Teaching Resources

COVID-19 Resources

Medical Education During the COVID-19 Pandemic

The COVID-19 pandemic has necessitated drastic changes in medical education. To help family medicine faculty continue to provide quality education to residents and students, while at the same time being attentive to patients and communities, STFM has aggregated resources identified by members and staff.

If you have something to add, email tbrazelton@stfm.org.

Family physicians are uniquely qualified to be in leadership positions in health systems. STFM has collected case studies that highlight how family medicine individuals and teams provided leadership during the COVID pandemic, helping health systems meet their commitments to communities.

Read the Case Studies

Technology

 

Telemedicine

Student Documentation of Telehealth Visits
From CMS: "In the CY 2020 Physician Fee Schedule (PFS) final rule, we adopted simplified medical record documentation requirements for physicians and certain nonphysician practitioners to allow the billing clinician to review and verify, rather than redocument, information added to the medical record by any member of the health care team. During the public health emergency, this principle applies across the spectrum of all Medicare-covered services, and will also apply to therapists so that they may review and verify, rather than redocument, notes added to the medical record by any other member of the health care team, including therapy or other students.

 

 

The following information is as of April 30, 2020

ACGME
ACGME is allowing residents to be involved in telehealth visits, following the rules related to direct (supervising physician monitoring, can be remote) and indirect (supervising physician immediately available, can be remote) supervision rules. ACGME posted clarification of these rules on their site on March 20 . For family medicine residents, programs should track each resident’s type and quantity of visits to report in the annual ACGME WebAds Major Program Update section.

CMS
A CMS Waiver released on March 30, 2020 states that teaching physicians can provide services with medical residents virtually through audio/video real-time communications technology. This does not apply in the case of surgical, high risk, interventional, or other complex procedures, services performed through an endoscope, and anesthesia services. 

On April 30, CMS published a new rule that includes technical changes STFM and the other academic family medicine organizations advocated for to allow for the application of the primary care exception to telehealth services. 

  • CMS now allows the teaching physician to "review the services provided with the resident, during or immediately after the visit remotely through virtual means via audio/video real time communications technology."
  • Billing codes have been added that can be used under the primary care exception – including phone visit codes. See list below. In addition to these codes, CMS confirmed (via personal communication to STFM staff on May 22, 2020) that during the public health emergency, the primary care exception has been expanded to include all levels of office/outpatient E/M services (e.g. 99204-5 and 99214-15)
  • With the understanding that phone visits are actually replacing E/M visits that would otherwise be occurring in person or through audio-visual telehealth, CMS is now providing increased funding for these codes and cross-walking them to normal E/M visit codes. See below for the financial and cross-walk information.
  • CMS confirmed (via personal communication with STFM staff on May 22, 2020) that remote supervision must be done with audio-visual real-time technology, not audio-only.

Telehealth Codes Allowed for Use Under the Primary Care Exception:

On an interim basis for the duration of the COVID-19 PHE, Medicare may make PFS payment to the teaching physician for the following additional services when furnished by a resident under the primary care exception:

  • CPT code 99441 (Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion);
  • CPT code 99442 (Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 11-20 minutes of medical discussion);
  • CPT code 99443 (Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 21-30 minutes of medical discussion);
  • CPT code 99495 (Transitional Care Management services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within two business days of discharge; medical decision making of at least moderate complexity during the service period; face-to-face visit within 14 calendar days of discharge);
  • CPT code 99496 (Transitional Care Management services with the following required elements: Communication (direct contact, telephone, electronic) with the patient and/or caregiver within two business days of discharge; medical decision making of at least high complexity during the service period; face-to-face visit within 7 calendar days of discharge);
  • CPT code 99421 (Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5–10 minutes);
  • CPT code 99422 (Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11–20 minutes);
  • CPT code 99423 (Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes);
  • CPT code 99452 (Interprofessional telephone/internet/electronic health record referral service(s) provided by a treating/requesting physician or qualified health care professional, 30 minutes);
  • HCPCS code G2012 (Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5–10 minutes of medical discussion); and
  • HCPCS code G2010 (Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment).

Audio-Only Cross-Walk with E/M Visit Codes

CMS is "establishing new RVUs for the telephone E/M services based on crosswalks to the most analogous office/outpatient E/M codes, based on the time requirements for the telephone codes and the times assumed for valuation for purposes of the office/outpatient E/M codes."

"Specifically, we are crosswalking CPT codes 99212, 99213, and 99214 to 99441, 99442, and 99443 respectively. We are finalizing, on an interim basis and for the duration of the COVID-19 PHE the following work RVUs: 0.48 for CPT code 99441; 0.97 for CPT code 99442; and 1.50 for CPT code 99443. We are also finalizing the direct PE inputs associated with CPT code 99212 for CPT code 99441, the direct PE inputs associated with CPT code 99213 for CPT code 99442, and the direct PE inputs associated with CPT code 99214 for CPT code 99443. We are not finalizing increased payment rates for CPT codes 98966-98968 as these codes describe services furnished by practitioners who cannot independently bill for E/Ms and so these telephone assessment and management services, by definition, are not furnished in lieu of an office/outpatient E/M service."

For more information on Medicare coverage and payment of virtual services in general, please see the CMS fact sheet and CMS COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing.

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Events

September 11-13, 2023: STFM Conference on Practice & Quality Improvement

Deadlines

May 26, 2023: Applications for Leadership through Scholarship Fellowship Due

May 26, 2023: 2024 STFM Conference on Practice & Quality Improvement Steering Committee Applications Due

June 6, 2023: Leadership Through Scholarship Applications Due

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June 9, 2023: Applications for Core Faculty for the FM POCUS Certificate Program Due

June 19, 2023: STFM Foundation Student Scholar Nominations Due

June 23, 2023: The STFM URM Mentorship Program Applications Due

July 7, 2023: 2024 STFM Board of Director Applications Due

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