Wednesday, August 31, 2016

Meridians: The Journal of Acupuncture and Oriental Medicine

keywords:  research literacy, research journal, resource

Meridians: The Journal of Acupuncture and Oriental Medicine is a peer-reviewed scientific journal in the field of East Asian Medicine.  This journal is Medline-compliant and in the following databases:
CINAHL--a nursing profession database
EBSCO--international scholarly database

In 2016 Meridians became the official journal of the National Certification Commission on Acupuncture and Oriental Medicine (NCCAOM).  As such, the electronic version of the journal is offered as a free member benefit to NCCAOM Diplomates.

To view or buy current or past issues of Meridians, go to their website.
For social media updates, check out their Facebook page.

Research Literacy
Meridians has a great Resource page for Scientific Writing and Research Literacy page compiled by editor Jen Stone.
Go check out the resources available or linked to this resource page:

  • 5 Short "How to" Articles on Scientific Writing
  • How to Write a Pilot Study
  • How to Write a Good Case Report
  • CARE Case Reports:  Resources
  • How to Write a Good Abstract
  • CONSORT Transparent Reporting of Trials
  • NIH Protocol Design Templates
  • International Committee of Journal Editors
  • Standards for Reporting Interventions in Controlled Trials of Acupuncture (STRICT-A)
  • Poster Presentation Resources
  • Federal Funding Resources
  • CAM Scientific Databases
  • Research Societies

Tuesday, August 30, 2016

Acupuncture, a covered Worker's Compensation Benefit

keywords:  worker's compensation act, state laws, legislation

Originally published in the De-Stress Vets blog, 2016.06.27

Acupuncture is one of the therapeutic procedures an East Asian Medicine practitioner (also known as Licensed Acupuncturist) uses when facilitating recovery from injury.  Acupuncture is one of several rehabilitation modalities that speed recovery from injury and help someone return to work more quickly (than not using it).  That is why it is now a commonplace procedure that is covered in worker's compensation laws.

Check your state for its requirements and laws on worker's compensation.  Here is a list of states that cover acupuncture for common workplace injuries under their worker's comp laws or acts (updated March 2016):

States where acupuncture is covered under worker’s comp benefit (29 + D.C.)
New Jersey
New Mexico
Rhode Island
New York
Washington DC
West Virginia

As of March 2016, 29 states and D.C. cover acupuncture services for worker's comp claims
A literature survey of state law was done in March 2016.  This survey noted that the above (in chart) states and D.C. cover acupuncture for at least one condition under that state's worker's comp benefit.

Note:  state law varies.  Worker's comp laws can change each legislative session, so check in with your local office for the latest update.

the Vet Choice Program

correction October 2018
For most recent information on acupuncture coverage by workers' comp, contact the AAC Info Network, which does training for Acupuncturists and their admin and billing staff on coding and billing in the field.

Wednesday, July 27, 2016

National Practitioner Databank

keywords:  credentialing and privileging process, hospital employment, new hire, hospital practice, malpractice insurance, adverse events

The National Practitioner Databank (NPDB) and the credentialing process

What is the NPDB?
The National Practitioner Databank tracks info on health care providers including malpractice insurance and reported adverse events.  It is standard practice in the process of hiring and credentialing a health care practitioner at a hospital to query the NPDB.  Just as background checks are standard practice.

How does it relate to or affect you?
Every health care provider who works in a medical center has an entry as a practitioner in the NPDB.
You can learn more about it and see an infographic at the NPDB website.  If you want to see what your entry looks like or if you have an adverse report, you can do a self-query.

There used to be two data banks which credentialers would have to check for a health care practitioner, the NPDB and the HIPDB.  As of May 2013, the HIPDB has been rolled into the NPDB to streamline the databank and query process.

related:  HIPDB

Friday, May 20, 2016

Meridians: JAOM published journal article, more references and resources

Landing page for paper accepted for publication in Meridians journal.

My Meridians article reference:
Gale M, Hospital Practice:  Recognition of Acupuncturist as a Licensed Independent Practitioner (LIP).  Meridians:  JAOM, 2016 3(4) (accepted for publication)

What is this? 
This is an endnote reference landing page for an article I wrote published in the Medline-compliant peer reviewed scientific journal, Meridians:  The Journal of Acupuncture and Oriental Medicine

For how to contact the author of the blog (myself), please see the contact email within the biography of the article or contact me.

