After the rapid spread of the COVID-19 coronavirus, social distancing guidelines quickly gave way to widespread shutdown orders that caused many businesses to close for an extended period of time. While some practices remained in operation, not every holistic practice was lucky enough to receive “essential” designation and joined businesses like restaurants and retail stores in closing their doors.
As several states begin to relax these guidelines, holistic practices need to start making plans to reopen to patients. Before they can do so, however, there are several factors they must take into consideration.
When Will Holistic Practices Start Reopening After COVID-19?
The question of when to reopen depends on a number of factors. First and foremost, COVID-19 shutdown orders have been implemented at the state level, so there has not been a universal standard applied to all practices across the country. This also applies to the decision to reopen, with some states moving very swiftly (perhaps too swiftly, in the eyes of some health experts) while others are more hesitant.
In some cases, holistic practices did not close at all. Chiropractic providers, for example, were designated as an essential service by the Department of Homeland Security in late March. While this designation took the form of an advisory rather than a federal mandate, it did create the justification for some states to allow these practices to stay open throughout the COVID-19 shutdown.
For massage therapy and acupuncture practices, however, the situation has been more complicated. Without clear guidance from federal authorities, most states have either specifically designated massage and acupuncture as “non-essential” medical services or failed to provide a clear exemption from shutdown guidelines. Since providing massage and acupuncture treatments is not possible without close contact with patients, many of these practices would most likely have experienced a significant drop-off in patient traffic even if they had been deemed essential medical services.
Given this complex environment, each state’s guidelines for relaxing shutdown policies must be considered individually. Some states are already allowing non-essential practices to reopen, but others are keeping strict social distancing guidelines in place for the foreseeable future. Holistic practices should check their state’s current status to make sure they’re using the most up-to-date information for deciding when (and how) to reopen.
What Do You Need to Do Before Your Holistic Practice Reopens?
If your state is allowing holistic practices to reopen, it’s important to realize that most businesses are reopening under very strict conditions that take the ongoing risk of COVID-19 into account. That means several changes will need to be made when it comes to managing and treating patients.
Here are a few things you should do before reopening your holistic practice:
Implement Patient Prescreening
Every patient should be prescreened by phone before they arrive at the office to make sure they are not symptomatic. Do not come into contact with anyone who may be infected with COVID-19. Patients who arrive at the office ill should be sent home immediately to avoid the risk of further infection. Since implementing social distancing measures will likely reduce the number of patients you can see in a day, you should also establish a system for prioritizing patients with the most urgent needs.
Rearrange Waiting Areas
Patients should not be in close proximity to one another while waiting to receive treatment. There should be at least six feet of distance between seating. Depending on the layout of the office area, guidelines may need to be put in place to avoid having too many people in narrow hallways or elevators. Non-essential items in waiting areas and treatment rooms (such as magazines, dishes with mints, or games) should also be removed as they could become transmission vectors.
Stagger Your Bookings
One of the easier ways to avoid having too many people in an office is to stagger appointments. This not only minimizes the number of people sitting in a waiting area, but also creates opportunities to clean and disinfect surfaces that could be contaminated. While this could mean seeing fewer patients during the day, lower patient volume is preferable to your holistic practice becoming a vector for COVID-19 infection.
Use Protective Gear
Even as states begin to reopen businesses, many of them are still advising customers and employees to wear protective equipment to minimize direct contact. Everyone working at your holistic practice should have a mask and gloves, and it would not be unreasonable to ask the same of patients.
Emphasize Handwashing
Handwashing is one of the most important steps you can take to minimize the risk of infection. It’s especially important for holistic practices, where some amount of patient contact is unavoidable. Stock up on soap and think about how to incorporate a rigorous handwashing routine into your practice. Even when wearing protective equipment and washing your hands regularly, avoid touching your eyes, nose, and mouth while treating patients to minimize the risk of transmission.
Get Your Holistic Practice Ready for Success With Holistic Billing!
Preparing your holistic practice to reopen after the COVID-19 shutdown is a major undertaking that will require you to rethink some of your core business practices. One area that could be more complicated than ever is patient billing. With many people losing their jobs and health insurance rules changing rapidly, it can be difficult to keep up with the demands of billing and coding for holistic practices.
