote patient monitoring services and a like programs for the last 13 years. Um So we're gonna share all of our best tips and tricks with you. Um And just, you know, give you as much information as we possibly can so that you two can have a successful remote patient monitoring program. Um And then we'll review the staffing needs. There is a lot that goes into it. Um And we'll share, you know, what makes the most sense. So I always like to kind of get started uh with what's driving. Why are we here today? Why are we talking about remote patient monitoring? Why did maybe you keep hearing about this? And so there's a number of things just happening in the world that have been really driving remote patient monitoring. First of all, chronic conditions, um and you're probably aware, so 60% of the United States adult population has at least one chronic disease. That's, that's over half of adults. It's, it's actually become the norm to have a chronic disease. Um And uh 40% of adults have at least two or more chronic diseases. Um and it continues to worsen a year after year. Um We also have a strong need to reduce the overall cost of care right now. The US healthcare system is spending $1.1 trillion to manage the effects of chronic disease. Um We have uh us healthcare staffing shortages uh during COVID, they call that the great resignation. Um but staffing shortages are still quite alive and well, they have been even before COVID. Uh we've got physician burnout. That's the term, but it's not just physicians, it's nurses, it's healthcare professionals. Um There was a, a survey conducted in 2023 this past year, two thirds of physicians and nurses did report burnout. And there were comments in this survey, some of them were saying, you know, it's the E hr S, it's the paperwork. Um I didn't go to med school to sit behind a desk. It's the long hours or not having enough time with patients. Um insurance companies trying to dictate patient care. So, um America Health care force is really under an unprecedented amount of strain these days. Uh We also have an aging patient population due to longer life expectancies, uh baby boomers and so all of this together makes for more patients and more chronic disease than ever before. Um We've got less staff and we've got physicians and nurses who are spread really thin. Um We need to find ways to be more proactive to provide additional care and services to patients, but do it in a way that doesn't incur additional cost and without imposing additional workloads and burdens on your staff and your providers. So we're gonna talk today about how remote patient monitoring can fit that bill and how these new reimbursements can allow you to start to uh develop a remote patient monitoring program uh that does help on, on various aspects that you see here. So when we talk about what is, I think most people have a general idea of what remote patient monitoring is, but there's a lot of misconception around what is all involved. Um So yes, there are medical devices that are involved. There's glucometers for patients who have diabetes or blood pressure monitors for patients who have hypertension or CAHF. Um we have, you know, pulse oximeter for patients who have COPD. Um There's a number of different devices that can be used and that is an essential part of remote patient monitoring, but those aren't the only essential parts. Um You also have the software, the software ensures that the data gets from point A to point B so that somebody who's home and they take their blood pressure or they step on their weight scale, that that's all they have to do and that, that data is automatically and wirelessly transmitted to a health care professional. And then that leads to that, that third bucket of what's involved with remote patient monitoring. And that is the clinical staff. Um that clinical team is crucially important to a successful remote patient monitoring program. I think a lot of you may be aware uh and have participated in R PM remote patient monitoring through some of the grants that have been initiated. So in 2021 2022 we saw grants from the FCC uh HS A as an example, they funded about $90 million in 2021 for hypertension uh to be able to provide grants to community health centers around the country to be able to um help with their patients who have hypertension to get more of them controlled. Um And even though there was a nice amount of funds that a lot of community health centers received because of the rules and the regulations of those um grants, they really only cover the cost of the medical device. Um And the grants overlook some really important aspects of remote patient monitoring, such as device distribution, patient education and certainly that clinical nurse or that clinical part of the program, um I'd always say remote patient monitoring technology in the devices, they're very impressive. Um But it's really that nurse to patient relationship that nurtures that long term patient compliance, engagement and satisfaction with the program. And that is what yields those better patient outcomes, right? So benefits to community health centers, there's a number of them, um it definitely enhances patient engagement. Patients essentially have their own personal nurse. It's an extension of your care, somebody that the patient can speak to and that knows