Message from APTA NH President regarding COVID 19

3.31.2020

Dear Members—
 
Last night Medicare made the decision to cover physical therapy services as part of telehealth coverage. That is great news but comes with a technical issue…we are not formally listed as providers by Medicare to offer telehealth services. I have attached the coverage memo sent out by CMS as well as the current understanding of how it is interpreted by APTA outlined below. There is a link highlighted in yellow for therapists to help advocate to CMS to get this issue rectified quickly so that we can access the therapy codes we need to appropriately treat our patients.
 
Please join me in sending a message to CMS regarding this important issue…Thank you. 
 
Although CMS announced on March 30, 2020, that it would add PT, OT, and SLP services to the list of services covered under the Medicare Physician Fee Schedule when furnished as telehealth, CMS did not expand the types of providers eligible to furnish telehealth. CMS noted in the interim final rule (page 35) that current Medicare law does not allow telehealth services to be furnished by PTs, OTs, and SLPs under 1834(m).
Thus, telehealth services furnished by PTs are still not covered under Medicare as of today.
That said, while this law doesn’t allow therapists to furnish telehealth under Medicare, this rule was written prior to the passage of CARES Act, which amended the 1135 waiver authority, and would allow CMS to waive additional telehealth restrictions if they so choose (doesn't require them to do so).
 
APTA is urging CMS to use its 1135 authority, amended by CARES, to expand providers eligible to furnish telehealth under Medicare, as is AOTA and ASHA. 
 
We also are encouraging individuals to use the CMS template letter to send an email to CMS, urging them to use their 1135 waiver authority, which can be found on this page: https://www.apta.org/telehealth/ 
 
 
Mark Mailloux, PT, MBA
Board Certified Orthopaedic Clinical Specialist
President, APTA NH

 
We wanted to make you aware of the volunteer opportunities / databases as a health care provider during the COVID 19 crisis. Please consider adding your name to one of these.
 
For the State of NH: www.nhresponds.org
 
APTA is working with other organizations and members to connect volunteers with facilities that need physical therapy services.
Here is the site with more information: http://communities.apta.org/p/fo/st/thread=15337&source=6

3/29/20

Dear Members,
 
As always, I hope this email finds you healthy and fairing as well as you can in this ever-changing healthcare landscape. Many of us are settling into a new reality whether it be offering our services via telehealth, looking for ways to keep busy and positive during a time of social distancing, adjusting and planning for a time period of fewer work hours available, attempting to manage our waning caseloads of in-person priority patients, switching up traditional therapy roles to help our hospitals manage the exponentially increasing stressors of the COVID crisis, analyzing the best path forward so our private practices can survive, and in general just trying to find some sense of normalcy in uncertain times.  We are a resilient bunch though and can look forward to the day when our sense of true normalcy returns.   
 
With all of this disruption, as is expected, more questions arise than are readily available and verifiable answers, particularly related to coverage for telehealth. My hope is that many of you have already taken advantage of resources available to discover the basic tenets of telehealth and e-visits, and now we are moving into phase of the mechanics of how we can actually be reimbursed for this important service to our patients. 
 
At APTA NH we are still working on a plan to provide accurate information pertaining to commercial insurer payments. As of this writing:
 
·      Medicare and Aetna are still covering e-visits only
·      United Healthcare has changed their stance from covering only e-visits and they are now covering telehealth
·      Anthem has been the least responsive insurer to date as to guidance (and are not included in list below because of that)…In addition, at this moment they are still planning to continue with the Medicare Advantage rollout on April 1, 2020 which we believe is a mistake and are advocating to block
 
Click here for the beginning of what insurers in NH are identifying as requirements for telehealth coverage. Please understand this is a moving target and could change, but at least it offers the current understanding of how/what can be billed for telehealth services. We will continue to modify and update as information becomes clearer. 
 
Here is a resource with more specifics regarding Medicare billing and e-visits (as well as telehealth in general…don’t forget to tell Congress to support expansion of coverage to telehealth):
 
 
It is also important to be aware of the relaxation of requirements/reporting deadlines around the Medicare Quality Reporting Program. Specifics are contained in this document:
 
 
And related to reimbursement and telehealth, here is the national Matrix Tracker offered by APTA as of this moment. It has some useful information but is still a work in progress:
 
APTA Telehealth Payment Chart Tracker:
 
And finally, here is another educational opportunity to learn about telehealth and maybe even more importantly to ask questions as it is offered through Facebook Live. It is tomorrow, Monday, March 30th at 3 PM
 
Facebook Live Event: Implementing Telehealth into Practice Q & A Opportunity:
 
I also want to share what amazing work the Sections and Academies are doing at APTA. Many have created COVID-19 resource pages that are open to anyone, not just members of that section or academy. Another example of how APTA has pulled together, risen to the occasion and has understood the need to get this vital information out to members. I am attaching links to the various section/academy websites that have useful information related to your practice area. Please visit these pages for more specifics: 
 
