Provider Resources and Education

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Information for Providers on COVID-19

Louisiana COVID-19 Information for Providers

As COVID-19 changes that way we deliver healthcare services, it is important that providers and patients have access to resources to understand the changing landscape. We have collected physician resources and online educational opportunities, funding opportunities and patient resources to help you, and we will update these as more resources are made available.

Diabetes Prevention and Management

As a chronic condition, it is more important than ever to help your patients prevent or manage their diabetes or pre-diabetes diagnosis. Take a look at these resources and educational opportunities to learn how you can support your patients during this time.

For information about National Diabetes Prevention Programs, click here to view the guidance document from the CDC. 

For diabetes-specific information and tools to assist you and your patients during the COVID-19 health threat, please visit the American Diabetes Association website. For diabetes focused COVID-19 updates, including telehealth services and client resources, please visit the Association of Diabetes Care and Education Specialists (formerly AADE) website.

There are many questions surrounding Diabetes Self-Management Education (DSMES) and telemedicine. We will update the below FAQs as information becomes available.

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Services provided via telemedicine must be delivered at the same standard of care as services delivered in person, as determined by the provider. Generally, telemedicine will require, at a minimum, a computer or other device with a microphone and camera to establish a live audio-video connection. The provider must determine if, based on the type of service provided and the needs of the patient, additional equipment (such as peripherals) is required to deliver the same standard of care.

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COVID-19 UPDATE: Effective 4/29/2020, CMS is waiving the requirements of section 1834(m)(4)(E) of the Act and 42 CFR § 410.78 (b)(2) which specify the types of practitioners that may bill for their services when furnished as Medicare telehealth services from the distant site. The waiver of these requirements expands the types of health care professionals that can furnish distant site telehealth services to include all those that are eligible to bill Medicare for their professional services. 

Medicare reimburses services provided by the following providers via telemedicine: Physicians, Nurse Practitioners, Physician Assistants, Nurse Midwives, Certified Nurse Specialists, Certified Registered Nurse Anesthetists, Clinical Phycologists, Clinical Social Workers, and Registered Dieticians or Nutrition Professionals. 

Louisiana Medicaid does not limit the providers that may provide services via telemedicine.

Each licensing board (LSBME, Board of Nursing, etc.) can allow or limit their providers ability to deliver services via telemedicine. Make sure your licensing board does not prohibit you from utilizing telemedicine.

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First, make sure that services are provided by a provider who is qualified to bill the relevant payer for services provided via telemedicine.

The same code as in-person visits would be utilized (G108 and G109) with the place of service code of “02” which indicates a telemedicine visit, for both Medicare and Medicaid billing.  

For Medicare, the “-GT” modifier should be appended to the relevant codes if billing under CAH Option Payment Method II.

For Medicaid, the “-95” modifier should also be appended to all relevant CPT codes to indicate that the service was provided via telemedicine. RHCs should also include the modifier on the header line.

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COVID-19 UPDATE: Effective 4/29/2020, Medicare DSMT Codes (G0108 and G0109) are now included on the list of telehealth services that can be provided via audio-only technology during the COVID-19 PHE.

When billing Medicaid, for the duration of the COVID-19 emergency (beginning with dates of service on or after March 17, 2020), in cases where an interactive audio/video system is not immediately available at the time it is needed, an interactive audio-only system (e.g., telephone) without the requirement of video may be employed, unless noted otherwise.  For use of an audio-only system, the same standard of care must be met and the need and rationale for employing an audio-only system must be documented in the clinical record. Providers will code/bill the same as a telemedicine (audio/video) visit. See the most current Medicaid Provider Update on the Medicaid Updates page here for more details.

Under normal circumstances, neither Medicare nor Medicaid reimburse DSMT/DSMES (G0108 or G0109) provided via audio-only communication.

Telehealth

Telehealth, or telemedicine, is rapidly growing and changing in response to COVID-19. You can find resources and educational opportunities on this page. If you have a specific question or want the latest updates on changes to policies and regulations, visit our COVID-19 Updates and FAQ page.