is looking out for them on a daily basis outside of the office. It is never to replace an office visit. It is to be used in conjunction with that office visit. So that way again, that care is brought from the office into the patient's home in between the regular scheduled office visits. Um It certainly improves access to care, you know, again, not to take away from office visits at all, but there's a lot of patients that don't get into the office like they should. Um So this is additional care that can be provided. It absolutely reduces er visits and hospitalizations. We'll talk about a couple uh specific uh statistics there and it does promote better health outcomes, reduces cost. And it will now allow you to generate a little bit of additional revenue while having a program that is easy to implement and sustainable benefits to patients. So this is personalized, this is preventative care. Um One of the best examples that I've heard of the difference between proactive and reactive care um is if you picture a patient picture, um this man in the picture as an example and he's up on the top of a, a mountain, maybe it's a double black diamond uh ski slope and he's got his skis on and he's ready to head down that mountain. But there is his R PM nurse, you know, that's up there and that says, hey, don't do that. That's not a good idea. Come with me, follow me. I'm gonna show you a better way to get down the mountain. That's proactive care. Whereas reactive care would be that nurse, she's at the bottom of the hill, she's waving him off and she's got a stretcher and an ambulance ready to take him to the er so those are the differences and that's truly what this program is. It's timely intervention, it's where we pick up little things that are happening. The blood pressures may be starting to get elevated or the heart rate. Um And we can resolve them before they become an emergency situation. There's a ton of data out there. There's uh 10 years worth of studies and data by various organizations. This is why we're seeing these reimbursements across the board and finally coming to community health centers. Um Just to give you a couple of quick examples. Um This study was done in 2022 published at the Journal of American Medical Association. Um In this particular study, this was looking at patients who had COVID and they were utilizing a pulse oximeter. Um So you can imagine the results are gonna be pretty strong here and they were um 87% fewer hospitalizations deaths reduced by 77%. And a reduction of per patient cost over the standard uh care Asher Health. Uh recently 2022 again in October, um they conducted a study, it was 90 days of program participation. Um Patients were either using a blood pressure if they had hypertension blood pressure monitor or they were using um a glucometer for type two diabetes within that 1st 90 days. And this was Medicare Medicare population. Uh 50% of hypertensive patients were able to reach their hypertension control uh goal. And then 60% of patients that had type two diabetes, they were able to get to goal within that 1st 90 days. Um And as they continued on the R PM program, they continued to see um additional improvements in results. Um Just a couple more studies, I'm not gonna bore you with studies. But um you know, banner health uh conducted a study, uh they had 75% reduction in hospital readmissions. Um in terms of admissions, there was a 50% reduction and they reduced the overall cost of care by 34% of the entire organization. Um The next one is uh they cut uh readmissions for patients in the cardio division by 51%. The last one that is a up MC study, 90% of patients um uh had a positive patient satisfaction score and we see that as well. The majority of the patients on the program, they get so much out of the program. Um They love just talking to the nurse, but they love having that sense of security that somebody is reaching out to them if necessary um on a daily basis. So go 511. This is a code specifically for FQH CS and Rh CS. Um This is the code that you can now bill for remote patient monitoring. So as of January 2024 C MS has added remote patient monitoring to this hick pic code GE 05 11. Um What else is so wonderful about this is it wasn't just remote patient monitoring. They added additional services, care management services for patients. So things like remote therapeutic monitoring and principal illness uh navigation, that one's new uh community health integration, that one is new as well. And while they're sort of grouping all of these into the same hick pick code go 511. Um It's wonderful because you are now able to build that code more than one time in a given month if patients are receiving um different services. So as an example, remote patient monitoring and chronic care management, they go hand in hand, chronic care management deals with patients who have two or more chronic diseases. Um It entails, you know, a patient care plan and you're having a discussion with that patient, making sure that they're following their care plan, doing best to meet their goals, things like that in a given month. Um Whereas remote patient monitoring is adding those medical devices to that patient's regimen at home. Um And now, instead of just assessing, you know, symptoms and things like that, we can take a look at what their vitals