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.