Safety Practices for LAcs: The Autumn 2022 Presentations from the HHP's Safety Practices Workgroup (Sept, Oct, Nov.)

HHP is the nonprofit collaborative learning network for healthcare system-based LAcs and program managers.

We are the home of the healthcare system-based acupuncturist community network

Help us keep the HHP's work going this year (2022) and into 2023.

Donate $10 (about 2 small cups of coffee) ☕☕today. Thank you.

Safety Practices for LAcs, a new set of resources from the HHP

Updates on this past year’s progress with the HHP’s Safety in Practice Workgroup

For the latest information on this workgroup and its work, from presentations to publications, go to these pages on the HHP's website:

Safety Practices for LAcs, an article getting updated with event info Sept - Nov 2022.

September public presentation, the event page.

October public presentation at the IM4US 2022 conference, "Speaking the Language of Safety in HROs for LAcs." The presentation landing page.

November 12th, 2022, "Introduction to Safety Practices for LAcs in Healthcare System Practice. For Acupuncturist clinicians, safety leads, and program managers." public presentation, the event page.

The Hospital Handbook Project for Acupuncturists and Their Hospital Sponsors is a program of Free Range Health®, a 501(c)(3) public charity. All or part of your donation may be tax-deductible as a charitable contribution. Please consult with your tax advisor. Federal Tax ID #45-4395933

Telehealth Roundtable for Hospital-based Acupuncture Programs--the Event

keywords: telehealth, pandemic prep & response, virtual health care, hospital-based acupuncture programs, coding and reimbursement for telehealth services for integrative health practitioners, acupuncture employee, acupuncture program manager, program examples, online event

You need a ticket to attend--looking for a ticket?

Join our experienced panel of hospital-based acupuncture program leads and managers to discuss setting up a telehealth program in medium to large healthcare systems and pivoting the work during the pandemic as part of phased re-opening/closing plans.  

Get your ticket to the “Telehealth Roundtable on Hospital-Based Acupuncture Programs”, an online conference scheduled for Saturday, June 20^th, 2020, starting at 0900 Central.

Theme for this Event

Telehealth Programs in Hospital-based Acupuncture Practice: Pivoting in the Pandemic

Lessons Learned, Benefits (patients, providers, system), Issues, Examples of Innovation, and Discussion

Why this online event?

The Hospital Practice Handbook Project has been hosting community discussion space online and in live zoom sessions at least weekly since mid-March for the hospital-based community to provide space for discussion, problem-solving, and sharing examples of innovation as we all respond to the pandemic in our various programs and through different stages of closing and re-opening.

The content approved to share with the community from those discussions are located in this online resource module.

Out of these sessions came a consistent need to do even more, particularly to host our own conference on telehealth.

Why a telehealth event specific to hospital-based acupuncture programs?

Telehealth capability is critical for all clinicians in the phased clinic opening/closing as communities respond to the pandemic. Some organizations had a telehealth program in place before the pandemic, but many stood theirs up during the pandemic as a way to support and protect both provider personnel and patients during a respiratory-based pandemic. Some are still in the process of standing theirs up and looking to the community for examples that match their system.

However, not all systems have been supportive or understanding of how acupuncturists can work via telehealth (vs. in-person), citing “lack of access to current examples”.

So, here we are, presenting current examples of telehealth programs in hospital-based acupuncture practice. And, having a professional Socratic discussion on the related topics.

You can't attend without a ticket.
Choose the type of event ticket that fits you here

How to engage in or support this event

Buy a ticket and share these links. 😊

Event landing page: https://www.thehospitalhandbook.com/telehealth-roundtable-event/2020/6/2/telehealth-roundtable-for-hospital-based-acupuncture-programs

Per community request, there are 3 ticket options:

1. Basic Ticket—access to the live event
1. https://www.thehospitalhandbook.com/support-the-project/basic-ticket
2. Ticket Plus—basic ticket plus access to the online resource with all the recordings and other content created for this event
1. https://www.thehospitalhandbook.com/support-the-project/telehealth-roundtable-ticket-plus
3. Recordings only—just access to the online resource with the recordings. No access to live event.
1. https://www.thehospitalhandbook.com/support-the-project/telehealth-roundtable-recordings-only

I hope you are able to attend or if you are otherwise engaged that day, consider supporting via the “recordings only” ticket and submitting your questions to the panelists in your ticket form.

