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COVID-19: Consider technology-based services to boost revenue, increase patient access

Posted on Apr 29, 2020 by Lisa Eramo

      Prepare your financesStay-at-home orders, self-quarantines, social distancing—all of these extreme measures help ‘flatten the curve’ and bring us one step closer to prevailing over COVID-19. Unfortunately, these measures also create financial hardship for medical practices as patient volumes dwindle.

      In fact, 97% of practices have seen a negative financial impact since the beginning of the public health emergency, according to new data from the Medical Group Management Association (MGMA). On average, practices report a 60% decrease in patient volume and a 55% decrease in revenue. 

      Many patients continue to delay or completely forgo preventive services, routine checkups, immunizations, and labs. What’s worse is that patients with chronic diseases may be particularly vulnerable during this time. Sixty-nine percent of patients with chronic conditions say COVID-19 has affected their ability to manage their disease. Nearly one-in-three of these patients report being afraid to leave their homes for treatments.

      The good news is that practices can offer a variety of services virtually, says Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, and independent coding and reimbursement consultant in Alabaster, Alabama. It’s about increasing patient access while also being able to collect revenue and retain patients in the long-run, she adds.

      In this article, Huey explain five technologies providers can use to render high-quality patient care during COVID-19—and how they can bill for those services using the correct CPT and HCPCS codes.

      1. Telephone. Now that in-person appointments are minimal, practices are seeing an uptick in phone calls as patients ask questions such as, ‘Could my cough mean that I have COVID-19?’ ‘What should I do about the fever I’ve had for three days?’ ‘Is this level of fatigue normal?’ This is in addition to a whole host of calls related to non-COVID-19 health concerns.

      Can providers who normally bill evaluation and management (E/M) services also bill for these conversations? In many cases, the answer is yes, depending on the payer, says Huey. Medicare, for example, permits coverage during the public health emergency.

      Here’s how it works: If it’s a short conversation (i.e., 5 to 10 minutes of medical discussion)—and the patientMedicare reimbursement has Medicare—report HCPCS code G2012 (virtual check-in), a code that took effect January 1, 2019. If the patient has a commercial insurance, report CPT code 99441 (telephone services). For longer conversations (i.e., lasting 11-20 minutes), report CPT code 99442. For those lasting 21-30 minutes, report CPT code 99443.

      Note that Medicare also accepts 99441-99443—but only during the public health emergency.

      Some commercial payers also cover telephone services provided by a non-physician practitioner. For 5-10 minutes of medical discussion, report CPT 98966. For 11-20 minutes and 21-30 minutes, report CPT code 98967 and CPT code 98968 respectively. 

      Revenue gained per service billed:

      G2012 - $14.80

      99441 - $14.44

      99442 - $28.15

      99443 - $41.14

      98966 - $14.44

      98967 - $28.15

      98969 - $41.14

      2. Telehealth. Still want to provide Medicare annual wellness visits (AWV) to check up on patients and educate them about COVID-19 prevention? Use telehealth, says Huey. Some Medicare Administrative Contractors don’t even require vital signs (an element of the AWV), while others accept self-reported vitals from the patient, she adds. What about new and established patient office visits, prolonged services, smoking and tobacco cessation counseling, annual depression and alcohol screenings, advanced care planning, and more?

      During the public health emergency, Medicare covers more than 80 additional services that help practices continue to provide access and generate revenue. However, commercial payer coverage of these services may vary, and it’s best to check with each individual payer, says Huey.

      Patient telehealthOne caveat: Although Medicare has waived many telehealth requirements during the public health emergency, the agency does continue to require a synchronous audio-video link with a patient. When this link is in place, providers can bill telehealth services using the appropriate CPT code with modifier -95 and whichever place of service (POS) code is most appropriate (for physician practices, it’s POS code 11), says Huey. Note that commercial payers may require a different modifier, she adds.

      Revenue gained per service billed:

      It depends on the specific service billed. Medicare currently pays telehealth services at the same rate as in-person visits, and some commercial payers have followed suit.

