Enabling Therapy Monitoring with the ID-Cap™ System
Start receiving new CMS reimbursement with minimal disruption to your existing workflow. The ID-Cap™ System includes everything you need to execute an RTM program in your practice.
About RTM
CMS has expanded its coverage for digital health solutions with the introduction of Remote Therapeutic Monitoring (RTM) effective January 1, 2022. It is intended for the management of patients utilizing FDA approved medical devices that collect non-physiological data, such as medication adherence for patients with a musculoskeletal or respiratory medical condition. The RTM family includes three practice expense (PE) codes; one for device set-up/training and two for the devices. The RTM device must monitor at least 16 days of data per each 30-day period.
The two professional work RTM codes require a minimum of twenty minutes of time in a month e.g., reading and interpreting data/reports, modifying care plans, communicating with the patient, documenting the RTM services and at least one interactive communication with the patient/caregiver, such as a video chat or phone call). RTM is intended to be provided and billed for by a much wider range of providers than other digital programs and are available to physicians and Qualified Health Care Practitioners (“QHCPs”) who are not able to independently order and bill for E/M services. RTM is in an evolving state of development.
CMS is currently taking comments for 2023 expansion of RTM coverage beyond the two organ systems currently approved. In addition, not only is there financial backing for RTM but several studies show that these services offer incredible value in improving health outcomes and increasing patient engagement, reducing medical costs, and increasing access to care.
How RTM Works
The ID-Cap™ System provides real time precise medication ingestion data, encapsulation options, various reader options, a patient application notifying them of their history, a practice dashboard to monitor patient progress and communicate with patients and encounter information to accurately and efficiently track for RTM revenue management.
The ID-Cap™ System
CMS’s guidance in the 2022 Final Rule states “the device used must meet the FDA definition of a device as described in section 201(h) of the Federal Food, Drug and Cosmetic Act (FFDCA),” which essentially states that medical devices should be: “Recognized in the official National Formulary, or the United States Pharmacopoeia, or any supplement to them”; Intended to diagnose or help cure, mitigate, treat, or prevent diseases or other conditions; Intended to affect the body without (or nearly without) chemical action; and unreliant on metabolization. The ID-Cap™ System is FDA cleared and meets all the criteria for use in RTM.
The ID-Cap™ System provides accurate and quick reporting that can be integrated into existing workflows and can be uploaded into most EHRs. The ID-Cap™ System automatically records and stores detailed ingestion documentation, audit trails and time stamps of patient communications. This will reduce the administrative burden for your team who already regularly check-in with the patients and fulfill regular tasks such as refills, appointments, referrals, etc.
ID-Cap App
The Patient’s Dosing Companion
- Available on iOS and Android platforms
- Configured by the etectRx server upon entry of an activation code – no user configuration required
- Reports and displays ingestion event history
- Configurable dosing reminders and notifications
- Allows the user to enter ingestion event manually along with reason for manual entry
- Provides updates on status of Reader
- May be used with or without the ID-Capsule & Reader
Clinician Dashboard
The Clinician’s View of the ID-Cap™ System
- Enroll patients in program
- Set up Groups and dosing times
- Manage readers and allocation
- View ingestion results in real time
- Set up and manage reminders and notifications for display on user phones
Encapsulation Process
Encapsulation can be completed at the practice pharmacy or provided by an outside party.
- Drug shipped to practice pharmacy or to practice from third party
- Capsule size determined by medication in use
- Standard or DB capsule sizes
- Industry standard equipment used for encapsulation
- In-house encapsulation training available
Data Flow
The ID-Cap™ System requires no real investment in infrastructure and can be implemented immediately using Wi-Fi and Cellular Networks. It comes with patient applications and practice dashboards to keep the patient and provider updated and in communications.
Patient Acceptance and Willingness to Use
- I thought it was easy. It helped, because I had a routine of just take the reader off of the charger and go get the medicine.
- I like getting the (text) message it showed me that the device was working.
- I think the digital pill is pretty, awesome to be able to track when you’re taking PrEP.
- Using the system actually really helped me to realize how much (oxycodone) I was taking.