Take a look at this video from CMS about common questions about the Medicare telehealth services benefit.

Well-Ahead Louisiana hosted a webinar to explain changes to telemedicine regulation and billing due to COVID-19 for RHCs and FQHCs.

Share these resources with your patients:

Here is a high-level overview of the changes to Telehealth under COVID-19 as of April 6, 2020 at 10:30 a.m.  Please note that these changes are only effective during the public health emergency and may change throughout the event.

The CARES Act (passed and signed on March 27, 2020) directs CMS to reimburse RHCs and FQHCs as a telemedicine distant site during the COVID-19 emergency period. Further guidance on billing and reimbursement is pending from CMS.

Effective for services starting March 6, 2020, Medicare will make payment for Medicare telehealth services furnished to patients in all areas of the country in all settings (including any healthcare facility and the patient’s home, regardless of rural/urban designation).

New Telemedicine Services (Medicare): For dates of service beginning March 1, 2020, Medicare has approved approximately 80 new codes to be billed via telemedicine. (Note: These services must be provided by a Medicare qualified distant site provider in order to be billed to Medicare). 

For dates of service on or after March 17, 2020, Louisiana Medicaid has expanded coverage for several Physical, Occupational, and Speech Therapy services provided via telemedicine. Effective for dates of service March 21, 2020, has also expanded coverage for mental health services provided via telemedicine. See Medicaid Informational Bulletins for more information.

Effective March 17, 2020, the HHS Office for Civil Rights (OCR) will waive penalties for HIPAA violations against healthcare providers that serve patients in good faith through everyday communications technologies without a Business Associate Agreement, such as FaceTime or Skype. Providers should attempt to utilize HIPAA compliant technology to deliver telemedicine services if possible. Public facing communications apps such as Facebook Live, Twitch, and TikTok should NOT be used.   

Effective March 31, 2020, Medicare has expanded “virtual check-ins” for utilization by new patients and practitioners such as licensed clinical social workers, clinical psychologists, physical therapists, occupational therapists, and speech-language pathologists. Medicare will now also reimburse several telephone codes which are normally considered non-covered services (only available for certain providers).

Beginning with dates of service on or after March 17, 2020, Medicaid, will reimburse audio-only services when an interactive audio/video system is not immediately available at the time it is needed (unless noted otherwise). The same standard of care must be met and the need and rationale for employing an audio-only system must be documented in the clinical record. 

Telehealth Webinar Series

ECHO COVID-19 Global Learning Collaborative Series | Mondays at 9:00 a.m. CST

This ongoing series is open to all healthcare workers around the globe working to combat COVID-19 and thinking deeply about how to create a new normal as we move forward. Register Here.

COVID-19: Develop and Define Your Telehealth Strategy | Wednesdays at 11:00 a.m. CST

This is part of a special COVID-19 Weitzman ECHO series featuring clinical care providers and operations leaders from FQHCs across the country sharing Coronavirus preparedness updates and best practices in this ever-changing environment. Register Here.

TexLa: Telehealth 101, Getting Started with Telemedicine | Third Thursday of the month at 1:00 p.m. CST

TexLa is hosting a weekly webinar to share how to get started with telemedicine and answer telehealth questions. Register Here.

Dental Services

Emergency Preparedness

Louisiana is all too familiar with the tragedy that an emergency situation can bring, and in preparing for the 2020 hurricane season, officials have provided guidance to help prepare for the hurricane response and preparedness measures amidst the ongoing COVID-19 pandemic.

Check out these resources for help in preparation:

Funding Opportunities

As the need for support increases in the wake of COVID-19, funding opportunities are becoming available to help support healthcare providers, hospitals and clinics.  Health Resources and Services Administration (HRSA) has created a frequently asked questions page about COVID-19 and funding programs administered by HRSA. Click here to view the FAQs. Check out the below available funding opportunities.

With the need of financial support during the COVID-19 pandemic, the federal government has appropriated funding to support rural health clinics. Please take a look at the below financial assistance programs.

