Ambulatory Virtual Health Services During Coronavirus COVID-19 Crisis March 19, 2020
In order to serve our communities and facilitate access to care during this time, Advocate Aurora Health, Inc. (AAH) is expanding the use of telehealth and telephonic care available to AAH employed providers. This will allow AAH employed providers to treat patients with COVID-19 symptoms, patients with confirmed COVID-19 diagnoses, and patients with other conditions if it is in furtherance of AAH’s goal to minimize potential exposure and/or transmission of COVID-19. Therefore, expanded use of telehealth and telephonic care is available to AAH employed providers until further notice.
The CMS granted a federal waiver of licensure requirements. We are optimistic that, in light of the federal waiver of licensure requirements, states will follow suit. In the interest of patient care we are allowing our physicians and other health care providers to practice across state lines during this emergency (but it is not mandatory). Additionally, even if states were not to follow suit, we believe the current emergency under which providers are operating would enable us to provide a focused and vigorous defense against any licensure-related issues. AAH will be staunch and vigilant in standing behind those providers who step in to help with this crisis.
What is Virtual Health? Virtual services are defined by the delivery of healthcare services, which includes: ➢ Video Visits – A visit between a clinician and patient that uses telecommunication ➢ systems via video, synchronous, or asynchronous. Can be quick-care or scheduled. Electronic Visits – A communication between a patient and their clinician and through ➢ an online portal Telephone Visits – Brief communication technology-based service, e.g. virtual check- ➢ in, by a clinician who can report evaluation and management services Remote Patient Monitoring - Interpretation and follow-up of recorded video and/or ➢ images Due to the COVID-19 outbreak, telehealth benefits and coverage was expanded through the Stafford Act and the National Emergencies Act under the 1135 waiver for Medicare beneficiaries
Approved Virtual Health Clinicians ➢ Physicians ➢ Nurse Practitioners (NP) ➢ Physician Assistants (PA) ➢ Nurse Midwives ➢ Clinical Nurse Specialists (CNS) ➢ Certified Registered Nurse Anesthetists (CRNA) ➢ Clinical Psychologists (CP) and Clinical Social Workers (CSW) ➢ Registered Dietitians or Nutrition Professionals Note: Per CMS, CPs and CSWs will be allowed to bill Current Procedural Terminology (CPT) codes 90792, 90833, 90836, and 90838 to Medicare for psychiatric diagnostic interview examinations with medical services or medical evaluation and management services due to the HHS 1135 Waiver to meet patients needs during the Coronavirus COVID-19 crisis. Medicare Telemedicine Health Care Provider Fact Sheet; March 17, 2020
Telephonic Care ➢ Established patients only ➢ All payers ➢ Additional restrictions related to other services and documentation requirements are noted in the appendix Payor Code Medicare G2012 – Virtual check-in Commercial & WI Medicaid 99441 (5-10 min) 99442 (11-20 min) 99443 (21-30 min) Behavioral Health Non-Psychiatrist 98966 (5-10 min) (this is “official” therapy – not aPCP 98967 (11-20 min) talking about depression) 98968 (21-30 min)
Most Important… GT Modifier ➢ Must be added to all telehealth services ➢ Make it a fast button on LOS
FAQ - briefly ➢ How to schedule? ➢ How to document? See requirements and make sure to include them ➢ Create a telephone encounter on-the-fly (see tip sheet) ➢ ➢ Who provides the care The person who is billing ➢ ➢ What kind of care qualifies? “sniff test” ➢
Video Visits ➢ New or established patients ➢ All payers ➢ Coding: standard E&M code for level of service provided
Most Important… GT Modifier ➢ Must be added to all telehealth services ➢ Make it a fast button on LOS
VIDEO VISITS
Hardware Requirements Preferred: Smart phone or iPad ➢ You will utilize Haiku or Canto ➢ 2nd option: personal computer with webcam ➢ 3rd option: AAH-issued laptop with webcam ➢ 4th option: webcam-free computer with a webcam peripheral ➢
Software Requirements ➢ Access to Epic from a computer ➢ Access Haiku or Canto ➢ Download Zoom to your computer and to your Smart Phone or iPad
Scheduling ➢ Patients will be scheduled on your normal schedule as a myChart Video Visit ➢ Your staff are receiving education as to how to schedule