are as well. So they go hand in hand and C MS has recognized as them as complementary so that you can bill and have your patients on both remote patient monitoring and chronic care management and bill that go 511, which yields about $73 per patient per month in the coming year. Um And you'll be able to build that two times if they're on more than one program, Aaron's gonna get into much more detail on that as well. Um But I just think it's a wonderful positive direction that we're seeing more and more services being added that community health centers can now bill for that are outside of the PPS. So this is something that you can build in addition, you know, to the PPS rate and $73 you know, that's, that's not bad. So just talking about implementing a remote patient monitoring program. So people always ask, you know, like, how do I even start this? How do I go about it? Um Where do I start with my patients? And so the first step that we always talk about is patient selection. So there may be various uh specialties or uh groups um within your organization that may be uh appropriate for this program. But it's always good to just kind of think about and start where you think it makes it will have the biggest impact. Um A lot of times especially with primary care and such, we're starting with patients who have hypertension or heart failure, uh diabetes, cop DC KD. Those are some of the most common areas that we see. Um But also we've worked with um you know, women's health clinics, um taking care of patients who have high risk pregnancies and nephrology groups. So there could be other areas as well. But again, finding that area that you think is gonna have the biggest impact for your patient population is the perfect place to start. Um Other ideas for inclusions that people often talk about. Um maybe this patient has a poor history of medication compliance R PM is a program that absolutely helps patient compliance. Um, maybe it's a patient who you've asked them to, um, use a home blood pressure monitor anyway. But they're writing their results down in, in their notebook. This would be a very big step up and very helpful for those patients and for your practice to manage that. Um, maybe it's patients who are just 65 and older because that's where we see the most chronic disease, maybe you start there. Um And then of course, the program isn't going to be right for every single patient that you have, even if they meet all of your inclusions. And so some examples of exclusions would be, you know, if patients are not physically or cognitively able to participate. So if they don't have a caregiver to help them and they can't, you know, physically get up and stand up and stand on that scale without a risk of a fall. Um or they can't physically put the blood pressure monitor cuff on their arm and hit the start button. That's probably not a patient that is appropriate. Um If they just refuse to participate and they just don't want to. Um then that's not an appropriate patient either. Um Although I will say that having your advocacy from the health care professionals is so important and so key, if you're expressing to that patient that this is important that this is gonna help you long term, this is gonna keep you out of the hospital, things like that the patient is much more motivated and likely to participate or at least agree to, to try the program. Um Once you sort of know your patient population that you want to start with, you wanna think about a protocol. Um so device allocation is one thing to consider. So if you're starting with, again, patients with um COPD as an example, and maybe you want to decide that uh or you decide that the pulse oximeter is the device that you're gonna use for them or if they have hypertension, the blood pressure monitor or diabetes is the glucometer. So you kind of know depending on that disease state, which device goes where um and how they're gonna be delivered to patients. Uh We in what we do, we ship the devices directly to patients homes. That seems to be the simplest way, but certainly might be beneficial to have a couple of devices on hand to provide to the patient if they're at the practice. Um But we do find that shipping them right to their home makes um makes it a little bit easier, especially on your organization. So you don't have to worry about the logistics of that, then you wanna think about biometric alert settings. So in that example, for somebody who has COPD, you wanna think, OK, if they um their blood oxygen saturation is below say um 86 something like that um then that's gonna create an alert. And so when that alert is created, then what happens next? Um So in our processes, we get an alert, nurses will then contact the patient to reconfirm that alert. There are so many times where there's a false alarm. Uh Maybe they're here was freezing cold when they put it in the pulse ox. Um maybe, you know, they forgot how to use the device. Um maybe, you know, they stepped on the scale with the dog in the morning and they, you know, they gained five pounds all of a sudden they have CHF and that's a cause for concern, but you know, you really wanna check and work with the patient and make sure you can reconfirm those results before starting to become worried. Um And then after you do that, you wanna assess them, are they