This blog serves one aspect of the Hospital Handbook Project.  For the mission and goals of this project, please see our About page: “What is the Hospital Handbook Project?” The blogposts are intended as basic descriptions of topics and issues related to Hospital Practice for an East Asian Medicine Practitioner (also known as an Acupuncturist).  Many topics are still conversations in progress and deeper discussions are, due to length and complexity, not covered in depth by the blog.  Hence, the blog is only one aspect of The Project.   If you are interested in joining the conversation or donating to this work, please contact the author/editor.

Short review of what LIP is, how it relates to Acupuncturists (East Asian Medicine Practitioners), how it is defined by The Joint Commission (TJC), how it relates to hire and credential process, and medical staff appointment:

endnote #2:  Referenced OPPE, FPPE, TJC, and peer record review

endnote #3:  hospital practice credentialing and privileging process
In 2015-2016 I was part of the NCCAOM Hospital-based Task Force.  We created a document that was published on the NCCAOM website in July 2016.  This document, Credentialing of Acupuncturists for Hospital-Based Practice:  A Resource Guide for NCCAOM Diplomates, is available to NCCAOM Diplomates for free and to all others for a low price.  To find this document, go to the NCCAOM website (, and look under “Diplomate Benefits” page. If you are an NCCAOM Diplomate, just log in for free access to the document.  If you are not, you can still access the document for a small fee by contacting NCCAOM or following the links on the website.

If you are interested in more information on this topic, please donate and join the email list to support this work

Endnote 6--the Excel file
The BLS occupational Code Comparison Chart of L.Ac.s to other LIP professions is available through the Hospital Handbook project.  Please contact the Hospital Handbook project author/editor. 

endnote #23:  Discussions on the following topics:

All of these continue to be conversations-in-progress.  If the info you are looking for is not here in the blogpost, please understand the posts are usually brief notes on the topic.  If you would like to join the conversation or support this work, please donate and join the email list. 

Endnote 24
The hospital sponsor is more than your average administrator.  The hospital sponsor is an innovator and a synergist.  The sponsor advocates for you, your field of practice, and navigates the hospital system world to create space for integrative medicine.  As a hospital-practice Acupuncturist, do what you can to support your hospital sponsor.

BLS Occupational Code update

Updates since Jan. 2018
On Jan. 1st, 2018, the Standard Occupational Code (SOC) for Acupuncturists began official use.
In February 2018, the VA announcing an update to their Staffing Handbook to include Acupuncturists.  The Handbook classifies the profession as LIPs, please see blogpost and its references for details.

Saturday, May 7, 2016

The Acupuncturist Occupational Code FAQs

keywords:  credentialing, hospital employment, national standards

Q:  Do Acupuncturists have a federal occupational code?  What is it?
Yes.  29-1291-Acupuncturist

Q:  When is the BLS occupational code finalized?  Is it useful for hospitals before it is finalized?
2018 and Yes.

The Acupuncturist Occupational Code, as tracked by the U.S. Bureau of Labor and Statistics (BLS) is not finalized until 2018.  The electronic print edition of the BLS's Standard Occupational Classification (SOC) handbook is scheduled to be published in summer 2017.

What is great about BLS and O*Net is that you can look online (O*NET) and see the final, detailed draft of the code.  I have heard from various hospital credentialing experts from as early as 2012 that this info, even while not “finalized” is useful info for them.  It writes their credentialing packet for them, in essence.  

While we wait this last year for the code to be finalized, it is good to know how useful just the final published draft of the occupational code is to credentialing experts and those who write position descriptions (job descriptions).

I have written more about the Acupuncturist occupational code and how it relates to hospital practice in the fall issue of Meridians, "Hospital Practice:  Recognition of Acupuncturist as a Licensed Independent Practitioner (LIP)".

Gale M, Hospital Practice:  Recognition of Acupuncturist as a Licensed Independent Practitioner (LIP).  Meridians:  JAOM, 2016 3(4):  11-16, 41.

NCCAOM has lead the way in the creation of the occupational code.  See their website for the latest update.

Friday, May 6, 2016

What is the Health Insurance Portability and Accountability Act (HIPAA)?

key words:  national standards, law, HIPAA, healthcare insurance

HIPAA is the Health Insurance Portability and Accountability Act, part of the Administrative Simplification Standard.

