The Listserve has been very busy lately with peer to peer discussions, lately on teleheath and coding, reimbursement. 
If you are not on this google listserve, be sure to sign up here, or review recent discussion here as well. 

https://groups.google.com/forum/#!forum/mapta-members

When you sign up, we need to verify you are a current member, so include your APTA number if you use an email address other than the one we have for you.

Telemedicine is allowed in Montana, and coverage for telemedicine is described in our statutes here: https://leg.mt.gov/bills/mca/title_0330/chapter_0220/part_0010/section_0380/0330-0220-0010-0380.html:

. “33-22-138. Coverage for telemedicine services. (1) Each group or individual policy, certificate of disability insurance, subscriber contract, membership contract, or health care services agreement that provides coverage for health care services must provide coverage for health care services provided by a health care provider or health care facility by means of telemedicine if the services are otherwise covered by the policy, certificate, contract, or agreement."

PTs are listed as a health care provider in the definitions.

Like any other service, it is important to refer to the policy and the contract for each case.

Before You Begin Practicing Via Telehealth

The use of telehealth is one approach that can help protect the patient and provider during this time of crisis. Investigate and consider the issues within the following areas as you make decisions on whether or not to use telehealth in your practice. In addition, become familiar with some of the commonly used terms in telehealth.

Telehealth: Billing and Coding Considerations

Medicare

Billing physical therapy services that have been provided through telehealth is an emerging challenge. Due to the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act, the Centers for Medicare and Medicaid Services (CMS) is expanding access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their providers without having to travel to a healthcare facility. For the first time, PTs will be allowed to bill Medicare for telehealth visits under codes associated with online assessment and management services (HCPCS codes G2061: Qualified non-physician healthcare professional online assessment, 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, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes; G2063: Qualified non-physician healthcare professional online assessment, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes). Providers must use place-of-service code “02”  and “GT” modifier. The payment rates are significantly lower than the traditional payment for an in-person visit under the CPT 97000 code series. To determine the reimbursement rates for G2061-G2063, visit the CMS Physician Fee Schedule lookup tool. Medicare coinsurance and deductible apply to the services.

To qualify as an e-visit, three basic qualifications must be met:

1. The billing practice must have an established relationship with the patient, meaning the provider must have an existing provider-patient relationship;
2. The patient must initiate the inquiry for an e-visit and verbally consent to check-in services;
3. The communications must be limited to a seven-day period through an "online patient portal."

Third-Party Payers

Payment for telehealth depends on your contract with your payer. There is no list of third-party payers that pay for telerehab. Also confirm with each payer whether the originating site can be a private home or office, if services must be real-time or can be asynchronous, and any other limitations to your use of telehealth.

For third-party billing, there are "telehealth" CPT codes. But before reporting CPT codes you traditionally use for clinical visits or billing for telephone services (98966-98969), check with your payer. Many of the physical medicine and rehabilitation codes (97000 series) specify "direct 1-on-1 patient contact," which by strict definition would exclude telehealth unless you and your payer have agreed to include these services. A payer also may require an addendum attached to the bill that identifies the service as being provided via telehealth, along with an explanation of the charges, so be prepared to outline the reasoning for using telehealth.

You also should check with your payer about using place-of-service code "02" when billing for telehealth services to specify the entity where service(s) were rendered. Regardless of the payer or policy, if you provide and bill for services using telehealth, make sure that you are practicing legally and ethically, and are adhering to state and federal practice guidelines and payer contract agreements.

Montana volunteers will have more about codes next week.

Platforms

Two commercial telehealth platforms are eVisit and VisuWell. If you use them, it's a good idea to check their information against the primary sources of state law.

Read more about Telehealth from APTA: 

Telehealth in Physical Therapy in Light of COVID-19

For business and employment questions around the handling of this crisis, resources include: 

1. Department of labor: http://dli.mt.gov/employer-covid-19

The COVID-19 emergency is now impacting the work and personal lives of Montanans throughout our state. The Montana Department of Labor & Industry is closely following the changing dynamics and policies at the state federal level. This page will be regularly updated to share updated information. Please bookmark this page and check back often.

Filing for Unemployment Insurance in Montana

Go to MontanaWorks.gov and click File for Unemployment. From there, you will be directed to login to your MontanaWorks account or create a new account. You can also find valuable resources and services for business and job-seekers on the MontanaWorks.gov portal.

