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Healthcare Provider FAQs

Disease Background

  • Coronavirus disease 2019 is an emerging illness. Many details about this disease are still unknown, such as treatment options, how the virus works, and the total impact of the illness.
  • New information, obtained daily, will further inform the risk assessment, treatment options and next steps.
  • In December 2019, there was a cluster of cases of pneumonia and respiratory diseases, first identified in the Wuhan City, Hubei Province, China.
  • Early on, many of the patients in the outbreak in Wuhan, China had some link to a large seafood and live animal market.

A previously unknown virus is responsible for the infections. The virus was originally named the “2019- novel coronavirus”. The virus was later renamed “SARS-CoV-2”, and the related disease is now called “coronavirus disease 2019” (or “COVID-19”).

Worry and anxiety can rise due to the spread of COVID-19. Concern for friends and family who live in places where COVID-19 is spreading or the progression of the disease is natural.

However, fear and anxiety can lead to social stigma, particularly toward specific demographics affected by the outbreak, people who were in quarantine, or those who are being tested for COVID-19.

Stigma is discrimination against an identifiable group of people, a place, or a nation. Stigma is associated with a lack of knowledge about the COVID-19 outbreak. Stigma hurts everyone by creating more fear or anger towards ordinary people instead of the disease that is causing the problem.

Coronaviruses are a large family of viruses that are common in many different species of animals, including camels, cattle, cats, and bats. Other examples of coronaviruses include SARS-CoV and MERS- CoV.

  • SARS-CoV causes severe acute respiratory syndrome that had a global outbreak in 2003.
  • MERS-CoV is causes Middle East Respiratory Syndrome, a respiratory illness that had global impact in 2012.

There are other species of coronaviruses that commonly infect humans can cause mild illness, like the common cold. These are different from SARS-CoV-2 and its related disease, coronavirus disease 2019 (COVID-19).

  • The virus is thought to spread mainly from person-to-person. Examples of person to person transmission include:
    • Between people who are in close contact with one another (within about 6 feet)
    • Via respiratory droplets produced when an infected person coughs or sneezes
    • Droplets landing in the mouths or noses of people who are nearby or possibly that could be inhaled into the lungs
  • In addition, other destinations have seemingly community spread because some people have been infected who are not sure how or where they became infected.
  • It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.

Symptoms, Diagnosis & Treatment

Patients with COVID-19 have reported mild to severe respiratory symptoms.

Symptoms include fever, cough, and shortness of breath.

Other symptoms include fatigue, sputum production, and muscle aches. Some individuals have also experienced gastrointestinal symptoms, such as diarrhea and nausea, prior to developing respiratory symptoms.

The CDC’s “Coronavirus Self-Checker” can provide you with information about seeking appropriate medical care based on COVID-19 related symptoms. However, it is not intended to diagnose COVID-19. People who think they may have been exposed to COVID-19 should contact their healthcare provider immediately.

Emergency warning signs for COVID-19 include, but are not limited to:

  • Trouble breathing
  • Persistent pain or pressure in the chest
  • Blueish lips or face
  • New confusion or inability to arouse

Contact your healthcare provider if symptoms are worsening or concerning.

Symptoms may appear 2-14 days after exposure.

However, infected individuals can be contagious before symptoms arise.

Individual risk depends on exposure to the SARS-CoV-2.

At this time, the immediate health risk from COVID-19 is considered low for the general American public, who are unlikely to be exposed to this virus.

Specific individuals will have an increased risk of infection, such as healthcare workers caring for patients with COVID-19 and other close contacts of persons with COVID-19.

Assessment of this risk could change as in time if the spread of the virus increases.

Those in close contact of persons with COVID-19, such as healthcare workers caring for patients.

Older adults and/or individuals with underlying medical conditions, such as heart disease, lung disease, diabetes, asthma, kidney disease, severe obesity, and those with weakened immune symptoms (due to medications or underlying illness) are at higher risk for complications from COVID-19 illness.

