COVID-19 FAQ

This page is continually growing, and is divided into the following sections:

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LEGISLATION FAQ

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ARE OPTOMETRISTS CONSIDERED HEALTH CARE PROVIDERS UNDER HR6021?

This is a very complex answer.  Under the Department of Labor optometrists are classified as health care providers just like MDs.  When they wrote HR6021, they referenced a definition of health care provider inside FMLA that applies to who can determine if an employee has a qualifying reason to collect FMLA.  That definition in standard FMLA is restricted to MD/DO.  The Department of Labor has hence ruled related to the coronavirus crisis, optometrists are considered healthcare providers just like MDs, even regarding the ability to determine if an individual should isolate or quarantine.

This clarification has nothing to do with the ability of any employer with less than 50 employees to ask for an exemption from the law based on financial hardship to the business.

HOW DOES THE RECENT TEXAS ORDER FROM GOVERNOR ABBOTT AFFECT EYE CARE?

 Governor Abbot's recent order was focused on doctors performing elective surgeries in hospitals or in a situation where complications could lead to hospitalization of the patient.  These two scenarios would strain the hospital capacity to deal with admissions related to COVID-19.  It does stress the recommendation that all doctors should be evaluating each patient that contacts them and making a prudent decision whether the care is necessary now or can be delayed.  The term "routine exams" is thrown around a lot and we should probably be more specific.  Most "routine exams" would not be considered essential or medically necessary at this time e.g. "I just want a new pair of glasses, I'm doing fine but our of contact lenses".  Someone who calls with significant vision concerns, lost their glasses, etc - those could actually end up a "routine exam" but evaluating them and solving their functional vision problem could certainly be considered essential.  When a patient calls for help, we should be spending a bit more time asking them more specifics about their needs and making appropriate decisions regarding when they need to be seen. 

WHAT ABOUT THE STAY AT HOME ORDERS IN OTHER STATES?

 Many states have issued stay at home, shelter in place or other similar rulings.  We know of no state order mandating health care providers to close their offices.  Optometrists provide essential vision and eye care services to the public.  Each doctor needs to decide what services would be essential and if they personally want to provide those services.  The profession in general should remember that this still is an individual physician decision and be respectful of how we all elect to address our role in this crisis. 

EMPLOYER FAQ

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PAY, FURLOUGH, OR LAY OFF – WHAT ARE THE BEST OPTIONS IF I CHOOSE TO CLOSE OR REDUCE HOURS?

Other than the point that all actions must be made inside the law and without discrimination, there is no real answer to this question.  Each employer must look at their business, decide what they want to do or can do for their employee and then make an individual decision that works for them.  Here are a few options to consider with some pros and cons.

     Close the office completely and lay off all hourly employees.

          PROS

  • Maximum and immediate reduction in employee expenses which is likely the or one of the largest practice expenses
  • If done before April 1, 2020, reduces or likely eliminates all obligations from State or Federal paid time off laws (see our post “Emergency Legislation HR 6021”)

          CONS

  • Creates largest burden for employee
  • Doesn’t feel good
  • Lay off is a termination of employment. It will still be your choice if you wish to simply reinstate employees or go through standard re-hire process once you start back toward full operations.
  • You still have to pay your salaried employees


     Close the office and furlough all hourly employees

          PROS

  • Maximum and immediate reduction in employee expenses which is likely the or one of the largest practice expenses

          CONS

  • If they are still technically employees this may not reduce or eliminate obligations from State or Federal paid time off laws
  • Creates largest burden for employee
  • Doesn’t feel good
  • Although there is no legal delineation of “furlough”, most consider this denotes a temporary situation more like a leave of absence but not receiving pay at this time, typically for economic reasons. The choice to reinstate or re-hire will still be the employers.
  • You still have to pay your salaried employees

     Try to maintain some pay to employees until you can build back to full operations

          PROS

  • Feels good
  • Provides some economic benefit to employees during the crisis
  • There are likely ways to achieve your goal without maintaining full employee status – reduced hours, maintaining a skeleton staff, etc. You can also consider providing them a large bonus in conjunction with a lay off or furlough.