The goal of HIPAA is to standardize and simplify the insurance processing system.

The NPI (national provider identifier) is part of HIPAA.

The Administrative simplification standard:

"To reduce paperwork and streamline business processes across the [United States] health care system, the Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the Patient Protection and Affordable Care Act (ACA) set national standards for:
  • electronic transactions
  • code sets
  • unique identifiers
HIPAA includes Administration Simplification provisions that the ACA expanded in 2010.  ACA introduced operating rules to standardize business practices."

HIPAA and ACA are U.S. law.

Who needs to comply with HIPAA and ACA?
Health care providers, health plans, and payers
Any provider or health care entity who conducts electronic transactions.

The intent of the Administrative Simplification standard has been to:
save time and cost while helping patients
by using standardized
  • transactions
  • operating rules
  • code sets
  • unique identifiers
Using these standardized sets helps allow information to be shared electronically in consistent ways.

The Operating Theory
The theory behind the creation of HIPAA and ACA is the idea that with common standards for content and formats, information would move more quickly as it is shared between providers and health plans in predictable ways.  Streamlined communications with insurers can help inform patients upfront about coverage, benefits, and out-of-pocket costs.
These standards have the potential  to give providers more time for care and decrease 
  • health costs
  • time spent on paperwork
  • administrative burden
reference:  CMS Admin Simplification Standards

A transaction is "an electronic exchange of information between two parties to carry out financial or administrative activities related to health care".  For more about  what qualifies as a "transaction" under HIPAA, see the full definition on the CMS site.

"Code Sets" as related to HIPAA are the following:
  • Diagnosis codes (currently ICD-10)
  • Procedure codes (these are your CPT codes)
  • Diagnostic tests
  • Treatments
  • Equipment and supplies
The above code categories translate to the following code sets:
  • ICD-10 (diagnosis codes)
  • Health care Common Procedure Coding System (HCPCS)
  • CPT (procedure codes)
  • CDT (dental procedure codes)
  • NDC (national drug codes)
CMS Code Sets reference.

National Identifiers
The "national identifiers" HIPAA requires are, for providers, your NPI.
Health plans need an HPID (Health Plan Identifier)
Employers need an EIN (employer identification number)

HIPAA requires that NPIs and EINs are used on all HIPAA transactions.
The enforcement period for HPIDs is current in an "discretion period" since 10.31.2014.  I think this means all transactions should also include the HPID but it not yet being strictly enforced.  Reference here.

update April 2018:  The U.S. federal bureau of Health and Human Services (HHS) has this summary about the current federal HIPAA law and its application.  Here is some very specific information from HHSon the rules for de-identifying a medical record.

Related Posts
What is CMS?
What is an NPI?

Thursday, May 5, 2016

What is the Centers for Medicare and Medicaid Services (CMS)?

keywords:  CMS, Medicare and Medicaid, federal health care, national standards

What is CMS?
The Centers for Medicare and Medicaid Services (CMS) is within the U.S. Department of Health and Human Services (HHS).  It is a federal entity. CMS administers the following  programs:  Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and the Health Insurance Marketplace.

The CMS website has videos that explain more about their mission and work:
short video
longer video (3.5 minutes) to learn a bit more about the programs CMS administers with examples.

CMS also provides and maintains the standards for Evaluation and Management (E&M) codes.
CPT codes (procedure codes) are owned and maintained by the American Medical Association (AMA).

CMS also maintains the Medicare Learning Network (MLN) on their outreach and education page.

related posts:

Wednesday, May 4, 2016

What is a National Provider Identifier (NPI)?

key words:  hospital practice, employment, NPI, HIPAA, insurance, Medicare and Medicaid (CMS), LIP

The National Provider Identifier (NPI) is a standard through the HIPAA (Health Insurance Portability and Accountability Act) Administrative Simplification Standard.

Remember the goal of HIPAA was (and is) to standardize and simplify the insurance processing system.

NPIs are issued to U.S. healthcare practitioners by the Centers for Medicare and Medicaid Services (CMS).  The CMS website explains that, "The NPI is a unique identification number for covered health care providers [who, along with all plans or companies who provide health care insurance] must use the NPIs in the administrative and financial transactions adopted under HIPAA.  The NPI is a 10-position, intelligence-free numeric identifier."