MontanaWorks

FAQ for Employers & Employees

This document is updated daily to reflect the questions we are receiving from employers and employees regarding COVID-19. If you are an employer and have a question that you don’t see answered here, please email: uieservices@mt.gov.

For employees, if you have a question that you don't see answered here, please email: uiclaims@mt.gov.

This side-by-side table is a tool for workers and employers to compare various eligibility scenarios including employer-sponsored sick leave, Unemployment Insurance, and Workers’ Compensation coverage. 

The U.S. Department of Labor also has extensive resources to help workers and employers prepare for and respond to the COVID-19 virus. Their guidance is at:https://www.dol.gov/coronavirus.

The U.S. Department of Labor has provided guidance to state workforce agencies regarding unemployment compensation flexibilities related to COVID-19. The Program Letter advising states can be found here.

You may also want to seek the advice of legal counsel.

1. Conduct proper screening procedures for your staff, patients and those individuals accompanying patients to their appointments. Those failing basic screening questions should be redirected back to their home. Identify high risk individuals and follow current guidelines using the information provided by CDC and MT DPHHS
2. Maintain social distancing in your clinics. This would involve utilizing private treatment rooms and modifying schedules to reduce patient-to-patient interactions.
3. Maintain the highest sanitary levels via frequent handwashing/sanitizer use and surface disinfection. Inform patients of your procedures via a posted notice at the time of check-in.
4. Follow guidance from federal, local, and state agencies that may influence how you handle any of the above suggestions. The CDC has provided a resource for getting your practice ready.
5. Information for healthcare professionals from DPHHS.MT.GOV: 

From http://dli.mt.gov/employer-covid-19

Workplace Safety and Health

Centers for Disease Control and Prevention (CDC):

• Interim Guidance for Businesses and Employers To Plan, Prepare, and Respond to Coronavirus Disease 2019
• Stop the Spread of Germs (poster)
• Stop the Spread of Germs (poster – Spanish)
• Understanding the Difference Between Surgical Masks and N95

Occupational Safety and Health Administration (OSHA):

• Guidance on Preparing Workplaces for COVID-19

U.S. Environmental Protection Agency (EPA):

• List of Disinfectants for Use Against SARS-CoV-2 (Coronavirus)

BCBS telehealth policy follows the MT Statute, which allows for PTs to bill for telemedicine services.  Based on the member’s benefits, the procedure may be covered, but benefits will drive coverage based on the plan type. 

As for pricing, physical therapy codes would follow CMS site-of-service differential for telehealth services and currently price at the professional facility rate.   (written prior to CMS change in coverage on 3/17/20)

The pricing for PT is located in the RBRVS fee schedules posted on the provider portal: Fee Schedules > Professional Fee Schedules.

Two commercial telehealth platforms are eVisit and VisuWell. If you use them, it's a good idea to check their information against the primary sources of state law.

from Kimberlee Raynovich, and here is the link: https://ptonice.libsyn.com/

Regardless if your state is a parity state,  Rob Vining, who did a great podcast on Monday,  #PTonICE Daily Show, therapists should double check with each and every insurance.  "Good suggestion is to call insurance, get an answer and then call the next day and make sure you get the same answer."   

Rob is saying that there is a lot to do to get started but you can access a ton of info on Telehealthpt.com.  There are some bundles to buy, but you can get all of the information, "everything that you need " for free if you sign up for the ICE course on there.  

Also, Rob explains about using the HIPPA compliant software.  Rob uses Zoom, which has a HIPPA compliant software for $200/mo.  Also, there is Doxy.me, which is $35 dollars a month.  He says don't use Skype, FaceTime, etc.  He also discusses scheduling, and other details such as the need to get consent, the patient needs to give written confirmation and then verbal at the time, to be recorded.

Official guidance and best practices change rapidly as the COVID-19 outbreak continues to evolve. APTA is curating critical advice from trusted sources such as the CDC.