All ticket revenue goes directly toward the outgoing costs of this event (platform hosting, data, recordings, video editing, etc.). My time and work are 100% volunteer.

For more information on confirmed panelists and updates

Go to our Facebook Event page and choose “interested” or “going” to see social media updates on this event.

Event Agenda

Introduction
Panelists each give short summaries of their programs
Socratic discussion of the topic by panelists
Some Qs from attendees posed to the panel for more discussion

Panelists include (confirmed to date)

• Paul Magee, lead acupuncturist, Penny George Institute of Health and Healing, Allina Health, Minnesota
• Christine Kaiser, acupuncture program manager and quality assurance, University Hospitals Connor Integrative Health Network, Cleveland, Ohio
• John Burns, acupuncture program manager, Advocate Aurora of Wisconsin and Illinois
• Juli Olson, National Lead, Acupuncture, Integrative Health Coordinating Center, Veterans Health Administration
• Galina Roofener, acupuncturist, Cleveland Clinic, Cleveland, Ohio
• Mori West, C.P.C. of AcuClaims, coding & billing expert
• Nancy Gahles, Integrative Health Policy Consortium, IHPC

Please buy a ticket and share this event with anyone who may benefit from it or enjoy attending and supporting. Thank you.

More resources on telehealth

University of WA Survey of Acupuncturists during the COVID-19 Pandemic

• For those of you practicing as acupuncturists, check out this IRB-approved survey from a colleague who is doing this research through the University of Washington. Looks like she is collecting data on how the pandemic is affecting practice, from direct clinical care to pivots in online resources including the use of telehealth: https://redcap.iths.org/surveys/?s=7FTTYN73X9& 
• suspension date: the survey closes June 8th, 2020
• More info: 
• The survey is intended for ALL licensed acupuncturists. You don't need to have a telehealth service in place to respond to the survey. One of the aims of this survey is to set the stage for larger survey studies of profession-wide effects similar to the benchmark studies in other healthcare professions. 
• The estimated time to complete the survey is 5 minutes.
• Principal Investigator: Tamsin Lee, DAOM

New Research Paper on Relevance of Telehealth Programs During Pandemic and Beyond, from a Duke University Team

• At a time when I hear disagreement in the definition of "telehealth", I offer this very useful definition they published, which dispels all previous confusing terminology I have heard in the medical field the last year or so:

"The term 'telehealth' refers to the entire spectrum of activities used to deliver care at a distance--without direct physical contact with the patient. Telehealth encompasses both provider-to-patient and provider-to-provider communications and can take place synchronously (telephone and video), asynchronously (patient portal messages, e-consults), and through virtual agents (chatbots) and wearable devices."

• The article was published May 17th, 2020, by a team from Duke University, "Telehealth transformation: COVID-19 and the rise of virtual care" in the Journal of the American Medical Informatics Association
• citation
• Jedrek Wosik, Marat Fudim, Blake Cameron, Ziad F Gellad, Alex Cho, Donna Phinney, Simon Curtis, Matthew Roman, Eric G Poon, Jeffrey Ferranti, Jason N Katz, James Tcheng, Telehealth transformation: COVID-19 and the rise of virtual care, Journal of the American Medical Informatics Association, https://doi.org/10.1093/jamia/ocaa067 

More Community Resources on Pandemic Prep & Response

• The Community Discussion online module on Pandemic Prep & Response
• Community Discussion in the closed Facebook group
• send me a message via the website contact page why you are interested, where you work and who your sponsor/mentor is
• The Google Survey, created by the community. New as of June 2020. 
• read more about the what, why and how here
• More on the Telehealth Roundtable Event
• Pre-Event video and quick notes: Why an event? and What is the potential in patient-centered health care for an Integrative Health Telehealth program model?