While an NPI is required to bill insurance, every LIP should have an NPI, even if you never plan to bill or take insurance.  It costs nothing and is an easy registration process.

You cannot work at a hospital without an NPI.  It is a standard requirement as part of employee paperwork.  To register for an NPI, go to the NPPES (National Plan & Provider Enumeration System) site.  The site has references to the related standard in the federal HIPAA rule.

For more on these terms, see related posts:


U.S. Public Law, the Patient Protection and Affordable Care Act.  Officially:  Public Law 111–148 111th Congress.  Currently dated March 23rd, 2010.  Length of document on pdf:  906 pages.

The implementation of this federal law is often called:  “The Affordable Healthcare Act (ACA)” or “ObamaCare”

Monday, January 11, 2016

Acupuncturists are LIPs and how that affects how to hire and credential them

updated 7.27.2016

keywords:  LIPs, credentialing, privileging, Joint Commission, NPI, CMS

Acupuncturists and LIP status.
Licensed Acupuncturists (L.Ac.) are Licensed Independent Practitioners (LIPs), and recognized as such in 43 states and the District of Columbia.
LIP is a legal term.  It is affected by and related to state licensing law (scope of practice by state).  It is defined by The Joint Commission. 
According to HIPAA (which is about insurance payment and coding streamlining and privacy protection), all LIPs must carry an NPI.   An NPI (national provider identifier) is used to track insurance claims.  When you are filling out employment paperwork at a hospital, you submit them your NPI (among many other forms).
The definition of NPI by CMS (Center for Medicaid/Medicare), “the NPI is a unique identification number for covered health care providers [who, along with all plans or companies who provide health care insurance] must use the NPIs in the administrative and financial transactions adopted under HIPAA.  The NPI is a 10-position, intelligence-free numeric identifier.”  [see related blogpost on NPI.]

Licensed Independent Practitioners (LIPs) and The Joint Commission (TJC)
The Joint Commission (TJC) and LIP.  TJC’s document, The Who, What, When, and Where’s of Credentialing and Privileging discusses the particulars of said process.  Related to L.Ac.s, we look at how they treat LIPs (since we are LIPs).  “An ‘LIP’ is a licensed independent practitioner, defined as an individual, as permitted by law and regulation, and also by the organization, to provide care and services without direction or supervision within the scope of the individual’s license and consistent with the privileges granted by the organization.”

Credentialing as a vetting process for a new hire.
Credentialing, is a vetting process, as a hospital admin colleague of mine explains.  In fact, going back to page 2 of TJC’s Who, What, When, Where document, under “credentialing”:  Credentialing is the process of obtaining, verifying, and assessing the qualifications of a practitioner to provide care or services in or for a health care organization. Credentials are documented evidence of licensure, education, training, experience, or other qualifications. Examples of credentials are a certificate, letter, or experience that qualifies somebody to do something. They can be a letter, badge, or other official identification that confirms somebody’s position or status. Your organization obtains primary source verification of the LIP’s education, training, certificates and licensure from the primary source, and maintains the file of information.

Credentialing of LIPs as medical staff appointments
Medical and dental staff appointments are a traditional in some hospital systems.  All staff appointments are LIPs.  But not all LIPs qualify for medical or dental staff appointment.  Every hospital system that has this tradition of medical staff appointments has related qualification standards.  For example, some centers state only full-time employee LIPs are eligible for staff appointment (not part-time).  Check your local medical facility for what their written medical appointment qualifying standards are.

Generally, the LIP recognition is what we go for when looking to be hired at an institution.  We are LIPs; start here.  


L.Ac.--  Licensed Acupuncturist, the most common state license title 
LIP--Licensed Independent Practitioner
HIPAA--Health Insurance Portability and Accountability Act
NPI--national provider identifier
CMS--Centers for Medicare and Medicaid Services

TJC--The Joint Commission, an independent non-profit entity that accredits and certifies healthcare facilities and programs; a major quality assurance entity.

For more thorough information on this topic, read my article in Meridians,
Gale M, Hospital Practice:  Recognition of Acupuncturist as a Licensed Independent Practitioner (LIP).  Meridians:  JAOM, 2016 3(4) (accepted for publication).

related blogposts: