Provider Resources

To help members, providers, and brokers access the last information, we have compiled – and will continue to update – a variety of resources for your reference.

URGENT COMMUNICATION RE: COVID-19

Our Fellow Colleagues:

The COVID-19 pandemic is a rare circumstance and great opportunity for us to fulfill our sacred obligation to help our patients and do our part to flatten the incidence curve and protect our friends, our families, and ourselves. The safety and wellbeing of our fellow healthcare providers are our most important priorities. With that goal in mind, we have been regularly monitoring developments.

The Center of Disease Control (CDC) is providing daily updates and recommendations regarding protecting all patients and healthcare workers. We wanted to take a moment to assist our providers with the most salient CDC recommendations for all of us to know:

Before Office Visits:

  • Remind entire staff to follow universal precautions with all patients assuming anyone can be affected
  • Practice diligent hand hygiene and wash hands for 20 seconds before and after every patient encounter, cover up cough/sneeze with Kleenex and dispose of immediately, socially distance staff 6 feet from each other when feasible
  • Remove magazines, toys, or any other shared items from the waiting areas
  • Contact patients prior to scheduled routine appointments to re-schedule if they are having symptoms in order to avoid spreading any virus contagion
  • Advise patients to call and re-schedule routine appointments if they develop symptoms
  • Post Alert Signs at facility entrance to passively screen for respiratory illness (see enclosed example) and advisory signs at reception desk and wash room entrances on proper handwashing technique (see enclosed example)

Patients Who Are Ill And Call Office:

  • Screen for potential COVID-19 infection:
    • Fever, cough, shortness of breath
    • Recent travel or close contact with affected patient
  • Consider telemedicine services via electronic communications (separate memo pending)
  • Advise at risk patients with symptoms who call office to contact the local Health Department hotline for disposition (559) 600-3332

Patients Who Are Ill And Arrive At Office:

  • Post Alert Signs to advise at risk symptomatic patients to avoid entering your waiting room and spreading possible contagion
  • When an at-risk symptomatic patient shows up for medical care in the office:
    • immediately provide a face mask to the patient (if available)
    • room the patient in an isolation room
    • limit the number of staff and visitors exposed to patient – log exposure risk and maintain record
    • interact with patient while wearing a properly fitted facemask and personal protective equipment (if available)
    • provide appropriate medical care as indicated
    • contact the local Health Department hotline for disposition
    • follow Health Department recommendations – generally they will have the patient tested at their drive-by testing facility or will have a provider meet patient at their home and will properly quarantine appropriate patients
    • After patient exits the room, conduct surface disinfection while continuing to wear protective equipment, and then disposing as per usual medical waste practice
  • If patient is deemed stable, then have patient remain home and advise to self-isolate themselves, until test results are known, and feeling better, and cleared by provider
  • If EMT transport is deemed necessary, contact 911 and inform them that a suspected case of COVID-19 needs transport so that they can take appropriate precautions
  • If Emergency Room care is deemed necessary, refer to the nearest ED and contact the ED to alert them to take the appropriate precautions for suspected case of COVID-19

Take Time To Educate Your Staff:

  • Educate your team about the facts of the COVID-19 outbreak. Reassure your team that you are working to help provide a safe workplace for them.
  • Less than 1-4% of at-risk symptomatic patients who are tested actually have a COVID-19 infection. The remaining have other causes of their respiratory illness e.g. cold or flu.
  • The most recent incidence curve from the CDC:

Remember New Government Mandates:

  • Waiver of Cost-Sharing Amounts – No Co-Pays, Coinsurance or Deductibles for all medically necessary screening and testing related to COVID-19
  • Ensuring Members Have Timely Access to Care – No balance billing for all medically necessary related services and treatment related to COVID-19 AND no Prior Auth required for all medically necessary related services and treatment related to COVID-19
  • CDC has provided official coding guidance related to COVID-19 encounters listed below:
    • Any related confirmed services should include diagnosis code of B97.29
    • Any related possible exposure to COVID-19
      • Z03.818, Encounter for observation for suspected exposure to other biological agents ruled out
      • Z20.828, Contact with and (suspected) exposure to other viral communicable diseases
    • Diagnosis Code B34.2, Coronavirus infection, unspecified, must not be used to code for COVID-19

Meeting and defeating this pandemic are a responsibility of our entire society collaborating together with each of us doing our part. The tactics that have been shown to be most successful are being deployed widely across our country. Social distancing, proper hygiene, careful evaluation of persons under investigation, and containment will flatten the incidence curve and hopefully shorten the duration of the outbreak.

Thank you for your ongoing compassion and dedication in the care of our mutual patients.

Michael Synn signature

Michael Synn, M.D.
Chief Medical Officer
Santé Health Systems

Tom Utecht signature

Tom Utecht, M.D.
Chief Quality and Medical Officer
Community Medical Centers