symptomatic? Have they taken their medications, those types of things? Um After you gain that insight, then who is the escalation point? Ok. It does look like this patient needs to have a visit with the doctor or to speak with the nurse, whatever it may be. Um And who is that escalation point? And how are you gonna escalate? Is it gonna be through the E hr is it gonna be a text message? So just kind of working out all those details beforehand is, is definitely key when it comes to patient enrollment um provider and like I mentioned, provider and staff advocacy is so important. Um Just so that if the patient happens to be in the office or call the office and says, hey, somebody called me and they're talking about this program. Yes. Yes. This is a program that we do recommend. That kind of thing is really important. Um So it's really important to just educate all your providers and staff if you can not, that they need to do anything or necessarily be involved. But just so that they're somewhat familiar with what's going on with these patients and what programs that you're offering. Um, talking about eligibility, discussing co-pays with the patients is really important. Uh, when you're on the phone with that patient or you have them live in the office and you're talking about the program and asking them if they like to participate. It's important to go over that copay. If they have one, it's important to go over their eligibility. It's important to go over, um, what's expected of them, you know, if they say, uh, you know, uh can I just use this device like when I don't feel well or, you know, once a week, you know, that's not an appropriate patient. It's really meant to be something where the patient uses it consistently on a daily basis is wonderful. Um, every other day, that's great too. Um But we try to get them in a routine of using it every day. So it becomes a pattern for them um And so that we can see their trends over time. That's what's really important to be able to see those trends. It's not so much, you know, where they are right now, but seeing a spike um or a decline from, from what their norm is. So the patient set up in training, um this is, you know, all these steps are more involved, I think, than a lot of people perceive. Um you want to ensure that the device gets there. You want to perhaps register a patient on the portal. Um Scheduling a training with the patient is so important that once that patient can sense and says, yes, I'd like to participate in this program that you give that advice to them. You get them started on the program as soon as possible because the longer you wait, the less likely that patient is gonna be to um participate or be compliant with the program. Um You wanna provide instructions for them how to use the device, not just written instructions but be on the phone with them. We walk the patients through, you know, ok, you should have a delivery today. Go get a pair of scissors to open up the box cause there's gonna be tape on it and you know, take the blood pressure monitor out, this is how it works, you know, put the scale on a hard surface, you really wanna walk them through even though it's a simple thing to do. Um, it goes a long way when you're actually, you know, there on the phone, walking the patient through exactly what they need to do and then having them take a test, uh use that device for the first time, making sure that you get the metric um over the portal or into the E hr as, as you should. Um you know, these things are important and then I can guarantee you that patients all set up, they're good to go. You think you've got them? And then the next day, it could be that you don't get those results. You don't get that measurement because the patient forgot how to use the device or maybe they forgot, they even signed up for the program, you know, and so there's a lot of interaction that needs to take place with that patient in the beginning to really get them, started to feel comfortable with the program, develop that relationship with their, their R PM nurse and then have them be consistent and compliant over time monitoring, an interaction once they're set up, you just wanna monitor those patients. Um People usually ask is this like 24 7 monitoring and that's not the case. So we don't provide 24 7 monitoring. The reason for that is because um this is not intended to be an emergency response system. Um Part of educating the patients in the beginning with the program is explaining to them that, you know, if they feel like they need to go to 911, they, you know, go to the hospital, they still need to go to the hospital. Um, this is not to take away from that. Um, if they take their blood pressure in the middle of the night on a Saturday, like an ambulance isn't gonna show up. If it's sky high, you have to have those discussions. Um, this is more of chronic care management. It's helping them better manage their disease. It's something that again, you start to see little things over time, maybe. Um, you know, the heart rate is going up and the blood pressure spiked one day and they get a phone call and the patient, you know, is being assessed and the nurse finds out, oh, well, they didn't take their meds today. You know, the husband was supposed to pick them up. But, you know, the heat. Um, so it's important to get them