General Allocation: $50 billion

On Friday, April 24th, HHS announced plans for distributing another $20 billion from the “general allocation” to providers. This $20 billion comes in addition to the $30 billion HHS administered to providers between April 10th and April 17th based on their Medicare reimbursements from 2019 to create the $50 billion general allocation. These funds will not have to be paid back but do come with terms and conditions which you can attest to here.

All providers who received money from the initial $30 billion, including those who automatically received money again last week, need to go this link to verify their 2018 net patient revenue in the general distribution portal. However, providers who have not received funding from the general allocation as of 5:00 pm EST on April 24th should NOT use the general distribution portal.

The first tranche of money ($30 billion) allocated, was based on roughly 6.2% of Medicare reimbursements from 2019. The second tranche of money ($20 billion), will be based on 2% of 2018 net patient revenue MINUS what you may have already received from the first allocation. For providers with large portion of Medicare patients, your first allocation may be more than 2% of your 2018 net patient revenues. In this scenario, you will likely not receive any additional funds in this second round. At this time, we do not believe that providers in this situation will have money recouped back to HHS, but we are in the process of confirming this.

If, however, your first payment did not exceed 2% of your 2018 net patient revenue, you can expect an additional payment. Provider-based RHCs should have already received this second payment last week based upon their 2018 cost report. Independent RHCs will receive their second payment after they verify their net patient revenue at the general distribution portal again.

Allocation for Rural Providers: $10 billion

HHS announced on Wednesday that $10 billion from the provider relief fund created by the CARES Act would go specifically to rural health clinics and hospitals. The details of how this will be administered are still being worked on however we do know that it will be based on “operating expenses.” This is a “targeted allocation” and considered separate from the general allocation pot. NARHC is meeting with HHS tomorrow to discuss how this might be operationalized. Funds from this targeted allocation may be distributed as early as this week.

Allocation for treatment of the uninsured: unspecified amount

This allocation is designed to ensure that providers are paid for testing and treatment related to COVID-19 they provide to uninsured patients. Beginning yesterday, providers should register here if you have provided testing or treatment for uninsured patients. Providers will be reimbursed “generally” at Medicare rates (subject to available funding) and claims submission is expected to begin on May 6th.

Rural Health Clinic specific grant/allocation: $225 million

An additional $225 million was set aside and dedicated specifically for RHCs in the phase 3.5 legislation more formally known as the “Paycheck Protection and Healthcare Enhancement Act.” The details of this program are being worked out but you can read our full article on this allocation here. This money must be “used to provide additional funding for COVID-19 testing and related expense...”

The Paycheck Protection Program was re-opened again yesterday after the first $349 billion was loaned out to businesses with less than 500 employees. The Paycheck Protection and Healthcare Enhancement Act, which was signed into law by President Trump last week, added another $310 billion to the program. Details on the PPP can be found here.

Notably for the rural health community, the Small Business Administration issued an interim final rule clarifying that hospitals owned by government entities ARE ELIGBLE for a PPP loan if they would otherwise qualify. The only caveat is that the government-owned hospital must receive less than 50% of its funding from state or local government sources (not including Medicaid).

As of April 26th, CMS announced that it is suspending its Advance Payment Program and reevaluating its Accelerated Payment Program. These programs allowed providers to receive advanced/accelerated payments from Medicare, but these payments would have to be repaid back to Medicare typically within the year. This program was designed to help providers get through liquidity issues but is now being suspended/reevaluated “in light of the $175 billion recently appropriated for health care provider relief payments.”

Patient Resources

COVID-19 is causing confusion and creating questions for everyone—especially patients. We have pulled together resources and information that you can share directly with your patients through social media, emails or by posting on your website.

  • If your patients have questions about COVID-19, please direct them to contact the Louisiana 211 Network by dialing 211. Or, they can text the keyword LACOVID to 898-211 for the most current information about the outbreak as it becomes available. They can also get answers on the  Louisiana 211 website.