Submitted by sean on Tue, 03/24/2020 - 00:21
Frequently Asked Questions
Primary Care Practices

Last updated: 3/9/2020
 

Eventually. Medicare will cover U0002 the test for SARS-CoV-2 in a private lab for any time from February 4, 2020. However, CMS will not have the ability to process those claims until April 1, 2020.

Last Updated: 3/13/2020
 

Starting in April, laboratories performing testing for SARS-CoV-2 can bill Medicare and other health insurers for services that occurred after February 4, 2020. Medicare’s initial payment for the CDC-developed test (U0001) will be about $36 & non-CDC tests (U0002) will be around $51. These prices may vary slightly depending on the local Medicare Administrative Contractor (MAC). View the full price by MAC list here: https://www.cms.gov/files/document/mac-covid-19-test-pricing.pdf
 

As with other laboratory tests, there is generally no beneficiary cost sharing under Original Medicare.

Last Updated: 3/11/2020
 

At this time, we must continue to advise that practices act in a manner consistent with the regulations and guidance of their local municipalities. We will think creatively with practices about how to protect themselves and their patients - reach out to us on any guidance that appears confusing or difficult to implement by emailing covid-response@aledade.com.

Last updated: 3/11/2020
 

In light of the nationwide shortage of N95 masks, CDC relaxed requirements to include regular facemasks for most services (with the exception of aerosolized procedures).  If you need N95 masks for these purposes, try contacting your local health department and the Occupational Health Services department of your local hospital to see if they might be able to help support their community practices by arranging fit testing for practice staff. 

Telehealth

Last updated: 3/9/2020
 

The recently passed legislation relaxing telehealth requirements is not limited to COVID-19 billings/visits. For the exact reason of limiting exposure and impact on the health care system, we would encourage any visit that can be safely and effectively done via telehealth to convert to telehealth during the public health emergency.

Last updated: 3/10/2020
 

Congress has passed and the President has signed legislation that waives nearly all of the Medicare telehealth requirements except for the use of video.  Medicare telehealth is reserved for the concept of paying for services that are traditionally done in the office. Think AWVs, evaluation and management visits, TCM, not care coordination or phone calls. A full list is available here. This would allow practices to replace office visits with video chats when the patient is at home. They would not be able to replace an office visit with just a phone call. CMS already covers “virtual check-ins” over the phone and of course chronic care management services. The law spells out a unique eligibility criteria.


The patient must meet two criteria:

  1. Been seen in the office by a provider in the practice at least once after becoming eligible for Medicare
  2. That visit must have been within the last three years

We will keep you updated as CMS implements this action.

Last updated: 3/10/2020
 

We have received many inquiries as to whether or not the telemedicine legislation will also enable Rural Health Centers and Federally Qualified Health Centers to bill for services. Reading the legislation we believe that health centers will be able to bill for these services.There is no published guidance on this from CMS at this time, so we are still waiting for a definitive answer.  We will communicate as soon as we have an answer to this important question.

We will keep you updated as CMS implements this action.

Last Updated: 3/11/2020

Medicare will pay the distant site practitioner (i.e., the one doing the CPT described service) the same rate they would have gotten for doing it in the office. To reference the source documentation, see page 162, section 190.6.2.

The law did not contemplate modifications to CPT codes and CMS has yet to issue guidance on implementation. Unless they do so, we assume all requirements are necessary to bill the code. Telehealth normally requires a patient to go to another health care facility where things like BP and weight can be taken. When the originating site is the home, the lack of certain capabilities may prevent certain codes from being performed even though they are on the telehealth list. 

Yes, the HHS Office of Civil Rights (OCR) issued a notice that specifically allows for use of private consumer technologies. However, purpose-built telehealth tools have many features such as billing assistance, consent management, waiting rooms, etc. that are not available in consumer technologies. If you use consumer technology, you need to ensure all state-required mandates are met, including requirements for patient consent The only thing the waiver does is waive enforcement of the privacy and security requirements of the technology itself.

The federal legislation required physicians to have an established relationship with a patient in order to use these new flexibilities, but CMS has said “HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency.”  This means that the “established relationship” federal requirement essentially does not apply in the current environment.  

Practices can charge a co-pay, however HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.

Personal Tips

It is thought that the virus spreads mainly from person to person

  1. Between people who are in close contact with one another (about 6 feet)
  2. Through respiratory droplets produced from coughing or sneezing and those droplets enter a new host commonly via the lungs.

 

  1. The best way to protect yourself according to the CDC
    1. Wash your hands often with soap and water for at least 20 seconds and dry well.  Use an alcohol-based hand sanitizer that contains at least 60 percent alcohol if soap and water are not available. 
    2. Avoid touching your eyes, nose, and mouth with unwashed hands. 
    3. Cover your cough or sneeze with a tissue, then through the tissue in the trash and wash hands per (a)
    4. Clean and disinfect frequently touched objects (such as cell phones) and surfaces (keyboards, doorknobs). 
    5. Avoid close contact with people who are sick 
    6. If someone is sick have them wear a face mask to contain respiratory droplets
  2. Get you home ready with a plan https://www.cdc.gov/coronavirus/2019-ncov/prepare/get-your-household-ready-for-COVID-19.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcommunity%2Fhome%2Fget-your-household-ready-for-COVID-19.html

 