back on that medication and then that can very well resolve the issue and they can continue off on their way instead of having them wait another day, another day and their blood pressure continues to spike. And the next thing, you know, it's an emergency situation just as an example. Um, so very important to be sure that you're monitoring them at least on, um, a daily Monday to Friday basis. Um, and then making sure that you're having that interactive communication with the patient. So they really know, they have a partner in this analysis is, is so important as well. I think just because you have this program and you want to know, well, what am I really getting out of the program? Um, making sure that what are my compliance metrics? How many of my patients are actually using this program? What is the attrition out of my patients to start the program? How many you stay on it? And for how long um what's the patient's satisfaction? Like? Um what are the trends, improvements, goals that you've set for those patients? What is my return on investment? Um So these are all really important to um you know, talk about at least on a monthly basis. Um And then last but not least. Yeah, last but not least is sorry. Um Just overcoming barriers. So we've done surveys um to various community health centers and said, what do you perceive as the biggest barriers to remote patient monitoring or implementing a program? Um They a lot of times have said limited resources, limited staffing, um patient enrollment who's going to enroll these patients, um patient participation and engagement. Like I started a program, I bought all these medical devices. They're sitting on the shelves or they're in my patients' homes. I gave them to the patient and they're not using them. Um co-pays have come up as a concern, uncertainty around billing. That's where Aaron's gonna come in next. But I just want to say that it is a lot. Uh There is a lot more involved with remote patient monitoring. Um We have been providing this program for so long. Please reach out to us if you have questions. Um We are more than happy to walk you through the program. Go over what your return on investment may look like. Go over the pricing. Um We just ask, you know, send us an email, you'll get a after the presentation of a message, I think we should be able to fill out a form and then we'll reach out to you um ask questions in the chat right now. We're gonna save time at the end um to answer everybody's questions as many as we possibly can. And again, thank you so much for your time and I'm gonna pass it over to air now. Ok. Thank you. Uh Thank you so much, Rebecca. Um Good afternoon, good morning to any folks on the west coast. Um joining you today to give a little bit of insight into uh how the final rule uh for calendar year 24 public by C MS just last week uh really will benefit FQH CS community health centers that are looking to implement um or start to bill for services that you potentially have already been providing um to your patients without the opportunity to bill for those services. Um As uh the introduction stated uh And from Corona Health, uh we provide uh billing solutions to all types of healthcare providers including uh FQHC si, like to say we um are the billing company formerly known as PM G A lot of our FQHC partners may recall us um prior to our acquisition by Coronas in late 2020. Um As Rebecca said, any questions about billing that we don't get to today, please feel free to reach out to me directly. Thanks. Of course, our standard disclosure that my compliance officer is so lovely. Uh forces me to, to state of course. Uh All the information here is is coming from the C MS final rule. I will say just an important caveat to some of the details we're sharing. Um is that this information was published by C MS and so it applies directly to traditional Medicare um service uh patients. So any patient who may be enrolled with a commercial plan or a managed Medicare plan or Medicaid, um There will be different billing caveats and we highly encourage all of our FQHC partners to review their contracts approach uh their payers that they have relationships with um to ensure that the expansion that C MS has provided to traditional Medicare um is also expanded to the Medicare replacement and commercial plans as well. But the, the rates and the billing uh guidance that we're providing here is specifically for traditional Medicare. So big news uh hot off the press uh late this summer was the proposed uh final rule was going to expand uh use of hick hick picks go 511 to include uh R PM and RT M services. Um So remote patient monitoring and remote therapeutic monitoring. I know today's focus is on R PM. Specifically as Rebecca stated, there were also a couple of other additional care management services that were added to the umbrella of GO 511. Um with the qualifying services um supported by uh the rule specifically related to R PM and RT M qualifying CPT codes are listed here. Um These codes uh will be billed with the GO 511 just like our entire other suite of general care management services um most critically and what was uh established in last year. Uh final rule and reiterated several times in this year's final rule is that the GE 05 11 can be billed more than once uh per calendar month for different qualifying