Academy of Acute Care Physical Therapy Resources:
 
COVID-19 Practice Guidelines for Acute Care Therapists:
 
Academy of Pediatric Physical Therapy Resources:
 
Academy of Physical Therapy Education Resources:
 
Health Policy and Administration Section Resources:
 
Home Health Section Resources:
 
Private Practice Section Resources:
 
Finally, here are the latest updates from APTA regarding COVID-19 as well as the link to a pretty comprehensive listing of COVID-19 information:
 
APTA Coronavirus Update (03/37/20)
Comprehensive Resource for Coronavirus
 
 
My thoughts and hopes are with each of you that you are able to keep positive and work successfully through this stressful time. Here at APTA NH we are here to support and offer the best info we can in an attempt to make all of this just a little bit easier. Please do not hesitate to reach out with questions or just to talk…we are here for you. #BetterTogether 
 
Best to all...Mark 
Mark Mailloux, PT, MBA
Board Certified Orthopaedic Clinical Specialist
President, APTA NH
(603) 548-3554

3/24/20

Hello Members… 
I hope this post finds you healthy and weathering this ever changing landscape well. As many of us shift our practice patterns and consider if the use of e-visits and/or telehealth services is right for our circumstances, I wanted to provide an update as to what current information is available. 
As we know per the NH governor’s executive order last week coupled with guidance from the OPLC, we are included as providers for telehealth services during this emergency period related to COVID-19. Reimbursement rates are supposed to be the same as in-person rates (remember telehealth is different from e-visits/e-visits have a different reimbursement structure and just three defined codes that can be used with the delivery of care). The therapy codes utilized are supposed to have an identifier and/or modifier that is added to denote that it is therapy delivered via telehealth and insurers are supposed to honor that charge…BUT, the insurers have the latitude currently regarding which modifiers they require, which codes we are limited to, and how the services are billed.  
Currently, Aetna is not covering telehealth and as we know Medicare is not as well, they are both covering e-visits. Generally, on some claim forms there will need to be an identifier of 02 in the Place of Service (POS) section to denote that the service is being delivered via telehealth. If an insurer’s policy states that modifier 95 is required to be reported with the code, our typical therapy codes will not work at this time.  These are just a few of the confusing qualifiers out there currently.  Specific to this situation though, I was informed today by APTA that there should be a national payer matrix out shortly that may help with this confusing state surrounding insurer coverage. Below is the link to the main telehealth page at APTA that explores many of the questions that therapists have, with the understanding that there are still questions that remain.
 
 
APTA continues to advocate for telehealth inclusion by therapists and coverage for therapy services from all insurers, including Medicare. Again, if you have not already, I encourage you to send a message to Congress and CMS regarding the need for telehealth services. As this continues to look more like a marathon, it may make sense to consider incorporating telehealth into your practice areas if you are able to do so. Having all the tools we can at our disposal offers us the best chance to offer skilled care to the patients we serve. If you follow this link and click on the Legislative Center on the APTA website you will be brought to a page with four actionable items listed, all worthy of our support, and two specifically targeting the COVID-19 crisis…telehealth and therapy relief for patients and providers.
 
 
Also, please remember that there is a webinar specific to Telehealth implementation on Thursday afternoon offered free to members through APTA. Please consider joining in to learn more.
 
 
I’m attaching the today’s update from APTA that in part speaks to the steadily decreasing amount of PPE available to healthcare providers as utilization spikes to treat patients. APTA is joining the call for Congress to explore and exhaust all possibilities to increase production and supply as well as advocating for more consistent guidelines surrounding use. This is a problem all around our state, and many states, that hospitals and providers are grappling with to maintain the safety of our healthcare workforce.  
 
One more thing to consider today…how we can have a vital role in pulmonary health particularly during this time of COVID-19.  Sean Collins, the DPT Program Director at PSU is holding zoom meetings regarding pulmonary patient exams for physical therapists. I’m sure this will be valuable information for anyone currently practicing in this area or considering incorporating this into your practice. The next zoom is tomorrow Wednesday, March 25th at 12:00. Here is the link to both resources and zoom information: Thank you to Sean for offering this information and for setting up this learning opportunity.
 
 
I realize that many of us feel inundated with the constant flow of information that is coming at us coupled with messaging from multiple sources that makes it hard to know what is accurate and what is not.  Please know that APTA NH is striving to offer you the best up to date information that is available even though it does change quickly. Keep doing what you can to keep you, your families and your patients safe…we will get through this! #BetterTogether
 
Best to all…Mark
 
Mark Mailloux, PT, MBA
Board Certified Orthopaedic Clinical Specialist
President, APTA NH

3/21/20

Dear NH PT Community,
 
I hope this post finds both you and your families well. As we continue to face the unprecedented challenges and uncertainties posed by COVID-19, I wanted to update you on what responses have occurred at the state level this week as well as the ongoing resources that are available through APTA.
 
