COVID-19 Testing, New Patient or Established
How do we determine if a medical patient is new or established? The decision is ultimately made based on the professional service they were given during their visit. Read more to learn how to recognize the differences between a new patient and an established patient when COVID-19 testing.nnIn the June 29, 2020 edition of Part B News, A really great question was submitted. To summarize, there is a clinic that has been doing COVID-19 testing. A person comes in, fills out a few forms, and then receives the test. When results are ready the patient will come back to the clinic and especially if the patient’s results are positive will see a doctor. Would this patient be considered a new or established patient for the visit with the doctor?nnThis is a great question that is really important with more and more tests being conducted in all 50 states. In order to answer this question, we need to evaluate the testing. Was this patient seen by a doctor who evaluated them for the need for a test? If this is that case then this patient received professional service with a physician or other qualified health care professional (QHP) and is now an established patient.nnOr is the testing completed by a laboratory tech, nurse, or medical assistant (MA), and the patient never sees a physician of QHP? If so and there was no “professional service” then when the patient comes back for their results and is seen by a doctor then this would be considered their first professional service and therefore would be a new patient. It all comes down to a matter of the “professional service” and if the patient has had a face-to-face encounter with a physician of QHP in the past.
As many of us in the healthcare industry have stayed particularly busy throughout the past few months, it’s important to remember the need for time-off. Even though current situations have many of us canceling or changing vacation plans, one aspect of time-off is always the stress involved with being away. Read below for more on the importance of taking time off from work.nnRecent polls show that over half of Americans do not take vacation time. Elizabeth Grace Saunders, a time management coach, wrote a great article in 2018 for Harvard Business news sitting four steps to help manage or relieve the stress that is associated with extended time-off. One of the most important being to “sign off”.nnWe constantly have work around us because of our cell phones. This can be one of the most challenging aspects for so many of us to not pick up the phone every time we hear a notification. Saunders also emphasizes the need to prioritize the items that can be put on hold while you are away.nnSo send your supervisor that time-off request that you have been holding onto and go enjoy some time away from work!nn
nnThe COVID-19 pandemic has posed many challenges around the globe, but one major setback this virus has created is the lack of finances within physician practices. In order to combat this issue and keep healthcare resources at it’s finest, below are some strategies that can be used to save your funds.nnThe COVID-19 crisis has been a financial fiasco for physician practices, including decreased patient volume and canceled elective surgeries.nnThere are strategies physician practices can pursue to weather the financial storm associated with the coronavirus pandemic.nnNinety-seven percent of physician practices experienced a negative financial impact from the coronavirus disease 2019 (COVID-19)nnpandemic, according to a Medical Group Management Association survey published in April. The financial hits have included decreased patient volume and loss of income associated with the canceling of elective surgery.1qnnThe COVID-19 pandemic poses an existential threat to the primary care sector, says Ann Greiner, president and CEO of the Primary Care Collaborative in Washington, D.C. “If we do not respond to the financial challenges that primary care is facing, we are going to see an already damaged foundation of our healthcare system crumble.”nnPhysician practices can pursue four primary strategies to keep their business finances afloat, says Al Crawford, chairman, CEO, and co-founder of Davie, Florida–based Bankers Healthcare Group.nn1. HOLD ON TO CASHn”Do not spend if you do not have to spend. You should just hoard cash. The more access you have to cash, the better,” Crawford says.nnDuring the COVID-19 pandemic, physician practices should limit new spending to practice enhancements related to the pandemic such as air purification systems, he says. “There are expenses required during the COVID-19 pandemic, but I recommend that you do not go beyond those required expenses in an environment like this. We are inthe middle of a pandemic, and what you do not need you should not buy.”nn2. DON’T PAY OFF DEBT, YETn”I would not be looking to pay down debt right now because of the No. 1 principle—cash is king,” Crawford says.nnMedical professionals should be careful about taking cash and paying down debt, he says. “For the next 90 to 180 days, I would try to stay cash-rich. If we’rennall back to work, there is a vaccine in the fall, your practice business is good, and you have saved a lot of money by being ultraconservative, then I would look at paying my debt down.”nnAlthough the Federal Reserve System has been taking actions to promote lending, physician practices cannot count on finding a lender if