By partnering with an experienced billing service like Holistic Billing, you can let someone you trust to manage the ins and outs of billing while you focus on getting your holistic practice ready to reopen. Contact our team today to make sure your business has everything it needs to manage billing the aftermath of the COVID-19 shutdown.
Operating a successful acupuncture practice can be a rewarding and worthwhile endeavor that makes a real difference in the lives of patients. Unfortunately, it can also be quite a challenge thanks to confusion over how to bill for services effectively. The ins and outs of medical coding are complex and even a minor error can cause a claim to be denied by insurance providers.
What Are Billable Units?
Like other therapy-based practices, acupuncture practices bill their services according to Current Procedural Terminology (CPT) codes. Each code is considered a billable unit used to track what treatments have been administered. Some of these codes are service-based, representing a specific billing amount for a specific treatment. It doesn’t matter how much time it takes for this treatment to be administered. For billing and coding purposes, a service-based code has the same unit value (in this case, one unit), regardless of whether it takes twenty minutes or two hours to administer treatment (although each code has an average expected treatment time). Only one unit of service-based codes can be billed at any one time.
Many acupuncture codes, however, are time-based or multiple-unit codes. This means that each code is billed according to 15-minute increments. Most insurance providers follow Medicare guidelines when it comes to measuring this time. Often referred to as the “Medicare 8 Minute Rule” or the “Rule of Eights,” Medicare’s standards for outpatient therapy services require practices to deliver direct, one-on-one therapy for at least eight minutes to receive reimbursement for a time-based CPT code.
Medicare calculates billable units by dividing the total minutes of direct therapy time by 15 and then rounding the remaining value up or down according to the Medicare 8 Minute Rule. For instance, if a time-based acupuncture treatment (such as ICD-10 code 97811 for subsequent acupuncture) takes 20 minutes to administer, the practice would only be able to bill for one unit (the remainder of 5 minutes would not qualify for an additional unit). If the treatment took 23 minutes, however, it would be able to bill for two units (the remainder of 8 minutes does qualify for an additional unit).
Why Is Accurately Calculating Billable Units Essential for Your Acupuncture Practice?
Since most acupuncture treatments involve direct, one-on-one therapy, they are classified as time-based codes. That means that an acupuncture practice needs to be very diligent and precise when it comes to calculating billable units. Failing to accurately document the amount of treatment time could result in rejected claims or far lower reimbursements than the practice should receive.
A typical 60-minute acupuncture treatment, for example, consists of four distinct billing units:
- 1 Unit of Initial Acupuncture (Code 97810): This treatment consists of the initial insertion of needles, which obviously requires one-on-one contact with the patient. The initial insertion is expected to take 15 minutes.
- 3 Units of Subsequent Acupuncture (Code 97811): This code covers any follow-up one-on-one, direct treatment by the acupuncturist after the initial treatment.
Where some practices get into trouble is when they fail to bill for multiple units. In the above scenario, the practice could mistakenly submit this claim:
- Initial Acupuncture 97810
- Acupuncture: 15 min 97811
when it should be submitting this claim:
- Initial Acupuncture 97810
- 1 unit
- Acupuncture: 15 min 97811
- 3 units
Failing to calculate billable units correctly can cause acupuncture practices to miss out on collecting revenue for treatments they’ve provided. In this case, the practice would have missed out on two units of code 97811. Spread over multiple patients, it’s easy to see how these oversights could add up quickly and have a devastating impact on a practice’s revenue cycle management.
3 Best Practices for Calculating Billable Units
1. Know Your Acupuncture Codes
One of the best ways to ensure billable units are being calculated accurately is to become very familiar with the most frequently used acupuncture treatment codes. This goes beyond the most basic codes for initial care to include services like evaluation management codes and more specific modalities. Every practice needs to know which codes can be billed multiple times to ensure that it’s being accurately reimbursed for its services.
2. Track Your Time and Treatments Accurately
Simply knowing which codes to use and which ones can be billed as multiple units is important, but that knowledge won’t be of much use if a practice doesn’t keep detailed and accurate records about patient treatments. Acupuncture practitioners need to document how much time they spend delivering direct, one-on-one care throughout the day.