          CONS

  • Largest economic burden on the employer
  • If they remained employed on April 1st and are entitled to all applicable benefits under HR6021
  • There is no magic or predictable time frame when this may resolve. It is likely NOT two weeks which has become an arbitrary standard for how long employers are trying to keep paying employees. Consider what your next step will be at the end of whatever continuation period you decide.

In the final analysis each business owner has to make a hard decision that is a balance that spreads the hurt out in a manner they can live with.

IS IT OK TO FURLOUGH AN EMPLOYEE SO THEY CAN KEEP THEIR INSURANCE AND RETIREMENT BENEFITS?

See the prior question on layoff vs furlough.  In some cases, furlough is recognized in the manner most look at it – the individual is still your employee just not receiving pay at this time.  Health care insurance and retirement plans may not agree. In many cases, whether you call it laid off or furloughed, your action will trigger a COBRA event.   You should check with your individual policies to see if your actions are allowed.  

CAN I MAKE MY EMPLOYEES USE THEIR ACCRUED TIME OFF IN LIEU OF THE REQUIREMENTS UNDER HR6021?

No.  Benefits under HR 6021 cannot be substituted by existing paid time off.  Again, this would only be for action taken after April 1st.  Prior to that time, and pending what your employee policies state, you have every right to ask them to use or allow them to use accrued paid time off during a mandated closure or reduction in hours.  You can likely even deviate from your employee policies given the crisis nature of this event but deviations must be uniformly applied to ALL employees – no potential discrimination.

CAN I ASK MY EMPLOYEES TO PERFORM SOME WORK AT HOME (WORK ON THE A/R, WORK ON INSURANCE)?

You can but we consider this a very bad idea unless the employee is exempt.  If you have laid off the employee, you can contract with them for part-time work at a negotiated rate for work at home – make this a short formal signed agreement that spells out the terms of what they are expected to do, how their time will be recorded and how you will pay them.  In most cases this would be an ill-advised action but we are in different times.

WHAT IF I DO NOT LAY THEM OFF BUT REDUCE THEIR HOURS AND ALLOW THEM TO DO ALL THEIR WORK FROM HOME

 See previous answer. You still should have a short agreement with them clearly stating the terms of the arrangement. You also have to avoid discrimination issues e.g. allowing some to work and not others. Make sure that what you are allowing them to do is a specific function for which they are uniquely competent and not something anyone in the office can do. Also consider looking into any shared work options under your state’s unemployment system.

CAN MY EMPLOYEE WHO IS NOW ON UNEMPLOYMENT UNDER FULL LAYOFF DO ANY PART TIME WORK FOR ME?

They can. They are directed to report any wages earned while they are collecting unemployment and it is likely that those amounts may be deducted from their unemployment benefits.

A FULL TIME EMPLOYEE GOT A TEMPORARY JOB ELSEWHERE. ONCE I GET THE PPP LOAN, DO I STILL PAY THEM?

An employee working full time somewhere else should not be included in the PPP loan 

IF MY ASSOCIATE DOCS APPLY FOR UNEMPLOYMENT WILL THEIR HIGH WAGES CAUSE A LARGE INCREASE MY TAXES?

In most states, the amount an individual can receive for unemployment has a cap.  High wage earners are typically not provided anywhere close to their usual wages under the unemployment system.

WITH THE $600 UNEMPLOYMENT BONUS MY EMPLOYEE MAY MAKE MORE, HOW WILL I GET THEM TO COME BACK TO WORK

Retention of unemployment benefits requires that the individual be ready and willing to work if work is available.  If you notify them they have a job waiting and they refuse to come back to work, their benefits will be terminated. 

IF I CLOSE ON OR AFTER APRIL 1 BECAUSE I CAN'T AFFORD TO STAY OPEN, DOES HR6021 STILL APPLY?

Closing a business due to economic impact is not a “qualifying event” under HR6021 and therefore does not apply. Any qualifying event that were to occur from April 1 to the time you close would apply. 

