Healthcare Compliance Pros COVID-19 Toolkit

We understand how Coronavirus Disease 2019 (COVID-19) is impacting employers world-wide. With many employers looking for ways to adjust their working arrangements to slow the spread of COVID-19, Healthcare Compliance Pros is here to assist. We have created handouts, modules, training programs, and more to help our clients be prepared to handle Coronavirus Disease 2019 (COVID-19).

Contact your compliance specialist (855.427.0427) to discuss adding Coronavirus Disease 2019 (COVID-19) to your existing compliance program.

Our new COVID-19 Toolkit includes:

WE WILL HOST A WEEKLY WEBINAR ON TUESDAYS AT 11AM DURING THE COVID-19 CRISIS TO KEEP YOU ALL INFORMED

Download the Webinar Slide Deck Here

03/19/2020 Webinar Questions and Answers

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: 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: Do we know the telemed 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: 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: 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: 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: What about the physical exam for the provider?

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

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.

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

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

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.

Q: Did the bill pass? It was last known to us to be in the House, how can we be sure that it is active?

Yes, the bill was passed and has been signed into law.

Q: What is the exact name of the bill that was just passed?

H.R. 6201, Families First Coronavirus Response Act. Signed into law by President Trump on March 18, 2020.

Q: Are there specific 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 has a summary of telehealth codes for Medicare purposes.

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: 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 a 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: 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 doing so during a pandemic does not put the practice at risk for discrimination.

Q: What was that slide that said something about business insurance? Where can we get that information?

We will email our PowerPoint presentation; the slide you are referring to is titled, We Can't Offer Remote Work. What can we do?

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.

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: 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: 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.

Q: Do we know if all insurances will be covering telemedicine?

So far we know that United Healthcare provided the following statement: "we have waived all member cost sharing, including copays, coinsurance, and deductibles, for COVID-19 diagnostic testing provided at approved locations in accordance with Centers for Disease Control and Prevention guidelines for all commercial insured, Medicaid and Medicare members. UnitedHealthcare is also supporting self-insured customers choosing to implement similar actions."

Several other companies said that they too would waive copays and other costs for testing:

o Anthem

o Aetna

o Blue Cross and Blue Shield Association Members

o Cigna

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.

Healthcare Compliance Pros is monitoring information from the Centers for Disease Control pertaining to COVID-19 and what employers need to do. Here are some resources to assist your practice with COVID-19

With the heightened awareness of a pandemic because of the COVID-19 threat, many employers are worried about a pandemic's impact on normal business operations. Are there steps an employer should take to be prepared to operate during a pandemic?

According to the CDC, employers need to consider how best to decrease the spread of acute respiratory illness and lower the impact of COVID-19 in their workplace. This includes identifying and communicating their objectives, such as reducing transmission among staff, protecting people who are at higher risk for adverse health complications, maintaining business operations, and minimizing adverse effects on other entities in their supply chains.

OSHA has also provided general guidance for workers and employers. Regardless of specific exposure risks it is always a good practice to:

• Frequently wash your hands with soap and water for at least 20 seconds. When soap and running water are unavailable, use an alcohol-based hand rub with at least 60% alcohol. Always wash hands that are visibly soiled.
• Avoid touching your eyes, nose, or mouth with unwashed hands.
• Avoid close contact with people who are sick.

OSHA also introduced the following recommendations to help organizations prepare for a pandemic, such as COVID-19:

· Defining select positions as critical to continuous operations and establishing specific duties and/or restrictions for employees in critical positions.

· Establishing "special circumstances" policy modifications including:

o Employee compensation/payroll continuation

o Sick leave absences (including liberal leave and non-punitive, as well as caring for ill family members)

o "Send home" policy for when employees become ill at work

o "Return to work" policy, including a method to verify employees are no longer contagious

o Telecommuting/flexible worksite considerations

o Flexible work hours (staggered and/or multiple shifts)

o Visitor restrictions/bans

· Defining which critical roles receive Personal Protective Equipment (PPE) and if families should / would be included.

· Establishing the employer's ability to demand or recommend travel restrictions and geographical evacuations.