This is especially important when it comes to auditing purposes, as they need to make sure they’re not overestimating how much time they’ve spent administering treatments. Technically, a provider cannot deliver more than four billable units of care in an hour because each unit is broken into 15-minute increments. If a practice seems to be billing more units than its staff can actually deliver, it could be inviting unwelcome scrutiny by external auditors.
3. Partner With an Acupuncture Billing Service
Delivering quality can be difficult when a practice also has to dedicate time to managing billing insurance providers for reimbursements. Since there are only so many hours in the day, most acupuncture physicians want to treat as many patients as possible in that time, which leaves little opportunity to handle the sometimes tedious paperwork of billing and coding. That’s why partnering with an experienced holistic billing service can be extremely beneficial.
Outsourcing the hassle of billing and coding to a trusted partner allows an acupuncture practice to see more patients and deliver better care without having to worry about whether or not they’re calculating the correct number of billable units.
Holistic Billing Services Can Help
Holistic Billing offers a variety of billing services for acupuncture, massage, and other integrated healthcare practices. In addition to our extensive experience with insurance billing, we understand the unique needs of these practices and what sets them apart from other medical practices.
Our certified team of coders, MBAs, CPAs, and IT professionals can help you get your claims reimbursed quickly and set up a reporting dashboard that makes it easier than ever for you to get a comprehensive view of your business. Contact us today to tell us all about your practice’s unique needs.
Keeping track of treatment codes to ensure accurate medical billing can be a challenge for small holistic practices. Proper billing requires familiarity with all the relevant CPT treatment codes and how they interact with one another. Not understanding how billable units are calculated, for instance, could result in an acupuncture or massage practice not getting reimbursed properly for its services. In addition to billing and coding, however, these practices also need to make sure that they’re keeping accurate patient records to document holistic treatments.
Why is Keeping Proper Patient Records Essential for Your Holistic Practice?
Put simply, keeping proper treatment records is often a necessary step for getting paid for patient services. That’s because many insurance companies request treatment notes to ensure that the treatments being administered conform to the specifications outlined in their policies. Simply providing billing information with the proper treatment codes is usually not sufficient for an insurer to evaluate whether or not the care being administered qualifies as good practice. Without supporting documentation that provides more detail about the treatment, the claim could be considered suspect and subsequently denied.
There is often a tendency among holistic practices, such as acupuncturists or massage therapists, to believe that they do not need to keep the same records as western-style medical practices. While this may have been (somewhat) true when most patients paid for services out of their own pockets, today these practices are submitting billing claims for reimbursement to private insurance providers, all of whom are very concerned with documenting exactly what services they’re reimbursing. For holistic practices that want to start treating these patients, it is extremely beneficial for them to view their practice the same way any other professional healthcare provider would regard theirs. That means keeping detailed and accurate medical records to improve the overall quality of care, provide evidence of treatment to third-party payers, and shield the practice from potential liability.
The Benefits of Keeping Proper Patient Records
In addition to the obvious benefit of helping a practice get its billing claims approved, keeping accurate patient records is extremely valuable for auditing purposes. When a holistic practice is audited, it is typically instructed to prepare certain files for review, but the auditors will then randomly select several additional files at the time of the audit to make sure the documentation process is consistent. If an office has poor documentation, it can be very difficult to explain why treatments were administered or prove that they were necessary.
Accurate documentation is also important when it comes to providing high-quality care to patients. When patients receive multiple treatments over a period of time, there should be a record of what treatments they received, when, and why. The size of the practice should not be relevant when it comes to the extent of recordkeeping. Without accurate documentation, it can be difficult to know whether or not the best possible treatment is being administered at any given time.
For example, even if an acupuncture practice only sees three insurance patients a day, three days a week, that still means over 450 acupuncture treatments were administered over the course of a year. If a patient returns a year later for additional treatment and there is no documentation of their first visit, the acupuncturist is left to rely on memory when determining what treatment was administered. At best, this will result in highly inefficient treatments. At worst, it could open them up to liability.
3 Tips for Keeping Patient Records
Fortunately, there are a few easy tips for keeping accurate, detailed patient records. Documentation may take a little bit longer to do properly, but the benefits of accurate patient records far outweigh the inconvenience of taking five to ten minutes charting or documenting treatments after patient visits.
