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.

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

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?

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

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