Considering Telemedicine in the Wake of COVID-19?
By Steve Levine,
texmed.org/TexasMedicineDetail.aspx
Much of America, Texas included, is engaged in a big “what if” conversation about what happens next with the coronavirus disease, COVID-19.
- What if a lot of cases show up in my town?
- What if schools must close?
- What if I have to stay home for a week or longer?
The Texas Medical Association and organizations like the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization are encouraging physicians to consider how they will respond to big surges in sick patients needing care; critical staff becoming ill or unable to come to work; and protecting non-infected patients from exposure to the virus from other patients in the office.
Could telemedicine be part of the solution for your practice?
“Shifting practices to triaging and assessing ill patients (including those affected by COVID-19 and patients with other conditions) remotely using nurse advice lines, provider ‘visits’ by telephone, text monitoring system, video conference, or other telehealth and telemedicine methods can reduce exposure of ill persons with staff and minimize surge on facilities,” CDC says in a recent guidance document. “Many clinics and medical offices already use these methods to triage and manage patients after hours and as part of usual practices.”
The laws and rules concerning telemedicine (members only white paper) in Texas have changed considerably to expand access over the past several years, in large part due to TMA’s efforts. In 2019 alone, the Texas Legislature passed a bill to streamline Medicaid’s telemedicine requirements, and another measure allowing physicians to choose the best platform for providing telemedicine services rather than having health plans dictate the platform.
For physicians looking to ramp up their telemedicine capabilities, TMA offers a 37-minute webinar, Telemedicine: The Changing Shape of Care, free to members thanks to the sponsorship of TMA Insurance Trust. TMA members are eligible for a free technology contract review from Coker Group, including a contract review of telemedicine vendor services, and TMA has created a free telemedicine vendor evaluation tool.
Texas Medicaid now can pay for services provided via telemedicine to patients who are in their homes under certain circumstances. Medicare Advantage plans can cover those services in patients’ homes for the first time this year; traditional Medicare cannot. Analysts tell TMA that, even in an emergency, the secretary of Health and Human Services (HHS) lacks the authority to waive the prohibition against paying for telemedicine services to patients who are in their homes; it requires an act of Congress. And this week, Congress acted.
The U.S. House of Representatives on Wednesday included authorization for HHS to take such actions in a declared national emergency as part of the coronavirus-response legislation that passed overwhelmingly. The Senate passed an $8.3 billion spending bill Thursday, and President Trump signed it Friday.
For up-to-date information on COVID-19, check TMA’s Coronavirus Resource Center. And turn to the TMA Telemedicine Resource Center for links, resources, and a look at TMA advocacy on telemedicine in Texas.
Last Updated On
March 09, 2020
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Steve Levine
VP, Communication
(512) 370-1380
steve.levine[at]texmed[dot]org
A former statehouse reporter, political press secretary, and state agency spokesman, Steve Levine has directed the Communication Division at TMA since 1997. He oversees Texas Medicine, Texas Medicine Today, TMA’s media and public relations activities, and the TMA Knowledge Center, website, and social media activities.
Will health plans pay for telephone consults/visits in light of State of Emergency?
This is the question of the week! POET is working on getting some sort of definite answer. We are posting web links and information provided by health plans when asked the question.
So far it appears most are easing policies on telemedicine (audio and visual) but no changes for telephone. We are in hopes there will be reconsiderations as events unfold.
We will keep you posted on what we learn. If anyone gets a definitive answer in writing, we would love to see it!
UHC, Provider Telehealth Policies 3/14/2020
Effective immediately, UnitedHealthcare is expanding their policies around telehealth services for our Medicare Advantage, Medicaid and commercial membership, making it even easier for patients to connect with their health care provider
To view UHC policies follow this link.
For UHC Provider’s Resource Library on CoVID-19, Corona Virus https://www.uhcprovider.com/en/resource-library/news/Novel-Coronavirus-COVID-19.html
ICD-10-CM Official Coding Guidelines, CoVID-19
ICD-10-CM Official Coding Guidelines – Supplement Coding encounters related to COVID-19 Coronavirus Outbreak Effective: February 20, 2020
For the official document follow this link.
CPT, HCPCS, IDC-10 and other codes you should be aware of related to COVID-19?
Aetna is complying with the CMS coding guidelines for COVID-19 lab testing.
From MGMA online community
Sharing for those that may not have seen this on Aetna’s website
What Common Procedural Technology (CPT) codes should be used for COVID-19 testing?
Aetna is complying with the CMS coding guidelines for COVID-19 lab testing. CMS adopted two CPT codes, (U0001) and (U0002), for COVID-19 testing.