1. Remember the 7 Cs
In order to comply with HIPAA regulations, patient records should always follow the same basic guidelines regardless of practice type:
- Correct
- Clear
- Concise
- Complete
- Consecutive
- Comprehensive
- Confidential
2. Don’t “Carry Over” Electronic Health Records (EHR)
For holistic practices that are documenting treatments with an electronic records system, there is often an option to “carry over” information, or copy one set of medical records into another patient’s chart. While this can sometimes be a time-saving trick, it’s important to remember that copying the same notes across multiple patients is going to look extremely suspicious to an auditor (as well it should). Every treatment should be considered unique, even if the previous five patients received the exact same treatment.
3. Use the SOAP Note Format
Long utilized by medical practices to document patient treatments, SOAP notes provide an overview of the entire patient visit and give context to whatever treatment was administered. Many payers require SOAP notes to be submitted alongside billing claims to ensure that treatments were medically necessary.
There are four characteristics of SOAP notes for holistic practices:
- Subjective: An overview of the information the patient brings into the visit, including their primary complaint, patient description of symptoms, progress since the previous visit, initial pain scale value, and medical history.
- Objective: A quantifiable evaluation of the patient performed by a healthcare professional, including measurable data like vital signs, physical symptoms, laboratory results, and other clinical documentation.
- Assessment: An interpretation of the connection between the Subjective and Objective information available to produce a diagnosis of the patient’s condition.
- Plan: A description of what treatment will be administered based on the diagnosis as well as recommendations for moving forward. This information should be very specific. For instance, an acupuncturist should indicate what the pain scale value was pre and post-treatment.
Improve Your Record-Keeping with Holistic Billing Services
Keeping detailed patient records in addition to managing billing claims can be quite a handful for many holistic health practices. Every moment spent filing paperwork is time that could be spent treating additional patients and increasing revenue. That’s why partnering with a billing service like Holistic Billing can help your practice focus its attention on the most important aspects of patient care. We can help to streamline your billing process and get your claims reimbursed faster and with fewer denials while you work on expanding your business. To learn more about how Holistic Billing Services can transform your practice, contact our experienced team today for a consultation.
Operating a healthcare practice of any kind, whether it’s a western-style medical office or a holistic health service, is a challenging and complicated undertaking. As if providing quality care to patients wasn’t difficult enough, there are many other factors practices must take into account if they want to be successful. Learning the ins and outs of health insurance coverage, for instance, is an ongoing process that changes every year as provider policies are updated. Implementing processes and systems for collecting revenue is also essential, especially if many of the practice’s health services aren’t covered by insurance.
Most of these issues fall under the broad responsibilities of healthcare management and healthcare administration. While these terms are quite common, there is a lot of confusion around them because they are often used interchangeably despite the fact that they do have specific meanings.
The Difference Between Healthcare Administration and Healthcare Management
What is Healthcare Management?
As the term “management” might suggest, this area refers primarily to how the business aspects of a healthcare or holistic practice are handled. The primary focus of healthcare management is to develop a business plan that meets the practice’s specific goals and then execute on that plan using a variety of management, negotiation, and leadership techniques. Most healthcare management professionals hold an MBA or have a background in accounting or facilities management. They are typically responsible for budget management, organizational policies, standards of patient care, marketing, compliance, and various aspects of healthcare law.
What is Healthcare Administration?
While healthcare management emphasizes the business side of a practice, healthcare administration is more focused on overseeing and coordinating the staff within a practice or department. The typical healthcare administrator supports the policies and processes that help medical personnel deliver effective care that impacts patients. While they may at times be responsible for meeting regulatory requirements that are associated with healthcare management, healthcare administrators primarily support, direct, and encourage employees to ensure that they are able to provide the best care. Crucially, they are often considered to be healthcare professionals, and it is common for these roles to be filled by physicians, nurses, or other public health specialists.
Healthcare Administration vs Healthcare Management: Who Handles Medical Billing?
There are a lot of similarities between these roles, and the distinctions are made even more confusing by healthcare organizations that use the terms interchangeably. In general, however, the primary difference is that healthcare managers are responsible for the operation of a facility as a whole while healthcare administrators oversee the operations of specific departments and medical staff.
