Rhythm sells the MD the ZioPatch and is telling the MD to bill, hookup, technical fee and profee! How can the MD legally bill the technical fee when iRhythm is still doing the scanning and analysis?? Doesn't sound correct to me.
thoughts??
Patient mails back to company. Takes them about a week to complete report.
Is it true iRhythm got approval for a 7 or 14 day CPT code for the ZioPatch?
Careful what you wish for. Reimbursement for the patch would be less than a holter. Hookup would be cut drastically, scanning would stay the same, and read would stay.
You would have to explain why you think it would go up. CMS will look at work load, which one of these is more work load and which is less.... by what amounts. Even if scan and read went up it would be offset by decreased hookup.
CMS will put that at $75.00. So what if the patient has to wear it for 14 days, how much work is it for MD and irhythm? They will not care if it is disposable, that is not their problem.
Interesting argument. First off if you look at the reimbursed amounts, hook-up is second, about 25% more than profession read. Just look it up, you cant argue this fact.Why wouldn't it? It has the recording capacities of about a dozen Holters so how would scanning stay the same? And hook-up is the lowest reimbursable component while scanning is the most lucrative. Even if there's a drop in the hookup (which I can't see how you could argue there would be, even if hookup is marginally quicker, since we're talking mere minutes), it'd be more than offset by a significant rise in the Technical component.
I totally agree with you, but this is not the way it works. The only time they look at yield is to get cpt approval etc.. Once that is approved, payment is based strictly on RVUs. Look it up, there is no place for arbitrary amounts. It is strictly workload. Period, nothing else. Please take a look at CMS calculations sometime and show us where they add in the arbitrary amounts to make you profitable etc. Sorry but they do not just grab things out of the sky to give to you. Great product but watch how fast CMS puts you out of business. IMO.You're right, they won't care. What they will care about is cost-effectiveness. Does it make fiscal sense to reimburse more for a device with several times the recording length and several times the diagnostic yield compared to a Holter? Yes, of course it does, because it will lead to a quicker diagnosis and cut down on additional health care costs. Pay a few dozen dollars more now to save hundreds, maybe even thousands, per patient over the long run? It would be irresponsible not to.
Interesting argument. First off if you look at the reimbursed amounts, hook-up is second, about 25% more than profession read. Just look it up, you cant argue this fact.
No drop in hookup, are you kidding? You really don't think anyone will believe attaching 7 electrodes, programming device, and then removing and cleaning, is the same as one patch that the patient mails back.
Everyone knows the device is algorithm based, it is not beat by beat with quantification's like a holter. The effort to scan and edit a 24 hour holter is about the same as 7 day patch.
I like the product just stating you are in fantasy land if you think any reimbursement goes up these days. Just my opinion, but this thing will get hammered and made non profitable for irhythm.
I totally agree with you, but this is not the way it works. The only time they look at yield is to get cpt approval etc.. Once that is approved, payment is based strictly on RVUs. Look it up, there is no place for arbitrary amounts. It is strictly workload. Period, nothing else. Please take a look at CMS calculations sometime and show us where they add in the arbitrary amounts to make you profitable etc. Sorry but they do not just grab things out of the sky to give to you. Great product but watch how fast CMS puts you out of business. IMO.
