These consensus recommendations, Q&A materials and references have been generated and gathered by the Washington Healthcare Forum COVID-19 Work Group. They are provided to all healthcare organizations and government agencies working to control the COVID-19 outbreak in Washington state. These documents may be used by organizations participating in this effort, including re-branding, re-posting or modifying.
Clinical Practice Guidelines
Guidelines from the Department of Health regarding PPE:
04/03/20 - Washington State Prioritization Guidelines for Allocation of PPE
04/03/20 - Washington State PPE Conservation Strategies
03/23/20 - Consensus Recommendations for Personal Protective Equipment Use: Collection of Nasopharyngeal (NP) or Oropharyngeal (OP) Swabs and Workplace Exposure
03/08/20 - Consensus Recommendations for the Protection of Health Care Personnel and Patients Related to COVID-19
Administration & Billing Materials
A workgroup was formed to address administrative issues related to the delivery of COVID-19 related healthcare, e.g. billing, pricing, reimbursement, etc.
- Identify pressing questions/issues/concerns related to COVID-19 Administration of Healthcare
- Quickly arrive at answers to common questions/issues/concerns. Arrive at consensus answers/policies/positions where possible
- Broadly communicate answers, policies/positions and/or variations
FAQs & OTHER DOCUMENTS
FAQ on COVID-19 Admin Guidelines for Industry & Provider Practices (last updated 03/23/20)
FAQ on COVID-19 Industry Guidelines (last updated 03/24/20)
FAQ on COVID-19 Health Plan Policies, Procedures & Practices (last updated 04/01/20)
Section A: COVID Related Billing
Section A Question 1
For all patients that meet the CDC criteria, plans will cover 100% of the cost of COVID testing and Diagnostic Test Panels in an outpatient setting without patient deductible or cost share?
Section A Question 2
In situations where HCPS U0002 or CPT 87635 is billed by the lab and the E&M visit is billed by the provider, how should providers submit the claim with the E&M visit -- so that it is clear that E&M visit is to be covered under the Emergency Order (since the testing will be billed by the lab)?
Section A Question 3
When do you anticipate that providers should submit claims to you for COVID testing?
Section A Question 4
If a claim was billed for COVID testing after the order (March 5th) and it was billed with an incorrect code, how should it be rebilled so that it is adjudicated under the order?
Section A Question 5
As provider organizations that do not have delegated credentialing bring on new providers to address the COVID demands, are there policies/practices under which the new provider can bill the health plan sooner rather than later?
Section B: Alternative Treatment Locations
Section B Question 1
Are ED services provided in tents and patient cars covered and if so, how should they be billed?
Section B Question 2
Are outpatient services provided in patient cars covered and if so, how should they be billed?
Section B Question 3
Are services provided in non-licensed space and/or non-licensed beds covered and if so, how should they be billed?
Section B Question 4
Is SNF care provided to COVID patients by hospitals in non-licensed beds covered and if so, how should they be billed?
Section C: Telehealth
Section C Question 1
Will a telemedicine visit for a care service be paid at the same rate as an in-person visit for that same care service?
Section C Question 2
Are you following the HHS guidelines for the methods that will be considered telehealth (e.g. SKYPE, Facetime, etc.)? How should they be billed?
Section C Question 3
Will a phone call with a patient be considered telehealth if there is no video feed; i.e. just voice interaction over the phone? If so, how should it be billed?
Section C Question 4
Will telehealth be a covered service for patients new to that provider?
Section C Question 5
For telehealth services during this interim period, will your plans allow the provider to select E&M code level based just on MDM OR on either MDM or time, with time defined as all of the time associated with the E/M on the day of the encounter?
Section D: Provider Workflow
Section D Question 1
Will the outpatient pre-authorizations and pre-authorizations for scheduled admissions be extended longer than 90 days? If so, by how much?
Section D Question 2
Will health plans ease authorization requirements for key components of after-hospital care, such as admission to SNFs or rehab, providing home health visits, during this COVID period?
Section D Question 3
Can any patient signature requirements be waived for COVID patients, e.g. Medicare MOON?
HEALTH PLAN COVID-19 LINKS
Health Plan COVID-19 Web Sites
Look under COVID-19 News and Resources in upper left corner.
Scroll down for COVID-19 items in the list.