So which of these roles is responsible for medical billing?
Perhaps predictably, it depends on the specific practice.
Larger healthcare practices and medical facilities generally have dedicated medical billers who are responsible for coding medical services and then filing and submitting claims. Some organizations classify this role as a management position while others consider it administrative. In most cases, medical billers are not required to have any medical training, which would suggest that they’re more on the management side. However, since medical billers must work closely with both medical staff and patients, their role fits more naturally within the framework of healthcare administration.
For smaller healthcare practices, the distinction is far less important because the lines between healthcare management and healthcare administration are not clearly drawn. These practices don’t have the revenue or patient volume to justify the existence of additional office personnel. In many cases, both managerial and administrative are handled by only a few (or even just one) people, in addition to many other tasks they’re responsible for. This is especially true of holistic practices, where the clinician may be responsible for every aspect of their practice without any assistance from employees.
The Value of Outsourcing Holistic Billing
For many acupuncture, massage therapy, and chiropractic practices, it can be difficult to provide quality care to patients while also keeping up with all the demands of healthcare management and administration. Medical billing, in particular, can be incredibly time-intensive, not only requiring holistic practitioners to organize, file, and monitor all billing claims, but also to keep up-to-date on the latest changes to coding and to which holistic healthcare services insurance companies will agree to cover.
Partnering with an experienced medical billing provider that specializes in holistic practices can streamline an office’s operations and allow clinicians to dedicate more of their attention to their patients. While there are many medical billing services available, it’s important to find a provider that understands the unique characteristics of holistic practices and can provide the specialized support that helps these practices to be more successful.
At Holistic Billing Services, we recognize that acupuncture, massage therapy, and chiropractic practices call for a much different approach to medical billing than traditional healthcare practices. That’s why we’ve focused specifically on this growing area of medical care and have partnered with over 1,200 practices to help them improve their revenue cycle management and boost their net collections. Our convenient and secure solutions can take the hassle of insurance verifications, claims processing, and denied claims follow-ups off your hands so you can focus on what matters most: delivering quality care to your patients.
To learn more about how our team of experts can help improve your holistic billing, contact us today for a consultation.
Holistic practices face unique circumstances when it comes to medical billing due to the ever-shifting regulatory guidelines that stipulate which holistic health services are covered by insurance, and which services remain strictly out-of-pocket. With patients paying more for their own care and insurers looking for practically any reason to deny claims (and save themselves money), monitoring collections closely is critical for staying on top of a holistic practice’s financial health and insulating it from potential changes in the regulatory landscape.
What is Net Collection Rate?
A holistic practice’s net collection rate is essentially a performance metric that measures how effective the practice is at collecting all legitimate forms of payments for services, which are typically the amount owed after all insurance company adjustments are made. The net collection rate will reveal deficiencies in this process. If a practice is struggling to collect revenue due to bad debt, late filings, coding errors, or claim underpayments, it will have a low net collection rate.
Since net collection rate is directly tied to a practice’s revenue stream, it’s one of the most important performance metrics to monitor. Typically calculated on a quarterly basis, the rate represents a snapshot of financial health and efficiency. A low net collection rate should be treated as an urgent priority because it indicates that the practice has a persistent problem when it comes to gathering revenue, which could indicate an organizational inefficiency or an issue with patient relations and communication.
Calculating and Monitoring Your Holistic Practice’s Net Collection Rate
For many holistic practices, assessing net collections on a quarterly basis may not be frequent enough to identify potential fluctuations or problems before they start to eat into the practice’s revenue. Calculating and monitoring net collection rate on an ongoing basis, whether it’s monthly or every few weeks, can help the practice flag issues quickly and prevent outstanding collections from snowballing to the point where they become unmanageable.
It starts with understanding how to assess a holistic practice’s net collection rate, which involves several important steps:
- Identify the time period that you want to monitor (e.g., 90 or 120 days). Assess data from an earlier period in which the majority of claims would be closed and cleared; ~6 months back is advisable.
- Calculate total payments (from insurance companies and patients) for the designated time period.