they experience a cash crunch, Crawford says. “You do not want to pay debt off, then something does not go right, and you go back to the banks and the banks are not lending. Then you do not have access to capital and that can kill your business.”nn3. USE GOVERNMENT ASSISTANCEnCrawford is bullish on the U.S. Small Business Administration’s Paycheck Protection Program (PPP).nn”You have an interest-free period for 24 weeks, which is fantastic. It is probably one of the best gifts that the U.S. government has ever given. If you follow the rules, such as spending 60% of your funds on payroll, and you get the loan forgiven at the end of 24 weeks, it is a home run,” he says.nnEven if a physician practice cannot get a PPP loan forgiven, the debt terms are a bargain, Crawford says. “If you can’t get the loan forgiven or you can’t pay your rent, it is an inexpensive loan. It is a 1% interest rate loan. So, it may make sense to do the 30-month payback and carry the loan if you can’t financially afford to bring your staff back.”nnFor physician practices that have gotten PPP assistance, the funds should be kept in a dedicated account to pay for program-approved expenses such as payroll and rent, he says. “When a practice pays for insurance or pays for payroll, they should reimburse out of the separate PPP account for the exact, specific payments. If they are making specific payments for rent, insurance, or payroll, they will have the proof for the bank and for SBA that the PPP funds were used for the purposes outlined.”nnPPP has been a lifeline for the Brownsville, Texas–based general surgery practice of Carlos Barba, MD. The cancellation of elective surgery in Texas hit the practice hard, Barba says.nnThe general surgery practice has a 10-member staff, including another surgeon and a physician assistant. “Fortunately, the federal government created the small business assistance program. We applied to that program, and I was able to get a loan. I did not have to reduce hours or cut my staff,” he says.nn4. APPLY FOR PRIVATE LOANS
Lending from banks and brokers also can stabilize a physician practice’s finances, Crawford says.nnBankers Healthcare Group has established an “assistance loan” that ranges as high as $500,000. Borrowers do not have to make a payment on the loan for the first 89 days.nnThe terms of the assistance loan can be crafted to limit the size of monthly payments, Crawford says.nn”We are giving the medical professional a term that goes out as long as 10 years. For the borrower, the additional years lower the monthly payment. In my opinion, right now everything is about the monthly payment. If you can lower the monthly payment, increase your savings, and decrease your spend, you have a much better shot of getting the business back to running well,” he says.nnPRIMARY CARE PAYMENT REFORMnReimbursement for primary care services must be reformed, Greiner says.nn”This pandemic has laid bare that fee-for-service has been an epic failure. It is a system that is based on face-to-face visits, which obviously does not work in a pandemic when you are trying to keep both patients and clinicians safe. So, the pandemic has prompted a lot of conversation both at the national level and the state level about moving to a prospective payment system,” she says.nnDuring the pandemic, the Centers for Medicare & Medicaid Services (CMS), as well as private health plans, have moved in the right direction on advance payments, Grnneiner says. “What both CMS and private health plans have done by putting advance payments in place is help primary care practices keep their doors open. That could be a step on a path toward prospective payments, but this is a conversation that has been going on for a long time.”nnIn addition to establishing a prospective payment system for primary care, government and private payers need to provide significant and appropriate reimbursement for innovative care delivery models such as telemedicine, she says. “We have to get to a payment system that is agnostic about the way care is delivered.”nnOriginal 
This week’s coding conundrum is regarding the Modifier -25. Not all insurers will pay you for separate E/M services even if you code in compliance with CPT rules, but this code can help you get reimbursed for the extra work you do at certain visits. Read below to find out more and 
Recently, CMS has released a new set of guidelines and considerations to encourage healthcare practices and organizations to resume in-person care. Below are 8 things to know in regards to reopening healthcare facilities. Read the article below to find out more!nnCMS is encouraging healthcare organizations to reopen facilities for non-emergency care and released a new set of guidelines and considerations for them to follow.nnMany health systems suspended elective procedures in mid-March to keep patients and providers safe and ensure the capacity to care for COVID-19 patients. Efforts to restart those procedures safely are underway.nn”While telehealth has proven to be a lifeline, nothing can absolutely replace the gold standard: in-person care,” CMS Administrator Seema Verma said. “Americans need their healthcare, and our healthcare heroes are working overtime to deliver it safely. Those needing operations, vaccinations, procedures, preventive care or evaluation for chronic conditions should feel confident seeking in-person care when recommended by their provider.”nnEight things to know:n