According to the CDC, it is not yet understood whether pregnant women have a greater chance of getting sick from COVID-19 than the general public. It is also not yet known whether they are more likely to have serious illness as a result.

Pregnant women experience changes in their bodies that may increase their risk of some infections. With viruses from the same family as COVID-19, and other viral respiratory infections such as influenza, women have had a higher risk of developing a severe illness. It is always important for pregnant women to protect themselves from illnesses.

The CDC recommends that a mother with flu continue breastfeeding or feeding expressed breast milk to her infant while taking precautions to avoid spreading the virus to her infant. A mother with confirmed COVID-19 or who is a symptomatic should take all possible precautions to avoid spreading the virus to her infant, including washing her hands before touching the infant and wearing a face mask, if possible, while feeding at the breast.

According to the data available to date, children do not appear to be at higher risk for COVID-19 than adults. While some children and infants have been sick with COVID-19, adults make up most of the known cases to date.

The CDC originally developed a diagnostic test to specifically identify the virus (SARS-CoV-2) and screen those suspected for COVID-19 illness. Expanded testing throughout the country can occur because of an Emergency Use Authorization (EUA) from the Food and Drug Administration (FDA). Clinicians should use their judgment to determine if a patient has signs and symptoms compatible with COVID-19 and whether the patient should be tested, according to updated guidance from the CDC.

The CDC has developed a scheme to help clinicians prioritize testing. At this time, the priorities include:

Priority 1

  • Hospitalized patients
  • Symptomatic healthcare workers

Priority 2

  • Patients with symptoms in long term care facilities
  • Patients 65 years of age and older with symptoms
  • Patients with underlying conditions with symptoms
  • First responders with symptoms

Priority 3

  • Critical infrastructure workers with symptoms
  • Individuals who do not meet any of the above categories with symptoms
  • Health care workers and first responders
  • Individuals with mild symptoms in communities experiencing high COVID-19 hospitalization

Non-Priority

  • Individuals without symptoms

Healthcare providers should immediately notify their local or state health department in the event of suspected COVID-19 illness.

There are currently no antiviral drugs licensed by the U.S. Food and Drug Administration (FDA) to treat patients with 2019-nCoV infection, nor is there a vaccine to prevent onset of COVID-19. Many companies are working with the CDC to develop treatments at this time.

Clinical trials and other evaluation of many medications, including anti-malarial, anti-viral, and other drugs, are currently underway; however to date, there is not yet definitive data to support use of a particular treatment.

Vaccine development is not a quick process, but many are working with CDC and federal officials to support vaccine development as fast as possible.

Ask patients complaining of fever and lower respiratory illness about recent travel to China or other infected areas.

Instruct symptomatic patients with travel history to China or other infected areas to wear a surgical or isolation mask and promptly place the patient in a private room with the door closed.

Health care personnel encountering symptomatic patients with travel history to China or other infected areas should follow contact precautions, airborne with N95 precautions, and wear eye protection and other personal protective equipment.

Refer to the CDC’s criteria for a patient under investigation for COVID-19.  Notify local and/or state health departments in the event of a patient under investigation for COVID-19.  Maintain a log of all health care personnel who provide care to a patient under investigation.

Monitor and manage ill and exposed healthcare personnel.

Safely triage and manage patients with respiratory illness, including COVID-19.  Explore alternatives to face-to-face triage and visits as possible, and manage mildly ill COVID-19 cases at home, if possible. 

Influenza, a contagious respiratory illness caused by the influenza viruses (Type A and Type B), has high activity in the United States at this time. Young children, older adults, pregnant women, and those with certain health conditions, such as asthma, diabetes, cancer, or HIV/AIDS, are at higher risk for influenza.

Everyone 6 months and older should receive an influenza vaccine.