- Calculate total charges minus approved write-offs (e.g., due to contractual reasons, bad debt, professional courtesy discounts, etc.) for the designated time period.
- Divide your calculation in step 2 by your calculation in step 3. Then multiply by 100.
- Do this consistently (e.g., every 90 days) for a period of at least one year to get the most accurate average rate.
What Should Your Net Collection Rate Be?
A 96% net collection rate is generally considered ideal across the healthcare industry, regardless of practice type. This applies to holistic practices as well. If the rate is closer to 90% (or lower), the practice is definitely leaving revenue on the table that it should otherwise be collecting.
The whole purpose of monitoring net collection rate is to identify these problems, or, to put it another way, take advantage of opportunities. A low score indicates that some issue is getting in the way of efficient payment collections. There are a few common culprits that bring down net collection rates for a holistic practice:
- Non-Paying Patients: For some reason, the practice has a high proportion of outstanding bills that it cannot collect from patients.
- Claim Denials: One or more insurance companies are consistently denying claims for holistic services.
- Unsubmitted Claims/Unbilled Patients: Claims and bills are not being sent out promptly, which has created a significant lag between point-of-service and revenue collection.
How to Improve Holistic Practice Net Collection Rate
Depending upon the source of the problem, there are a number of solutions that a holistic practice can implement to boost its net collection rate.
1. Require Up-Front Payments
One of the easiest steps to take is to collect 100% of copayments and deductibles from patients at the initial point-of-service. This ensures that no one walks out of the office with an outstanding bill and avoids the resulting hassle of collecting payments afterward, which can be just as inconvenient for the patient as it is for you or your staff. Setting up appointment reminders that inform patients they must pay for holistic services up-front is essential for making this strategy effective. If a patient is unable to cover the cost at that time, the appointment can be rescheduled or other payment options can be discussed.
2. Educate Patients
Many patients who seek holistic medical care may not understand which services their insurance will cover and which services they will be responsible for paying. This can create a great deal of confusion when it comes to billing. To avoid any surprises, either at the point-of-service or in the event of a denied claim, it’s important to educate patients about the unique nature of holistic medical services and how their specific insurance plan regards them. Providing a brochure or reference sheet can be helpful, but patients may have many questions that require more detailed explanations. Having a staff member with the expertise and resources to field these questions can help to reduce confusion about how the claims and payment process works for holistic practices.
3. Provide Payment Options
Expanding payment options requires some investment on the front-end, but it can have a major impact on net collections over time. Mailing out a billing statement and asking patients to write a check was an inefficient collection strategy 30 years ago, and it’s even less efficient today. As consumers, patients are accustomed to being able to pay for services in a variety of ways, whether it’s by credit/debit card, through an online portal, or via a mobile app. For some patients, an installment plan might be the only way they can realistically afford holistic healthcare services that aren’t covered by their insurance provider. By providing a variety of payment options, patients are far more likely to find one that suits their needs and pay their bills promptly.
4. Reassess Your Own Process
When evaluating the reasons for a low net collection rate, it’s easy to assume that the problem stems from patients not paying their bills. In many cases, however, the issue has as much to do with the way a holistic practice handles its billing. Since these offices typically don’t have as much staff support as the average healthcare practice, holistic care providers are sometimes forced to wear many different hats. That can lead to administrative tasks like preparing insurance claims or billing patients being put off in favor of much more urgent tasks.
Unfortunately, time is of the essence when it comes to revenue collections. Taking too much time to submit an insurance claim could lead to a denial, and patients may be less inclined to pay a bill promptly when it takes a long time to arrive in their mailbox. More importantly, filing an insurance claim is a very detail-oriented process, so even the slightest error could result in a claim being denied. Putting a system in place that files claims accurately and promptly (as well as bills patients consistently) is essential for any holistic practice hoping to improve its net collection rate.
Improve Your Net Collection Rate with a Holistic Billing Service
Whatever the causes of a low net collection rate, partnering with a reputable holistic billing service is one of the fastest and easiest ways to turn this key revenue metric around. An experienced billing service can overhaul the way a holistic practice prepares and submits claims to payers to minimize the rate of denials. Turning the billing process over to a third party also frees up time for office staff to focus on providing the best service and care possible. Instead of spending hours on the phones trying to collect outstanding payments, they can focus on expanding the holistic practice’s patient base and improving services to better retain the patients it already has.
