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. 2024 Dec 29:19322968241308920.
doi: 10.1177/19322968241308920. Online ahead of print.

Building a Diabetes Educator Program for Remote Patient Monitoring Billing

Franziska K Bishop  1 , Annette Chmielewski  2 , Jeannine Leverenz  2 , Shannon Lin  2 , Barry Conrad  2 , Anjoli Martinez-Singh  2 , Laura Pike  3 , David Scheinker  1 , Priya Prahalad  1   2   4 , David M Maahs  1   2   4
Affiliations

Building a Diabetes Educator Program for Remote Patient Monitoring Billing

Franziska K Bishop et al. J Diabetes Sci Technol. .

Abstract

Objective: Develop workflows and billing processes for a Certified Diabetes Care and Education Specialist (CDCES)-led remote patient monitoring (RPM) program to transition the Teamwork, Targets, Technology, and Tight Control (4T) Study to our clinic's standard of care.

Methods: We identified stakeholders within a pediatric endocrinology clinic (hospital compliance, billing specialists, and clinical informatics) to identify, discuss, and approve billing codes and workflow. The group evaluated billing code stipulations, such as the timing of continuous glucose monitor (CGM) interpretation, scope of work, providers' licensing, and electronic health record (EHR) documentation to meet billing compliance standards. We developed a CDCES workflow for asynchronous CGM interpretation and intervention and initiated an RPM billing pilot.

Results: We built a workflow for CGM interpretation (billing code: 95251) with the CDCES as the service provider. The workflow includes data review, patient communications, and documentation. Over the first month of the pilot, RPM billing codes were submitted for 52 patients. The average reimbursement rate was $110.33 for commercial insurance (60% of patients) and $46.95 for public insurance (40% of patients) per code occurrence.

Conclusions: Continuous involvement of CDCES and hospital stakeholders was essential to operationalize all relevant aspects of clinical care, workflows, compliance, documentation, and billing. CGM interpretation with RPM billing allows CDCES to work at the top of their licensing credential, increase clinical care touch points, and provide a business case for expansion. As evidence of the clinical benefits of RPM increases, the processes developed here may facilitate broader adoption of revenue-generating CDCES-led care to fund RPM.

Keywords: Certified Diabetes Care and Education Specialist (CDCES); continuous glucose monitoring (CGM); remote patient monitoring (RPM); type 1 diabetes (TID).

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: DMM, DS, and PP have received support from NSF, Stanford MCHRI, and Stanford HAI. DMM has received funding from the Helmsley Charitable Trust. DMM has had research support from the NIH, and his institution has received research support from Dexcom. PP has consulted for Sanofi. DMM has consulted for Abbott, the Helmsley Charitable Trust, Lifescan, Sanofi, Medtronic, Provention Bio, Kriya, Biospex, and Bayer. The remaining authors declare no competing interests.

Figures

Figure 1.
Figure 1.
4T data flow overview.
Figure 2.
Figure 2.
Opportunities for RPM.
See this image and copyright information in PMC

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