- U0001 – 2019 Novel Coronavirus (2019-nCoV) Real-Time RT-PCR Diagnostic Panel should be used when specimens are sent to the CDC and CDC-approved local/state health department laboratories.
- U0002 – 2019-nCoV Coronavirus, SARS-CoV-2/2019-nCoV (COVID-19), any technique, multiple types or subtypes (includes all targets), non-CDC should be used when specimens are sent to commercial laboratories, e.g. Quest or LabCorp, and not to the CDC or CDC-approved local/state health department laboratories.
For more information and future updates, visit the CMS website and its recently issued FAQs. CMS has not set pricing for COVID-19 testing, but they are expected to soon.
What CPT, HCPCS, IDC-10 and other codes should I be aware of related to COVID-19?
Reporting codes related to COVID-19 include:
ICD-10 Reporting Codes
- An emergency ICD-10 code has been created by WHO.
- Code U07.1, 2019-nCoV acute respiratory disease, will be implemented into ICD-10-CM with the update effective October 1, 2020. Until then, providers must use available ICD-10 codes and guidance.
Exposure to COVID-19
- Z03.818 (Encounter for observation for suspected exposure to other biological agents ruled out). Used for cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation.
- Z20.828 (Contact with and (suspected) exposure to other viral communicable diseases). Used for cases where there is an actual exposure to someone who is confirmed to have COVID-19.
Signs and Symptoms
- For patients presenting with any signs/symptoms (such as fever, etc.) and where a definitive diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms such as:
-
- R05 (Cough)
- R06.02 (Shortness of breath)
- R50.9 (Fever, unspecified)
Cigna MA PCP Newsletter March 2020
Topics this month include:
- Colorectal Cancer Awareness Month
- Social Determinants of Health (SDOH): Food Insecurity
- CAHPS Corner – CAHPS Survey
SARS-CoV-2/2019 Lab Testing
CMS develops the First HCPCS Code for testing for Coronavirus
From MGMA GovChat 3/6/2020, Drew Voytal
Last month, CMS developed the first HCPCS code (U0001) to bill for tests and track new cases of the virus. This code is used specifically for CDC testing laboratories to test patients for SARS-CoV-2. The second HCPCS billing code (U0002) allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19). On February 29, 2020, the Food and Drug Administration (FDA) issued a new, streamlined policy for certain laboratories to develop their own validated COVID-19 diagnostics. This second HCPCS code may be used for tests developed by these additional laboratories when submitting claims to Medicare or health insurers. CMS expects that having specific codes for these tests will encourage testing and improve tracking.
The Medicare claims processing systems will be able to accept these codes starting on April 1, 2020, for dates of service on or after February 4, 2020. Local Medicare Administrative Contractors (MACs) are responsible for developing the payment amount for claims they receive for these newly created HCPCS codes in their respective jurisdictions until Medicare establishes national payment rates. Laboratories may seek guidance from their MAC on payment for these tests prior to billing for them. As with other laboratory tests, there is generally no beneficiary cost sharing under Original Medicare.
Update 3/10/2020: To follow up to the previous post, I am sharing new CMS FAQs for Medicare providers regarding Medicare payment for lab tests, drugs/vaccines, and physician and hospital services. As new Medicare COVID-19 resources become available I will be sure to post them here, and as always please feel free to reach out with any questions.
Thank you,
Drew
Announcing Alegis Care Complex Care Program
Cigna/HealthSpring/CareAllies
In a continued effort to positively impact the overall well-being of their members, Cigna Medicare is excited to announce an additional program in partnership with Alegis Care. They are introducing the Complex Care Program (CCP) program in the NETX POD service area effective February 17, 2020. View or download a summary of the Alegis Care CCP Program.
Termination of the Patient-Physician Relationship.
TMA Office of the General Counsel, September 2017
The patient-physician relationship is grounded in the personal relationship that exists between the physician and the patient. The patient-physician relationship is the result of a contract between a physician and a patient that the doctor will treat the patient with proper professional skill. Although the relationship is contract-based, the contract need not be formal — it can be implied, which means the acts and conduct of the parties demonstrated there was a mutual intention to contract. When that relationship becomes untenable for either party, dissolution of the relationship may become necessary. While both the physician and the patient have the right to terminate the relation-ship, the requirements for termination are more complicated for physicians than for patients.
This white paper discusses the general legal and ethical issues related to termination of the patient-physician relationship. And it includes a form letter.
Provider – Patient
Relationship Termination Checklist, MGMA 2/6/2019
Firing a patient is never a task we like to undertake. Unfortunately, sometimes it cannot be avoided. MGMA has provided a checklist for just such instances. POET Ink is building a file called “Provider-Patient Relationship. You can locate that file in “The Business End”.
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