ARE WE RESPONSIBLE FOR 2 WEEKS OF SICK PAY &THE 120 DAY REQUIREMENT IF WE LAY AN EMPLOYEE OFF BEFORE

The FMLA extension benefits afforded in the Families First Coronavirus protection act still contain the rule that the employee must have been on the job thirty (30) days prior to claiming benefits under FMLA (including the extension).  Technically the employee would have to return to work for thirty days before accessing the FFCRA benefit.  The benefits under unemployment would normally require the same but the CARES act makes clear most all restrictions for unemployment access should be viewed with leniency.  The employee is likely eligible when she returns to work in this scenario but the bottom line is you will need to check with TWC for the best answer.

I HAVE AN EMPLOYEE ON MATERNITY LEAVE, DUE BACK MID-APRIL. WHEN IS SHE ELIGIBLE FOR UNEMPLOYMENT?

The FMLA extension benefits afforded in the Families First Coronavirus protection act still contain the rule that the employee must have been on the job thirty (30) days prior to claiming benefits under FMLA (including the extension). Technically the employee would have to return to work for thirty days before accessing the FFCRA benefit. The benefits under unemployment would normally require the same but the CARES act makes clear most all restrictions for unemployment access should be viewed with leniency. The employee is likely eligible when she returns to work in this scenario but the bottom line is you will need to check with TWC for the best answer.

WORKPLACE safety FAQ

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WHAT IS A REALISTIC APPROACH FOR MASKS, GLOVES, SANITIZERS FOR INTERACTING WITH PATIENTS

 Practice guidelines can be found here 

WHAT IF EMPLOYEE TESTS POSITIVE FOR COVID-19 WITHIN ARBITRARY 14-DAYS AFTER I LAID THEM OFF

If the layoff occurred prior to April 1, 2020, you have no obligations under that law.  The employee likely has benefits under any health insurance you provide or they have individually.  They are also likely to have rights afforded under the worker’s compensation program (varies by state law). 

AN EMPLOYEE HAS BEEN COMING TO WORK BUT THEIR SPOUSE JUST TESTED POSITIVE FOR COVID? WHAT DO I DO?

The staff member should stay home and maintain quarantine for fourteen days.  If this occurred prior to April 1, 2020, you have no obligation to pay them for anything except what is stated in your employee manual.  If after April 1, 2020, the employee could claim benefits under Families First Coronavirus Recovery Act.

I HAVE AN EMPLOYEE WHO HAS BEEN ON VACATION. CAN I ASK THEM TO SELF-ISOLATE? DO I HAVE TO PAY THEM?

Unless the employee meets one of the qualifying events under HR6021 (refer to our post on this issue), no obligations exist under HR6021.  You could pay them, not pay them or allow them to use any additional paid time off they have accrued.  You also have the right to ask them to be tested before returning to work.

MY EMPLOYEE DOES NOT WANT TO WORK B/C THEY FEAR THEY WILL CONTRACT THE VIRUS. CAN I FORCE THEM

There is no clear answer to this question.  This is not a qualifying event under HR6021 so it would not apply.  The employee likely does have rights under OSHA which does allow an employee to refuse to come to work.  Even if you consider their concern to not be an imminent threat to serious harm as defined under OSHA and feel you can force them to work, consider if this might be the wrong action. 

IF AN EMPLOYEE OR ASSOCIATE IS SELF ISOLATING, DO I LAY THEM OFF OR PAY THEM?

Until we have all the details of CARE Act it is hard to say.  Even then this will be a decision that likely can only be made after review of all your individual employee, tax and business specifics by a qualified accountant and possibly legal counsel.  it just inst as simple as everyone would like it to be. 

EMPLOYEE FAQ

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ARE EMPLOYED OPTOMETRISTS ELIGIBLE FOR PAID SICK LEAVE AND FMLA EXPANSION BENEFITS?

The original working of FFCRA related to the definition of health care providers was confusing for sure.  The Department of Labor just recently released clarification on this issue citing a very broad definition of what constitutes a health care provider.  An optometrist would definitively be included in that designation.  It is still up to the owner optometrist to decide if they want to allow their employees to be eligible for those benefits or exclude them.

IF MY WORK-SITE CLOSES ON OR AFTER APRIL 1, BUT BEFORE I GO ON LEAVE, CAN I GET SICK PAY OR FML?

