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COVID-19 Guidance for Providers | Ambetter from Absolute Total Care
Coronavirus disease 2019 (COVID-19) is an emerging illness. Many details about this disease are still unknown, such as treatment options, how the virus works, and the total impact of the illness. New information, obtained daily, will further inform the risk assessment, treatment options and next steps. We always rely on our provider partners to ensure the health of our members, and we want you to be aware of the tools available to help you identify the virus and care for your patients during this time of heightened concern.
- Know the warning signs of COVID-19. Patients with COVID-19 have reported mild to severe respiratory symptoms. Symptoms include fever, cough, and shortness of breath. Other symptoms include fatigue, sputum production, and muscle aches. Some individuals have also experienced gastrointestinal symptoms, such as diarrhea and nausea, prior to developing respiratory symptoms.
- However, be aware that infected individuals can be contagious before symptoms arise. Symptoms may appear 2-14 days after exposure.
- Instruct symptomatic patients to wear a surgical or isolation mask and promptly place the patient in a private room with the door closed.
- Health care personnel encountering symptomatic patients should follow contact precautions, airborne with N95 precautions, and wear eye protection and other personal protective equipment.
- Refer to the CDC’s criteria for a patient under investigation for COVID-19. Notify local and/or state health departments in the event of a patient under investigation for COVID-19. Maintain a log of all health care personnel who provide care to a patient under investigation.
- Monitor and manage ill and exposed healthcare personnel.
- Safely triage and manage patients with respiratory illness, including COVID-19. Explore alternatives to face-to-face triage and visits as possible, and manage mildly ill COVID-19 cases at home, if possible.
- Be alert for patients who meet the criteria for persons under investigation and know how to coordinate laboratory testing.
- Review your infection prevention and control policies and CDC's recommendations for healthcare facilities for COVID-19.
- Know how to report a potential COVID-19 case or exposure to facility infection control leads and public health officials. Contact your local and/or state health department to notify necessary health officials in the event of a person under investigation for COVID-19.
- Refer to the Centers for Disease Control and Prevention (CDC) and the World Health Organization for the most up-to-date recommendations about COVID-19, including signs and symptoms, diagnostic testing, and treatment information.
- Be familiar with the intended scope of available testing and recommendations from the FDA.
This guidance is in response to the current COVID-19 pandemic and may be retired at a future date.
Temporary Marketplace/Commercial Waivers Expiring for Applicable COVID-19 Treatment and Telehealth Services on June 1, 2021
As we continue to address the COVID-19 pandemic, we want to update you on important changes for our Marketplace/Commercial plans. Last year, we instituted temporary member cost share liability and prior authorization waivers for select services to ensure critical care could be quickly delivered to our members during a time of heightened need. On June 1, 2021, these temporary waivers will expire and our members’ Marketplace/Commercial plan benefits will be reinstated for the following services:
COVID-19 Treatment Related Services
- COVID-19 treatment related services (those billed with a confirmed ICD-10 diagnosis code) will continue to be eligible for coverage at this time, in accordance with the member’s plan benefits.
- Beginning June 1, 2021, prior authorization will be required for COVID-19 treatment related services, in accordance with CMS guidance and plan benefits.
- Providers should also resume collecting Marketplace/Commercial member liability at the point of service for applicable treatment related services on June 1, 2021 onward.
All Telehealth Services
- Any services that can be delivered virtually will continue to be eligible for telehealth coverage at this time.
- Providers should resume collecting Marketplace/Commercial member liability at the point of service on June 1, 2021 onward, in accordance with the member’s plan benefits.
- Providers should reflect telehealth care on their claim form by following standard telehealth billing protocols in their state.
- For further coding guidance for telehealth services, we recommend following what is being published by:
Prior authorization requirements and member cost share liability (copayments, coinsurance and/or deductible cost share amounts) will continue to be waived for COVID-19 testing, screening services and vaccinations at this time.
We are working in close partnership with state, local and federal authorities to serve and protect our members and communities during the COVID-19 pandemic, including ensuring that our providers have relevant and up-to-date information. We value your partnership during these unprecedented times.
This guidance is in response to the current COVID-19 pandemic and may be retired at a future date.
Talking to Your Patients About the COVID-19 Vaccine: How You Can Engage and Inform in a Meaningful Way
As COVID-19 vaccines are approved and distributed, providers will be a key part in its adoption and administration to the American public. Patients look to their healthcare professionals for medical guidance and assurance, and while much is still unknown, you can start laying the groundwork now for when the vaccines are available. As your partners in healthcare, we want to share some tips for effectively setting expectations and addressing questions from your patients.
Start COVID-19 Vaccine Conversations Early
Even before you are able to offer COVID-19 vaccinations, consider including the topic in your conversations with patients. This will give you the opportunity to set expectations about vaccine availability, including if/when you might recommend vaccination for them, and learn about any concerns they have.
Engage in Effective COVID-19 Vaccine Conversations
Effective engagement can occur during an in-person office visit, through messages on your patient portal, or at a telemedicine appointment. Patients trust in their providers to help guide healthcare decisions, and your strong vaccine recommendation is the most important part of the conversation.
Start with empathy and understanding.
- Acknowledge the disruption COVID-19 has caused in all our lives.
- Provide an opportunity to recognize common concerns that can be addressed by a vaccine.
Assume patients will want to be vaccinated but may not know when to expect it.
