In this article, you will learn:
- How continuous glucose monitors (CGM) can be integrated with Remote Physiological Monitoring (RPM)
- How coverage includes Medicare and Medicaid
- About our Medical Billing Checklist you can use at your clinic
Short Answer: Absolutely! A continuous glucose monitor estimates what your glucose level is every few minutes and keeps track of it over time, which can greatly benefit Remote Physiologic Monitoring. By integrating CGM into RPM services, healthcare providers can monitor patients’ blood sugar levels in real time, which can be especially helpful for diabetic patients. For example, a study by the American Diabetes Association found that patients who used CGM technology had an average A1C level of 7.2%, compared to an average A1C level of 8.0% for those who did not use CGM technology¹.
Furthermore, integrating CGM into RPM technology can help healthcare providers identify potential health issues before they become serious. For example, a study published in the Journal of Diabetes Science and Technology found that CGM technology helped identify hypoglycemic events (low blood sugar) in diabetic patients, allowing healthcare providers to intervene before the event became serious. The study found that patients who used CGM technology had a 57% reduction in hypoglycemic events compared to those who did not use CGM technology².
Government Medicare for CGMs
CGM technology has shown significant potential in improving Remote Patient Monitoring (RPM) for Medicare patients. By integrating CGMs into RPM devices, healthcare providers can remotely monitor blood sugar levels in real-time for diabetic patients. This level of monitoring can help identify any fluctuations or abnormalities in glucose levels promptly and allow for timely interventions. Additionally, CGMs provide Medicare patients with a convenient and non-invasive method of monitoring their blood sugar levels regularly, reducing the need for frequent visits to healthcare facilities.
The utilization of CGMs in RPM for Medicare patients offers several advantages:
- Enables healthcare providers to closely monitor blood sugar levels, helping to prevent complications and improve overall glycemic control
- Studies have shown that CGM use in RPM for diabetic patients can lead to a reduction in A1C levels, which is a crucial indicator of long-term glucose control. By maintaining optimal blood sugar levels, Medicare patients can potentially reduce the risk of developing complications associated with diabetes
- Provide Medicare patients with valuable data that can be shared with healthcare providers during virtual check-ups or consultations
- This data allows healthcare providers to gain insights into patients’ glucose trends, patterns, and potential issues, even when they are not physically present
- By having access to this information, healthcare providers can make more informed decisions regarding adjustments to the patient’s care plan, medication, or lifestyle modifications
- Enhances diabetes management, improves patient outcomes, and reduces healthcare costs associated with hospital readmissions and complications
- This empowers Medicare patients to take an active role in their healthcare management while receiving remote support from their healthcare providers³
State Medicaid and CGMs
There are currently 27 states where Medicaid covers CGMs for both type I and type II diabetes, while others cover CGMs only for patients with type I diabetes. Medicaid continues to update its coverage policies and expand coverage as CGM use becomes more prevalent⁴.
For underserved populations, CGMs integrated into Remote Patient Monitoring (RPM) programs can offer several advantages. First, it allows healthcare providers to remotely monitor blood sugar levels and provide personalized guidance and support to patients, even when they may not have easy access to healthcare facilities. This can help bridge the gap in healthcare access and ensure continuous care for individuals who may face barriers to regular in-person visits.
Additionally, CGMs can empower patients from underserved populations by providing them with valuable data and insights into their glucose trends and patterns. This information can help them make informed decisions about their diet, exercise, and medication adherence, leading to better self-management of their diabetes. Moreover, CGMs integrated into RPM can enable healthcare providers to track patient progress, identify areas for improvement, and provide targeted interventions and education to address specific challenges faced by underserved populations.
To ensure the successful implementation of CGMs for underserved populations, it is essential to address barriers such as cost and accessibility. Initiatives focused on making CGMs more affordable and accessible can help overcome these challenges and ensure that individuals from underserved communities benefit from this technology. Collaborations between healthcare organizations, government agencies, and community-based programs can play a vital role in expanding access to CGMs and RPM for underserved populations.
By leveraging CGMs in RPM programs, healthcare providers can empower underserved populations to actively participate in their diabetes management, improve their health outcomes, and reduce healthcare disparities. It is crucial to prioritize equitable access to CGMs and RPM technologies to ensure that all individuals, regardless of their socioeconomic status, have the opportunity to benefit from these advancements in healthcare⁵.
Medical Billing Checklist: Medicare Coverage of CGMs
Yes, Medicare does cover CGMs (continuous glucose monitors) for eligible beneficiaries. Medicare Part B may cover CGMs if certain criteria are met, such as a diagnosis of diabetes and a prescription from a healthcare provider. However, coverage details and requirements may vary, so it is recommended to consult with Medicare or a healthcare professional for specific information regarding coverage and eligibility.
Must meet the following criteria:
▢ Patient has diabetes mellitus
▢ The patient’s provider concludes that the patient has sufficient training on the CGM
▢ The CGM is prescribed in accordance with the FDA indications for use
▢ The patient meets at least one of these two criteria: patient is insulin-treated OR patient has a history of problematic hypoglycemia with documentation (either recurrent level 2 hypoglycemic events that persist despite multiple attempts to adjust medications and/or modify treatment plan OR a history of 1 level 3 hypoglycemic event)
▢ Within 6 months before ordering the CGM, the provider has an in-person or Medicare-approved telehealth visit with the patient to evaluate their diabetes control and verify that the above criteria are met
▢ Every 6 months following the initial prescription of the CGM, the provider must conduct an in-person or Medicare-approved telehealth visit to document adherence to their CGM regimen and diabetes treatment plan
How Certintell Can Help
Population health powered by Remote Patient Monitoring is continuing to grow in the healthcare field. This growth will help us understand the significance that more supportive healthcare methods can have on our populations.
Certintell can help! Certintell supplies clients with a comprehensive RPM and health data reporting platform and furnishes the devices and care managers health systems need to adapt to this new future in healthcare. With our services, health systems can easily access data and receive alerts regarding patient stats. Our supporting staff helps aggregate and interpret this data, as well as help patients achieve higher levels of self-management. Contact us to learn more.
Sources
¹Bergenstal, R. M., Beck, R. W., Close, K. L., Grunberger, G., Sacks, D. B., Kowalski, A., …Cefalu, W. T. (2018). Glucose management indicator (GMI): A new term for estimating A1C from continuous glucose monitoring. Diabetes Care, 41(11), 2275–2280. doi: 10.2337/dc18-1581
²Hermanns, N., Heinemann, L., Freckmann, G., Waldenmaier, D., & Ehrmann, D. (2019). Impact of CGM on the management of hypoglycemia problems: Overview and secondary analysis of the HypoDE study. Journal of Diabetes Science and Technology., 13(4), 636–644. doi: 10.1177/1932296819831695
³Tang, M., Nakamoto, C. H., Stern, A. D., & Mehrotra, A. (2022). Trends in remote patient monitoring use in traditional medicare. JAMA Internal Medicine, 182(9), 1005–1006. https://doi.org/10.1001/jamainternmed.2022.3043
⁴Howe, G., Chavis, J., (2022). Expanding medicaid access to continuous glucose monitors. Center for Health Care Strategies, 11.
⁵Agarwal, S., Simmonds, I., & Myers, A. K. (2022). The use of diabetes technology to address inequity in health outcomes: Limitations and opportunities. Current Diabetes Reports., 22(7), 275–281. doi: 10.1007/s11892-022-01470-3
