Frequently Asked Questions: COVID-19

General Questions

Q Q: Which recommendation should organizations be following?

For COVID-19, we will be providing our clients with updated information frequently. Other resources we recommend include CDC, CMS, OSHA, HHS, and local health departments.

Q Q: In the COVID-19 toolkit, will there be information provided on billing, documenting, and coding?

It will include basic information. Our coding department does provide detailed information for our coding and auditing clients.

Telemedicine

Q Q: Can we do both Skype type of tele-visits as well as the phone right now?

Yes, you can do tele-visits on both Skype as well as on the phone right now.

Q Q: What are telemed billing codes?

The normal billing guidelines will apply. The codes that will be billed for what Medicare actually defines as Medicare "telehealth services" will typically be evaluation and management (E/M) codes (for example, 99213, 99214) along with a telehealth POS 02 and potentially a modifier (if required by a commercial payer). CMS also has provided a summary of Medicare specific telemedicine codes/requirements.

Q Q: How do we document for a telemedicine visit?

The documentation is exactly the same as a face-to-face visit but with noting that it was telemedicine. Phone calls are different (e.g., time based depending on code).

Q Q: Which insurances are confirmed to be accepting telemedicine?

There are several, including Anthem, Blue Cross Blue Shield, United, and others. A recent list of these can be found here: https://www.ahip.org/health-insurance-providers-respond-to-coronavirus-covid-19/

Q Q: What about the physical exam for the provider?

Yes, this will still be documented as visualized (or similar language).

Q Q: We provide pain management and now have the ability to e-prescribe narcotics. But we must see the patient in a face-to-face per Florida pain management guidelines, does telemedicine still make us compliant?

Yes, telemedicine now can be used under the conditions outlined in Title 21, United States Code (U.S.C.), Section 802(54)(D).

While a prescription for a controlled substance issued by means of the Internet (including telemedicine) must generally be predicated on an in-person medical evaluation (21 U.S.C. 829(e)), the Controlled Substances Act contains certain exceptions to this requirement. One such exception occurs when the Secretary of Health and Human Services has declared a public health emergency under 42 U.S.C. 247d (section 319 of the Public Health Service Act), as set forth in 21 U.S.C. 802(54)(D). Secretary Azar declared such a public health emergency with regard to COVID-19 on January 31, 2020. (https://www.hhs.gov/about/news/2020/01/31/secretary-azar-declares-public-health-emergency-us-2019-novel-coronavirus.html). For as long as the Secretary's designation of a public health emergency remains in effect, DEA-registered practitioners may issue prescriptions for controlled substances to patients for whom they have not conducted an in-person medical evaluation, provided all of the following conditions are met:

The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of his/her professional practice
The telemedicine communication is conducted using an audio-visual, real-time, two-way interactive communication system.
The practitioner is acting in accordance with applicable Federal and State law.

Provided the practitioner satisfies the above requirements, the practitioner may issue the prescription using any of the methods of prescribing currently available and in the manner set forth in the DEA regulations. Thus, the practitioner may issue a prescription either electronically (for schedules II-V) or by calling in an emergency schedule II prescription to the pharmacy, or by calling in a schedule III-V prescription to the pharmacy.

Important note: If the prescribing practitioner has previously conducted an in-person medical evaluation of the patient, the practitioner may issue a prescription for a controlled substance after having communicated with the patient via telemedicine, or any other means, regardless of whether a public health emergency has been declared by the Secretary of Health and Human Services, so long as the prescription is issued for a legitimate medical purpose and the practitioner is acting in the usual course of his/her professional practice. In addition, for the prescription to be valid, the practitioner must comply with any applicable State laws

Q Q: To confirm our understanding - providers can use private video conferencing like Facetime, Skype, Webex, Anydesk, but we should NOT use public interfacing platforms like Facebook, TikTok, etc.?

Yes, that is correct. Any open - public interfacing platforms should NOT be used.

Q Q: What would be considered verbal consent for when the provider is on FaceTime a telehealth session?

In most states, consent requires that the patient be advised of three things: 1) the nature of the procedure; 2) the substantial risks and hazards of the procedure; and 3) the reasonable alternatives to the procedure (including, when appropriate, the option of doing nothing).

We can look at this for telehealth. Explain what will be happening, the risks of using the communication platform (e.g., skype) and alternatives (e.g., coming into the office at a later date). The verbal consent can happen with the patient is on FaceTime with the provider. However, it would be expected that the patient had already agreed to use FaceTime to speak with the provider.

Q Q: Would the provider get the verbal consent while they are on FaceTime?

Yes, they can provide their consent while on FaceTime, over the phone, electronically, in person, or in writing. What is important is the recent guidance allows it to be via a telecommunication system between a provider and a patient.

Human Resources

Q Q: Do we count our provider owners in the employee headcount for the Family First Act?

Private-sector employers with fewer than 500 employees, government employers, and all other non-private entity employers with more than one employee are required to provide their employees with paid sick leave. The bill entitles employees of covered employers to paid sick leave regardless of how long the employee has worked for the employer. The legislation further gives the Secretary of Labor the authority to exempt small businesses with fewer than 50 employees from the bill's paid leave requirements if those requirements would jeopardize the viability of the business. According to the Family First Act, this includes any person acting directly or indirectly in the interest of an employer in relation to an employee. Based on that information, in our opinion, provider owners would count in the headcount.

Q Q: Can we get the graphic on WC and paid leave?

Yes, it will be sent out in our webinar PowerPoint.

Q Q: We were not aware of any specific bills being passed at this time regarding staff (i.e. sick time, etc.) Please advise?

Yes, it is included under the Families First Coronavirus Response Act. H.R. 6201, Families First Coronavirus Response Act. Signed into law by President Trump on March 18, 2020.

Q Q: What if an employee needs to be terminated due to a downturn in business?

States laws still apply; however, it is important to note federal law permits significant flexibility for states to amend their laws to provide unemployment insurance benefits in multiple scenarios related to COVID-19. For example, federal law allows states to pay benefits where:

An employer temporarily ceases operations due to COVID-19, preventing employees from coming to work;
An individual is quarantined with the expectation of returning to work after the quarantine is over; and
An individual leaves employment due to a risk of exposure or infection or to care for a family member

Q Q: What about having employees that are 65 to 75 years old that are at a higher risk of COVID-19?

According to the CDC, COVID-19 is a new disease and we are learning more about it every day. Older adults are at a higher risk for severe illness from COVID-19.

8 out of 10 deaths reported in the U.S. have been in adults 65 years old and older, creating a higher level of concern. Because of this, organizations should perform a risk assessment to determine if your employees that are 65-75 years old are at greater risk in your facilities and come up with a strategy to reduce those risks (e.g., barriers, social distancing, remote work, reduced schedule, etc.).

Q Q: What should we tell our older at high-risk employees if we decide to send them home?

We recommend focusing on explaining the risks of exposure from COVID-19, or if it is due to staffing needs, cite that as well. It is our understanding of doing so during a pandemic does not put the practice at risk for discrimination.

Q Q: If an employee is out sick with a cold, how long should they stay home before returning to work?

Our recommendation from a compliance perspective in-line with CDC guidelines would be until they are no longer have a fever (if they did) or no longer experiencing respiratory symptoms.

HIPAA

Q Q: Can we require our patients to get their medical records any way EXCEPT coming into the office to get them? For example, can we mail, email, or electronically deliver them to keep them from needing to come to us in person?

Rather than require, we would recommend citing alternatives such as patient portal, email, mail, etc. and state that it is due to the heightened concerns over COVID-19. It is important to prevent unnecessary exposure because the records can be provided in another format.