April 08, 2020

A Message From Your President...

Hi Everyone.

The presidents' council met last week by phone conference. This group is composed of the NYSPMA division presidents, the NYSPMA BOT officers, ED Mr. Dan Kline, and our state association attorney Mr. Matthew Feldman. Also joining the conference call was past president and APMA board member, Dr. Larry Santi, and APMA board liaison Dr. Scott Hughes. Dr. Santi and Dr. Hughes provided an update on the measures APMA is taking to assist membership during this pandemic crisis. Please visit the APMA website Covid-19 page for updates.

Dr. Nick D'Angelo, our insurance chair, joined us on the call and presented recent updates on Telehealth. Most insurances are allowing Podiatry to provide telehealth. Dr. D'Angelo also presented information regarding the loans and grants available for our practices.

COVID-19 related information changes daily. Please contact the association with any questions and PLEASE visit the NYSPMA website COVID-19 page for the most up to date information.

Please note, this page is available to members and nonmembers. Also, numerous webinars have been made available by APMA, NYSPMA working with CME Online and others. You can find them on the APMA and NYSPMA COVID sections of our websites. The next scheduled video is Monday, April 13 at 8:30pm, “Protecting your Practice, brought to you by CME Online and NYSPMA. Please see more information below to register for this free video. There is also a series of COVID-19 educational videos being produced (For CME) and NYSPMA is waiving their portion of the registration fee for members. Please click here to register for these videos. Finally, the NY Academy of Sciences is offering a free video on COVID on April 22.

The association has not received any formal response from the governor regarding our limitations to help during this crisis. PLEASE practice within the scope of our license.

Podiatrists should be limiting professional health care activities to ‘essential' care, like emergencies, post-operative follow-up, wound care and other procedures they deem to be urgent or emergent, unlike routine foot care and patient follow-ups. Examples would include infections, wounds, acute injuries like fractures, and post-op patients. Please use a telehealth visit (telephone or video) for some of these patients if possible. These limitations are for the safety of you, your staff and your patients.

As I said last week, the House of Delegates this year is canceled. The Board of Trustees will be meeting next week to discuss accomplishing any necessary business of the House in a way that fufills the bylaws while keeping our membership safe. We all know this is a very serious and dangerous virus.

I would like to wish all of you a Happy Passover and a Happy Easter. These religious holidays represent a new beginning and a joyous time. I hope you will be able to celebrate in some way with your family.

I hope and pray for a speedy end to this crisis.

Stay healthy and safe.

Dan Keating DPM

President NYSPMA

CME Online Teleconferences

Protect Your Practice, Attend this Free Webinar

Monday April 13th- 8:30 PM EST

The webinar will cover: Medicare Accelerated Payments, Paycheck Protection Program, SBA EIDL Loans, Cash Flow Management & More.

To register, please visit CMEOnline.com

NYSPMA Legal Tip: COVID Resources

By: Matthew S. Feldman, Esq., General Counsel

New York State Podiatric Medical Association

Coronavirus in Employment Law Letter

COVID Educational Resource PowerPoint

Mr. Feldman is available for legal consultation if needed and can be reached by phone at (716) 852-5875 or by email at MFeldman@feldmankieffer.com

Weekly CPR Billing and Coding Tip of the Week: UPDATE: Telehealth Billing for Podiatrists

CPR Tip by: Hoda Henein

During the COVID-19 Public Health Emergency, there are four non-face-to-face service types podiatrists can provide to most patients:

Telehealth for Medicare Part B and Medicare Advantage Patients—Services that are normally furnished in person which are instead furnished remotely using interactive, real-time telecommunication technology
Use G2012 when a virtual check-in is provided to a Medicare Part B or Medicare Advantage patient
Telephone E/M services for patients with any insurance
Online digital E/M services for patients with any insurance

As of March 30, 2020 CMS is allowing all four of these services to be provided for both new and established patients.

Telehealth for Medicare Part B and Medicare Advantage Patients—Services that are normally furnished in person which are instead furnished remotely using interactive, real-time telecommunication technology

On March 17, CMS announced that providers can perform certain E/M services when performed remotely. The provider can be in any location and the patient can be in any location. More services were added to that list and further clarification was provided on March 30, 2020.

Some private payers have followed suit, also allowing certain E/M services to be provided remotely. Check private payer policies for details.

