Newly released studies suggest around 80% of COVID-19 patients have experienced mild illness (1). In order to limit exposure of healthcare professionals to coronavirus and help reduce the community spread of COVID-19 in the United States the Centers for Disease Control and Prevention (CDC) has recommended alternatives to face-to-face interactions with doctors and clinic visits. A summary of the recommendations is below.
The following options can reduce unnecessary healthcare visits and prevent transmission of respiratory viruses in your facility:
- Instruct patients to use available advice lines, patient portals, on-line self-assessment tools, or call and speak to an office/clinic staff if they become ill with symptoms such as fever, cough, or shortness of breath.
- Identify staff to conduct telephonic and telehealth interactions with patients. Develop protocols so that staff can triage and assess patients quickly.
- Determine algorithms to identify which patients can be managed by telephone and advised to stay home, and which patients will need to be sent for emergency care or come to your facility.
- Instruct patients that if they have respiratory symptoms they should call before they leave home, so staff can be prepared to care for them when they arrive.
Health systems and clinics may already utilize remote care management of patients after hours as part of their current practices. Although telehealth services could help with remote diagnosis of patients, testing for the virus would still need to be done in person (at least until home test kits become available).
1) Wu Z, McGoogan JM. Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China. JAMA [Internet] 2020; available from: https://jamanetwork.com/journals/jama/fullarticle/2762130
Reimbursement
In order to address the growing number of coronavirus cases Medicare, states, and health insurers are taking steps to ensure vital testing and treatment costs are covered. Telemedicine consultations with healthcare professionals are a key part of the reimbursement to help improve access and manage potential patients in remote settings. As conveyed by America’s Health Insurance Plans (AHIP) “There are three critical areas health insurance providers are proactively addressing right now: Prevention, testing, and treatment”. Insurance providers are offering various telemedicine reimbursements to help improve access for their members. Aetna for example is “offering zero co-pay telemedicine visits for any reason, and it is extending its Medicare Advantage virtual evaluation and monitoring visit benefit to all fully insured members”, a comprehensive list of health plans and their response to COVID-19 is available at AHIP. Blue Cross Blue Shield Association (BCBSA) also announced “that its network of 36 independent and locally-operated Blue Cross and Blue Shield (BCBS) companies will waive prior authorizations and increase coverage for COVID-19, increase access to prescription drugs, enhanced telehealth and other clinical support systems”. As of this writing the major insurance companies also agreed to cover the costs of telemedicine associated with COVID-19.
President Trump has signed H.R. 6074 into law. The Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020 is an $8.3b spending bill to fund efforts to address the coronavirus. The bill allocates $500m to Medicare telehealth services (i.e., live voice/video) spending, allowing the HHS Secretary to waive Medicare telehealth restrictions during the coronavirus public health emergency so that care can be provided regardless of where a patient is located, and with the home being an originating site. Under this bill, a qualifying provider of telehealth services would need to have provided a service to that patient in the last three years.
Reimbursement Resources
NGA Telehealth Memo
From the National Governor’s Association:
“One of the key strategies in this effort is telemedicine – allowing individuals to receive virtual care – which can reduce the spread of the virus and expand health care capacity by keeping potentially ill individuals in their homes, reducing exposure of health care workers and reducing the number of people needing care in facilities”
https://www.nga.org/wp-content/uploads/2020/03/COVID-19-Telehealth-Memo-20200320450pm.pdf
Medicare Telemedicine Healthcare Provider Fact Sheet
CMS
“Centers for Medicare & Medicaid Services (CMS) has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility. These policy changes build on the regulatory flexibilities granted under the President’s emergency declaration. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations” Act
https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
UnitedHealthcare Reimbursement Statement
According to a statement released by UnitedHealthcare on March 27th, 2020, telehealth visits for physical, occupational therapy and speech therapy will be reimbursed during the COVID19 emergency.
The full statement and link is below:
UnitedHealthcare will reimburse physical, occupational and speech therapy telehealth services provided by qualified health care professionals when rendered using interactive audio/video technology. State laws and regulations apply. Benefits will be processed in accordance with the member’s plan.
This change is effective immediately for dates of service March 18 through June 18, 2020.
Reimbursable codes are limited to the specific set of physical, occupational and speech therapy codes listed here.
UnitedHealthcare will reimburse eligible codes when submitted with a place of service code 02 and modifier 95.
Additional Resources
CMS issued several fact sheets addressing, to some degree, use of digital health (telehealth) in addressing the COVID-19 crisis:
- Medicare: https://www.cms.gov/files/document/03052020-medicare-covid-19-fact-sheet.pdf
- Medicaid and CHIP: https://www.cms.gov/files/document/03052020-medicaid-covid-19-fact-sheet.pdf
- Individual and Small Group Market Insurance Coverage: https://www.cms.gov/files/document/03052020-individual-small-market-covid-19-fact-sheet.pdf
CMS has also announced it has developed a second Healthcare Common Procedure Coding System (HCPCS) code that can be used by laboratories to bill for certain COVID-19 diagnostic tests:
https://www.cms.gov/newsroom/press-releases/cms-develops-additional-code-coronavirus-lab-tests
CDC Guidance
CCHPCA Telemedicine resource on Reimbursement / update on HB6074
National Association of County and City Health Officials (NACCHO) Directory of local health departments
NHS information on COVID-19
CMS directs a second round of historic expansion of telehealth services and reimbursements so that doctors and other providers can deliver a wider range of care to Medicare beneficiaries in their homes. Beneficiaries thus don’t have to travel to a healthcare facility and risk exposure to COVID-19