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:

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

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

More about focused and ongoing professional practice evaluation (FPPE, OPPE) and peer record review. 

Joint Commission references 

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 (www.nccaom.org), 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.

  

Explaining the Semantics of credentialing and privileging for the Acupuncturist as LIP, advice from Megan and Fuji.  

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:

Hospital sponsor, supervision and the hospital sponsor

Dual-licensees and the hospital sponsor

Supervision of an acupuncturist

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.

Hospital sponsor  

Supervision 

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.

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.

related blogposts:  
My Meridians article reference page

Updates since Jan. 2018
The official BLS Standard Occupational Code (SOC) for Acupuncturists, Jan. 1st, 2018
The VA Occupational Staffing Code for Acupuncturists announced, Feb 2018

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?

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:
HIPAA
NPI





https://www.cms.gov/About-CMS/About-CMS.html

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:

CMS

LIP

HIPAA

References:

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

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