Daily COVID-19 Email Update - May 8, 2020

NCOS Webinar: 20/20 Vision - A Further Look Into COVID-19 Employment Issues

The NCOS webinar, 20/20 Vision - A Further Look Into COVID-19 Employment Issues, is now available and ready to be viewed! The NCOS has partnered with Ward & Smith, P.A. to bring members this exclusive webinar.

Watch Now

Click here to view the first webinar: 20/20 Vision - A Look Into COVID-19 Employment Issues.

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Practical Considerations for Your "Return to Work" Plan 

Didn't See That Coming: Unexpected Results of FFCRA Paid-Leave "Temporary" Regulations

Employer's Recordkeeping Requirements For Leave Requests Under the FFCRA

Employer's Alert: Third Round of Informal Guidance and FAQs on the FFCRA Issued

Are Health Care Providers Exempt from the FFCRA Paid Leave Requirements

FFCRA Health Care Providers Exemption: New Guidance Published

Employers Required to Post Employee Rights Notice Under Families First Coronavirus Response Act

Enhanced Unemployment Assistance Under the CARES Act

CARES Act: Providing Payroll Relief to Employers in Response to COVID-19

The CARES Act and the Healthcare Industry

Personal Consultations from Ward and Smith, P.A.

Ward and Smith, P.A. is offering NCOS members a flat-fee personal consultation with Ken Gray (or another, experienced member of their Labor and Employment team). Pending a conflicts check and the completion of a short form, they would schedule a one-hour time slot for members to have a one-on-one discussion and Q&A session. The flat fee for this consultation is $400.

Click here to learn more!

A Message from Dr. Rebecca Wartman, NCOS Third Party Liaison

Report From CMS Call - May 7, 2020

Thank you Milan Lockhart, OD (NCOS Third Party Committee) for being on the CMS call on May 7, 2020. 
Below, was the main point of interest to optometry.

Q: Should 99441-99443 codes utilize the 95 modifier? 
A: YES, in connection with the increased payment rate, CMS is asking for the 95 modifier to be applied. Providers need not re-submit claims if they have already submitted, the MACs will re-process the claims. The recording and transcript will be posted on the CMS podcast page here.

Phase 1 Begins May 8, 2020 at 5pm

Updated daily by 11 a.m. Last updated 11:00 a.m., May 8, 2020.

We are all aware that Phase 1 begins today at 5pm which will allow us to reopen our offices. This is great news, but it is important that we continue to be vigilant and ensure everyone's safety. Remember you can access the COVID-19 infection data for your zip code here and by county here.

The NCOS posts the websites where you can track the cases in NC, nationally and worldwide. While NC is moving into Phase 1, we could go backwards if the 4 key areas that the State DHHS are watching begin to slide showing an increase in infections, hospitalizations, etc.

You can view all the NC DHHS COVID-19 information here.

CMS Expansion of the Telemedicine Permitted Codes

Yesterday, I reported that CMS issued an expanded list of codes allowed for telemedicine. This list included 92002-92014. You need to understand that the AOA and the NCOS have VERY SERIOUS concerns about the ability of anyone being able to properly provide these services via telemedicine as none of the guidelines for using these codes have been changed. At this point, the recommendation is to continue to provide medically necessary services via telemedicine when appropriate and when it would endanger the patient's health or the staff/doctor's health if the patient came to the office. Code these medically necessary services using the 99000 code series which does have new guidance on how the coding levels are chosen.

No one really knows how telemedicine and all the telehealth codes will be applied and used once the COVID-19 1135 waivers have been cancelled. The general consensus is that telemedicine and other telehealth tools will remain, but the expanse and rules are likely to revisited.

Telehealth Video: Medicare Coverage and Payment of Virtual Services

This updated video provides answers to common questions about the expanded Medicare telehealth services benefit under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act.

NC Medicaid

The NCOS is in communication with NC Medicaid to see if we can get some codes added for our use during the COVID-19 health emergency to include at least the new patient 99201-99205 codes and to allow G2010. We included a few other codes as well that are allowable for MD/DO/NP/PA providers but not for optometry. In the letter we sent to NC DHHS, we addressed all the reasons these codes should be added and tried to set the stage for NC DHHS to consider changing the status of doctors of optometry to be on a more equal footing to our MD/DO colleagues. We hope to get a response to the COVID-19 issues soon.

Below is a slide from the webinar last night. Of note is that the Policy Provisions that have been applied during COVID-19 will not end before July 25, 2020 and we will be given a 30-day notice before any provisions end. If you have any questions about any of the NC DHHS policies, please let us know. Also, the reimbursement for the telephonic (telephone only) visit has increased to 80% of the E&M regular fee schedule.

COVID-19 Plus Triage Line

CCNC has opened a COVID-19 triage line for patients and providers to get their questions answered. The slide below is some of the data they compiled from this triage line. 

CMS Reissues Current Office Visit E&M Service Medlearn Article

You can find the document here and it will be posted to the NCOS website. Until January 2021, the rules for office E&M codes HAVE NOT CHANGED. Yes, CMS did change the guidance for the telemedicine use of these codes during the COVID-19 Health Emergency, but not for office. A review never hurts. 

