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Medical Group Management Association

Maximizing reimbursement in COPD management

Insight Article - August 29, 2019

Coding & Documentation

Reimbursement

The annual cost of chronic obstructive pulmonary disease (COPD) management in the United States totaled $32.1 billion in 2010 with a predicted increase to $49 billion by 2020. Medicare and Medicaid paid 51% and 25% of those 2010 costs, respectively; an additional $3.9 billion was lost to absenteeism in 2010, which was attributed to approximately 16.4 million days of lost work.

Effective reimbursement strategies are changing with the Centers for Medicare & Medicaid Services’ (CMS) implementation of the Bundled Payments for Care Improvement (BPCI) initiative in 2013 and the BPCI Advanced initiative in 2018. These initiatives provide insight into bundled payments, including the role of quality metrics. Seeking maximum reimbursement becomes particularly relevant in COPD, given the relative economic burden, readmission rates and patient complexity.

Other recent CMS changes allow for increased compensation for closer patient monitoring, including updated CPT codes for transitional and chronic care management services. As of 2019, providers can also bill for remote patient monitoring services, which is increasingly relevant in COPD as the scope of telehealth broadens.

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