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What to Do If a Staff Member or Patient Tests Positive

By Joey Berlin

Originally published on the Texas Medical Association website.

As cases of COVID-19 continue to climb, the greater the chance it will find its way to your office. If it hasn’t happened already, no doubt you’ve been bracing for that possibility for months.

The Texas Medical Association is here to make sure you’re prepared.

The TMA COVID-19 Task Force has created a guide for what to do when someone in your office – whether a staff member or a patient – tests positive for the disease. The guide includes links to important information on disinfection, work-restriction, and legal and ethical resources from the Centers for Disease Control and Prevention (CDC), the Environmental Protection Agency (EPA), Texas law, and more.

TMA’s guide explains three steps to take following a positive test:

  1. Follow routine cleaning and disinfection procedures – The guide contains links for recommended environmental control and personal protective equipment (PPE) practices from CDC and EPA.
  2. Notify your staff of the potential exposure, and implement appropriate work restrictions – The document includes an adaptation of CDC’s Healthcare Personnel Assessment Guide, which breaks down how to handle at-risk staff members, plus tips on determining when people with confirmed COVID-19 may have become infectious.
  3. Notify any patients who might have been exposed and recommend appropriate public health guidance – Included is an adaptation of CDC’s Public Health Guidance for Community-Related Exposure chart, as well as links to ethical and legal guidance on patient privacy laws and regulations.

Click here to read the rest of the article.

It’s Time to Assess Your PPE Needs

From the Texas Medical Association

The Texas Medical Association PPE Portal is your tool to inform state-managed warehouses how much personal protective equipment (PPE) your practice needs. 

As long as you need PPE, use this link to the PPE Portal to refresh your data once per week per practice. These data inform distributors about how much PPE you currently have on hand and how much you use each day.

The PPE Portal is available only for licensed Texas physicians (and nursing homes and home health professionals) who are not hospital-based and who cannot obtain PPE through other channels. The PPE Portal is NOT an order form. Because of the limited supplies and uneven distribution of the PPE, there is no guarantee individual practices will get all – or even some – of what they need.

The data you submit to the TMA PPE Portal are sent to the state’s Hospital Preparedness Program (HPP) partners and Regional Advisory Councils (RACs). The state purchases PPE throughout the worldwide supply chain. The HPPs and RACs are responsible for distributing it. They ship PPE allocated for physicians within their regions to local county medical societies, who then distribute it to individual physician practices. The PPE you receive from the RAC or HPP through the TMA PPE Portal will be free.

A local county medical society or state warehouse will contact you when and if PPE is ready for you to pick up.

If you are not the person who keeps track of this information for your practice, please share this email (with your personal PPE Portal link above) with the staff member or other physician who will enter it for your practice. Please report PPE usage by all staff who regularly need it to interact with patients, including physicians, physician assistants, nurses, and support staff. Coordinate within your practice to make sure it submits only one response, even if your practice has multiple locations.

For more details, see TMA’s updated PPE Distribution FAQ document and check our PPE Status by County webpage

Insurance Payments for Telemedicine Visits Extended to September

By David Doolittle

Originally published on the Texas Medical Association’s website.

Texas-regulated insurers must continue to pay for telemedicine services, including mental health visits, at the same rate as in-person visits through Sept. 12, the Texas Department of Insurance (TDI) said today.

TDI announced it is extending the requirement that was part of an emergency rule that has been in place since March. It was set to expire July 14.

Under the emergency rule, state-regulated health insurers and health maintenance organizations (HMOs) also must:

  1. Cover telemedicine services using any platform permitted by state law; and
  2. Not require more documentation for telemedicine services than they require for in-person services.

To make telemedicine available to more patients and their physicians during the emergency declaration period, many state and federal rules and regulations regarding telehealth, including a waiver for audio-only visits, have been relaxed temporarily.

Click here to read the full article.

COVID-19 Deadlines for Doctors

Originally published on Texas Medical Association’s website.