Holistic Billing Services has years of experience handling coding and billing issues for holistic health providers, with a special focus on acupuncture, chiropractic, and massage practices. We understand that each practice is unique and requires a customized solution that aligns with its long-term goals. That’s why we work closely with our clients to help them set up the solutions that meet their specific needs and allow them to deliver the best holistic care possible. To find out what we can do for your holistic practice, contact our team today for a consultation.
The questions that we have attempted to answer in this inaugural edition of Holistic Billing COVID-19 FAQs derive from a variety of resources, including direct questions from practitioners from across the country.
The answers to these questions and recommendations put forth originate from institutional guidelines from selected academic centers, relevant websites, and a wide range of individual experiences sent to us.
Our FAQs are by no means exhaustive but, hopefully, enough to provide practical guidance to a broad cross-section of integrative medicine practices. As new information emerges, Holistic Billing will update the FAQs.
1. What is a pandemic?
The definition of a pandemic, according to the World Health Organization (WHO), is a worldwide spread of a new disease. A pandemic occurs when a new virus emerges and spreads around the world, and most people do not have immunity.
2. What is coronavirus? What are the signs and symptoms of coronavirus?
Coronaviruses are a family of viruses that can cause illnesses such as the common cold, severe acute respiratory syndrome (SARS), and Middle East respiratory syndrome (MERS). In late 2019, a new coronavirus was identified as the cause of a disease outbreak in China. The virus is now known as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease it causes is called coronavirus disease 2019 (COVID-19).
Signs and symptoms of COVID-19 may appear two to 14 days after exposure and can include:
- Fever
- Cough
- Shortness of breath or difficulty breathing
The severity of COVID-19 symptoms can range from very mild to severe. People who are older or have existing medical conditions, such as heart disease, may be at higher risk of serious illness; this is similar to other respiratory diseases, such as influenza.
SOURCE: Mayo Clinic
3. What is the best estimate for the incubation time after exposure?
According to information from the Centers for Disease Control and Prevention (CDC), the estimated incubation period for COVID-19 ranges from two to 14 days, based on existing literature from other coronaviruses such as MERS-CoV and SARS-CoV.
4. Are there guidelines for a practice to follow if a patient tests positive for COVID-19? If a clinic sees a patient, should the clinic be quarantined?
At this time, there is no published guidance available that would address the specific question of how an outpatient facility should respond if a recently seen patient has COVID-19 infection beyond what is described in the CDC guidance.
The CDC has published guidance for infection control and prevention in health care settings in the context of COVID-19. The CDC also published guidance for risk assessment and public health management of health care workers who may be exposed or infected with COVID-19.
Providers and integrative medicine practices are encouraged to follow this guidance where possible. Consider the following point to guide clinic preparation and planning:
Patient scheduling:
- It may be reasonable to postpone routine treatments or follow-up visits of patients or to conduct those appointments via telemedicine.
- Consider calling all scheduled patients one day in advance of the practice visit to screen for COVID-19 exposure/symptoms.
5. Should I wear gloves during treatments on an asymptomatic patient with no risk factors?
There is no reason to do so at this time. Be vigilant with hand hygiene and wiping down any equipment that touches the patient.
6. How should patients be assessed when they enter the clinic?
Ideally, patients should be screened by clinic staff before the patient comes to the clinic.
7. What are some practical steps to protect clinic staff?
Each clinic must determine what is possible and what facilitates essential patient care. The first step is to create a plan for your facility. The following are practical first steps to consider:
Screen staff
- Educate staff on red flag symptoms (fever, cough, shortness of breath)
- Mandate self-reporting of symptoms and exposures by all staff
- Symptomatic staff should remain home and await further instruction re when to return to work, testing, etc.