You can support this community-wisdom-sharing work by buying me a coffee
or other support option via our website.
Thank you.

www.thehospitalhandbook.com

The Medicare Denial Letter

Topics: Medicare (CMS) denial letter, reimbursement issues in a hospital-based practice

Do you need a pdf copy of this article?
You can request a pdf copy of this blogpost via the website for the cost of a cup of coffee. All proceeds go toward basic operating costs to keep this HH Project work going. Thank you.

The Medicare Denial Letter:

useful for this period of history when Medicare does not cover acupuncture services

Contributors: 

Bobbee Vang, LAc, Timothy Suh, DAOM, LAc, and Megan Kingsley Gale, MSAOM, LAc

 

example of a Medicare Denial Letter

CMS = U.S. Center for Medicaid and Medicare Services

FQHC= federally qualified health centers, more info at the FQHC website

BLUF = bottom line up front. Acronym communication tool

SBAR = situation, background, assessment, recommendation. A team communication tool.

Question(s) for practitioners working in CMS facilities (this includes FQHC) 

When a patient is eligible for Medicare, but Medicare does not cover acupuncture nor acupuncturists as providers, what is the process in billing for care? 

How do you process coverage for a Medicare-qualifying patient in a CMS facility?

Background: The rule in a CMS facility is that Medicare must be billed as primary and then denied in order to bill secondary/co-insurance or supplemental insurance. All other payors we bill under our credentials (as licensed acupuncturists).

Situation (Example): Since Medicare does not cover acupuncture services nor acupuncturists as providers, how does one deal with coverage for a Medicare-qualifying patient in a CMS facility?

In this case, my colleague is dealing with the supplemental insurance which is denying all reimbursement because they are “awaiting CMS denial”. My colleague’s GY modifiers are now getting denied, too. Prior to Jan. 1^st, 2018, they were getting covered/accepted.

Assessment: Yes, you cannot bill. If you bill Medicare, it won’t be considered. So, then it will not be “officially denied”. Treatment must be officially denied by Medicare before you can bill any other insurance or reimbursement program.

Recommendation:

BLUF: Ask the patient to submit a “request for medical reimbursement”. Since the patient is enrolled in Medicare, the payor must respond to the payment. The response [from CMS/Medicare] is the denial. That response lasts a lifetime and does not need to be renewed. Make a copy of that denial for future billing.

What form is the “request for medical reimbursement”?  

screenshot of form CMS 1490S

8.2019: Form number has changed. The correct form is now CMS 1490S, “request for medical reimbursement”.

Note from the CMS website:

• “Effective April 1, 2019, only the revised 01-18 version will be accepted for the Form CMS-1490S. the provided link below includes the form and all the applicable instructions. Please read all the instructions prior to submitting a claim to Medicare. (1) The Form CMS-1490S is fillable, can be completed online, printed then mailed. (2) Mail the completed form and itemized bills to the correct Medicare Administrative Contractor as indicated on pages 7 through 18 of the instructions.”
• Landing page
• Form: English version; Spanish version
• If you read this and the form is again outdated or you want to make another correction, please note it in the comments below or contact me on the website. Thank you.

“We have kept a denial letter from our early insurance years stating the denial. We keep this letter and send it to the secondary insurance. Most supplement insurance will not cover what Medicare does not deny. The one supplement insurance I have noticed covering acupuncture in my region this year is a Medicare Advantage plan, ‘UnitedHealthcare AARP Medicare Advantage Supplement’. However, a true secondary insurance may have coverage. “–Timothy Suh

Since the CHRONIC Care Act of 2018, some supplement insurance, namely Medicare Advantage plans, do cover acupuncture services. This coverage is highly variable, though. To learn more about this special case coverage in Medicare Advantage and what the CHRONIC Care Act is, go to the related blog post on this health policy. 