Patient Requirements ➢ Patients must be registered for myChart ➢ Automatic link will be sent as text or email at the time of scheduling if they are not activated ➢ Rapid proxy access will be allowed ➢ Must have a smart phone, tablet, or computer with web cam ➢ Must download Zoom to whatever device they’re going to use before beginning the visit
Check-In ➢ Patients will enter through their myChart account ➢ Directions are on our AAH website ➢ They will complete the Pre-Check In process ➢ All co-pays will be billed after the service
The Visit ➢ Enter as you normally would ➢ When ready, initiate video ➢ iOS – you can “hand off” to Haiku right from the chart ➢ Android – you must go into Haiku on your device, go to your schedule, click on the patient, click on summary , click on start video visit ➢ Complete the visit as normal ➢ YOU are the only touchpoint for the patient. Therefore, complete med rec, allergies, pharmacy, applicable care management, etc
Documentation ➢ Must include a statement that the visit was done by two-way live audio/visual technology. dotphrase developed ➢ ➢ Enter any vitals obtained in to the note, not the vitals section
Follow-ups ➢ Send a note to your staff if there are any f/u recommendations that you want completed – additional appointments made, etc ➢ Work with your market protocols for routine labs, imaging, etc ➢ Bill your normal E&M code for the service you provided
Most Important… GT Modifier ➢ Must be added to all telehealth services ➢ Make it a fast button on LOS
APPENDIX
References ➢ Epic COVID-19 Ambulatory Tools ➢ Telehealth Consultations for Medicare ➢ CMS Telehealth Services MLN Booklet ➢ COVID-19 & HIPAA Bulletin Limited Waiver of HIPAA Sanctions and Penalties During a Nationwide Public Health Emergency ➢ Telehealth Expansion for Medicare Beneficiaries
Virtual Health Coding Typeof HCPCS/CPT Codes Patient Type Documentation Requirements Acceptable Visit Payers • • Video 99201-99205 (NewPt/Office) * New & Statement that service was provided usingVideo All payers • • Established 99499.32 (On-demand) Patient's consent; • • G0425-G0427 (Telehealth Consults:ED, Medical issues discussed; • Initial IP) Pertinent findings; • • G0406-G0408 (Follow-up IPtelehealth Assessment or diagnosis, if new; • consults) Any medication adjustments or refills; • Labs ordered; • Follow-up recommendations/plan of treatment, if new. • Date and time of patient contact via phonecall, • Electronic 99421 - 99423 Established All payers video, Online digital evaluation &management email, or patient portal;and service by a physician or other qualified healthcare professional Note: If the patient provides vitals, the clinician should v fier GT should be added to all telehealth ser Note: Modi ices. also include this in their documentation will review and submit telehealth charges wi A PB coder th ed payer modifier. the approv
Telephone Specific FAQs Q: Can I bill for telephone visits? A: Yes, we can bill for any telephone encounters required by COVID restrictions and should be doing so. This includes both direct COVID calls (e.g. a patient with respiratory symptoms) and calls for unrelated conditions where the service cannot be performed in-person due to COVID restrictions (e.g. a follow-up diabetes visit). Q: How do I bill for telephone visits? A: See slides 6 for code details OR on the AAH COVID-19 Website Q: What is the Epic workflow? A: Telephone specific workflow and screen shots AAH COVID-19 Website
Telephone Specific FAQs Q: Will patients be billed for these visits? A: The *WI Office of Commissioner of Insurance has issued a directive to all payers to cover directly- COVID-related visits with no out of pocket costs to patients. While we cannot guarantee that all insurers will follow this, most should do so. The charges for a telephonic visit (see below) will also be much less than an office visit. * March 6, 2020 State of WI Office of the Commissioner of Insurance Bulletin Q: How do I distinguish between a formal billed telephone encounter and a simple phone call? A: Patients are required to give consent to be billed for a formal telephonic encounter ✓ A telephonic encounter cannot be billed a week after or just before a face-to-face encounter ✓ “Sniff test” is this a service that would have been handled as an office visit in ‘normal’ clinic times, or something you would normally just do as part of your workflow? Generally this is not used to code for simple phone calls from the patient such as “Does the doctor recommend I cancel my upcoming trip?” or a call back to answer a question, such as “Is it normal to still have ear fullness 2 weeks after a sinus infection”.
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