Information is added hourly, daily. Please continue to check back:

http://www.apta.org/Coronavirus/

As of 3/18/2020:

APTA Resources

APTA Statement on Patient Care and Practice Management During COVID-19 Outbreak (March 17, 2020)
As actions are taken across the country to reduce the spread of COVID-19, a virus that spreads easily from close contact, APTA encourages physical therapists to use their professional judgment to determine when, where, and how to provide care, with the understanding this is not the optimal environment for care, for anyone involved.

Telehealth in Physical Therapy In Light of COVID-19 (March 16, 2020)
The use of telehealth is one approach that can help keep both patients and providers safe, but PTs and PTAs need to understand the current regulatory and payer telehealth landscape to decide whether telehealth is right — or even a possibility — for them. (And be sure to tell Congress to waive restrictions on the use of telehealth!)

National Health Emergency Triggers CMS Waivers for Medicare, Medicaid, CHIP (March 16, 2020)
The "blanket waiver" system now in effect eases a wide range of requirements, but CMS still won't reimburse for telehealth by PTs. Take action!

CMS Moves to Allow Digital Communications by PTs (March 17, 2020)
The new regulatory waivers will allow PTs, OTs, and SLPs to engage in patient-initiated "e-visits" for purposes of assessment and management services.

Coronavirus Update: March 17, 2020 (March 17, 2020)
APTA provides a statement, resources, and guidance; CMS allows limited digital services by PTs; the CDC says gatherings should be fewer than 50 people, and more.

CDC Resources

CDC Information and Resources (updated frequently)
Includes information for providers including infection control and preventing transmission in health care settings, guidance for clinical and home care, contact information for local and state health departments, and more; plus information for facilities, families, schools, communities, and businesses.

• Interim Guidance for Healthcare Facilities: Preparing for Community Transmission of COVID-19 in the United States
  Includes information about personal protective equipment, infection prevention and control guidance, and considerations for specific settings.
• CDC on Mass Gatherings or Large Community Events
  CDC recommends canceling, postponing, or conducting virtually in-person events that consist of 50 people or more for next 8 weeks. Recommendation does not apply to day-to-day operation of schools, institutes of higher learning, or businesses.

CMS Resources

CMS Issues COVID-19 Guidance on Infection Control, Protective Equipment (March 11, 2020)
The ever-growing list of resources from CMS includes guidance related to particular settings including hospice, SNFs, and home health.

CMS Guidance for Infection Control and Prevention of COVID-19 in Nursing Homes (March 13, 2020)
CMS is providing additional guidance to nursing homes to help them improve their infection control and prevention practices to prevent the transmission of COVID-19, including revised guidance for visitation.

Additional Resources

Novel Coronavirus: A Wake-up Call for Best Practices in Preventing Pathogen Transmission (March 10, 2020
In addition to taking precautions to avoid aerosolization (the production of airborne particles containing an infectious virus or bacteria), we must disinfect surfaces touched by infected people. Thus, in physical therapy clinics, in anticipation of future patients being infected by the SARS-CoV-2 virus, we must think holistically in terms of clinic disinfection and protection.

APTA Events and Operations

In an effort to reduce the spread of the coronavirus (COVID-19), effective March 11, 2020, APTA is suspending in-person meetings and APTA business travel by staff or members through April 15, 2020. This includes the Federal Advocacy Forum in Washington, DC.

APTA has not made any decisions about events occurring after April 15, 2020, including the House of Delegates and NEXT Conference & Exposition in June. We intend to continue to monitor the situation and announce a decision about those events by April 20, 2020.

APTA will contact members affected by any suspended in-person events to share any related details, including information about registration refunds or the potential for replacement virtual meetings, as appropriate.

This decision by APTA national does not dictate the status of activities hosted by APTA chapters and sections.

We will continue to monitor the developments around the spread of coronavirus. As with all public health situations, we primarily rely on the Centers for Disease Control and Prevention, the Occupational Health and Safety Administration, and the U.S. Office of the Surgeon General for the best information and preventive strategies.

If you are registered for an APTA event beyond April 15, 2020, and don't want to attend due to coronavirus, contact APTA member services and you will be given a refund. (For quickest service, email memberservices@apta.org with the name of the event and the reason for your cancellation. If you have any other questions, please contact us.)

We will continue to update this page if there are further changes to APTA's events and operations.

https://dli.mt.gov/employer-covid-19-faq

https://dli.mt.gov/Portals/57/Documents/24-11-355adp-emerg.pdf