Advice for Therapy Clinics During the Covid-19 Crisis

At TheraPlan and our sister company, Edwards Electronic Processing, our business has been significantly affected by the threat of Covid-19. We know it’s likely that yours has too. Because we have far-reaching connections within the Florida therapy community, we feel we have a responsibility to compile and provide you with pertinent updates as we become aware of them.

Thus, this is a bit of a different blog post. Following is a bullet-point summary of the advice that Stephen Edwards, our CEO, has been releasing to our Florida therapy community via YouTube video updates over the past few weeks. Please see the end of this post for links to resources that contain the most up-to-date information about this crisis and any new regulations that affect your business.

With this post, we aim to give you realistic answers to your most pressing questions, and we are guiding our community with a conservative approach. The following advice is from a business standpoint, not a patient care standpoint.

If your therapy clinic is still treating patients on-site:
- Implement a no waiting room policy.
  - Use TheraPlan’s text messaging feature to allow patients to wait in their car. This helps you avoid a waiting room scenario and gives your therapists the ability to notify a patient the moment they are ready.
- Disinfect your entire facility at least once per day, and each treatment room between patients.

If you are transitioning to telehealth:
- Make sure your platform is HIPAA compliant. Here are some options:
  - TheraPlatform
  - Skype for Business
  - Zoom (*you must have a business associate agreement with Zoom in order to make this a compliant platform)
  - Doxy.me
  - TheraPlan is looking to add a video platform in the next 30 days. Be sure to follow both TheraPlan and EEP on Facebook for regular updates.
- If you do not already have a list, by therapist, of patients that are eligible for teletherapy, create one! This will require having your admin staff or therapists contact every patient to have them sign a teletherapy acknowledgement and verify that they are willing to proceed. However, this does not mean the payer will pay for therapy in this form. (See below.) Add a patient to your schedule only after you have confirmed these details.
- Consider one patient per payer and see if claims are going through or being denied. If they are denied, you will have to bankroll that payer.
  - Medicaid announced that they are going to cover teletherapy for speech, physical, occupational, and Early Intervention therapy services. This means that MMAs will have to cover it.
  - Florida Medicaid is also going to cover teletherapy.
    - Medicare does not yet cover teletherapy for your provider type.
    - If you are going to treat Medicare Type B patients, they need to be private pay and you must have an ABN (Advanced Beneficiary Notification).
- Start collecting for self pay patients. One way to do this is to have admin staff call those patients that were seen in a given day and take payment over the phone later that same day, not at the time of service. It’s much easier on families to do this on a per session basis rather than to send them a big bill at the end of a month. Billing every day will also help maintain your clinic’s cash flow.
- We advise that you roll out teletherapy strategically and keep a couple things in mind about how this transition is working for insurance companies:
  - Start immediately with Wellcare, MMA, Title 19 and Title 21, because we know that teletherapy goes through their underwriters. You will get paid during the normal billing cycle. If a claim does not go through underwriting, it is not going to get paid.
  - These new billing systems that cover teletherapy could take awhile to be officially set up. It could take 45-90 days to go through an appeal if your initial claim does not go through the correct underwriting process.
  - Many payers have cut down their admin staff.
    - Expect your secondary claims, appeals, and claim status calls to be much longer than normal. We have gotten reports of two-and-a-half-hour wait times already.
    - Expect that payments from secondary insurance providers will also be delayed.

Measures for keeping your therapy clinic afloat during the Covid-19 crisis:
- Seek out government assistance, if it applies to you.
  - The Florida Small Business Administration is offering loans of up to $50,000.
  - The U.S. Small Business Administration is offering a $10,000 expedited payment loan program.
  - The CARES Act could also be a source of funding. You can find out more by contacting your financial institution.

Additional FAQs:
- Can Speech-Language Pathology Assistants (SLPAs) treat patients via teletherapy?
  - From FLASHA, we learned that the answer to this question is yes.
- Where can I get valid information about what’s happening in the therapy industry?
  - To get the latest information about the medical piece of the puzzle, visit www.cdc.gov.
  - For Florida-specific updates, visit the Florida Department of Health’s Covid-19 page.
  - Look to your licensing board for clinical updates.
  - Get insurance updates directly from any payer that you are in network with.
  - Do not seek out information from groups or comments on social media (such as Facebook).
  - Make sure that you comb through any communication to make sure it’s relevant to your provider type. If it is, understand the system still may not be set up yet to pay for that service.
- What should my self pay rate be?
  - We recommend charging $1 per minute for teletherapy, so this can be split 50/50 between the therapist and the providers. Your therapists are likely going to need to take a cut if you are going to reduce the amount it costs for teletherapy. That might not be popular, but it is a reality of having to make payroll.