"Not all patients with COVID-19 require hospital admission"
Q: Do patients with confirmed or suspected COVID-19 need to be admitted to the hospital?
A: Not all patients with COVID-19 require hospital admission. Patients whose clinical presentation warrants in-patient clinical management for supportive medical care should be admitted to the hospital under appropriate isolation precautions. Some patients with an initial mild clinical presentation may worsen in the second week of illness. The decision to monitor these patients in the inpatient or outpatient setting should be made on a case-by-case basis. This decision will depend not only on the clinical presentation, but also on the patient’s ability to engage in monitoring, the ability for safe isolation at home, and the risk of transmission in the patient’s home environment. For more information, see Interim Infection Prevention and Control Recommendations for Patients with Known or Patients Under Investigation for Coronavirus Disease 2019 (COVID-19) in a Healthcare Setting and Interim Guidance for Implementing Home Care of People Not Requiring Hospitalization for Coronavirus Disease 2019 (COVID-19).
Smart clinic administrators have to come up with an alternative plan than the ancient way of having sick patients waiting in reception areas infecting others.
Yes, it can be super profitable if a home URI monitoring is structured properly. I call it a home URI program because the initial symptoms of a cold, influenza and COVID-19 are similar - with some minor discrepancies.
Medicare is paying super well with it and I believe that if medical providers would approach Blue Cross Blue Shield, UHC, AETNA, CIGNA and others the right way - they would jump on board. What if you were to call your BCBS rep and say "You have a choice. I can send a monitor home with the patient for them to use at home for about half a month or I can hospitalize the patient on the differential or rule out diagnosis of COVID-19. If I hospitalize them, you're paying $30,000 to $80,000. If I send the patient home and have my nurse call the patient every 8 hours, you'll pay a small fraction of that. Will you cover codes 99453 through 99458 and if so - how much for each code?"
Medicare is paying super great on these - as you already know - but what if you structured it so that one of your nurses or MAs were calling the patient every 7 -10 hours (yes, this means someone is going to call at night at 9pm and again the next morning at 7am) and then again at 2pm. When they call, they are only asking the patient "How are you feeling and what has your temp been since the last call?" They already have the pulse and O2 numbers from the portal. They log in each call. You figure each call is 3 minutes per call on average. 9 minutes a day times 15 days = 130 minutes.
You're billing out to the carrier and Medicare's allowed would be:
99453 $ 18.47 set up/training the pt
99454 $ 61.75 providing equipment
99457 $ 50.96 first 20 minutes
99458 x 3 $249.96 Additional 20 minute increments $41.66 x 6
less $ 60.00 Paying your nurse for two hours to call patients at night from home
less $ 46.25 monthly rental on monitoring system
Net $274.89 per patient for half a month
Yes, it makes money, but more importantly is that your patients are being monitored at home, without taking up the space in the office, infecting your staff and other patients. And - it saves the insurance companies $30,000 to $80,000!
If you wish to schedule a time to discuss this or any other monitoring with Don Self, just click on the link below to lock in a time in Don's schedule. The link is my scheduling program.