services. As long as each of those qualifying services, um documentation requirements were met and they don't have pick picks related um uh inclusivity uh rules. So if, if there are certain care management services that can't be rendered in the same time period because they are uh inclusive to each other, those would not be considered covered uh more than once per calendar month. But as Rebecca stated, the real win here is in the same month, we certainly can build chronic care management and R PM services under the go 511. Um for that same time period for reimbursement, of course R PM and RT M are defined as one practitioner once per 30 day period, we need at least 16 days of documented data collection in order to support support billing for this service for this service. Excuse me. And this is effective January 1st. What we are anticipating and hoping that future guidance from C MS offers additional clarity on is how the interaction of the definition of these RP Mh picks saying once per 30 days and the definition of the GE 05 11 saying once per calendar month, which could inevitably with some of our timings be slightly different. We're hoping for clarity from C MS on exactly how those two different definitions uh will coincide with each other. As of now, we are encouraging our health centers to review the frequency in which these codes are built to ensure um that they are compliant with both the once per calendar month of the GE 05 11 per uh care management service as well as the 30 day period requirement of the general hick picks code. Another uh key win for our community health centers is that as long as the R PM service is not related uh to the same diagnosis used for another global period we are allowed to build during that period. Um So if you have a patient receiving an R PM service for a diagnosis of diabetes, and they're also in a global period uh for a procedure related to COPD as long as those primary diagnoses are different. Um We do uh anticipate uh and C MS has indicated those would this would that would qualify for additional payments outside whatever had been built globally? Ok. Next, next slide, please. So here, um we're outlining the national rates published by C MS for these services. Um Please note this is the national rate. Uh This would be adjusted uh per your specific areas, uh geographic adjustment factor which is by Lo C MS locality. Um But this is the standard rate uh across the board just under $73 for each instance of GE 05 11 20% coinsurance does apply here uh for these services. So please keep that in mind. Uh As Rebecca mentioned, it's important to educate your patients on the coinsurance res uh that they will be responsible for. You can see a slight decrease in the rate uh compared to last year. Last year, we were just under $78 full reimbursement this year just under 73 before you let the wind get out of your sales too much on the deck. Um It could have been as a my compliance officer who helped me compile this said it could be a lot worse. Um As one of Rebecca's earlier slides mentioned, uh C MS did take in did change the methodology for this rate setting um to include a weighted average. Um Previously, the rate had been set based on the average of the fees for the four categories of chronic care, uh care management services included in the go 511 C MS has reviewed data from claims received and has used a weighted average in order to set. Um, this reimbursement rate had just the standard fee for all of the newly added codes been used without a weighted average. Uh considering which of these codes had been used most frequently. Um We probably would have seen more of a decrease on that reimbursement as the go 511 expanded to include more services. So um a little bit of a bummer and very atypical, we always see our fqhcpps rate increase slightly um every calendar year. Uh This unfortunately went the other direction. But again, we're using a weighted average uh for the uh standard physician fee for all of the services provided as stated, it was clarified in last year's final rule. Sort of buried deep in the regulations. We get this question all the time about GEO 511 being used more than once per month. Um It was restated several times and repeatedly throughout this year's final rule. Um and really cementing in federal regulation that the H picks of GE 05 11 is intended to cover the entire suite of care management services. And C MS recognizes that FQHC patients may receive more than one care management service at any given time. And as such, the FQS uh should be reimbursed for each of those instances. Billing. I don't see any, I don't, it's hard to see any questions. Uh I don't know if there are any specific billing questions uh related here, but we've included just um and I believe folks will receive um some follow up from this, just the final rule as well as the proposed rule um that outlined uh these updates. Very exciting updates for us. Of course, thank you to mckesson for having us on today. Uh Thanks so much, Erin here. I can jump in here. We do have a few questions that have come in. Um And uh some of them are, are related to Medicare. Medicaid is Medicaid included in this as well from a, from a billing perspective. Um The C MS uh final rule uh directly impacts Medicare reimbursement. Um We do know that state Medicaid