Treatment for influenza includes:

  • Antiviral drugs can treat flu illness
  • Antiviral drugs are different from antibiotics. Flu antivirals are prescription medicines (pills, liquid, intravenous solution, or an inhaled powder) and are not available over-the-counter
  • Antiviral drugs can make illness milder and shorten the time you are sick. They also can prevent serious flu complications, like pneumonia

If a patient is low risk (healthy, not elderly or with chronic diseases), most likely the illness will run the course similar to a mild case of the flu. Treatment recommendations for the fever, dry cough and fatigue should be hydration and rest. Studies have shown that the infection tends to be less severe in children.

Some people develop a more severe case with shortness of breath and even respiratory failure. Those people need immediate medical attention.

Healthcare providers should notify any necessary local and/or state health departments in the event of a person under investigation for COVID-19.

For the most up-to-date information, please visit any of the following sites:

Lane County Dept. of Health COVID-19 site
Oregon Health Authority (OHA) COVID-19 site
CDC Coronavirus site

As of March 18, 2020, the following guidance can be used to bill for services related to COVID-19 testing.

  • All member cost share (copayment, coinsurance and/or deductible amounts) will be waived across all products for any claim billed with the new COVID-19 testing codes.
  • We have configured our systems to apply $0 member cost share liability for those claims submitted utilizing these new COVID-19 testing codes.
  • In addition to cost share, authorization requirements will be waived for any claim that is received with these specified codes.
  • We will temporarily waive requirements that out-of-state Medicare and Medicaid providers be licensed in the state where they are providing services when they are licensed in another state.

As of April 1st, 2020, providers performing the COVID-19 test can bill us for services that occurred after February 4, 2020, using the following newly created HCPCS codes:

  • HCPCS U0001 - For CDC developed tests only - 2019-nCoV Real-Time RT-PCR Diagnostic Panel.
  • HCPCS U0002 - For all other commercially available tests - 2019-nCoV Real-Time RT-PCR Diagnostic Panel.
  • CPT 87635 - Effective March 13, 2020 and issued as “the industry standard for reporting of novel coronavirus tests across the nation’s health care system.”
  • Please note: It is not yet clear if CMS will rescind the more general HCPCS Code U0002 for non-CDC laboratory tests that the Medicare claims processing system is scheduled to begin accepting starting April 1, 2020.

Providers billing with these codes will not be limited by provider type and can be both participating and non-participating.

Adjudication of claims is currently planned for the first week of April 2020.

We are complying with the rates published on 3/12/20 by CMS:

  • U0001 = $35.91
  • U0002 = $51.31
  • Please note: Commercial products will reimburse COVID-19 testing services in accordance with our negotiated commercial contract rates.

We will follow these CMS published rates except where state-specific Medicaid rate guidance should supersede.

Any additional rates will be determined by further CMS and/or state-specific guidance and communicated when available.

All member cost share (copayment, coinsurance and/or deductible amounts) will be waived for COVID-19 screening visits and if billed alongside a COVID-19 testing code.

If no testing is performed, providers may still bill for COVID-19 screening visits for suspected contact using the following Z codes:

  • Z20.828 – Contact with a (suspected) exposure to other viral communicable diseases
  • Z03.818 – Exposure to COVID-19 and the virus is ruled out after evaluation

This applies to services that occurred as of February 4, 2020.

Providers billing with these codes will not be limited by provider type.

Any medically necessary treatment related to COVID-19 would be considered a covered benefit. We are committed to ensuring access to COVID-19 treatment services in accordance with federal and state law.

Centene will waive prior authorization requirements and member cost sharing for COVID-19 treatment for all members.

For dates of service from February 4, 2020 through March 31, 2020 providers should use the ICD-10 diagnosis code:

  • B97.29 – Confirmed Cases – other coronavirus as the cause of diseases classified elsewhere

For dates of service of April 1, 2020 and later, providers should use the ICD-10 diagnosis code:

  • U07.1 – 2019-nCov Confirmed by Lab Testing

No. We will not require prior authorization, prior certification, prior notification and/or step therapy protocols for medically necessary COVID-19 diagnostic testing, medical screening services, and/or treatment when medically necessary services are ordered and/or referred by a licensed healthcare provider.

