COVID-19 / E-Visits Update

*DISCLAIMER: All information below is current as of 3/20/2020*

We're learning more every day...

TheraOffice PE Surveys

              The original intent of our webinars this week was to introduce our new, web-only TheraOffice PE feature and show users the Surveys platform, which was set to be released this week. Due to priorities changing with the recent COVID-19 pandemic, however, we have decided to push back the official release date of TheraOffice PE and extend the beta period. Web customers who are interested in learning more about TheraOffice PE and potentially beta testing the surveys should fill out a form at www.theraoffice.com/PE.

COVID-19 General Information

              In this very uncertain time, it would be irresponsible for us not to mention where to find the most up to date and accurate information on the COVID-19 Pandemic. Please see information available from the CDC and WHO here. Please remember to wash your hands often, avoid coughing into your hands, stay home if you are experiencing symptoms, and maintain a social distance as much as possible. Follow local ordinances and stay safe.

              In the healthcare sphere, we are all aware of the capacity of the healthcare system and we would like to remind everyone to do their part to flatten the curve.

The Impact on PTs

              With temporary clinic closures and nervous patients, many PTs are already seeing their cancellations go up and patient volume significantly decreasing. We know this is a scary time for everyone, not only from a health perspective, but also as a business.

              To help you keep track of the impact on your clinic, we have created a new report, Trended Cancel No Shows. This report breaks down the trend of cancellations and no shows from week to week visually, as well as in a table. The report has already been uploaded for all web customers and onsite customers can request it—free of charge—through Support.

SBA Low-Interest Loans for COVID-19

              If your clinic has been impacted by the COVID-19 crisis, the Small Business Administration is “offering designated states and territories low-interest federal disaster loans for working capital to small businesses suffering substantial economic injury as a result of the Coronavirus (COVID-19).” These loans are funded by your state’s governor. Per Donald Trump’s Coronavirus Preparedness and Response Supplemental Appropriations Act, over $8 billion have been allotted to fund this program and more funding may become available as the crisis continues to evolve.

              These loans are available at a 3.75% interest rate for businesses in qualifying areas. For more information and to see whether your area currently qualifies, please visit the SBA website. We strongly recommend learning about this early if you believe your business will need this support, as funding in each area will be limited.

BREAKING NEWS from CMS: E-Visit coverage for Medicare beneficiaries

              Medicare made an announcement on 3/17/2020 that during the coronavirus public health emergency, they are expanding coverage for telehealth and e-visits. Technically, PTs still aren’t authorized for telehealth, but for e-visits, which are G0261, G0262, and G0263. Unfortunately, PTAs and students are not currently authorized to perform e-visits.

              An e-visit is a limited form of telemedicine, not technically telehealth. CMS defines these as “non face-to-face patient-initiated digital communications that require a clinical decision that otherwise typically would have been provided in the office.” While care can progress a patient’s treatments, it is important to keep in mind that e-visits are not replacements for in-office visits, and they are more limited than traditional telehealth. Medicare copays and deductibles continue to apply to these visits, but the billing process will be a little different from traditional, in-office visits.

To qualify for an e-visit, 2 things must happen:

  1. There must be an established relationship between the patient and provider. Meaning that the patient needs to have been treated in person by this provider previously. For this reason, e-visits are not to be used for evaluations. 
  2. The patient must initiate and verbally consent. Meaning that clinics cannot advertise for e-visits, but, if a patient cancels their appointment, the clinic can offer an e-visit as an alternative. The patient must consent to be treated via an e-visit, at least verbally. You will need to notate this consent in your documentation.

The e-visit codes are as follows:

  • G2061: Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the 7 days; 5–10 minutes
  • G2062: Qualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11–20 minutes
  • G2063: Qualified non-physician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes.

Reimbursement for these codes will vary from state to state, so we recommend checking your fee schedule here.

              Late on March 19, 2020, the APTA released clarification on the 7-day aspect of these codes. According to the APTA, this means that these codes are billed once during a 7-day period of care. Meaning that from the day the patient initiates care via e-visits, the provider may provide multiple e-visit sessions for the patients over a period of 7-days. However, you can only bill one unit for the cumulative total time of the e-visits over 7 days. You would bill on the 7th day after the initiation of care.

News About Telemedicine Platforms

              As of 3/17/2020, the Department of Health and Human Services has declared: “providers will be allowed to use everyday technologies to talk to patients” for the duration of the National Public Health Emergency issued on March 13. This means that any private platform (i.e., not publicly broadcast) can be used to perform these visits. This includes Skype, Facetime, Facebook Messenger, etc. but does not include streaming platforms, such as Facebook Live, TikTok or Twitch. Providers must exercise good faith in trying to provide privacy to the patients.

              According to the APTA late on March 19, 2020, telephone calls are currently allowed for physical therapy e-visits.

But, what about commercial payers?

              Commercial payers and non-Medicare insurances are making their own determinations, at this point. Our current recommendation is to speak with your payers individually before seeking payment for telehealth or e-visits.

              The APTA has indicated that Aetna may be permitting e-visits, however, it is still strongly recommended that you speak with the payer to confirm.

The APTA Campaign for Telehealth

              Clearly, e-visits are extremely limiting and while it is a step in the right direction, there is no doubt that the work for the rehab industry is not done. The next step is pushing for further coverage and moving away from e-visits toward telehealth.

