Keeping up with Covid-19: Latest Info for NC Health Care Professionals

Remember: The most timely and credible information is available at the

    • Centers for Disease Control and Prevention website.
    • For immediate questions/concerns from members of the public, please have them call 866-462-3821.
    • For your non-urgent questions as a health care provider, please email [email protected].
    • For urgent provider or local health department questions ONLY, please call 919-733-3419 (available 24/7).

 

Covid-19 Testing guidance

Here is the latest information on laboratory testing guidance from the NC Department of Public Health.

To facilitate greater access to testing for the virus that causes Covid-19, NCDHHS is encouraging providers to submit specimens to LabCorp when ALL of the following conditions are met:

• Fever
• Signs/symptoms of lower respiratory illness (e.g., cough, shortness of breath)
• Negative influenza test (rapid or PCR).

Guidance for testing at LabCorp is available here.

Here is the latest NCDHHS testing guidance.

Clinicians should use their judgment to determine which patients are most in need of testing. NCDHHS does not recommend testing of asymptomatic patients for COVID-19.

Read the memo from NCDHHS on testing through LabCorp.

Personal Protective Equipment Guidance

For the latest on Personal Protective Equipment recommendations, visit the CDC webpage here.

Reimbursement Guidance

While there is no code for Covid-19, utilization of the CDC recommended codes should lead to less questioning by commercial insurers like Blue Cross and Blue Shield of NC and a higher likelihood of payment. Here is the ICD-10 coding guidance from the CDC.

We’ve been hearing concerns about reimbursement for telehealth, testing and other issues arising from Covid-19. For NCMS member practices, the NCMS Plan has signed an amendment with Blue Cross and Blue Shield of NC covering COVID-19 testing.

Below is information from each of the major commercial insurance companies in the state and what they have provided thus far to their physicians and PAs.

Aetna
Guidance on telehealth
General clinical updates

Blue Cross and Blue Shield of NC
Telehealth policy

Clinical guidance

Cigna
Testing reimbursement
Telehealth update

Humana
Message for clinicians with resource links
Telehealth guidance

United Healthcare
General guidance
Telehealth guidance

Medicare/Medicaid

On March 12, the Centers for Medicare and Medicaid Services (CMS) posted a fact sheet with information relating to the pricing of both the CDC and non-CDC tests.

CMS’ Quarterly Update for Clinical Laboratory Fee Schedule and Laboratory Services Subject to Reasonable Charge Payment contains the latest information on Advanced Diagnostic Laboratory Tests, pricing and new codes. On page 3 of the update, the new COVID-19 codes are referenced.

Essential Health Benefits (EHB) Coverage
On March 12, CMS issued Frequently Asked Questions (FAQs) about EHB to ensure individuals, issuers and states have clear information on coverage benefits for COVID-19. This action is part of the broader, ongoing effort by the White House Coronavirus Task Force to ensure that all Americans – particularly those at high-risk of complications from the COVID-19 virus – have access to the health benefits that can help keep them healthy while helping to contain the spread of this disease.

For more information specific to CMS, please visit the Current Emergencies website.

The President’s declaration of a national emergency last week, empowers the Secretary of Health and Human Services (HHS) to take proactive steps through 1135 waivers to waive certain Medicare, Medicaid and Children’s Health Insurance Program (CHIP) program requirements and conditions of participation.

Waivers and Flexibilities for Hospitals and other Health Care Facilities: CMS will temporarily waive or modify certain Medicare, Medicaid and CHIP requirements. These waivers provide continued access to care for beneficiaries. Learn more.

Provider Enrollment Flexibilities: CMS will temporarily suspend certain Medicare enrollment screening requirements including site visits and fingerprinting for non-certified Part B suppliers, physicians and non-physician practitioners. In addition, CMS will allow licensed providers to render services outside their state of enrollment. CMS will also establish a toll-free hotline for providers to enroll and receive temporary Medicare billing privileges.

Flexibility and Relief for State Medicaid Agencies: The national emergency declaration also enables CMS to grant state and territorial Medicaid agencies a wider range of flexibilities, which are outlined in the Medicaid and CHIP Disaster Response Toolkit. Examples of flexibilities available to states include the ability to permit out-of-state providers to render services, temporarily suspend certain provider enrollment and revalidation requirements to promote access to care, allow providers to provide care in alternative settings, waive prior authorization requirements and temporarily suspend certain pre-admission and annual screenings for nursing home residents.

Get more information and to access the toolkit.

Suspension of Enforcement Activities: CMS will temporarily suspend non-emergency survey inspections, allowing providers to focus on the most current serious health and safety threats, like infectious diseases and abuse.

CMS  hosted two webinars in 2018 regarding Emergency Preparedness (EP) requirements and provider expectations including emergency power supply, the 1135 waiver process, best practices and lessons learned from past disasters, helpful resources and more. Watch those webinars.

Access information on NC Medicaid fee schedules here.

For questions, concerns or input on issues around NC Medicaid and Covid-19 use this email address:

[email protected].

Telehealth

To help protect patients and staff from spread of Covid-19 many practices are looking to telehealth technology.