The following deadlines and extensions are in effect during the COVID-19 pandemic.

Aetna is moving its provider portal to Availity (from NaviNet) effective May 31. After that date, you’ll lose access to Aetna on NaviNet, including electronic transactions. Aetna also: 

  1. Has extended coverage for commercial telemedicine service, including audio-only visits, through Aug. 4; and  
  2. Will no longer waive cost sharing for any in-network telemedicine visits for commercial plans starting June 4

Blue Cross Blue Shield of Texas has extended access to telemedicine/telehealth services with no cost sharing for all medically necessary, covered services and treatments through June 30. That access was set to expire May 31. 

Cigna will extend certain cost-share waivers, including customer cost-sharing for telemedicine screenings for COVID-19, and other benefits through at least July 31.

Several Medicaid and Children’s Health Insurance Program(CHIP) flexibilities, including paying for Texas Health Steps (THSteps) medical checkups via telemedicine and CHIP copay waivers, will be extended through June 30. Payments had been set to expire May 31.

Medicare’s 2020 Quality Payment Program (QPP) registration window is open for the Merit-Based Incentive Payment System (MIPS) web interface reporting method and Consumer Assessment of Healthcare Providers and Systems survey through June 30.  

Medicare’s 2019 QPP final performance feedback, which includes your overall MIPS score (0-100 point scale) and 2021 Medicare payment adjustment (bonus or cut) worth up to 7%, is expected July 1 via the  QPP portal. Physicians who did not submit any 2019 MIPS data or who filed an application for an exception due to COVID-19 should not receive a 2021 payment cut. 

Find each payer’s effective and expiration dates of waivers on this chart on the Texas Medical Association’s COVID-19 Resource Center.

Sue Bailey, MD, Takes Office as AMA President; “Let Doctors Be Doctors”

By Steve Levine

Originally published on the Texas Medical Association website.

Watch her inaugural address above

Susan Rudd Bailey, MD, is American physicians’ new leader in the battles against COVID-19 and outside interference in patient care. The Fort Worth allergist took the oath of office as president of the American Medical Association on Sunday, becoming the sixth Texas physician to lead the organization.

“After more than 30 years in a small, private practice, I’m a passionate defender of the independent physician and, like the AMA, I’m determined to remove all those obstacles that have come between us and our patients,” Dr. Bailey said in her online installation address, delivered from a Fort Worth video studio.

Dr. Bailey’s organized medicine resume includes stints as presidents of the Texas Medical Association and Tarrant County Medical Society as well as speaker of the TMA and AMA House of Delegates.

“It’s been a joy to watch her negotiate this path,” said Robert Rogers, MD, who has been Dr. Bailey’s partner in Fort Worth Allergy & Asthma Associates for more than 30 years. “I was 100% convinced that she would be president of the AMA. Watching her do this, I know that she had that as a goal. There was nothing in her that said there’s going to be a limit, a ceiling that she couldn’t break through.”

Dr. Bailey said she didn’t have her “eye on that prize” early in her career.

“At that point in time, there had never been a female president,” she said. But Richmond family physician Nancy Dickey, MD, winning the office in 1997 “made all the difference for me. That made it all real for me.”

Texas physician leaders say they are proud of their colleague’s accomplishment and very comfortable with her being the face of American medicine in these difficult times.

Click here to read the rest of the article.

Which Plans Pay for Telemedicine Services – and for How Long?

Originally published on the Texas Medical Association website.

As you’re no doubt aware, telemedicine has made it possible for many physicians to continue seeing patients while reducing the risk of spread during the COVID-19 pandemic. 

Temporary changes to state and federal rules, particularly regarding payment for services, have helped push up the new demand for and use of telemedicine. 

Prior to the pandemic, health plans did not have to pay physicians the same rate for telemedicine visits as for in-person visits. 

But what does each type of plan pay for visits? 

