Despite our essential business status, physical distancing strategies decrease demand for chiropractors’ hands-on treatment as people try to stay home more. However, we are able to apply our broad knowledge and skill sets to continue serving the people of NH, even when they aren’t able to reach our offices. Telehealth provides an opportunity to reach people in their homes.
Patient and provider connect by video in a telehealth appointment
There are a broad array of services available for telehealth consults. To hit the ground running, choose one that is affordable and simple to use for you and patients. Free options include Doxy.me, and other options ranging from Google Meet at $12/mo or VSee at $50/mo, to ExamMed and Zoom for Healthcare at $200/mo. The cloud-based EHR Jane, which is popular among chiropractors, integrated a telehealth feature in March in response to increased demand, and we will see this market continue to grow.
Each of the options listed above is HIPAA compliant. However, the US Department of Health and Human Services announced that during the emergency period they have relaxed HIPAA restrictions around remote consults. They are prioritizing getting care to patients, so they’ll honor our good-faith attempts to provide quality care, even if that means using more informal services like FaceTime, Skype, Messenger or Hangouts. In NH, emergency order #8 also interpreted the use of audio-only phone consults as valid telehealth service.
You should also know about billing and regulations. Medicare only covers manipulation codes, so we are excluded from telehealth reimbursement. NH Medicaid plans mostly exclude service from chiropractors, but plans that allow chiropractic are currently expected reimburse for telehealth under emergency order #8. Private insurance plans are expected to reimburse for telehealth consults and guided rehab at the same rate as in-office care, though this may vary. According to ChiroCode, E/M codes will be used most frequently, with level based on time and coded with a -95 modifier. You should brush up on this documentation and coding at the ChiroCode website. Additionally, VP Pence has also encouraged states to create temporary avenues for interstate telehealth, a situation we will continue to monitor.
As front line health care providers, we selflessly serve humanity. And from time to time we as doctors find ourselves amid a public health crisis. Today is such a time.
The outbreak of COVID-19 in the United States is affecting both the way you practice and the business side of practicing. The available information changes by the day and much of it influences our practices. And the available misinformation seems to change even faster. We at the NHCA will try to give you resources to benefit your practice and, of course, your patients.
SPREAD IN NEW HAMPSHIRE
The NH Dept of HHS’ most recent count is 55 confirmed cases in the state as of 3/20/20 at 9 am. Most of these cases are in Rockingham, Hillsborough and Grafton counties. The promised, more widespread, availability of testing may well make this number go up dramatically in the coming week. DHHS website for tracking coronavirus is: www.nh.gov/covid19/
ADVICE TO HEALTHCARE FACILITIES
Kentucky has ordered all DC offices to close, no other state has followed suit and many have declared all doctors’ offices to be essential. Advice from CDC to healthcare facilities can be broken down into two categories:
Screening patients pre-visit:
As of March 16, 2020 CDC recommends asking patients:
Have you traveled outside the state or country in the last 14 days?
Have you had contact with anyone with confirmed COVID-19 in the last 14 days?
Have you had: Fever over 100, Difficulty breathing or a Cough?
If the answer is no to all, then they may be scheduled for an appointment. However, if the answer is yes to the health questions, refer them for testing. If yes to contact or travel questions, then wait 14 days.
Sanitary procedures for healthcare facilities:
Clean tables, armrests and headrests esp. between each patient
Clean chair rails, doorknobs, toilet and sink handles and any other surface patients may touch regularly
Regularly clean those things staff touch regularly, such as keyboards, adding machines, copiers, etc.
Separate and/or remove chairs from reception area to maintain a 6-foot distance between patients (basic test: if two people sit in chairs and reach toward each other, they can’t touch if the chairs are 6 ft apart)
Wearing gloves is optional at this time and masks are generally ineffective unless you are a carrier.
Hand washing for at least 20 seconds is very effective, water temp. is unimportant, the use of soap is what gets rid of the virus.
Avoid face touching.
HIPAA REMINDER – COVID-19 FROM NCMIC
Original article here from NCMIC HIPAA has a special guidance section for what information and to whom that information can be released during an emergency situation. You can review these guidelines as release by US DHHS.
The 18 Protected Health Information (PHI) identifiers include: names, dates (except year), telephone numbers, geographic data, fax numbers, social security numbers, email addresses, medical record numbers, account numbers, health plan beneficiary numbers, certificate/license numbers, vehicle identifiers and serial numbers including license plates, web URLs, device identifiers and serial numbers, internet protocol addresses, full face photos and comparable images, biometric identifiers (i.e. retinal scan, fingerprints), any unique identifying number or code.
For up to the minute information from CDC this is a good reference which is more chiro specific:
There is a great amount of fear and trepidation about the current situation so allow patients to cancel their appointments without judgment. Also, some insurers may reimburse for telehealth visits and all may be ordered to soon. A good article on these including coding information are available online.
Finally, if you find you need to lay off staff, they can take advantage of the unemployment guidelines and receive help earlier than usual through NH Employment Security.
Please know those of us at NHCA are here to help. If you have any questions or concerns, please don’t hesitate to contact us directly or via our social media channels. We wish you all the best of luck and hope you stay safe during these trying times.