NCTracks on Behalf of NC Medicaid

ADA and Rehabilitation Act Guidance

As a reminder, federal law requires all Medicaid providers in North Carolina to comply with the Americans with Disabilities Act (ADA) and Rehabilitation Act, which includes providing reasonable accommodations for people living with disabilities. Two publications provide information and guidance regarding individual rights and visitors in health care settings:

For individuals with a cognitive impairment or intellectual disability, it is important to ensure the individual has adequate support for decision-making and treatment. These individuals may need to have a caregiver accompany them in either the ambulance or in the hospital. Accompaniment should be allowed in accordance with the guidance above.

For more information, please refer to SPECIAL BULLETIN COVID-19 #83: Title II Americans with Disabilities Act (ADA) and Section 504 Rehabilitation Act (RA) Protections during the COVID-19 Pandemic on the NC Medicaid website.

UnitedHealthcare Is Waiving Cost Share for Medicare Advantage Members

UnitedHealthcare is waiving cost share (copays, coinsurance and deductibles) for UnitedHealthcare Medicare Advantage plan members for all covered office-based professional services performed by both primary care physicians and specialists with dates of service starting May 11, 2020 until at least Sept. 30, 2020. Waiving cost share for primary care and specialty care can make it easier for members to get the care they need, however they choose to access it.

This applies to all UnitedHealthcare Medicare Advantage members, including Group and all Special Needs Plan (SNP) members. More information about the Medicare Advantage cost share can be found here.

COVID-19 Cost Share Recap

Waiving cost share for Medicare Advantage members is in addition to actions UnitedHealthcare has already taken to waive cost sharing across their Medicare Advantage, Medicaid, and Individual and fully insured Group Market health plans for telehealth visits, as well as COVID-19 testing and testing-related visitstreatment and antibody testing.

Updated Telehealth Audio-Visual Requirements

Starting May 11, 2020, telehealth visits for Medicare Advantage members, including DSNP members, must be an interactive audio-video visit (such as Zoom, FaceTime, Skype, Google Duo or dedicated telehealth solutions) to qualify for reimbursement, except for certain audio-only visits classified by CMS on May 1, 2020. Medicare fee schedule rates for audio-only evaluation and management codes have been adjusted retroactively for dates of service March 1, 2020 or later, such that reimbursement aligns with in-office fee schedule rates for comparable codes.

Cost share for both covered interactive audio-video telehealth visits and audio-only telehealth visits will continue to be waived.

Please visit UHCprovider.com/covid19 for complete COVID-19 resources.

CSI Solutions - Telehealth Community

CSI Solutions is pleased to announce the launch of the Telehealth Community on its www.healthcarecommunities.org website.

During the Covid-19 health crisis and beyond, health care organizations are launching a broad range of telehealth services. Many healthcare professionals are seeking resources and peer support to successfully plan, implement, and sustain telehealth.

For more than 10 years, CSI has hosted www.healthcarecommunities.org to support improvement initiatives and communities of practice. They received requests through this list and others for workflows, policies, and other information related to telehealth. They surveyed list members about interest in a dedicated telehealth community and were overwhelmed with the positive response. As a result, they have launched the new Telehealth Community where users can post questions, find or share resources, workflows, webcasts, and tools to help health care organizations optimize telehealth. The site is moderated by CSI Solutions and a group of subject matter experts.

How to Participate

  • Visit www.healthcarecommunities.org and choose the green Visit the Telehealth Community button in the orange Telehealth announcement banner. 
  • Once in the Community, you may browse resources and Telehealth Updates. Participation in the Discussion Forums requires login. If you are already registered for the Healthcare Communities website, simply select the Login option in the blue bar above the Forums. If you are not a registered user of the website, choose the Register option in the blue bar instead.
  • If you have questions or comments use the Help tab at the top of the page.

Participation in the Telehealth Community is free. You will not receive unsolicited emails from CSI or its partners although you may choose to receive email notification of new posts using the Subscriptions option in the Discussion Forums.

Register Today: #AskAOA Webinar on Practice Reopenings for Paraoptometrics

The current COVID-19 public health emergency continues to create challenges and uncertainties for many doctors of optometry, but AOA remains committed to relaying actionable, timely information and guidance that doctors need to know immediately.

The latest #AskAOA Webinar will focus on practice reactivation guidance and recommendations for paraoptometric staff with information concerning waiting room design, cleaning procedures, best practices for re-engaging patients and more.

What: #AskAOA Practice Reactivation Guidance for Paraoptometric Staff
When: 9 p.m. ET, Thursday, May 14

Register here.

New Resources

CMS Evaluation and Management Services Guide (5/8/20)

Androgens May Explain Male Vulnerability to COVID-19 (5/7/20)

COVID-19: 8 Steps for Getting Ready to See Patients Again (5/7/20)

"Do I Need to Return My PPP Loan?" SBA Extends Safe Harbor Deadline to May 14 (5/7/20)

AOA President Warns People To Avoid Scams Claiming To Offer Eye Exams At Home (5/6/20)

COVID-19 Statistics

NCDHHS COVID-19 Dashboard

Johns Hopkins Coronavirus Resource Center 

WorldoMeter Coronavirus Website