March 19, 2020

Ambulatory Virtual Health ServicesDuring Coronavirus COVID-19 Crisis

In order to serve our communities and facilitate access to care during this time, Advocate Aurora Health, Inc. (AAH) is

expanding the use of telehealth and telephonic care available to AAH employed providers. This will allow AAH employed

providers to treat patients with COVID-19 symptoms, patients with confirmed COVID-19 diagnoses, and patients with other

conditions if it is in furtherance of AAH’s goal to minimize potential exposure and/or transmission of COVID-19.

Therefore, expanded use of telehealth and telephonic care isavailable to AAH employed providers until further notice.

The CMS granted a federal waiver of licensurerequirements. We are optimistic that, in light of the federal

waiver of licensure requirements, states will follow suit. In the interest of patient care we are allowing our physicians and other

health care providers to practice across state lines during this emergency (but it is not mandatory). Additionally, even if states were not to follow suit, we believe the current emergency under

which providers are operating would enable us to provide a focused and vigorous defense against any licensure-related issues. AAH will be staunch and vigilant in standing behind

those providers who step in to help with this crisis.

What is Virtual Health?➢ Virtual services are defined by the delivery of healthcare services, which includes:

➢ Video Visits – A visit between a clinician and patient that uses telecommunication systems via video, synchronous, or asynchronous. Can be quick-care or scheduled.

➢ Electronic Visits – A communication between a patient and their clinician and through an online portal

➢ Telephone Visits – Brief communication technology-based service, e.g. virtual check-in, by a clinician who can report evaluation and management services

➢ Remote Patient Monitoring - Interpretation and follow-up of recorded video and/orimages

Due to the COVID-19 outbreak, telehealth benefits and coverage was expanded through the Stafford Act and the National Emergencies Act under the 1135 waiver for Medicare beneficiaries

Approved Virtual Health Clinicians➢ Physicians

➢ Nurse Practitioners (NP)

➢ Physician Assistants (PA)

➢ Nurse Midwives

➢ Clinical Nurse Specialists (CNS)

➢ Certified Registered Nurse Anesthetists (CRNA)

➢ Clinical Psychologists (CP) and Clinical Social Workers (CSW)

➢ Registered Dietitians or Nutrition Professionals

Note: Per CMS, CPs and CSWs will be allowed to bill Current Procedural Terminology (CPT) codes90792, 90833, 90836, and 90838 to Medicare for psychiatric diagnostic interview examinations withmedical services or medical evaluation and management services due to the HHS 1135 Waiver to meetpatients needs during the Coronavirus COVID-19 crisis.

Medicare Telemedicine Health Care Provider Fact Sheet; March 17, 2020

Telephonic Care➢ Established patients only

➢ All payers

➢ Additional restrictions related to other services and documentationrequirements are noted in the appendix

Payor Code

Medicare G2012 – Virtual check-in

Commercial & WI Medicaid 99441 (5-10 min)99442 (11-20 min)99443 (21-30 min)

Behavioral Health Non-Psychiatrist (this is “official” therapy – not a PCP talking about depression)

98966 (5-10 min)98967 (11-20 min)98968 (21-30 min)

Most Important…

GT Modifier

➢ Must be added to all telehealth services

➢ Make it a fast button on LOS

FAQ - briefly➢ How to schedule?

➢ How to document?➢ See requirements and make sure to include them

➢ Create a telephone encounter on-the-fly (see tip sheet)

➢ Who provides the care➢ The person who is billing

➢ What kind of care qualifies?➢ “sniff test”

Video Visits➢ New or established patients

➢ All payers

➢ Coding: standard E&M code for level of service provided

Most Important…

GT Modifier

➢ Must be added to all telehealth services

➢ Make it a fast button on LOS

VIDEO VISITS

Hardware Requirements

➢ Preferred: Smart phone or iPad

➢ You will utilize Haiku or Canto

➢ 2nd option: personal computer with webcam

➢ 3rd option: AAH-issued laptop with webcam

➢ 4th option: webcam-free computer with a webcam peripheral

Software Requirements

➢ Access to Epic from a computer

➢ Access Haiku or Canto

➢ Download Zoom to your computer and to your Smart Phone or iPad

Scheduling

➢ Patients will be scheduled on your normal schedule as a myChart Video Visit

➢ Your staff are receiving education as to how to schedule

Patient Requirements

➢ Patients must be registered for myChart➢ Automatic link will be sent as text or email at the time

of scheduling if they are not activated

➢ Rapid proxy access will be allowed

➢ Must have a smart phone, tablet, or computer with web cam

➢ Must download Zoom to whatever device they’regoing to use before beginning the visit

Check-In➢ Patients will enter through their myChart account

➢ Directions are on our AAH website

➢ They will complete the Pre-Check In process

➢ All co-pays will be billed after the service

The Visit

➢ Enter as you normally would

➢ When ready, initiate video➢ iOS – you can “hand off” to Haiku right from the chart

➢ Android – you must go into Haiku on your device, go to your schedule, click on the patient, click on summary , click on start video visit

➢ Complete the visit as normal➢ YOU are the only touchpoint for the patient.