Acceptance of system (9/10, 90%)*
- 90% of participants reported a positive experience integrating digital pill in medication regimen
- Digital pills were easy to swallow
- System became part of medication routine and participants developed different techniques for system use based on individuals
- Appreciated receiving text messages after taking medication when an ingestion event was recorded
Willingness to use in chronic disease (8/10, 80%)*
- Participants were willing to use in coordination with health care provider for observation of medication taking behavior
Reimbursement & Benefits
New RTM Reimbursement Potential
| Physician Monthly Reimbursement Potential |
One Communication |
Two Communications |
Three Communications |
|
|---|---|---|---|---|
| Revenue Month 1 | ||||
| 98975 | patient education | 19.38 | 19.38 | 19.38 |
| 98976 | equipment | 55.72 | 55.72 | 55.72 |
| 98980 | monthly monitoring: first 20 min. | 50.18 | 50.18 | 50.18 |
| 98981 | monthly monitoring: additional 20 min. | NA | 40.84 | 81.68 |
| Total | 125.28 | 166.12 | 201.12 | |
| Revenue Month 2+ | ||||
| 98976 | equipment | 55.72 | 55.72 | 55.72 |
| 98980 | monthly monitoring first 20 min. | 50.18 | 50.18 | 50.18 |
| 98981 | monthly monitoring: additional 20 min. | NA | 40.84 | 81.68 |
| Total | 105.90 | 142.09 | 187.58 | |
| Annualized Reimbursement Per Pt. | $1,290.18 | $1,729.11 | $2.264.50 | |
| * CPT codes 98975, 98976, and 98977 require RTM device to monitor at least 16 days of data per each 30-day period. | ||||
New 2022 CMS Remote Therapy Monitoring (RTM) Codes
| CMS RTM Reimbursement Amounts | Billed through physician’s office | |
|---|---|---|
| Code | Description | Allowable Amount |
| 98975 | Remote therapeutic monitoring (e.g.respiratory system status, musculoskeletal system status, therapy adherence, therapy response); initial set-up and patient education on use of the equipment | $19.38 |
| 98976 | Remote therapeutic monitoring (e.g.respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device)s) supply with scheduled (e.g.daily) recording(s) and/or programmed alert(s) transmission to monitor respiratory system each 30 days | $55.72 |
| 98977 | Remote therapeutic monitoring (e.g.respiratory system status, musculoskeletal system status, therapy adherence, therapy response); device)s) supply with scheduled (e.g.daily) recording(s) and/or programmed alert(s) transmission to monitor musculoskeletal system each 30 days | $ 55.72 |
| 98980 | Remote therapeutic monitoring treatment, physician/other qualified healthcare professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during a calendar month: first 20 minutes | $50.18 |
| 98981 | Remote therapeutic monitoring treatment, physician/other qualified healthcare professional time in a calendar month requiring at least one interactive communication with the patient/caregiver during a calendar month: additional 20 minutes | $40.84 |
| Source: 2022 CMS Physician Fee Schedule | ||
Practice Benefits
- Provides a new reoccurring reimbursement stream
- Improves the delivery of chemotherapy in the home setting. Especially beneficial when there are patient isolation requirements or patient lives in rural areas far from chemotherapy center.
- Documents actual medication adherence data in relationship to outcomes
- Documents actual medication adherence data in relationship to side-effects
- Helps justify the dispensing of high cost oral medications. Also provides opportunities for lowering spending on preventable hospitalizations, ED visits, and urgent care.
- Supports the implementation of clinical trials, Chronic Care Management (CCM) and Medication Therapy Management (MTM) programs
- Increases patient engagement with the practice
- Adherence data can be interfaced with a symptom tracker or other medical data
- Allows for early patient intervention and care coordination
- Provides real time data so as to correctly follow a treatment algorithm or pathway and not prematurely move to subsequent lines of therapy
- Provides the practice a framework for value-based payer contracts
Practices who are early adopters and understand the paradigm shift to digital health will take advantage of new technologies that build strong revenue streams while improving patient outcomes.
Explore how etectRx’s solution can support your launch of an RTM program
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