Navigating the CCM and RPM Landscape
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What is the main topic discussed in this episode?
This episode of AHLA Speaking of Health Law is brought to you by AHLA members and donors like you. For more information, visit American Health Law.org.
Hello and welcome to today's podcast. My friend and colleague, Pam, who will introduce herself momentarily from VMG Health and I are presenting on a very timely topic related to CCM and RPM. And specifically that is an area of compliance as well as services that can be rendered to patients, which really focuses on Another vehicle to help control and manage chronic conditions. I'm Rachel Rose. I'm an attorney in Houston, Texas, where I have my own firm. I primarily focus on healthcare, cybersecurity, securities law, government enforcement actions. I do transactional. Compliance and litigation, as well as bringing false claims act cases. I most recently had a case intervened in by the United States Department of Justice that related to Medicare Part C upcoding and
Although the type of coding we're going to be talking about, or more specifically, Pam is going to be talking about today as a coding expert is very different than what goes into A Medicare Part C risk adjustment. But with that, Pam, tell us a little bit about yourself.
Thank you, Rachel. Um, appreciate the opportunity, of course, to be here with my colleague Rachel and be able to have uh this opportunity to talk to all of you about coding and compliance. I think it's just an area folks like Rachel and I work together. I work with a lot of attorneys on these types of specific issues. And there's so much involved with the coding and compliance component of it and the documentation requirements. So certainly. uh appreciate the opportunity to be here today. I serve currently as the managing director of the coding and compliance division at VMG Health. We are a healthcare only consulting firm with a lot of different areas of specialty. And this area of coding and compliance is just one of them.
But Thank you all for having us today.
And thank you, AHLA, for not only having us as a guest on the podcast, but also for publishing our article, which is going to be the framework of our discussion here today. So, Pam, our article really opens with for those of you who can recall the Atari Game Froger. where the frog's trying to get from one side of the road to the other without getting hit by a car or a truck. And really when Pam and I were discussing it, that's kind of the way healthcare compliance encoding works, especially in the RPM and CCM space. So Pam, do you wanna explain generally what RPM is and C CM is and then how they differ from each other?
The the services are different. They all kind of fall under this care management umbrella. And I think there's been a lot of interest by providers in these particular types of codes. They've been evolving. If you look at the codes, you'll see that in some of the code series the the numbers aren't even consecutive. And it's because these have been add-on and evolution of codes, and it it isn't as consistent as we would have thought. I think they keep thinking about types of patients and how we can care for those patients. And with that, they've been introducing over the last couple of years these different types of codes. Now, chronic care management for a patient who has Multiple chronic issues, that that's part of the issue is being able to ensure that we are meeting the specific criteria for those codes.
And it's about the patient. And then if the patient meets that criteria, having the appropriate type of provider who would be providing that kind of ongoing care to the patient. And then all of the associated documentation requirements along with that. So chronic care management, we've got these patients who. For the month, we're providing them a lot of different services. They've got these multiple conditions that we're managing. And so we've got a care plan, we've got outreach to the patient, we're managing their um all of their prescriptions. There's a lot of coordination for those particular types of patients. So all of that from a time perspective.
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Chapters
4 chapters
1
What is the main topic discussed in this episode?
0:05–21:05
2
What is the difference between Chronic Care Management (CCM) and Remote Patient Monitoring (RPM)?
21:05–27:22
3
How do providers meet the documentation and coding requirements for CCM services?
27:22–33:25
4
What are the core components required for a compliant RPM program?
33:25–51:42
Speakers
2 identifiedMore from AHLA's Speaking of Health Law
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