- Proactively screen staff each day
Prevention
- Increase disinfection according to CDC guidelines
- Protect janitorial staff with safe handling of trash and linens
- Consider masks and gloves for therapists who are in contact with patients
- Consider wearing clean scrubs daily
- Patients and clinicians are urged to follow the CDC’s recommendations on mask wear
- Strongly encourage patient and therapist hand washing prior to and after entry of your facility
Social distancing
- Allow non-essential staff to work from home when possible
- Keep three to ten feet apart in clinics and workspaces where possible
8. What is the best way to disinfect the clinic?
According to CDC guidelines:
“The fundamental frequency of cleanings is unclear but recommended that individual practices work to clean their facility at least once daily but as often as feasible with staffing. All high-volume contact surfaces need regular cleaning, including counters, cell phones, light switches, faucet, and toilet knobs, doorknobs and door faces, and keyboards.”
SOURCE: CDC
9. How can we limit patient volume in the clinic to decrease the risk to staff?
There is no “one size fits all” recommendation; it depends mainly on the patient population of individual practices.
Here are a few measures that one can take to decrease risk to staff:
- Limit the number of people allowed to accompany the patient (e.g., no more than one)
- Consider asking patients with a mobile phone to wait in their car until their scheduled treatment time or until staff contacts the patient to come inside; this limits the number of people near the waiting area.
10. What sort of education should we be providing to patients and their families?
First, educate yourself with the CDC guidelines for healthcare professionals. Educate patients and families on red-flag symptoms such as fever, cough, or shortness of breath. Reinforce the importance of prevention with social separation (maintaining three to ten feet distance from others in public) and proper hygiene (handwashing, covering their cough, avoiding touching their face). Tell them that symptoms can occur two to 14 days after exposure, and ask them to report exposure to symptomatic or test-positive persons or recent international, cruise, or air travel.
11. What procedures are eligible for telehealth visits?
Insurance payers are quickly updating telehealth guidelines in response to the COVID-19 pandemic. The majority of plans covering telehealth visits for integrative medicine practitioners limit coverage to the pre-existing patients of in-network providers.
At the time of this writing, most codes eligible for telehealth for integrative medicine practitioners are E/M or office visit codes. You must check with your state license guidelines, insurance payer policies, and malpractice coverage provider before proceeding with telehealth visits for integrative health.
12. Can I still provide services for the Department of Veterans Affairs?
The VA recently distributed documentation asserting that providers supporting Veteran’s Affairs Choice Network are “operating as an Essential Business under contract with them to provide services for the Community Care Network (CCN).” In addition, they consider the “continuation of these services is for official federal Government business for the furtherance of the delivery of healthcare for the Department of Veterans Affairs.
Based on the VA documentation, the services you provide to support Veterans through your contract with the VA 3rd party administrators are essential to support the health and wellbeing of Veterans during this time of crisis. To help providers safely care for Veterans and to prevent further spread of the virus, VA is allowing providers to deliver care through telehealth and telephone consults for Veterans with an approved referral. To the extent you make decisions about changing your current delivery of care during the pandemic, they ask that you, please check with your VA 3rd party administrator.
Do you have more questions about COVID-19? Does your practice need assistance to get through the COVID-19 outbreak? Holistic Billing Services is here to help!
You need an experienced advisor who can help ease the stress that comes with running and growing a successful holistic practice—especially during this trying time. Our seasoned, specialty-specific consultants will help ensure your holistic practice can continue to run efficiently—and safely. Contact us today for more information!
DISCLAIMER
Answers to the Frequently Asked Questions (FAQs) regarding COVID-19 were developed by HOLISTIC BILLING) volunteers based on the information available to them from a variety of resources, including the CDC, WHO, combined with their own practical experience and knowledge. Provided for voluntary, educational use by health care providers during an urgent and evolving COVID-19 pandemic. They are not medical or legal advice and not intended for diagnosis or treatment of specific conditions. They do not endorse or recommend particular products or therapies, mandate any one course of medical care, or constitute a statement of the standard of care. The answers are not inclusive of all proper approaches or exclusive of other methods reasonably directed to obtaining the same results. Each health care provider must make the ultimate judgment regarding treatment and management approaches considering all the circumstances presented. HOLISTIC BILLING does not assume liability for the information, conclusions, and recommendations contained in the FAQs or any injury or damage to persons or property arising out of or related to any use of this information or any errors or omissions. The FAQs are based on information available at the time of the responses. There may be new developments that are not reflected here and that may, over time, be a basis for HOLISTIC BILLING to revisit and update the FAQs.
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