NC Medicaid will allow practices to bill for defined telehealth services. Review the updated policies in this special NC Medicaid Bulletin.

Blue Cross and Blue Shield of NC has expanded Telehealth Measures effective March 6, 2020. Visits that previously required an in-person encounter can be performed virtually and will be paid at parity with office visits as long as they are medically necessary, meet criteria in the updated Blue Cross NC Telehealth Corporate Reimbursement Policy, and occur on or after March 6, 2020. They offer the following guidance:

  • These temporary measures include virtual care encounters for patients that can replace in-person interactions across appropriate care settings, including outpatient clinics, hospitals, and the emergency departments.
  • Please do not file telehealth claims with Blue Cross NC until March 21, 2020 and use Telehealth as Place of Service (02).
  • For providers or members who don’t have access to secure video systems, telephone (audio-only) visits can be used for the virtual visit. Please use both Telehealth as Place of Service and CR (catastrophe/disaster-related) modifier for audio-only visits.
  • If you believe an eligible telehealth claim has been improperly denied, please resubmit it after March 21, 2020.
  • Some commercial members can access MDLIVE or TeleDoc as a virtual care benefit, as noted on their member ID card. Federal Employee Program (FEP) members can only access virtual care through the Teledoc service. Teledoc offers both video or audio virtual services. You can view COVID-19 benefits for the Federal Employee Program here.

Guidance to Providers Regarding Virtual Visits for Blue Cross NC Commercial and Medicare Advantage Members These measures will remain in effect for a 30-day period, starting March 6, 2020, and then be re-evaluated for extension.

If you are interested in learning more about how to implement telehealth into your practice, Curi, a Medical Mutual Company, offers this quick one-page summary offering guidance on the structure/execution of clinical telehealth services, as well as a number of links to resources and regulatory bodies. Curi Telehealth Overview.

Wake County Health Department Offers Help

The Wake County Health Department has compiled a list of Q&As to assist in getting the information health care professionals need about this evolving situation, while also providing a better understanding of public health’s role in working to contain this novel coronavirus. Access that list.

Some of the questions addressed in the FAQs include:
• What should I do with a patient who is exhibiting the symptoms associated with COVID-19?
• Who should be tested for COVID-19?
• What if one of my patients test positive for COVID-19?
• How can our office test for COVID-19?
• What is my risk to my staff and providers?
• Should I send patients that need COVID-19 testing to the Wake County Health Department for testing?

You can visit the Wake County Health Department’s  COVID-19 webpage, which has a set of frequently asked questions to educate providers. You can also email the department questions at [email protected], or you can call its COVID-19 information line at 919-856-7044. The county is also sharing important information on its Facebook, Twitter and Instagram accounts.

NC Medical Board Adopts Emergency Rules

The NC Medical Board (NCMB) and the NC Rules Review Commission have approved emergency rules allowing a physician or PA who inactivated his or her NC medical license within the past 24 months to quickly obtain a temporary license to support Gov. Roy Cooper’s declaration of a state of emergency due to Covid-19. The license would authorize the physician or PA to practice for 90 days or until the state of emergency in North Carolina is declared over. Read the rules.

Over the next few days, NCMB will develop an online application form to receive temporary license requests from interested physicians and PAs. We expect to have this application ready by sometime next week. NCMB is not currently accepting requests for the new temporary emergency license.

Issuance of temporary authority to practice is subject to the following conditions:
• The applicant must demonstrate that he or she has practiced clinical medicine for at least 80 hours during the most recent 24 months;
• The applicant must have been licensed continuously for at least 10 years prior to making his or her medical license inactive;
• The applicant must have no history of public discipline and must not have inactivated his or her license while under investigation; and
• The applicant must confine his or her practice to areas in which he or she is clinically competent.

Please note that the NCMB adopted the emergency rules to support the Governor’s declaration of a state of emergency, which identifies a need to develop additional medical resources in the state, including additional providers. This is a preparedness step – there’s no indication that there’s a current need for additional medical providers to assist with COVID-19.

NCMB will likely advise inactive physicians and PAs who may be interested in returning to practice to check in with their local public health departments, former employer/practice, local hospital or other health care employer to determine if they are needed.

For the most up-to-date information visit the NCMB website.

Other Resources

Toolkit for Independent Physicians

Thanks to our friends at Avance Care, who have shared this toolkit for independent practices grappling with their response to Covid-19. The kit includes practical advice and resources to protect staff; recommendations for room decontamination; sample scripts for patients who may demand testing even if it’s not warranted by clinical guidelines and links to other resources.

Access the toolkit.

Hand hygiene videos

This New England Journal of Medicine video on hand hygiene is excellent and pretty technical. It’s 14 minutes long.

For patients, this National Health Service hand hygiene video has no words, just a great demo and lasts just 44 second. has a that has no words, just a great demo, 44 seconds

CDC Hand Hygiene Fact Sheets and Posters

Patient fact sheet

Provider fact sheet

Provider Poster :Clean-Hands-Count

Poster Clean Hands Count For My Patients

Articles of interest

Coronavirus (Covid-19): New Telehealth Rules and Procedure Codes for Testing, FPM Journal, 3-10-20