agencies uh typically expand upon what Medicare has approved rather than uh restrict. However, each and every state's uh roll out of this expansion and their interpretation of how it applies to their beneficiaries will be different. Um Again, the, the guidance here is at this time strictly related to traditional Medicare. Excellent. Um uh Will this affect the typical rate Medicare pays in any way? No, no, there is no impact to um our uh PPS received for office visits. This is in addition to uh and as bill, no impact on separate office visits performed. Ok. Uh I have another question about uh Medicare Advantage plans. Uh Can you bill these codes to Medicare Advantage? Um Again, we uh do not have firm. Uh You know, I, I can't, we can't make any broad statements around each particular Medicare Advantage plan. Um The your contract or a health center specific contract with each Medicare Advantage plan will determine billing guidance. Um But again, as this is C MS uh covered and uh Medicare Advantage plans typically uh follow the C MS uh lead. We do anticipate additional coverage for these services, but we strongly recommend our health centers review their current contracts, reach out to their payer contacts um and start to discuss how this expansion may be included in, in that relationship. Excellent. I've got a few questions that are coming here about uh remote patient monitoring specifically. Um Rebecca does re meric help help with the patient set up and training. Uh So great question. Uh Yes. Um Some of the services that we provide um really start to finish. We don't want to put the onus or the burden on your practice or your organization. Um We have either a patient list or some kind of criteria to look for within the E hr uh we will reach out to those patients on your behalf um to see if they would like to participate in the program, explain all the ins and outs of the program to them and how it can benefit them and just ask them if they would like to participate. Um If they do, we then ship a medical device to their home. Um Once that device is delivered, the nurse will contact that patient, we'll walk them through exactly how to utilize the device, set them up on the program. Um and then begin to build that relationship with them and monitor them on a daily basis. Um At the end of the month, we simply provide our organizations with a statement that has exactly what services are rendered and boast based on that, which reimbursements they can now bill for. So we really take care of it all and service truly as an extension of your care and partner with you. Um to provide that service to that patient, could you speak a little bit to um doing uh any sort of assessments or anything in the home? Uh Either before or after the equipment is shipped um for monitoring equipment functioning. Um And you know, determining best location in the home, uh the best location in the home for the medical devices. Um And I hope I'm answering this. I I'm getting the question correct. But yes, so with the Bluetooth can, it depends on what kind of device is necessary for that patient. Um So we offer two different types of devices through mckesson. So we have Bluetooth devices and we have cellular devices. Um We determine when we have that discussion with patients, which device is necessary for them based on their internet connectivity situation. Um But if they're utilizing a Bluetooth device, their phone should at least be in the same general room as them. Um If they're using a cellular device, it doesn't matter that it has no bearing on their phone. Um in terms of placement, you know, you know, you can keep the device, you know, anywhere that they'd like. Um I would suggest the only, you know, with this weight scale that should be on a hard surface. So maybe the kitchen or the bathroom is where you'd want to put the weight scale. But as far as the other devices, um there's, you know, there's no right or wrong uh place to put them. Excellent. Um So for uh the providers, are there any requirements to be aware of there? So, um is this like a nurse monitoring or does it have to be a doctor or NP? Yeah, great question. Great question. Um So obviously it's the physician that would bill. Um But the person that is responsible for the day to day, the care of the patients, um that is a nurse. Um So we use RNS and LP NS um that is, is caring for the patient and providing those services. And then it's the physician nurse practitioner or P A that would bill the actual service, but it's not the physician nurse practitioner or P A. That's actually um providing that service to the patient because the service is allowed to be provided under general supervision. Ok, excellent. Um So uh how, let's see, someone asks, how do you refer a patient for R PM services? Great question. Um Definitely contact us. Um We will discuss that with you. It's very easy to refer a patient to us. Uh We work closely with you often it's a patient list. Um You will receive somebody to work with uh directly for enrollment as well as a nurse that's assigned to your account that you can work with directly. Excellent, excellent. Um And is there any type of co pay required from that patient? So, and Erin maybe I'll let you take this one. But it, yes. So if it's a me, if it's a patient who has Medicare, then they are subject to the standard