No. If your employer closes after the FFCRA’s effective date (even if you requested leave prior to the closure), you will not get paid sick leave or expanded family and medical leave but you may be eligible for unemployment insurance benefits. This is true whether your employer closes your worksite for lack of business or because it was required to close pursuant to a Federal, State or local directive. You should contact your State workforce agency or State unemployment insurance office for specific questions about your eligibility. For additional information, please refer to https://www.careeronestop.org/LocalHelp/service-locator.aspx

IF MY EMPLOYER CLOSED MY WORKSITE BEFORE APRIL 1, CAN I STILL GET PAID SICK LEAVE OR FML?

No. If, prior to the FFCRA’s effective date, your employer sent you home and stops paying you because it does not have work for you to do, you will not get paid sick leave or expanded family and medical leave but you may be eligible for unemployment insurance benefits. This is true whether your employer closes your work site for lack of business or because it is required to close pursuant to a Federal, State, or local directive. You should contact your State workforce agency or State unemployment insurance office for specific questions about your eligibility. For additional information, please refer to https://www.careeronestop.org/LocalHelp/service-locator.aspx

WHAT IS THE EFFECTIVE DATE OF THE FAMILIES FIRST CORONA VIRUS RESPONSE ACT?

The Families First Coronavirus Response Act (FFCRA), which includes the Emergency Paid Sick Leave Act and the Emergency Family and Medical Leave Expansion Act provisions are effective on April 1, 2020, and apply to leave taken between April 1, 2020, and December 31, 2020.

I AM AN EMPLOYED OD. DO I HAVE TO RELY ON MY EMPLOYER TO GET PPP ON MY BEHALF?

PPP loans are not applicable to employees.  As an employee, you will either be paid by your employer regardless of their actions regarding a PPP loan or if you are laid off or have your hours significantly reduced you can apply for unemployment benefits.

AS AN ASSOCIATE DOC IN TEXAS WITH A BASE SALARY PLUS PRODUCTION, HOW DOES UNEMPLOYMENT WORK?

Reduction in past wages is one of the eligibility requirements and the basis of your potential unemployment benefit amounts. Texas uses the taxable wages, earned in Texas, your employer(s) have reported paying you during your base period to calculate your benefits.

BUSINESS OWNER FAQ

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IF I PAY MYSELF PARTIALLY WITH A W-2 AND THE REST FROM SUB S PROFITS CAN I FILE FOR UNEMPLOYMENT?

All wages, salaries and commissions, and any employee receiving a W-2 may be counted but high wage earners applicable wages are limited to $100,000.

CAN I APPLY FOR AN EIDL LOAN AS A 1099 INDEPENDENT CONTRACTOR AND FOR MY OWN OFFICE?

As of April 3, 2020, SBA ruling states that independent contractors may not be counted in the owner’s payroll.  Independent contractors are allowed to file for their own PPP loan.

Your 1099 status and your owner status are separate as long as the practice is not paying you as a 1099 contractor.  There is no guidance on whether each entity can apply for benefits but it appears you can.

CAN CORPORATE OWNERS OR INDIVIDUALS NOT EMPLOYED FOR CERTAIN LENGTHS OF TIME ACCESS UNEMPLOYMENT?

Yes.  Under the Pandemic Unemployment Act most all prerequisites and other conditions for employment are removed.  Those requirements are typically state law specific but the CARES Act action supersedes those regulations.  At this time, the Department of Labor has not provided instructions to the states on how to process these types of requests for unemployment benefits. Given this, it is possible if the individual applies now they could be denied.  Further directions on this issue should be forthcoming from the DOL.

WHAT IF THE OWNER PAYS THEMSELVES WITH DISTRIBUTION (K-1) INSTEAD OF W2? ARE WE COVERED?

You are not covered under the SBA loan programs specific to the CARES Act (PPP) but you are still eligible for standard SBA loans.  You are eligible for unemployment under the Pandemic Unemployment benefit under CARES. 

IF I’M A SOLE PROPRIETOR NOT CURRENTLY WORKING AND GET APPROVED FOR A PPP LOAN, SHOULD I PAY MYSELF?

