The Executive Suite: Five Medicare Services to Keep Your Patients and Practice Healthy During COVID-19

Sunday, April 5, 2020

Five Medicare Services to Keep Your Patients and Practice Healthy During COVID-19

As the COVID-19 outbreak continues to spread, physicians are under immense pressure to maintain continuity in caring for their patients while promoting social distancing. In response to this, Medicare has urged providers to use telehealth for the provision of services to all beneficiaries.

The main narrative from Medicare has been focused on providing telehealth E/M visits. Although there is a need for such visits, there are other non-face-to-face Medicare services that can protect patient health, provide an opportunity to educate patients on the current crisis, and increase practice revenue to help balance out the drastic shortfall in outpatient visits.

To help keep your practice (and patients) healthy during the crisis, consider providing the following five Medicare services.

1. Annual Wellness Visit (AWV)

The AWV is included in the current telemedicine waiver, is relatively easy to provide via telehealth, and has been overlooked by many practices. Providers are allowed to reach out to patients to schedule and perform AWVs, making it a great opportunity to contact some of your most vulnerable patients to check up on their health and educate them on COVID-19 prevention and response.

Since the AWV can be performed under Medicare's "direct supervision" standard, it can be performed primarily by clinical staff, giving practices a solution for using staff who might otherwise be idle due to the reduced in-person patient volume. Further, many practices have been reporting difficulties collecting the copayments required for telehealth E/M visits, which are completely waived for the AWV. This can be a great incentive for patients not sold on the idea of telehealth to try the program.

During such a tumultuous time, patients may also want to discuss advance care planning (ACP) which can be billed as a separate service. ACP has its copay waived when provided with an AWV.

2. Preventive Services

The current telehealth waiver also covers many Medicare preventive services. These services can largely be billed together during the same televisit and in conjunction with an AWV. When grouped together, they can make a single telehealth call go further for patients and practices. Many of the preventive services, particularly those involving behavioral and mental health, are critical as patients are needing to manage more of their health concerns at home.

3. Remote Patient Monitoring (RPM)

Medicare has bolstered its reimbursement for "care management" services, such as RPM, over the past few years. These services are performed outside of an office visit, but are not considered telehealth services by Medicare and thus avoid telehealth restrictions.

RPM was expanded by Medicare in 2020 and is particularly well suited for the current crisis. Even the FDA has acknowledged the importance of RPM, having recently announced a temporary policy to allow device manufacturers expanded leeway to produce RPM devices to help meet demand.

Many practices have patients with chronic conditions who come into the office periodically for what amount to vital checkups. With the crisis, these patients have largely been told they must remain at home. RPM allows providers to electronically collect and monitor health data, such as blood pressure, glucose, or weight, from their patients. As of 2020, RPM can be furnished under Medicare's "general supervision" standard, meaning it can be conducted by auxiliary staff. The devices themselves can be mailed to a patient for use in the program once the patient has provided verbal consent to participate in the program.

4. Chronic Care Management (CCM)

CCM is Medicare's original care management service. Medicare has expanded CCM steadily for years, including major improvements in 2020.

CCM reimburses practices for spending 20 or more minutes communicating with and managing patients with two or more chronic conditions. CCM is another general supervision service, so patient communication can be conducted by clinical staff.

Although enrolling a patient into CCM requires a bit more work than the other services on this list, ongoing support for patients with chronic conditions is critical during this pandemic. Risk for major complications from COVID-19 are much more likely in older patients with chronic conditions. Two-thirds of Medicare patients have two or more chronic conditions.

5. Virtual Check-ins

Finally, let's discuss a relatively new Medicare service that covers brief telephone or messaging communication with patients. The vast majority of Medicare telehealth services, even under the current waiver, require real-time video communication. Although the virtual check-in does not pay much, it has extremely low time requirements and can be furnished over the phone. This is especially helpful for less technologically adept patients.

The virtual check-in has a sister service called remote evaluation or "store and forward." This pays a provider to briefly evaluate an image or video sent by the patient.