We are closely monitoring and following all guidance from the Centers for Medicare and Medicaid (CMS) as it is released to ensure we can quickly address and support the prevention, screening, and treatment of COVID-19.

As new coverage decisions are made in response to the evolving COVID-19 situation, we will update all providers accordingly.

The American Medical Association (AMA) has produced comprehensive advice for COVID-19 billing, designed to apply best coding practices.

Information provided by the AMA does not dictate payer reimbursement policy and does not substitute for the professional judgement of the practitioner performing a procedure, who remains responsible for correct coding.

In order to ensure that all of our members have needed access to care, we are increasing the scope and scale of our use of telehealth services for all products for the duration of the COVID-19 emergency.

These coverage expansions will benefit not only members who have contracted or been exposed to the novel coronavirus, but also those members who need to seek care unrelated to COVID-19 and wish to avoid clinical settings and other public spaces.

We believe that these measures will help our members maintain access to quality, affordable healthcare while maintaining the CDC’s recommended distance from public spaces and groups of people.

  • MEDICARE ADVANTAGE: Effective March 1 and throughout the national public health emergency, Medicare will pay physicians for telehealth services at the same rate as in-office visits for all diagnoses, not just services related to COVID-19.

Effective immediately, the policies we are implementing include:

  • Continuation of zero member liability (copays, cost sharing, etc.) for care delivered via telehealth*
  • Any services that can be delivered virtually will be eligible for telehealth coverage
  • All prior authorization requirements for telehealth services will be lifted for dates of service from March 17, 2020 through June 30, 2020
  • Telehealth services may be delivered by providers with any connection technology to ensure patient access to care

*Please note: For Health Savings Account (HSA)-Qualified plans, IRS guidance is pending as to deductible application requirements for telehealth/telemedicine related services.

No, CMS has approved the use of any telephonic or video channel to deliver virtual care.

However, we are encouraging providers to participate in a formal telehealth platform, as it serves both to protect patient privacy through secure connections, as well as give providers training on best practices related to delivering care remotely.

Qualified providers who have delivered care via telehealth should reflect it on their claim form by following standard telehealth billing protocols in their state.

Medicaid providers must follow state specific guidelines for telehealth billing.

Office-based physicians should use their usual place-of-service (POS) code to be paid at the non-facility rate for telehealth services and add modifier 95 to telehealth claim lines. Telehealth services billed using POS code 02 (telehealth) will be paid at the facility rate.

Any provider claim with a date of service beginning 3/17/20 through 6/30/20 will have $0 member liability.

Any provider claim with a date of service beginning 3/17/20 through 6/30/20 will have $0 member liability applied.

However, any provider claim with the following modifiers regardless of location will also be in scope:

  • Modifier 95
  • Modifier GT
  • Modifier GQ

Office-based physicians should use their usual place-of-service (POS) code to be paid at the non-facility rate for telehealth services and add modifier 95 to telehealth claim lines. Telehealth services billed using POS code 02 (telehealth) will be paid at the facility rate.

No. If you have access to virtual health visits in your practice already, please simply continue to utilize that service.

However, Centene has partnered with two telehealth vendors, Babylon and Teladoc, to deliver virtual care to our members so that they may avoid public spaces without foregoing needed care.

While CMS has approved the use of any telephonic or video channel to deliver virtual care, we are encouraging our providers to contract with one of our vendor partners.

Participation in a formal telehealth platform serves both to protect patient privacy through secure connections, as well as give providers training on best practices related to delivering care remotely.

Please contact Teladoc directly to begin the contracting process:

Teladoc

888-835-2362 (Option 5)

teladoc.com/providers

The timeline to implement virtual visits, which normally takes 4-6 months, could be implemented in 18 to 53 days depending on the regulatory environment, provider network and other state-specific factors.