The Texas Medical Association has compiled information for various types of plans. Remember that some plans’ policies are different for audio-only visits

Commercial

  1. State-regulated plans. The Texas Department of Insurance’s (TDI) emergency rules requiring state-regulated health insurers and HMOs to pay an in-network health professional at least the same rate for a telemedicine or telehealth service as they would for the same service or procedure in-person took effect March 17. Those rules remain in effect for up to 120 days (mid-July). They can be extended for an additional 60 days if needed. (For more details, see TDIs FAQs.)
  2. ERISA (self-funded) employer-sponsored plans. There is no requirement for these federally regulated plans to pay the in-person rate for telemedicine care. However, many ERISA employee health plans are administered by Texas insurers – as a Third-Party Administrator (TPA). Many of the plans’ administrators have encouraged these plans to pay for telemedicine services at the same level as TDI-regulated plans, and many have. 

Medicare:

  1. The Centers for Medicare & Medicaid Services (CMS) has opened up a number of telemedicine payment policies for Medicare telemedicine services. The telehealth waiver remains effective until the Health and Human Services Department secretary declares the public health emergency has ended.
  2. In addition to audio and video services, CMS also allows for telephone-only encounters to be billed and paid at the in-person rate, retroactive to March 1. Refer to the Telemedicine Payer Policies matrix on the  TMA Telemedicine Resource Center for payer policy updates. 

Medicaid:

  1. Texas Medicaid recently authorized telemedicine payment for well-child checks for children older than 24 months. The state also approved other telemedicine flexibilities, such as payment for audio-only telemedicine and telehealth visits. These waivers all expire May 31, but TMA anticipates the Texas Health and Human Services Commission (HHSC) will extend them at least for one more month. TMA and state societies representing primary care and obstetrical physicians          have asked for a six-month extension, through November. 

You can find more information on the Telemedicine section of TMA’s COVID-19 Resource Center, which is updated with the latest news, resources, and government guidance regularly.

Questions About Treating Obstetric Patients During COVID-19? Ask the Experts

Managing pregnant and postpartum patients during the COVID-19 pandemic has changed the way obstetrician-gynecologists provide screenings and treatment, in both hospitals and clinical practices.

Pick up your phone at 7 pm (CT) Monday, May 18, for the Texas Medical Association’s next Tele-Town Hall meeting on COVID-19, specifically for Texas OB/Gyns. Hear from Texas physicians who will share COVID-19-related epidemiological trends, clinical best practices, and tips for improving your practice’s financial viability, including how to effectively use telemedicine and patient outreach.

Our tentative list of speakers includes:

  1. Catherine Eppes, MD, Baylor College of Medicine
  2. Valerie Smith, MD, member of TMA’s COVID-19 Task Force
  3. John Thoppil, MD, president of the Texas Association of Obstetricians and Gynecologists
  4. Joseph Valenti, MD, chair of TMA’s Practice Viability Workgroup 

There’s no need to RSVP or register for this event. TMA will call the home telephone number on file in your membership records. If you prefer we call a different number – or don’t call at all – please email that information to the TMA Knowledge Center by 5 pm (CT), Thursday, May 14.

TMA designates this townhall for a maximum of 1 AMA PRA Category 1 Credit™.  

During this interactive, hour-long event, you can ask questions of our panel. TMA President Diana Fite, MD, will host, and Eugene Toy, MD, chair of the American College of Obstetricians and Gynecologists District XI (Texas) will moderate the call.

Get the latest information about the coronavirus on the TMA COVID-19 Resource Center.

Share This Poster with Patients Before They Arrive at Your Practice

Created by the Texas Medical Association. Read their article about it here.

By now, you have most likely made several practice changes to keep you, your staff, and your patients safe during the COVID-19 pandemic, including requiring face masks, keeping sick and well patients separated, and using telemedicine wherever possible.

But patients coming to your practice – for COVID-19 care or other health issues – might not be aware of all you’ve done.

The Texas Medical Association is here to help.