Before we get to the updates though, I want to take a moment to acknowledge and reflect on the dizzying pace of changes that have occurred, enormous disruption to our daily lives, and general sense of uneasiness that COVID-19 has brought to bear. I've heard from several clinics around the state who have had to make difficult choices regarding their daily operations and staffing as we all try to navigate how we can best protect our patients and ourselves in uncertain circumstances. I want to share with you that from the stories I have heard how proud I am to be part of a profession that has responded in so many amazing and thoughtful ways. As we know it is in times of challenge and strife that our characters are most revealed, and from what I have heard and seen, PTs/PTAs has risen to the challenge despite the painful decisions that needed to be made. Our commitment to patient-centered care is more evident than ever. We have been an exemplar of how to respond in a crisis and I wanted to offer a moment of thanks and for all of us to reflect and highlight how proud you all should be of your collective response.
 
Now onto the updates…On March 18th Governor Sununu released an Executive Order that along with Guidance from the State of NH Office of Professional Licensure and Certification (OPLC) that appears to provide guidance for utilization of telehealth by physical therapists in NH. Both documents are attached here for you to review.
 
 
While the executive order from the governor does not explicitly detail physical therapists, the additional OPLC guidance states that “effective immediately, the Governor has ordered ‘all medical providers[…] be allowed to perform health care services through the use of all modes of telehealth, including video and audio, audio-only, or other electronic media, to treat the residents of the state of NH for all medically necessary services.’” The guidance goes on to assert that “The State’s temporary expansion of telehealth services applies to all medical providers including but not limited to those professions licensed, certified, or registered by the Office of Allied Health Professionals, ….”
 
We have heard from a representative of the NH PT Governing Board that services offered via telehealth are within our scope of practice.
 
We should all have reason to believe from the reading of these documents that physical therapists utilization of telehealth is not only allowed now but should have reimbursement attached to the service. I know some around the state have already either started to use or are investigating the use of telehealth in their practices. With that being said, there are still questions to be answered regarding implementation and levels of coverage by insurers and we are researching to get more clarity on those questions. Please consider participating in an upcoming webinar offered by APTA that will review strategies on how to effectively implement telehealth in our practice settings. It will be offered on Thursday, March 26th at 2:00 – 3:30.
 
  
It is important to note the distinction of “e-visits” that have been approved by Medicare and this temporary expansion of telehealth services as they are not the same thing. I have attached the latest information that delineates between the two and offers guidance on how to pursue utilization of e-visits.
 
 
In relation to e-visits and Medicare, if you have not yet done so, please make sure that your voice is heard by CMS and Congress regarding inclusion of physical therapists as providers of telehealth services to Medicare beneficiaries.
 
 
I am also attaching links to the latest information on Coronavirus offered by APTA that may be helpful for you and your practice:
 
 
 
In closing, I want you to know that here at APTA NH, we will continue to work on your behalf and update you as this situation continues to evolve. Please reach out to us if you have specific questions and we will do our best to either answer or provide direction on where to find the answer. Please feel free to share any of these resources with non-members as well. We are in this all together and how great is it that we have each other to rely on for support during these most challenging of times…#BetterTogether (in a way that honors social distancing recommendations of course)
 
Best of health and safety to all…
 
Mark Mailloux, PT, MBA
Board Certified Orthopaedic Clinical Specialist
President, APTA NH
 

 

3/18/20

Dear Members,

As we all try to navigate this uncertain time, I want to share the most up-to-date information that APTA has to offer regarding COVID-19.  It is an excellent resource for information surrounding COVID-19 and outlines information that is readily applicable to practice in this rapidly changing environment. Below is a list of links with the most recent updates, most notably in regard to telehealth coverage for “e-visits” by PT approved by CMS.  I am confident that we will continue to find ways that help us to creatively meet the needs of the patients we serve.  We are all in this together and our united voice is helping to create positive change.  #BetterTogether

Stay safe and healthy everyone!

Mark 

Mark Mailloux, PT, MBA

Board Certified Orthopaedic Clinical Specialist

President, APTA NH 

 

COVID Resources:

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

Telehealth and PT:

http://www.apta.org/PTinMotion/News/2020/03/17/E-VisitsCMSCoronavirus/

COIVD Infection Control and Protective Equipment

http://www.apta.org/PTinMotion/News/2020/03/11/CMSCoronavirusGuidance/

Patient Care and Practice Management

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

CAPTE Response regarding Students

http://www.capteonline.org/uploadedFiles/CAPTEorg/Homepage/CAPTEResponsetoCOVID19.pdf#search=%22Covid%22

Coronavirus Update: March 17, 2020

http://www.apta.org/PTinMotion/News/2020/03/17/CoronavirusUpdateMarch17/

Students: Statement from CAPTE

http://www.capteonline.org/uploadedFiles/CAPTEorg/Homepage/CAPTEResponsetoCOVID19.pdf 

 

 

 


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