Yes.  You are like another employee in this case.  Your documentation of payment to yourself would be your W-2 or if you do not get a W-2 documentation of any disbursements of funds to you from your account. 

SBA LOAN FAQ

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THE SBA SYSTEM KEEPS CRASHING, BANK SAY THEY ARE NOT READY. HOW DO I APPLY?

The SBA is obviously completely overwhelmed with applications for loans related to the coronavirus crisis.  No system would have been build to withstand this kind of activity.  Despite encouragement from the SBA to utilize the online application portal, you may consider it advantageous to work through your local bank.  The Treasury Department released the regulations for these loans and processing instructions on March 31, 2020.  It states the banks may start taking applications for most business owners on April 3. 2020.  This predominantly relates to the PPP loan – the EIDL loan application is typically online.

WHAT ARE THE SBA LOAN REPAYMENT TERMS?

The law stated the Administrator could set terms at no more than 4% and no more than 10 years.  On March 31, 2020 the Treasury Department released the regulations setting the interest rate for these loans at 1.0% and the payout of no more than two years.

PPP LOAN FAQ

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IF I AM A PRACTICE OWNER WHO ONLY TAKES DRAWS - NO W2- CAN I INCLUDE MYSELF IN THE PPP CALCULATIONS?

Yes.  You are considered a sole proprietor and are eligible for all the benefits under the CARES Act.  The payroll you would attribute to yourself is the amount on your 2019 Schedule C, limited to the first $100,000.

IF I OFFER TO REHIRE A LAID OFF EMPLOYEE AND THEY REFUSE, DOES IT AFFECT PPP FORGIVENESS

No. The SBA and Treasury intend to issue an interim final rule excluding laid-off employees whom the borrower offered to rehire (for the same salary/wages and same number of hours) from the CARES Act’s loan forgiveness reduction calculation. The interim final rule will specify that, to qualify for this exception, the borrower must have made a good faith, written offer of rehire, and the employee’s rejection of that offer must be documented by the borrower. Employees and employers should be aware that employees who reject offers of re-employment may forfeit eligibility for continued unemployment compensation.  

TO GET FORGIVENESS WHAT DO I NEED TO DO WITH RETAINMENT OF EMPLOYEES AND ASSOCIATES?

This is a very complex decision based on your individual practice.  There are many opportunities for assistance with loans, tax credits and other benefits.  It is also dependent on much you want to keep your business open for essential care during the crisis.

HOW DO I CALCULATE THE NUMBER OF EMPLOYEES FOR FORGIVENESS

It is VERY confusing.  CARES did not clearly define full-time (FT) well but very recent Treasury guidance did.  For loan calculation, FT is not a traditional SBA amount. For PPP loan amount calculation, it is a straight head count "individuals employed on a full time, part time or other basis".  Someone working 5 hours a week is part of the head count and counts as 1.  For forgiveness, the calculation uses "full time equivalent" (FTE) which for CARES was clarified to be the total number of people working 30 hours or more  plus the total hours of employees not working 30 hours or more divided by 30 (for one week or like 240 if counting for eight weeks). 


EXAMPLE: FTE calculation.  During the eight week period of your loan amount you have ten employees that work 30 hours a week or more, two employees that each work 20 hours a week and two employees that work 10 hours a week.  The FTE for the part time workers is their total hours during the eight week period (20+20+10+10=60) times the number of weeks in the calculation period (8X60=480) divided by number of potential FT hours during the same period (30 x 8= 240 so 480/240=2).  Your FTE is the 30 employees working 30 hours a week or more PLUS two more FTEs from your part time workers.  For more info, see:  https://practicecompliancesolutions.com/blog/f/calculation-of-ppp-forgiveness 

WHAT IF YOU ARE NO LONGER PAYING AN EMPLOYEE >100K AFTER APRIL 1? DOES THAT AFFECT 7A LOANS?

 The loan forgiveness amount is a very complex calculation based on payroll expenses as incurred during the time period one year before the date of the loan application.  But this as everything in CARES could change with final passage. 

IS THERE ANY REASON NOT TO APPLY FOR THE PPP LOAN?

