Washington Healthcare Forum COVID-19 Work Group

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

Link to document

04/03/20 - Washington State PPE Conservation Strategies

Link to document

Consensus Recommendations

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.

Specific Objectives

  1. Identify pressing questions/issues/concerns related to COVID-19 Administration of Healthcare
  2. Quickly arrive at answers to common questions/issues/concerns.  Arrive at consensus answers/policies/positions where possible
  3. 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)

Full document

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?

Link to answer

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)?

Link to answer

Section A Question 3

When do you anticipate that providers should submit claims to you for COVID testing?

Link to answer

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?

Link to answer

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?

Link to answer
 

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?

Link to answer

Section B Question 2

Are outpatient services provided in patient cars covered and if so, how should they be billed?

Link to answer

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?

Link to answer

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?

Link to answer

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?

Link to answer

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?

Link to answer

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?

Link to answer

Section C Question 4

Will telehealth be a covered service for patients new to that provider?

Link to answer

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?

Link to answer

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?

Link to answer

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?

Link to answer

Section D Question 3

Can any patient signature requirements be waived for COVID patients, e.g. Medicare MOON?

Link to answer

HEALTH PLAN COVID-19 LINKS