“Personally, I believe Medicare is a fight worth fighting for. [In a few years it is likely] we will have coverage. All the signs point toward it. The only issue is to create the data that backs our medicine in a biopsychosocial model that is accepted by the current system.” -Bobbee Vang

Review

To clarify:

1. The fill-able form, “request for medical reimbursement” is on the CMS website.
2. The screenshot at the top of this post is an example of what a Medicare Denial Letter looks like.
3. Once you have a Medicare Denial Letter for a specific patient, keep it.
4. This letter is good “forever” or until the law changes.
• It takes an Act of Congress for a profession to be added as a covered benefit in Medicare law/Social Security Act. For more info see section 1861 of the Social Security Act. 

• “Medicare is a defined benefit program. For an item or service to be covered by the Medicare program, it must fall within one of the statutorily defined benefit categories outlined in the Social Security Act.”—cms.gov

Related Blogposts

• What is CMS?
• The CHRONIC Care Act: A Health Policy focused on Addressing the Social Determinants of Health
• For more on team communication techniques like BLUF and SBAR, see the HH Project’s
• “Basics of Being an Employee in a Healthcare Setting: Focus on Performance Metrics” series
• or the “New Hospital Employee” resource  

Did you find this information useful or interesting?
You can request a pdf copy of this blogpost via the website for the cost of a cup of coffee. All proceeds go toward basic operating costs to keep this HH Project work going. Thank you.

Subscribe to our email list for the latest updates and follow us
 on the public Facebook Page.

You can support this community-wisdom-sharing work by
 buying me a coffee or sponsoring a newsletter via our website.  Thank you.

www.thehospitalhandbook.com

More Documentation and Coding Resources

keywords: documentation, charting, coding, CPT, E/M, and modifiers, licensed acupuncturist, east Asian medicine practitioners, integrative health

Here are some new resources for reviewing documentation and coding standards in the profession

Documentation and Coding Review Video with Sam Collins, DC of the American Acupuncture Council Information Network, dated May 15th, 2019:

• Link to YouTube Video (14 minutes):

Coding and Use of Modifiers with Evaluation and Management (E/M) codes

• Article by Sam Collins, DC in the May 2019 edition of Acupuncture Today, volume 20, issue 05.  "The Most Common Modifier for Acupuncture Claims".
• Summary of content: 
• An insurance company can deny a claim if you do not code your work to their standard. The common denial issue he discusses in this issue is choosing and using the correct modifier with your E/M code.
• Types of modifiers he covers in this article include: level 1 modifiers, modifier 25, and modifier 59.  There is also the special case GP modifier that is common in the VHA program that covers acupuncture services by some vetted community providers, "Veterans Choice".
• source: article by Sam Collins, DC in the May 2019 edition of Acupuncture Today, volume 20, issue 05.  "The Most Common Modifier for Acupuncture Claims". Link to the digital edition of this article. And the webpage version of the article on Acupuncture Today.

Related Blogposts on Documentation include

• Peer Record Review
• Physical Exam Training for Acupuncturists
• Prescribing in the Hospital Setting: pharmaceuticals, medication review, nutraceuticals, self-care
• The Medication Review and Calculating Morphine Equivalent Dose
• Professional Practice: Discerning Medication Side Effects from Symptoms and Signs
• The Pain Scale in Your Chart Note: Using a Validated Tool
• From the NAM Clinician Well-Being Series, see their resource, Care-Centered Documentation in the Digital (EHR) Environment: Solutions to Alleviate Burnout
• The EHR use Community Survey and SAR 2019 conference prequel
• HIPAA
• Acupuncturists are healthcare professionals, Licensed Independent Practitioners
• Gale M, Hospital Practice: Recognition of Acupuncturist as a Licensed Independent Practitioner (LIP). Meridians: JAOM, 2016 3(4): 11-16, 41. open access article.

Did you find this information useful or interesting?
You can request a pdf copy of this blogpost via the website for the cost of a cup of coffee. All proceeds go toward basic operating costs to keep this HH Project work going. Thank you.

Subscribe to our email list for the latest updates and follow us
 on the public Facebook Page.

You can support this community-wisdom-sharing work by
 buying me a coffee or sponsoring a newsletter via our website.  Thank you.

www.thehospitalhandbook.com