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COVID-19 FORUM

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  • March 16, 2020 1:54 PM
    Message # 8835022
    Anonymous member (Administrator)

    PAHPM--Please share your experiences, best practices, and questions here regarding COVID-19.  It's an evolving situation and we all have much to learn from each other.

    Thanks!

    Jeff

  • March 16, 2020 1:59 PM
    Reply # 8835030 on 8835022
    Anonymous member (Administrator)

    Just wanted to share what my inpatient and outpatient palliative care teams our doing here in Portland,OR:

    • Inpatient Team--to help keep us healthy and preserve both personnel and medical resources, we are reducing our inpatient physical presence to two in-person providers, and 1 at-home provider who can field this palliative needs that don't require face-to-face visit.  If needed, we are preparing to do some visits via phone as our hospital has already had to restrict visitors.  Still evolving.
    • Outpatient Team--our providers are attempting to do most visits by phone.  Especially since the majority of our patients are oncology patients who are already at greater risk.
    Do others have unique ways you're managing your services.
  • March 16, 2020 2:10 PM
    Reply # 8835111 on 8835022

    Thanks for this thread.

    We have not offered phone appts or telemedicine in past so I am wondering - were you already set up for telemedicine? If not and you are doing appointments by phone are you billing for those, and how?

    Thanks so much, Be well

    Ann Curry

  • March 16, 2020 2:34 PM
    Reply # 8835154 on 8835022
    Anonymous member (Administrator)

    Ann,

    We were not set-up for virtual visits, either by phone or other.  Initially our Hem/Onc clinic is supporting us just moving forward, documenting as normal with time information, and the billing is still to be determined.  We are hoping CMS will provide some more updates and guidance.

    Our institution just started an online training today--I plan do that today!

    I'll post more as we get more info on the details.

    Jeff

    ****Post-Training update!

    Here is a more informed answer after I just did part of the training:

    • We use EPIC and are using the MyChart function which allows for Virtual Visits.  
    • Virtual (Webcam) visits are billable by many insurers, and we are getting preauths with them prior to the visit (so it will vary by insurer, and my guess this will evolve as the pandemic last longer)
    • The patient must physically be in the same state in which the provider is licensed.
    • Need to document that it's a virtual visit and if anyone helped with an exam (patient family member, other)
    • Phone visits along are not billable--but we likely will continue to do them as needed during this crisis

    Bottomline--a lot of the "virtual" part depends on your institutions ability.

    Hope that is helpful.

    Jeff


    Last modified: March 16, 2020 3:34 PM | Anonymous member (Administrator)
  • March 17, 2020 9:58 PM
    Reply # 8838746 on 8835022
    Anonymous member (Administrator)

    Sharing a great practice. Our medical students are offering to provide free childcare and run errands for staff needing help! Great idea that maybe others can replicate!

    jeff

  • March 18, 2020 10:33 AM
    Reply # 8839723 on 8835022
    Anonymous member (Administrator)

    Sharing this info from Doug Brown he has from CMS regarding telehealth visits:

    Here are some takeaways I extracted from the following resource …


    https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet


    1. There are three types of virtual services, MEDICARE TELEHEALTH VISIT, VIRTUAL CHECK-INS, and E-VISITS.


    2. TELEHEALTH VISIT


    a. Patient must be established, but HHS will not audit for claims submitted during this event.

    b. PAs are eligible for reimbursement.

    c. Interaction must be real-time.

    d. Visits are considered the same as in-person visits, and are reimbursed at the same rate.


    3. VIRTUAL CHECK-IN


    a. Medicare patients can initiate a “brief communication service” with practitioners, by telephone conversation or via videos or images.
    b. Visits should be initiated by patients, but practitioners can educate patients on the availability of this option.
    c. Must be an established patient, and not be related to a visit within the prior 7 days or next 24 hours.
    d. Patient must verbally consent to agree to virtual check-in.
    e. Modalities include telephone, audio/video, secure text messaging, patient portal, or email.
    f. Patient may send videos or images apart from virtual check-in under a different HCPCS code.


    4. E-VISIT


    a. Patient must be established.

    b. Patient must initiate the inquiry via patient portal, and verbally consent to services.

    c. Transaction may occur over a 7-day period, and is reimbursed by time accumulated over 7 days. [Interestingly, this apparently counts only for “practitioners who may independently bill Medicare for services (for instance, physicians and nurse practitioners)” … ?!]

    . 99421, 7-10 minutes

    . 99242, 11-20 minutes

    . 99243, 21+ minutes

    d. "Clinicians who may not independently bill for E&M services…” use the following codes:

    . G2061, 7-10 minutes

    . G2062, 11-20 minutes

    . G2063, 21+ minutes

    e. No geographic or location restrictions for this type of visit.

    f. Big question is this: How does reimbursement work for with PAs as sole proprietors?


  • March 20, 2020 3:23 PM
    Reply # 8845684 on 8835022

    Some additional info ...

    It seems like telephone is good for both VIRTUAL CHECK-IN and E-VISIT types. I forgot to mention that TELEHEALTH VISITs require "interactive audio and video telecommunications system that permits real-time communication between the distant site and the patient at home."

    I also forgot to include this statement from the web page:

    Effective immediately, the HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency.  For more information: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/index.html

    Last modified: March 20, 2020 3:24 PM | Douglas Brown
  • March 22, 2020 5:39 PM
    Reply # 8848593 on 8835022
    Anonymous member (Administrator)

    Sharing our draft plan for inpatient palliative. 
    we are teaming up with the inpatient geriatric team. Just posting this if it is helpful for anyone to see. 
    thanks

    jeff

    1 file
  • March 26, 2020 6:44 PM
    Reply # 8861265 on 8835022
    Anonymous member (Administrator)

    FYI--New COVID-19 Tool Resource Page has been uploaded to our Education tab.  Check it out for some more resources, including some good talking points on communication.

  • April 02, 2020 12:39 PM
    Reply # 8875100 on 8835022
    Anonymous member (Administrator)

    Just wanted to share a practice, or ask how others are managing these issues.  I think we all know the "value" of families seeing their loved one declining--it can help them accept that comfort may be the right next step, can give them closure, etc.

    Our team is noting some instances where we've advocated for a one time visit from 1 healthy family member when otherwise they wouldn't be able to visit due to the new no visitor policy we have.  It's been so meaningful for that family member to see--either helping them to say, "no more," or yes, we should change code status.  

    How are others dealing with this?  Would love to hear.

    Thanks.

    Jeff

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