For Medicare patients, providers can use this option for office/other outpatient E/Ms (CPT 99201–99215) and

Initial hospital E/M (CPT 99221-99223)
Subsequent hospital E/M (CPT 99231-99233)
Initial nursing facility E/M (CPT 99304 – 99306)
Subsequent nursing facility E/M (CPT 99307-99310)
Emergency Dept E/M (CPT 99281-99285)
Observation services (CPT 99217-99220, 99224-99226, 99234-99236)
Hospital discharge day management (CPT 99238-99239)
Domiciliary / rest home E/M (CPT 99327 – 99328, 99334 - 99337)
Home visits (CPT 99341-99345, 99347-99350)
Physical Therapy (not payable to therapists) (CPT 97161 – 97164)
Occupational therapy (not payable to therapists) (CPT 97165 – 97168)
Therapeutic procedure (CPT 97110-97112, 97116)
Orthotic management and training – (CPT 97760)
Prosthetic training – (CPT 97761)

Must use a communication tool that has interactive audio and video
Communication tool must allow real-time communication
Providers are permitted to reduce or waive cost-sharing for these services if they wish
Use modifier 95
Use the Place of Service that would have been used had the service been rendered in person (e.g., POS 11 for CPT 99213 and POS 32 for CPT 99307)
These services will be paid at the regular rate
This waiver is in place as long as the public health emergency lasts
Postoperative global periods apply
Document a progress note just like one would do when this service is provided face-to-face. This interaction is an E/M service and the same documentation requirements apply. The level is selected based on the 1995 or 1997 CMS guidelines for evaluation and management services, except when using CPT 99202-99215. When using CPT 99202–99215 for telehealth, the level may be selected based on “Medical Decision Making alone or total time alone."

Use G2012 when a virtual check-in is provided to a Medicare Part B or Medicare Advantage patient using telephone interactions in addition to synchronous, two-way audio interactions that are enhanced with video or other kinds of data transmission

G2012: Brief communication technology-based service (e.g., virtual check-in) by a physician or other qualified health-care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5–10 minutes of medical discussion
Can be any type of telecommunication tool, including telephone
CANNOT relate to any service in the last seven days
CANNOT result in patient coming in within the next 24 hours or soonest available appointment
No modifiers needed
Providers are permitted to reduce or waive patient cost-sharing for these services if they wish

Telephone E/M services for patients with any insurance

This interaction is an E/M service and documentation must support an E/M just like any other E/M type. Must have history, as much of an evaluation as possible, and some form of medical management.
Must be initiated by patient or the patient’s guardian
Provider may educate patients about this option
Not reimbursed by some payers
CANNOT report if call results in decision to see patient within 24 hours or next available urgent appointment
CANNOT report if call refers to E/M service performed by same provider within previous seven days
CANNOT report if call refers to a problem for which a patient is in a global period
CANNOT report if provider performed a telephone E/M or online digital E/M for the same patient for the same problem in the last seven days
CANNOT report if the call is part of Home Care Oversight Services, Care Plan Oversight Services, Home/Outpatient INR Monitoring, Complex Care Management Services, or Transitional Care Management Services

CPT 99441 - Telephone evaluation and management service by a physician or other qualified health-care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous seven days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5–10 minutes of medical discussion
CPT 99442– ; 11–20 minutes of medical discussion
CPT 99443– ; 21–30 minutes of medical discussion

Online digital E/M services for patients with any insurance

This interaction is an E/M service and documentation must support an E/M just like any other E/M type. Must have history, as much of an evaluation as possible, and some form of medical management.
Examples of digital platforms:

Electronic health record
Email
Text message
Other two-way digital communication

Must be initiated by patient via a digital platform
Provider may educate patients about this option
Not reimbursed by some payers
Providers are permitted to reduce or waive patient cost-sharing for these services if they wish
CANNOT report if service refers to a problem for which a patient is in a global period
CANNOT report if service is initiated within seven days of any E/M for same problem
CANNOT report if performed on same day as in-person E/M service
CANNOT report if service is part of Home Care Oversight Services, Care Plan Oversight Services, Home/Outpatient INR Monitoring, Complex Care Management Services, or Transitional Care Management Services
Time spent is cumulative time over seven days starting with review of the request
Can only report once per seven-day period
Time includes:

Review of inquiry
Review of patient records
Interaction with other staff
Development of management plan
Rx
Ordering tests
Communication with patient

Add time if multiple providers in same practice perform this service for the same patient over the same seven-day period
If within seven days of the initiation of an online digital E/M service, a separately reported E/M visit occurs, then the provider work devoted to the online digital E/M service is incorporated into the separately reported E/M visit
CPT 99421: Online digital evaluation and management service, for an established patient, for up to seven days, cumulative time during the seven days; 5–10 minutes
CPT 99422 ; 11–20 minutes
CPT 99423 ; 21 or more minutes

It is highly recommended that you obtain informed consent for these services and advise patients that there will be a charge for these services, that copays and deductibles may apply, and referrals may be necessary if required by the insurance plan.

Tickets at Work

Helping Employees During the Coronavirus Pandemic

Tickets at Work is establishing new partnerships daily to provide your employees with discounts on everything they need during this difficult time, including 50% off on:

home technology
grocery and wine delivery
television streaming services
health and wellness subscriptions
financial resources
and so much more!

If you haven't signed up yet for an account yet, you can enroll for free using our company code: NYSPMA0617

And to support you personally, we’ve pulled together a comprehensive list of resources the Human Resources community is using to effectively sustain operations, as well as information that can be shared with employees to help them through their unique situations. Our first topic of the series is: COVID-19 Resources for Businesses and their Employees - Mental, Physical, and Financial Health

CMEonline COVID Webinars

Use the code "NYSPMA" for $20.00 off registration fees.

"Centers for Medicare & Medicaid Services (CMS) has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility. "

There are some important points that you need to know about providing, documenting and billing telehealth services.

The webinar on Sunday will go over all of these points and will end with a round table discussion with what should be a very lively Q and A session.

Not receiving helpful weekly tips from NYSPMA yet?

Your NYSPMA team sends out weekly texts including helpful content such as practice management tips, legal tips, CPR tips, association news, legislative updates, and more. You can always opt-in and opt-out at any time!

Text "NYSPMA" to 8449476386 to sign up!

[FREE] NYS-Compliant Opioid Prescriber Training

DPMs who took this 3-year training in 2017, when this new training requirement was introduced, will need to re-train in 2020

Complete your minimum of three (3) hours of course work or training in pain management, palliative care and addiction for prescribers with online courses through the University of Buffalo or Boston University - free of charge. Use the links below for the course work.

Check out the NYSPMA Fall Prevention Program! Earn 1 CME, FREE to NYSPMA Members

Our fall prevention webinar is ready to be viewed. I am encouraging everyone to view this course for free CME, as we are doing this in cooperation with the Department of Health, as partners in the prevention agenda. Please take advantage of this member benefit, and help advance podiatry and add this important service to your practices. ACCESS THE WEBINAR HERE.

NYCPMConnect has launched!

Sign up now at https://nycpmconnect.com/ for access to an exclusive mentoring and networking community for NYCPM alumni and students!

Featured Member Partner Programs-

Updated Medical Insurance Plans for 2020-New Medicare Supplement!

NYSPMA through Creative Wealth Planning (CWP) offers a variety of medical, dental and eye care insurance with excellent customer service. CWP has just announced a new Medicare Supplement Plan, which can be viewed at www.creativewealthplanning.com/medicaresupplement . Other CWP plans for NYSPMA members can be viewed at www.creativewealthplanning.com/nyspma Creative Wealth Planning, LLC. CWP is an independent insurance brokerage firm with over 35 years of experience, specializing in group and individual medical insurance. CWP can design coverage for you, your dependents, and staff, as well as options for those covered by Medicare. CWP works directly with members to tailor plan options that are best suited to your needs.

NYSPMA: Connect on Facebook & Twitter

NYSPMA has a Facebook page and is now on Twitter. These pages provide Association announcements and updates. We are always looking for great news stories to share on our pages. If you’ve recently been quoted in the media, received an award, launched a new project or have relevant news to share, please email info@nyspma.org.

Poster for Your Office: We have developed an 8 1/2 x 11 Full-Color Poster/Flyer that can be displayed in your office to encourage your patients to visit our consumer site, www.nyfoothealth.com, to stay up to date on the latest foot health news and get updates on diabetes, bunions, heel pain...and more.

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