While PCS cannot make specific recommendations regarding your business operations, it seems logical that everyone would want to consider taking out a PPP loan.

HOW CLOSELY WILL THE LENDER MONITOR USE OF PPP FUNDS?

Expect extreme scrutiny of your loan proceeds usage.  Some experts advise you create a separate expense accounting system that could easily be provided upon request.

DO YOU RECOMMEND SETTING UP A SEPARATE BANK ACCOUNT (WITHIN YOUR BANK) TO HANDLE YOUR PPP LOAN?

You do not have to do this, but it is an excellent way to document, sort, and track activity. 

WHEN DOES THE PPP LOAN GO IN EFFECT - WHEN THE MONEY IS RECEIVED OR WHEN I ELECT TO USE IT?

The PPP loan period starts on the funding date of the loan and continues for the next eight weeks.  The only control you have over when the eight weeks begins is based on when you decide to file for the loan and if you can ask your lender to assist in controlling the funding date.

SHOULD I APPLY FOR A PPP LOAN IF I WILL NOT HAVE STAFF BACK IN THE OFFICE UNTIL JULY?

PPP is designed to help you continue to pay your employees, If employees are re-hired at initiation of loan, any reduction in forgiveness will be limited to how much your expenses were reduced compared to the prior year period.  The loan will also assist in payment of certain applicable operation costs like rent, utilities, etc.  The logic of your question is sound.  The best scenario is to obtain funding at a point you can best guess will coincide with a time business will be heading back to normal.   Otherwise for the most part you are funding a payroll of a mainly empty staff that could have been on unemployment.

WHAT DOCUMENTATION WILL BE REQUIRED FROM THE BANK TO PROCESS A PPP LOAN?

The CARES Act places the decision of what documentation is required with the lender.  As a rule, these are the things you might consider gathering before you apply:  

  • Articles of Incorporation/Organization of each borrowing entity
  • By Laws/Operating Agreement of each borrowing entity
  • All owners Driver’s Licenses
  • Payroll Expense verification documents to include:
  • IRS Form 940 and 941
  • Payroll Summary Report with corresponding bank statement
  • If a Payroll Summary Report is not available, Employee Pay Stubs as of February 15, 2020 (or corresponding period) with corresponding bank statement, and,
  • Breakdown of payroll benefits (vacation, allowance for dismissal, group healthcare benefits, retirement benefits, etc.
  • 1099s (if Independent Contractor)
  • Certification that all employees live within the United States. If any do not, provide a detailed list with corresponding salaries of all employees outside the United States 

ARE PPP FUNDS COUNTED AS INCOME FOR TAX PURPOSES?

No.  The IRS has ruled that you will not be able to deduct the PPP loan repayment as an expense for income tax purposes.

EIDL LOAN FAQ

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IF I APPLIED FOR AN EIDL LOAN BEFORE MAY 30TH SHOULD I REAPPLY?

If you have received confirmation of your application you should do nothing.  If you have not received confirmation, contact SBA for a status report before making a second application.  What you do not want to do is have two EIDL loan requests operational at the same time.

IF AN INDEPENDENT CONTRACTOR APPLIED FOR UNEMPLOYMENT, DO YOU WAIT FOR A DENIAL TO APPLY FOR EIDL?

The SBA loan process/benefits and the unemployment system are unrelated.  Your decision to apply for one, both or none would be based on your individual financial needs and how much available cash you want.

CAN WE GET BOTH A DISASTER LOAN (WITH NO FORGIVENESS) AND THE 7A LOAN WITH POSSIBLE FORGIVENESS?

 As written right now yes you can.  But any monies you receive from your EIDL disaster loan will be deducted from  the forgiveness amount awarded on the SBA loan.

CAN I APPLY FOR THE EIDL LOAN, GET THE $10,000 ADVANCE AND SAY THAT I DON’T WANT THE LOAN?

According to recent posts on the SBA website, the answer is yes.

IF I USE THE EIDL LOAN TO PAY FOR DIFFERENT EXPENSES THAN THE PPP LOAN WILL IT TAKE AWAY FR?