- Consider providing the following general
information to patients about the timeline for COVID-19 vaccines:
- Limited COVID-19 vaccine doses may be available in 2020.
- It is anticipated that vaccine supply will increase substantially in 2021.
- The goal is for everyone to be able to easily get a COVID-19 vaccine as soon as large quantities are available. However, not everyone will be able to get vaccinated right away.
- Encourage patients to continue taking steps to protect themselves from COVID-19 and let them know how you plan to share updates about vaccine availability.
Give your strong recommendation.
- Let your patients know if you plan to recommend
COVID-19 vaccination for them.
- Share the importance of COVID-19 vaccines to protect patients’ health as well as the health of those around them.
- Talk about your personal plans to get a COVID-19 vaccine.
- Reassure your patients that the vaccine is safe.
Listen to and respond to questions.
- If a patient has concerns or questions, this doesn’t mean they won’t accept a COVID-19 vaccine. Sometimes patients want your answers to their questions.
- Your willingness to listen to their concerns will play a major role in building trust in you and your recommendation. Make it clear that you understand they have questions, and that you want to answer them, so they feel confident in choosing to get vaccinated.
- Seek to understand patient/caregiver concerns and provide information they need in a way they can understand it (see Q&A below).
Keep the conversation open.
- After answering their questions, let your patients know that you are open to continuing the conversation and answering any additional questions they may have.
- Encourage patients to take at least one action like:
- Scheduling another appointment.
- Reading any additional information you provide them about COVID-19 vaccination.
- Encourage others to get their COVID-19 vaccine when available.
- Continue to remind patients about the importance of getting a COVID-19 vaccine during future routine visits.
Answering Patient Questions about the Vaccine
Your patients will likely have a lot of questions about the vaccine, and as their healthcare provider, they will turn to you for answers.
Pharmacies are generally the most convenient locations to individuals and they also have great expertise in administering vaccines. While many providers anticipate to have the vaccine in their office later on, for now we recommend patients visit their local pharmacy. The website www.vaccinefinder.org can help them locate the closest location with current inventory.
Initially, there will be a limited number of vaccines available. Because of the limited supply, some groups are recommended to get the vaccine first:
- Phase 1A will include residents and employees of nursing homes and long-term care facilities. They are recommended to get the vaccine first, as they are deemed highly vulnerable. Long-term care facilities account for a high percentage of the deaths from COVID-19 (40%).
- Additional phases are being developed by federal and state governments. This will address first-responders, essential workers, older adults and people more at risk for either contracting the virus or becoming seriously ill with the virus.
The Food and Drug Administration (FDA) carefully reviews all safety data from clinical trials. It only authorizes emergency vaccine use when the expected vaccine benefits outweigh potential risks.
- The Advisory Committee on Immunization Practices (ACIP) reviews all safety data before recommending any COVID-19 vaccine for use.
- FDA and CDC will continue to monitor the safety of COVID-19 vaccines to make sure even very rare side effects are identified.
Explain the potential serious risk COVID-19 infection poses to them and their loved ones if they get the illness or spread it to others.
- Remind them of the potential for long-term health issues after recovery from COVID-19 disease, especially for those who have chronic conditions, are older, or have weakened immune systems.
- Explain that scientists are still learning more about the virus that causes COVID-19. And it is not known whether getting COVID-19 disease will protect everyone against getting it again, or, if it does, how long that protection might last. Therefore getting a vaccine is a safer choice.
- Some vaccines are more effective than the natural illness; it is not clear whether natural illness or vaccination will provide more effective immunity in this case.
- Early information indicates that COVID-19 vaccination may reduce the severity of illness, as well as the incidence of illness. As we learn more about the efficacy of the vaccine, we will also learn more about potential long-term protection it may bring.
- Describe how the vaccine was tested in large clinical trials and what is currently known about its safety and effectiveness.
- Be transparent that the vaccine is not a perfect fix. Patients will still need to practice other precautions like wearing a mask, social distancing, handwashing and other hygiene measures until public health officials say otherwise.
- The first vaccine primes the immune system and
helps recognize the virus. The second vaccine strengthens the immune response.
- The two doses are given a few weeks apart (e.g. 21 or 28 days depending on vaccine type). Explain the dosing options available in your office and advise the patient that they can set up an appointment before they leave to come back for a second dose.
- Provide members with a vaccination record card to ensure that they know when they received their first vaccine, what type of vaccine they received, and when they need to come back and receive their second vaccine.
- Direct them to their insurance health plan to set up non-emergency transportation, if applicable.
List the most common side effects from vaccination are and how severe they may be (e.g. fever, headache, body aches, cold symptoms). Emphasize that a fever could be a potential side effect and when to seek medical care.
- Symptoms will typically go away on their own within a week. Let them know when they should seek medical care if their symptoms don’t go away.
- Explain that the vaccine cannot give someone COVID-19 as the vaccine does not contain a live coronavirus.
- Explain that side effects are a sign that the immune system is effectively working.
No! The vaccine will be at no cost to patients. They will not have to pay for either dose of the COVID-19 vaccine.
Additionally, CMS has also published a set of toolkits to help providers prepare to swiftly administer the vaccine once it is available. If you have any further questions about this upcoming vaccine or the COVID-19 services Ambetter from Absolute Total Care covers, please contact Provider Services at 1-833-270-5443.