Medical Wearables – Need for Solutions that Provide Clinically Valid Data and Assimilate Existing Billing Codes

by | Published on May 3, 2017 | Medical Billing

Medical Wearables
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Medical wearables are transforming healthcare as they have the potential for the detection, prevention, and treatment of chronic diseases such as congestive heart failure, diabetes, hypertension, and chronic obstructive pulmonary disease. Early disease warnings can reduce costly stays in the hospital. However, industry experts say that, to succeed, healthcare wearables need to provide clinically valid data and fit within existing medical billing and coding systems.

Fitbits, glucose monitors and other wearable devices are changing the way physicians provide care and the way patients care for themselves.

  • In a 2012 nationwide Pew Research Center survey, 46 percent of the respondents said that tracking health data changed their overall approach to maintaining their health or the health of a person for whom they provide care. In addition, 40 percent said monitoring data prompted them to ask their doctor new questions or encouraged them to get a second opinion.
  • The real-time feedback that wearable medical devices provide also allows patients to be more engaged and face up to their medical issues. The immediate feedback also helps them to make better decisions.
  • While clinical monitoring only provides a snapshot in time, wearables provide physicians with contextual, continuous data.
  • The data that wearables collect can be used to forecast an increased risk of a potentially fatal health event and alert physicians when an intervention may be needed.
  • Real-time data collected from medical healthcare wearable devices in clinical trials alerts researchers quickly about potential adverse events or patient non-compliance

However, in an interview to MPO Magazine, Biotricity founder and CEO, Waqaas Al-Siddiq pointed out that the relevance of wearables used for tracking cardiovascular conditions or chronic health concerns depends on their clinical accuracy.

“Integration will only happen if providers see clinical value in the data received from these devices, and if the physicians are reimbursed for their time using this data”, he says.

Due to the high cost of medical wearables, reimbursement is a major issue both in terms of patients’ out-of-pocket costs as well as physician reimbursement for time required to interpret and act on the data. According to him, the market will favor companies that can deliver wearables that provide clinical-grade data and easily integrate their solutions into existing medical billing systems. If the medical device solution does not fit with the existing billing codes, the entire burden of the cost will fall on the patient.

Medical billing companies are well aware that physician compensation depends on patient volume and the use of accurate medical billing codes. If there is no compensation connected to the data from the medical wearable, physicians will order an additional test that has a billing code, since they are reimbursed on pre-approved billing code systems. Therefore, even though the medical wearable may provide the same information as the medical test, physicians will prefer ordering the test as it can be coded and billed appropriately. To support data from medical wearables, physicians need

  • To have relevant, clinically valuable data that can be processed quickly
  • To be compensated for the time they spend on interpreting the data and using it

Physicians will find it easier to recommend or integrate new medical wearables into their practice with cost-effective benefits to patients only if the products provide clinically relevant data that integrates with existing billing codes.

According to a report published in MarketWatch, wearables could raise the cost of patients’ health insurance with the repeal of the Affordable Care Act (ACA). Under the ACA, insurance companies could not deny coverage to people with pre-existing conditions. The lifting of the rule might prompt insurers to examine wearable devices for evidence they could use to deny coverage to this segment or set rates based on such data. If this were to happen, the consequences would be devastating as, according to the Centers for Medicare and Medicaid (CMS), almost half the American population has a chronic condition such as asthma, cancer or mental illness, which can be used to deny them coverage.

Meghann Drella

Meghann Drella possesses a profound understanding of ICD-10-CM and CPT requirements and procedures, actively participating in continuing education to stay abreast of any industry changes.

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