TMA has created a digital poster you can share with patients before they arrive that outlines your COVID-19 safety precautions. The poster includes steps for patients, such as calling ahead to learn your practice’s facemask policy, completing intake forms before arriving, and asking family members to stay home. You can send it to patients before their appointments, post it on your website, and share it on your social media accounts.

The “COVID-19 Safety at the Doctor’s Office Checklist” also outlines some of the steps you might’ve taken, including checking patients’ temperature in their vehicle, and social distancing in the waiting room. Also, TMA soon will publish a version for you to download, print, and post in your office.

If you’re looking for more tips and resources to increase patient visits safely, TMA’s practice viability experts have organized the information you in need in one document: Road to Practice Recovery: A Guide for Reopening Your Practice Post-COVID-19.

In addition, TMA’s COVID-19 Resource page includes posters and tools to inform your patients and staff about staying safe, including a COVID-19 social media toolkit, and a minimum standards of safe practice notification required by the Texas Medical Board.

The resource page is updated frequently with new information and resources so check back often.

Check out TMA’s Guide to Reopening Your Practice Post COVID-19

The COVID-19 pandemic led to a public health emergency the damaged medical practice viability. Physicians are in the difficult position of having to navigate operational, financial, and clinical challenges while still staying up-to-date with compliance, payment, and coverage issues. These changes have had a significantly negative impact. According to TMA’s COVID-19 telephone town hall meeting in mid-April, 36 percent of poll respondents indicated that they have lost between half and three quarters of their revenue since the start of the pandemic. Another 24 percent have lost three-quarters to all of their
revenue.


As the COVID-19 curve flattens and trends downward, you can take decisive actions to restore your practice operations. TMA’s practice viability experts have organized the information you may need to successfully reopen
your practice in one resource: Road to Practice Recovery: A Guide for Reopening Your Practice Post-COVID-19. From evaluating staffing levels and managing patient appointments, to ensuring patient safety and communicating regularly with patients and staff, this guide will provide the information practices need to more confidently head in the right direction.

Refer to TMA’s COVID-19 Practice Viability web page for additional tools, resources, and frequently asked questions regarding operational challenges that affect your practice’s viability.

Payers Extend Prior Authorization Windows During COVID-19

By Ellen Terry

Originally published on Texas Medical Association’s website.

Commercial payers have temporarily modified prior authorization timelines to help physicians care for patients during the COVID-19 emergency.

Below is an overview of some payers’ COVID-19 prior authorization policies:

Blue Cross and Blue Shield of Texas is temporarily extending approvals on services with existing prior authorizations until Dec. 31. This applies to services originally approved or scheduled between Jan. 1 and June 30. It applies to most nonemergent elective surgeries, procedures, therapies, and home visits for all group, fully insured, retail, self-funded, and Medicare Advantage members.. 

Aetna is approving prior authorization requests for commercial members for nine months instead of the standard six months. Physicians who already have received an approval for six months and plan to go over that time need to call Aetna to extend it for an additional three months. Aetna also will review precertification requests for elective procedures because the approvals are effective for a predetermined length of time.

CignaFor prior authorization requests received March 25 until at least May 31, Cigna is temporarily increasing the authorization window for all elective outpatient services from three months to six months. This applies to all prior authorization requests received for all Cigna lines of business. Elective outpatient prior authorization decisions made between Jan. 1 and March 24 will be assessed when the claim is received and will be payable as long as it is within six months of the original authorization. 

Humana is extending previously approved authorizations to a 90-day approval timeframe, except for home health authorizations, which are being extended for 60 days.

UnitedHealthcare has instituted a 90-day extension of open and approved prior authorizations, including those for many physician-administered drugs, with an original end date or date of service between March 24 and May 31 for services at any setting. This applies to all individual and group health plans, and Medicaid and Medicare Advantage plans, and to in-network and out-of-network existing prior authorizations. Approvals issued on or after April 10 will not be subject to extension. If a prior authorization approves the number of visits or services, the physician must obtain a new prior authorization for additional units, visits, or services beyond what was approved in the original authorization.