      3. Patient portals. The portal is a highly-valuable tool to communicate with patients about all types of health concerns. Huey provides this example for a patient with Medicare: A patient logs onto the portal and sends a picture of a severe flare of atopic dermatitis on her arms. A physician reviews the image, prescribes a medication to address the flare, and instructs the patient to call the office if her condition worsens. Physicians can bill G2010 (remote evaluation of patient-generated recorded video and/or images).

      For commercial payers, physicians can report CPT codes 99421-99422 (online digital E/M service), depending on how much cumulative time they spend. These services require a clinical decision that would otherwise be made during an office visit, says Huey. Note that Medicare also accepts these codes. The major difference between G2010 and 99421-99422 is that the latter are time-based requiring a minimum of five minutes.

      There are similar codes for nonphysician professionals. For Medicare, report HCPCS codes G2061-G2063, and for commercial payers, report CPT codes 98970-98972.

      Note that all of these codes are only billable when the patient isn’t subsequently seen in the office or via telehealth within seven days.

      Revenue gained per service billed:

      G2010- $12.27

      G2061 - $12.27

      G2062 - $21.65

      G2063 - $33.92

      98970 – Payment varies depending on commercial payer.

      98971 – Payment varies depending on commercial payer.

      98972 – Payment varies depending on commercial payer.

      99421 - $15.52

      99422 - $31.04

      99423 - $50.16

      4. Remote patient monitoring. Want to keep tabs on patients without requiring them to come into the office? Consider remote patient monitoring. During the public health emergency, Medicare covers this service for new and established patients with one or more acute and chronic conditions, says Huey. Commercial payer coverage may vary, she adds.

      For example, physicians can remotely monitor a patient’s pulse oximetry, weight, blood pressure, or respiratory flow rate. To do this, they would first educate the patient on how to set up and use the remoteRemote patient monitoring monitoring device (and bill CPT code 99453). Next, they would monitor daily recordings or programmed alerts (and bill CPT code 99454 every 30 days). If the physician also communicates remotely with the patient to discuss and address their data (e.g., to talk about weight reduction or weight increase strategies), they can report CPT code 99457 for the first 20 minutes and CPT code 99458 for each additional 20 minutes.

      There are also two CPT codes specifically for self-measured blood pressure using a device validated for clinical accuracy. Physicians can report CPT code 99473 for training patients on how to use and calibrate this device and CPT code 99474 for reviewing the data (i.e., separate self-measurements of two readings one minute apart, twice daily over a 30-day period). Physicians must also communicate a treatment plan to the patient as well as average systolic and diastolic pressures

      Revenue gained per service billed:

      99453 - $18.77

      99454 - $62.44

      99457 - $51.61

      99458 - $42.22

      99473 - $11.19

      99474 - $15.16

      Special considerations

      One important consideration is the fact that not all malpractice carriers will cover all of the services included in this article, says Huey. For example, some carriers may only cover audio-visual telehealth—not telephone calls. Some may cover audio-visual but only when it’s used with established patients. Others may only cover telehealth rendered by physicians (not nurse practitioners or physician assistants).

      As previously mentioned, another important consideration is that commercial coverage and billing requirements for virtual services varies by payer. Huey says to ask these questions of commercial payers before billing:

      1. Are virtual services covered? If so, which ones? And is this only for services related to COVID-19?
      2. Can nurse practitioners, physician assistants, and other qualified healthcare providers render virtual services?
      3. What are effective dates for coverage of virtual services?
      4. What codes should we use to bill virtual services?
      5. What POS code should we use?
      6. What modifiers are necessary?

      The time to be embrace virtual care is now, says Huey. Practices that offer these services—and bill for them correctly—will be most successful during COVID-19 and beyond, she adds.

      For more information on thriving during and after this crisis, check out our free webinar series "Practice Comeback Plan." It is a four-part series, but any missed sessions will be sent to you via email. 

      Register Now

      Lisa Eramo

      Lisa Eramo

      Lisa A. Eramo, MA is a Rhode Island-based healthcare journalist who contributes to various trade publications covering topics such as health information management, health information technology, medical coding, and clinical documentation improvement. She also assists clients with content marketing efforts. Visit www.lisaeramo.com for more information.

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