Medicare 20% deductible. Um And oftentimes a lot of the patients that we work with who do have Medicare oftentimes do have a supplemental program that will uh pick up that deductible. Yeah. Um Exactly the this service is not exempt from uh the 20% coinsurance uh that Medicare uh does enforce for uh this type of professional service. Um But as Rebecca said, especially in the FQHC world, our patients very often have um an additional second and potentially even tertiary coverage, whether that's a supplemental plan to Medicare or um a Medicaid um or other secondary um that may pick up coinsurance. But again, um your particular State Medicaid plans and and other commercial carriers will need to be reviewed to ensure coverage. Excellent. Um Another technical question here, someone asked if you've seen any issues with the communication of the devices with EMRS. Great question. Another great question. So there are some medical devices out there that communicate with the E HR S. Um That's, you know, one way to get the data in the E HR s. Um not the way that we prefer. Um the easiest way to do it is have all of the data, patient trends, nursing documentation, all of that sync directly with the E hr not necessarily through the medical device because the E hr is not gonna be reaching out to that patient to say, hey, let's let's do something with your medical device and fix it. We're not getting that data. Um So all the way our program works is that all of the data from those medical devices are transferred to our web portal and through our web portal and relationships that we have with E HR S, the data is then pushed into the E hr and it's a two by way directional uh integration and there's no issues there. If there is an issue there, our nurses won't get a reading that day. And so then they'll have to reach out to the patient and say, hey, I didn't get a reading to you and the patient would say, oh, I did my reading and then we'd have to say, oh, ok, let's see what's going on and we're able to address it right away. You might add to that too. Rebecca that there is a Rheum health app and the patient can follow along with their data there. Yeah, great. Yeah, thanks Jason. Um Do you send any or, or what sort of documentation do you send back to the referring provider regarding patients care? So it depends on the relationship that we have and what that practice would like. Um We always send at the end of the month, a couple of different things. So we send them what we call their reimbursement report. That would be a list of all of the patients that are on the program. Exactly what services were provided and based on that, what codes they can now bill for. Um They also have often times we do analysis with them. We have monthly meetings where we talk about, you know, they receive a report and it talks about what's um been provided during that month, positive um uh stories and situations that have happened throughout the month. Um We go over uh what their return on investment is. So how much money is coming in with the reimbursements, how much money is going out in terms of the cost that they're paying for the program and then what's left over. Um So we provide them with a thorough analysis of just the overall program on a monthly basis. Uh in terms of documentation though, if, if they want the data in the E hr for instance, Athena Health, we are directly integrated with. And so all of that information automatically transfers back and forth. Um oftentimes if we are working with a patient and we have an alert as an example. Um and that patient is really in need, we need to escalate that situation to the doctor. The nurse will communicate with the doctor and say, hey, here's a quick snapshot of what their trends look like. So here there is their trend previously, then here's the spike. So this is what's going on. So sometimes there's information shared that way as well. Excellent, excellent, excellent. Well, uh thank you both so much for your time today as we uh near the end of the hour. Um I just wanna thank you both uh for the time today is excellent information and thank you to all of our uh participants who uh joined today. Um We are going to be sending out a recording of this presentation. So definitely be sure to look for that in your email. Also, we will include a link so that you can schedule some time uh with for metric. Um in case your question did not get answered today, uh We'll also be sharing all of that information with for metric as well so that they can uh answer your questions. Um If you notice on your screen there, uh just a link to our uh uh to continue learning with mckesson. Um You can visit us at M ms.mckesson.com/educational dash webinars. Uh There you can register for a future webinar share with your colleagues or sign up to receive regular updates on our webinar schedule. Now, I am going to attempt to uh share out this link to with our viewers um so that they can uh schedule time with you. Uh But if that, if that does not work, please watch your inbox for a copy of the recording of today's presentation as well as some information on uh for the discussion with your metric. Erin Rebecca. Thank you all for your time today. I really appreciate it. Thanks so much Brandon. Appreciate everybody on the call today. Excellent. Have a great day, everyone. Bye bye.