· Defining policies for employer childcare service restrictions (including shutting down on-site daycare programs).

· Establishing policies related to vaccination mandates and recommendations.

Healthcare Compliance Pro's Recommendation for Clients

Based on the facts restated above, in our opinion, developing a business continuity plan for a range of emergencies is important. If you haven't already, we recommend following the CDC's and OSHA's recommendations to include preparations for pandemic outbreaks of varying severity levels. Additionally, the CDC states that employers should be encouraging everyday preventative actions including:

• Staying home when you are sick
• Covering your coughs and sneezes with tissues
• Washing your hands frequently for at least 20 seconds
• Use at least 60% alcohol-based sanitizer if soap and water are not available
• Clean frequently touched surfaces and objects multiples times per day

Beyond that, non-pharmaceutical interventions (NPIs) have been recommended by public health officials to prevent the spread of communicable diseases. These additional actions include:

• Allowing staff members to telework
• Flexibility in allowing staff to stay home if they or someone in their house is sick
• Increasing space between staff at work as much as possible, by at least 3 feet
• Decreasing the frequency of contact among staff members
• Consider postponing or canceling work events with gatherings over over 150 people
• Canceling or postponing non-essential work travel.

Also, employers should prepare for the possibility that a large portion of their staff may be unable to work during a pandemic. When developing a business continuity plan for possible pandemics you should ask several questions such as:

1. What circumstances will cause us to enact our pandemic plan?

2. What functions are critical and needed for continuous operations?

3. Will we enact "special circumstances" policies as recommended by OSHA (Employee compensation/payroll continuation, Sick leave absences (including liberal leave and non-punitive, as well as caring for ill family members), "Send home" policy for when employees become ill at work, "Return to work" policy, including a method to verify employees are no longer contagious, Telecommuting/flexible worksite considerations, Flexible work hours (staggered and/or multiple shifts), Visitor restrictions/bans)?

4. How many absences can we handle before operations are affected?

5. How do we handle employee absences during an epidemic?

6. Will we allow employees to take sick leave if a family member is sick?

7. If an employee is symptomatic, will we send them home?

8. Will we pay employees while they are on sick leave? For how long?

9. How do we keep operations running during an interruption?

10. Will we allow employees to work virtually or telecommute?

11. How will we verify employees can return to work and are no longer contagious? Will we require a doctor's note?

12. What changes can we make to keep the business running effectively?

13. If we have to temporarily close, will we offer employees temporary pay and benefits? Will we require them to file for unemployment and obtain COBRA? Who will pay for benefits?

The answers to these questions are all contingent on your regular operations and how your organization feels it could handle a possible pandemic situation. However, we do recommend following the CDC's guidance as mentioned above. Please also review the following link for more guidance from the CDC for businesses and employers:

https://www.cdc.gov/coronavirus/2019-ncov/community/guidance-business-response.html

With some exceptions, employers are free to establish their own paid leave and benefits policies and administer those benefits according to the best interests of the business. However, any policies implemented during this period are just like any other. They must be enforced uniformly for all workforce members to comply with federal, state, and local labor laws. Additional things you may want to consider, especially since you currently do not have the ability to work remotely, would be FMLA, paid time off, any sick leave policies or laws currently in effect, unemployment insurance, etc. Even during a pandemic, employees would be entitled to take paid leave or sick time as long as it complies with your policy.

Finally, because this is an evolving situation and the CDC is providing new guidance on a regular basis, we recommend that you keep up with the news of the COVID-19 outbreak, follow the instructions of your public health officials, update any policies that you may develop to keep in line with new recommendations as they may be announced, and ensure that you provide accurate and consistent information to your employees reflecting the guidelines of OSHA, the CDC, and other governmental agencies that may be providing them.

Healthcare Compliance Pros recognizes the importance and seriousness of Coronavirus 2019 (COVID-19), and how it is impacting providers. If you are concerned about letting your employees telecommute, how to train employees on handling a viral outbreak, or need assistance, please contact your compliance advisor. Our agents are ready to assist you with all COVID-19 questions.