Several questions.  First, you cannot use EIDL for exactly the same thing as your PPP funds or it will decrease the amount of your PPP forgiveness.  If you have both loans, use the PPP funds as much as possible for direct payroll costs and the EIDL funds for other allowed expenses (rent, utilities, etc).  Second, you cannot “roll” your EIDL loan into your PPP loan unless you received you EIDL funds prior to April 1, 2020.

SHOULD I USE THE EIDL LOAN TO PAY FOR DIFFERENT EXPENSES THAN THE PPP LOAN?

You cannot use EIDL for exactly the same thing as your PPP funds or it will decrease the amount of your PPP forgiveness.  If you have both loans, use the PPP funds as much as possible for direct payroll costs and the EIDL funds for other allowed expenses (rent, utilities, etc).  

CAN THE EIDL LOAN AMOUNT BE ROLLED INTO THE PPP LOAN?

You cannot “roll” your EIDL loan into your PPP loan unless you received you EIDL funds prior to April 1, 2020.

TELE-HEALTH FAQ

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I AM CONFUSED ON WHICH TELE-SERVICE CODES I SHOULD USE – CAN YOU TELL ME WHICH ONES I CAN USE?

Under CMS and most state board rulings, optometrists have access to ALL FOUR of the tele-service codes.  The key points to remember in selecting the most applicable code would be:

  1. The virtual sign in services (G2010 and G2012) must be initiated by the patient and requires patient authorization before the service is provided.  This is a short communication where you are simply “checking up” on the status of the patient.  Reimbursement for this service is low.
  2. Telephone services (99441-2) are on time telephone communications that can be initiated by the physician.  These codes are not usually paid by CMS but have been authorized during the COVID crisis. 
  3. On-line digital services - also referred to as E-visits by some (99421-3) were originally restricted to EMR portal communications but the requirement has been eased to include other two way forms of communication.  These are based on time you spend communication with the patient.  The time is cumulative over seven days and you do not bill until then or when the encounter is deemed complete.  Reimbursement of this service is low.
  4. Telehealth services (utilizing standard E&M codes) apply to remote evaluation of a patient concern.  These are likely the codes to consider in cases like this crisis where a patient has a red eye or other acute symptom and you want to evaluate the potential for management remotely or recommending an in-office evaluation.  


Refer to the PCS post on telehealth services for more information.


WHAT PLACE OF SERVICE CODE DO I USE?

Recent rulings state that for the place of service code we should use the location where the face to face care would have occurred (almost always the office – 11), not the usual -02 for telehealth services. 

WHAT MODIFIER DO I USE?

All telehealth service codes should be followed by the -95 modifier.

DOES ANYONE HAVE A GOOD PROGRAMS FOR TELEHEALTH?

There are several good solutions on the market including:

Also note that during the COVID crisis CMS rules have been relaxed allowing the use of Non-HIPAA compliant platforms in Telehealth during the COVID crisis as long as they are not public facing. Examples include: Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Whatsapp video chat, Skype. This means you could provide telehealth with as little as a cell phone and access to your EMR.

CMS FAQ

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IN APPLYING FOR THE MEDICARE ADVANCED PAYMENTS, DO I USE THE GROUP PTAN?

There is nothing we have seen in print to confirm this.  What we do know is solo practitioners who have submitted using the individual  Provider Transaction Access Number (PTAN) have been approved and those in multi-doctor locations using the group PTAN have been approved. Multi-doctor locations using each individual doctor PTAN have NOT been approved.

How do I apply for the HHS grant?

The first payment will be automatically deposited into your bank account. Once you receive that payment you have to have attest that you received it at:  https://covid19.linkhealth.com/#/step/1.  

After you have attested to 1st payment, go to  https://chameleoncloud.io/review/2977-5ea0af98f0fd0/prod

  • Scroll down to the bottom to where it says "how to apply". 
  • Click on the picture. 
  • Click on "Access the portal" 
  • Click "General Distribuition Portal". 
  • It will have you update bank information, file out W9 info, input gross revenue from the last tax filing and lost revenue for March 2020 and April 2020. You will also have to upload the 1120S form from last tax filing and then sign the forms.