              There is a campaign right now to “Tell Congress to Waive Restrictions on the use of Telehealth for Physical Therapy Services” via the APTA. We strongly recommend supporting this campaign to push for further expansion of telehealth coverage to help the Physical Therapy industry stay afloat. You can join the campaign here: https://www.votervoice.net/APTA/campaigns/72525/respond

E-Visits and TheraOffice Logistics

There are a few things you can do to get your documentation ready:

  1. Set up a new appointment type for E-Visits. This will help you to keep track of things, as well as keep your reports squeaky clean.
  2. Link the E-Visit appointment type with a document type. We recommend daily notes.
  3. Decide on the platform you wish to use for e-visits. Provide that service to the patient on the platform.
  4. Each time you see a patient via an e-visit, you will need to document for that e-visit in your notes. E-Visit documentation should include: a notation that the patient initiated the request and that they have given consent to care via an e-visit, information about the clinical decision which resulted from the call.
  5. 7 days after the first initiation of e-visit care by the patient, you will document an e-visit summary note, at which point, you will bill the appropriate E-Visit HCPCS code (G2061, G2062, or G2063).

              For more specific instructions on each of these steps, please keep an eye out for our E-Visit Documentation Framework document, which is part of our COVID-19 Toolkit. We will be discussing these in our webinar on Monday, March 23.

Billing for E-Visits

              As far as billing for e-visits, there is still some uncertainty, but the process is beginning to take shape as information from CMS and the APTA becomes available.  

              According to the APTA, the traditional 11 Place of Service code should be used for e-visits. TheraOffice has added the 02 POS should things change down the line, however, the 11 POS is the official Place of Service as of 3/20/2020.

              E-Visits can be billed once for 7 days of treatments. These codes, while based on the time spent with the patient, are untimed, so only one unit should be billed. You will bill for the cumulative time treating the patient via the appropriate HCPCS code (G2061, G2062, or G2063) on the 7th day after a patient’s initiation of care via e-visits. However, these codes are untimed, so you can only bill one unit per 7-day period.

              In the same announcement where the APTA announced the POS, they also recommended using the CR (Catastrophe Relief) modifier alongside the E-Visit Codes. No other modifiers are necessary, which means the legacy modifiers of GT and 95 should not be used for these codes.

              We will continue to release information about billing for E-Visits as we learn it and will include Billing Framework in the COVID-19 Toolkit referenced earlier.

Mass-Emails for Patients

              We have seen an influx of requests in Support regarding mass-emailing patients. Unfortunately, TheraOffice does not have a native means of sending out mass emails at this time.

              However, if you are already utilizing an email campaign, TheraOffice does have a standard report, All Patients – Contact Information, which can be generated and exported to upload contact information to your campaign platform. This should save you time over manually gathering contact information.

3 Comments
  1. Thanks for a concise and well-written summary of recent events. Been following it all, but this is a nice digest. I definitely would advocate for email communication through theraoffice. It, quite frankly, is one of the limitations that is making me start to passively evaluate other systems. It is cumbersome to export, format, and update 3rd party lists every time a communication needs to be sent. It would take a lot to make me truly undertake a migration away, but patient communication Beyond surveys needs to be a priority in my opinion.

    All that said, thanks for being responsive to the COVID situation and extending beta on the PE portal feature!

  2. Thanks for a concise and well-written summary of recent events. Been following it all, but this is a nice digest. I definitely would advocate for email communication through theraoffice. It, quite frankly, is one of the limitations that is making me start to passively evaluate other systems. It is cumbersome to export, format, and update 3rd party lists every time a communication needs to be sent. It would take a lot to make me truly undertake a migration away, but patient communication Beyond surveys needs to be a priority in my opinion.

    All that said, appreciate the quick response to the COVID situation and extending beta on the PE portal feature!

    1. Thank you for your honest feedback; we are listening. Our research indicated that the best return on investment for our clients with patient engagement is to “engage” active patients in treatment that are not happy with their services. This is a time when a clinic or provider has the best chance to identify an issue and take corrective action to keep the patient under your care which is why we made the decision to implement patient surveys first. I can tell you that email marketing has always been in the plans for TheraOffice PE (Patient Engagement) and is currently the next feature planned for TheraOffice PE. Obviously, with the world’s current situation with COVID-19, we have been forced to shift focus to finding ways to help our clients in this very difficult time. Our first move was to setup all of our staff to be able to operate from their homes so we can continue to support all of our clients. The second move was to add some capabilities to schedule and document e-visits and telehealth (which we are finding some states adopting quicker than others – able to bill and be reimbursed for full PT services). We also felt it was important to centralize all of the information we are learning from all over the country to serve as reference during this time. I have also challenged our staff (clients feedback is welcomed too) to come up with ideas for us to help clinics speed the recovery process when things normalize. This is where we feel mass email would be very helpful. Until TheraOffice has the feature built in, we do believe we have a very cost effective and efficient way to send emails to all of your clients through the use of reports and 3rd party email systems. We chose this method because it is very similar to the process we use to send targeted emails to the over 15,000 TheraOffice followers (and therefore we can support and help clients). This is a difficult time, and we are absolutely doing everything we can to help clinics. We are here to help in anyway we can, so please keep contacting us.

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