Any clinician that is permitted to bill Medicare for evaluation and management (E&M) codes can bill for telehealth services. Distant sites (where the clinician is located) can include any health care facility including FQHCs and rural clinics. Home health agencies cannot bill for telehealth. Hospices can only bill for telehealth for their recertifications.

Prevention & Staying Healthy

Be alert for patients who meet the criteria for persons under investigation and know how to coordinate laboratory testing.

Review your infection prevention and control policies and CDC's recommendations for healthcare facilities for COVID-19.

Know how to report a potential COVID-19 case or exposure to facility infection control leads and public health officials.  Contact your local or state health department healthcare providers to notify local or state health department in the event of a person under investigation for COVID-19.

Refer to the Centers for Disease Control and Prevention (CDC) and the World Health Organization for the most up-to-date recommendations about COVID-19, including signs and symptoms, diagnostic testing, and treatment information.

Decrease exposure to other sick individuals.

Use hand hygiene and other steps to decrease the spread of any communicable illnesses.

  • If you are running a fever, you should not be in close contact with other people.
  • Cover your nose and mouth with a tissue when you cough or sneeze.
  • Wash your hands often with soap and water or products with 60% alcohol.

Refer to the Centers for Disease Control and Prevention (CDC)’s website for up-to-date guidance.

According to the CDC, the best way to prevent illness is to avoid being exposed to this virus. Stay home except to get medical care, and separate yourself from other people and animals in your home.

According to the CDC, if you develop a fever and symptoms of respiratory illness, such as cough or shortness of breath, within 14 days after travel from China or other infected areas, you should call ahead to a healthcare professional and mention your recent travel or close contact.

According to the CDC, if you have had close contact with someone showing these symptoms who has recently traveled from infected areas, you should call ahead to a healthcare professional and mention your close contact and their recent travel. Your healthcare professional will work with your state’s public health department and the CDC to determine if you need to be tested for COVID-19.

People who think they may have been exposed to COVID-19 should contact their healthcare provider immediately.

Healthcare providers should follow appropriate testing protocols and notify any necessary local and/or state health department authorities if case is of suspected diagnosis.

Common sense measures are essential to controlling the spread of the disease. These steps are helpful to reduce the spread of any communicable virus, such as:

  • Try to avoid close contact with sick people.
  • While sick, limit contact with others as much as possible to keep from infecting them.
  • If you are running a fever you should not be in close contact with other people.
  • Cover your nose and mouth with a tissue when you cough or sneeze. After using a tissue, throw it in the trash and wash your hands.
  • Wash your hands often with soap and water. This simple measure is the most effective method to control the spread of many viral illnesses. If soap and water are not available, use an alcohol- based hand rub.
  • Avoid touching your eyes, nose and mouth.
  • Clean and disinfect surfaces and objects that may be contaminated with germs thoroughly and often.
    • Wear gloves during cleaning
    • Include high-touch surfaces such as tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, sinks, etc.
    • Clean the area or item with soap and water or another detergent if it is dirty.
    • Use an EPA registered disinfectant or diluted bleach solution (i.e. 5 tablespoons (1/3rd cup) bleach per gallon of water), or alcohol solutions with at least 70% alcohol.
  • Maintain social distancing recommendations by local, state, and federal governments.

People can fight stigma and help others by providing social support.

Counter stigma by learning and sharing facts such as:

  • Viruses do not target specific racial or ethnic groups
  • How COVID-19 actually spreads

Take care of your body. Take deep breaths, stretch or meditate.

Connect with others. Share your concerns and how you are feeling with a friend or family member. Maintain healthy relationships and a sense of hope and positive thinking.

Share the facts about COVID-19 and the actual risk to others. People who have returned from areas of ongoing spread more than 14 days ago and do not have symptoms of COVID-19 do not put others at risk.

For more information, see the CDC’s suggestions for mental health and coping during COVID-19