  1. Use a common EPA-registered household disinfectant that is appropriate for the surface you are cleaning. See Disinfectants for Use Against SARS- CoV-2 (https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2)
  2. Other options include:
    1. Diluting household unexpired bleach
      1. 5 TBSP (⅓ c) bleach per gallon of water
      2. 4 Teaspoons bleach per quart of water
    2. Alcohol solutions of at least 70% alcohol
  1. It is recommended that you have a sufficient supply of food and supplies that could last for at least a week or two. 
  2. Practice good hand washing techniques with everyone in your household.
  3. Coordinate efforts to disinfect high use surfaces on a regular basis.
  1. Symptoms can vary.
  2. Fever, cough and shortness of breath are common
  3. Emergency warning signs that require medical attention include 
    1. Difficulty breathing or shortness of breath
    2. Persistent pain or pressure in the chest
    3. New confusion or inability to arouse
    4. Bluish lips or face

If exposed to a confirmed Covid-19 individual, self quarantine at a single location and preferably to a single room as long as you have no symptoms or you are mildly ill. 

  1. Separate yourself from other people as much as possible-- use a separate bathroom if possible.
  2. Limit contact with pets and animals.
  3. Quarantine in general means the separation of a person reasonably believed to have been exposed to a communicable disease but not yet symptomatic, from others who have not been so exposed, to prevent the possible spread of the communicable disease
  1. There is no general agreement on the answer to this question.  If there is known disease in your community, avoidance is still best.  If there is disease in your community, social distance is best observed.  This means at least 6 feet (2 meters) of space between people and disinfect and wash your hands very regularly. 
  2. One might discourage going to community gyms, as it is difficult to clean some of the communal areas well. 
  3. For shopping, try to choose times when there are fewer people in the store and ALWAYS wash your hands when you return home.

 

There are some simple things you can do while in public spaces to minimize potential contact with a virus. Wearing cloth gloves if you will be touching things in public places and either washing the gloves each night or putting them in the dryer for 10 minutes to kill any viruses is an easy way to create a physical barrier without having to overuse hand-sanitizer.

  1. ​​​​​​Call your personal health care provider for guidance or check your community’s public health page (https://www.naccho.org/membership/lhd-directory) to learn where you can go to get tested. 
  2. Wear a facemask which will contain as much of your aerosolized particles when you are around other people. 

 

​​​​​​Follow the advice of your health care provider. Not everyone needs to be hospitalized if they have the virus. The hospital is appropriate for the elderly and unstable sick individuals.

  1. ​​​​​​Follow the hygiene recommendations listed above. 
  2. Follow the advice of your health care professional. 
  3. Stay away from everyone you might infect via self quarantine.

 

  1. Limit exposure to the infected person by using a mask and gloves when you must be closer than 6 feet. After tending to the ill individual, dispose of the mask and gloves and institute good hand washing hygiene and disinfecting all items that the infected person came in contact with.
  2. Use protective measures including social distancing, hand washing, cleaning and disinfecting, gloves, mask.

 

No one knows the answer to this question. The company will be monitoring the situation across the country and will make the best decision with the available information to keep our workforce out of harm's way as able.

There are some simple things you can do while in public spaces to minimize potential contact with a virus. Wearing cloth gloves if you will be touching things in public places and either washing the gloves each night or putting them in the dryer for 10 minutes to kill any viruses is an easy way to create a physical barrier without having to overuse hand-sanitizer.

​​​​​​Guidance from the CDC on getting your household ready for COVID-19 can be found here.


Some highlights:

Clean frequently touched surfaces and objects daily (e.g., tables, countertops, light switches, doorknobs, and cabinet handles) using a regular household detergent and water.

​​​​​​The CDC recommends washing your hands with soap and water first and using hand-sanitizer if that’s not an option.


Guidance from the CDC:

Wash your hands often with soap and water for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing. If soap and water are not readily available, use a hand sanitizer that contains at least 60% alcohol. Always wash your hands with soap and water if your hands are visibly dirty.

Testing
  • If you have been in close contact with someone who may have coronavirus or have a fever, cough or shortness of breath, you may need to get tested.
  • Public health officials have advised that not everyone needs to get tested!
    • If you are healthy, most illness caused by coronavirus is mild. If your illness is mild, you do not need to see your doctor and do not need to get tested, but it is important to stay home and pay careful attention to your symptoms.

    • If you have other health conditions, call your doctor to ask if you should get tested. If you start feeling worse for any reason, call your doctor.

    • If you or your family notices that you are starting to experience confusion, bluish lips, trouble breathing or difficulty waking up, these could be signs of an emergency -please call 911.
  • Before getting tested, contact your doctor’s office or your state’s hotline.
  • DO NOT go to your doctor’s office without calling first.
  • Depending on where you live, you may be given a test for flu and other viruses first before getting the coronavirus (COVID-19) test.
  • If you get the coronavirus test: You may have samples taken from your nose and throat.
  • You should receive results in 2-5 days.
  • Stay home and have less contact with other people as much as possible until you hear your test is normal. Click here to find your state hotline and to learn more about testing.
  • Stay home except for medical care needed
  • Separate yourself from others
  • If you’re not feeling well, call your provider first
  • Cover your coughs & sneezes
  • Clean your hands often
  • Clean surfaces daily

Disclaimer: Aledade endeavors to provide the most recent, actionable information pertaining to the quickly evolving state of emergency around COVID-19. Aledade regularly reviews a variety of publicly available health sources and updates its materials accordingly. Because data, regulations, and official pronouncements around COVID-19 change so frequently, however, some information contained herein may become outdated before we get the chance to update it. For the very latest on COVID-19, please continue to use online resources from CDC, WHO, and your state or local public health departments.