Therefore, complete med rec, allergies, pharmacy, applicable care management, etc

Documentation

➢ Must include a statement that the visit was done by two-way live audio/visual technology.➢ dotphrase developed

➢ Enter any vitals obtained in to the note, not the vitals section

Follow-ups

➢ Send a note to your staff if there are any f/u recommendations that you want completed –additional appointments made, etc

➢ Work with your market protocols for routine labs,imaging, etc

➢ Bill your normal E&M code for the service you provided

Most Important…

GT Modifier

➢ Must be added to all telehealth services

➢ Make it a fast button on LOS

APPENDIX

References

➢ Epic COVID-19 Ambulatory Tools

➢ Telehealth Consultations for Medicare

➢ CMS Telehealth Services MLN Booklet

➢ COVID-19 & HIPAA Bulletin Limited Waiver of HIPAA Sanctions and Penalties During a Nationwide Public Health Emergency

➢ Telehealth Expansion for Medicare Beneficiaries

Virtual Health Coding

v

Type of Visit

HCPCS/CPT Codes Patient Type Documentation Requirements Acceptable Payers

Video • 99201-99205 (New Pt/Office)• 99499.32 (On-demand)• G0425-G0427 (Telehealth Consults:ED,

Initial IP)• G0406-G0408 (Follow-up IPtelehealth

consults)

* New & Established

• Statement that service was provided using Video• Patient's consent;• Medical issues discussed;• Pertinent findings;• Assessment or diagnosis, if new;• Any medication adjustments or refills;• Labs ordered;• Follow-up recommendations/plan of treatment, if

new.• Date and time of patient contact via phone call,

video,email, or patient portal;and

Note: If the patient provides vitals, the clinician should also include this in their documentation

All payers

Electronic

Note: Modi A PB coder the approv

• 99421 - 99423Online digital evaluation & management service by a physician or other qualified healthcare professional

fier GT should be added to all telehealth serwill review and submit telehealth charges wied payer modifier.

Established

ices. th

All payers

Telephone Specific FAQsQ: Can I bill for telephone visits?

A: Yes, we can bill for any telephone encounters required by COVID restrictions and should be doing so. This includes both direct COVID calls (e.g. a patient with respiratory symptoms) and calls for unrelated conditions where the service cannot be performed in-person due to COVID restrictions (e.g. a follow-up diabetes visit).

Q: How do I bill for telephone visits?

A: See slides 6 for code details OR on the AAH COVID-19 Website

Q: What is the Epic workflow?

A: Telephone specific workflow and screen shots AAH COVID-19 Website

Telephone Specific FAQsQ: Will patients be billed for these visits?

A: The *WI Office of Commissioner of Insurance has issued a directive to all payers to cover directly-COVID-related visits with no out of pocket costs to patients. While we cannot guarantee that all insurers will follow this, most should do so. The charges for a telephonic visit (see below) will also be much less than an office visit.

* March 6, 2020 State of WI Office of the Commissioner of Insurance Bulletin

Q: How do I distinguish between a formal billed telephone encounter and a simple phone call?

A: Patients are required to give consent to be billed for a formal telephonic encounter

✓A telephonic encounter cannot be billed a week after or just before a face-to-face encounter

✓“Sniff test” is this a service that would have been handled as an office visit in ‘normal’ clinic times, or something you would normally just do as part of your workflow? Generally this is not used to code for simple phone calls from the patient such as “Does the doctor recommend I cancel my upcoming trip?” or a call back to answer a question, such as “Is it normal to still have ear fullness 2 weeks after a sinus infection”.

Telephone Specific FAQsQ: What is the fee and reimbursement for telephone services provided by aphysician or other qualified health care professional?

A:

Note: Fees and wRVUs per Epic Fee Schedules as of March 19, 2020

Code Description WI Epic Fee Schedule Unit Charge

WI Epic wRVU

IL Epic Fee Schedule Unit Charge

IL Epic wRVU

99441 Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion

$135.00 0.25 $63.00 0.25

99442 Same; 11-20 minutes of medical discussion $240.00 0.50 $102.00 0.50

99443 Same: 21-30 minutes of medical discussion $310.00 0.75 $146.00 0.75

Note: Fees and wRVUs per Epic Fee Schedules as of March 19, 2020

Telephone Specific FAQsQ: What is the fee and reimbursement for telephone services provided by a non-psychiatrist in behavioral health?

A:

Note: Fees and wRVUs per Epic Fee Schedules as of March 19, 2020

Code Description WI Epic Fee Schedule Unit Charge

WI Epic wRVU

IL Epic Fee Schedule Unit Charge

IL Epic wRVU

98966 Telephone assessment and management service provided by a qualified nonphysician health care professional to an established patient, parent, or guardian not originating from a related assessment and management service provided within the previous 7 days nor leading to an assessment and management service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion

$90.00 0.25 $28.00 0.25

98967 Same; 11-20 minutes of medical discussion $155.00 0.50 $49.00 0.50

98968 Same: 21-30 minutes of medical discussion $200.00 0.75 $65.00 0.75

Note: Fees and wRVUs per Epic Fee Schedules as of March 19, 2020

Resource ContactsWisconsin:

Physician Coding: Physician Coding Liaison: Caregiver Connect -> Coding-Physician -> I’m a Clinician-> Find My Coder

Medical Group Compliance: Caregiver Connect -> Compliance and Integrity -> Compliance Team

Epic Informatics: Local CI support team member; if unsure, see reference on your Learning HomeDashboard

Operational Resources: Respective Senior Director or Jon Kluge

Physician Resources: Dr. Betsy Winga or Dr. Timothy Lineberry

Illinois:

Physician Coding: Rosa Rodriguez, Amber Crowley, Dawn Englebert, and Rocky Peralta

Clinical Informatics: Odeh Neshawait and Vanessa Negron

Operational Resources: Site Directors and Managers

Physician Resources: Dr. Betsy Winga and VPs of Med Management