All Entries in the "Access Q&A" Category
Can physician move patient directly into observation after surgery?
Q: We have come across cases in which the physician performs either a surgery or procedure on a patient, and then the physician places an order to admit the patient into observation. Can the physician place the patient directly into observation without waiting four to six hours, as long as it is medically necessary?
And if so, what type of documentation in the medical records would be required to substantiate this type of action?
A: Yes, physicians may do this. A patient may qualify for observation post-surgery before a four to six-hour period. Documentation would show the unexpected medical problem that occurred, for example, a spike in blood pressure. Documentation usually shows the intervention made during the regular recovery phase to resolve the complication. For example, an IV push of an anti-hypertensive medicine and the nurse documentation of continued elevated blood pressure. Then the physician orders observation.
Observation time begins when the patient is moved to the floor after this physician order to observation. Also, when a patient leaves a recovery area to the floor, the physicians often must rewrite orders for the nursing floor. This is additional documentation to support the observation status.
Editor’s note: The APCs Weekly Monitor team of experts answered this question.
Q&A: Informing a teen’s parents
Q: A 19-year-old presents an insurance card listing him or her as a qualified dependent on a parent’s health plan. If the parent calls for information about why the child was at the healthcare facility, can we release any information other than verifying the patient’s presence?
A: Assuming the age of majority is 18 in your state, this patient is an adult. Although his or her parent’s plan provides coverage, the parent does not have the right to access his or her PHI without written authorization.
Editor’s note: Mary Brandt, president of Bellaire, TX-based Brandt & Associates, LLC, answered this question. This is not legal advice. Consult your attorney for legal matters.
NPIs: Taxonomy code for psychiatric residents?
Q: We are told that teaching hospitals must apply for NPIs for residents. What does one use for the taxonomy code for residents? We train psychiatric residents in an acute care hospital. I found no codes under the specialty of psychiatry for residents.
A: Here’s the answer from “CMS FAQ 5809.” Basically, if they have to be reported on an electronic claim (and they don’t have a license yet) there is a code for students.
Here’s the question on the CMS Web site: “Which Healthcare Provider Taxonomy Code(s) should be selected by medical students, interns, residents and fellows when applying for National Provider Identifiers (NPIs)?”
To read CMS’ answer, click here.
Editor’s note: Richard McNeil, MBA, MIS project leader on the financials team at Southcoast Hospitals Group in New Bedford, MA, answered this question.
Are we ready for hospital-branded credit cards?
Q: What are your thoughts on the movement toward hospital-branded credit cards and how they may tie into the more savvy/educated consumer?
A: The primary place where we see the use of credit cards expanding is through HSA accounts. When these accounts are established, your financial institution typically issues you either a credit card or checkbook to pay for medical expenses.
As far as hospital-branded credit cards, the adoption has been slow. Hospitals initially responded positively to the idea of credit cards but consumers didn’t. For them there isn’t much benefit to use a credit card over setting up a payment plan. As far as credit cards go, it is hard for hospitals to match all the bells and whistles that traditional issuers can offer.
Editor’s note: Keith Siddel, MBA, PhD, president and CEO of HRM, answered this question.
Where is state transparency coming from?
Q: Who is driving the push for state transparency? Is it generally a government authority or a special interest group or some other group?
A: The push is coming from many directions. On the national level, there have been two congressional bills which were introduced but died in committee.
On the state level, the push is primarily coming from consumer advocates. Some states like California have had the laws on the books for a number of years. Other states have only recently joined the bandwagon. In addition to consumer advocates, payers have also played a strong role in disclosing hospital prices because it is in their best interest.
Editor’s note: Keith Siddel, MBA, PhD, president and CEO of HRM, answered this question.
NPIs for teaching hospital residents?
Q: Our hospital is a teaching hospital. Are our residents required to have an NPI?
A: If you are billing in the residents’ names then they need an NPI. In other words, if you would put their UPIN or other similar number on a claim form you will need an NPI.
Editor’s note: Susan Miller, JD, chief operating officer and chief privacy offer of HealthTransactions.com, answered this question.
UB-04: Is box 70 the same diagnosis as box 69?
Q: Could you please verify that box 70 is the same diagnosis as box 69? Also, what is box 81 a, b, c, and d? And what is the “qual” on boxes 76-79?
A: The value submitted in 70 is at times the same as what is put in box 69. But that should not be set as a default. Box 69 is the diagnosis used to indicate the reason for the admission, while 70 is used to indicate, for an unscheduled outpatient visit, what the patient indicated as their reason for visit to the provider.
Form locator 81 is the code-code area-to allow for additional data elements to be reported. It’s described in the manual in detail. For example, the taxonomy code that hospital providers are required to report to Medicare A. Other usages have been identified in the manual, and future usages will most likely be identified.
The qualifiers in 76-79 identify the values being sent to identify the physician.
Editor’s note: Jim Whicker, director of electronic commerce/EDI and accounts receivable management at Intermountain Healthcare in Salt Lake City, UT, answered this question.
UB-04: Is a ‘how-to’ manual available?
Q: I would like to know if there is a manual explaining each box on the form and what information we need to enter? Is there a list of coding required as well? If so, how can we obtain one?
A: The UB-04 Data Specifications Manual is available through a subscription. Go to the NUBC website (www.nubc.org) and click on “Become a Subscriber.”
Editor’s note: George Arges, senior director of the American Hospital Association, answered this question.
UB-04: What is meant by ’service location?’
Q: I’ve heard that “FL1″ must be completed with the service location of the provider. For the UB-92, the prior field was for the “provider submitting the bill.” Can you please explain more about what aas meant by “service location?”
For example, if the main hospital campus has one address such as 123 Main Street with EIN 12-345678 and this hospital has a provider based clinic or diagnostic center located at another address, 4567 Main Street, with EIN 12-345678, what address would be used in “FL1″ for the provider-based claim, the physical practice location or the address of the main hospital campus/provider?
A: The NUBC changed the description in “FL1″ to coincide with the electronic standard-namely service location. For the most part, providers should continue with the way they are submitting claims today to their health plans. A campus facility that has multiple buildings within the campus area will likely use one location to represent their service location. As these providers look to transition to an NPI they may choose to enumerate some of these different areas within the campus separately-in this case the ones with different NPIs would bill separately-generally by service location.
Editor’s note: George Arges, senior director of the American Hospital Association, answered this question.
Should we read into changes in ’source of referral’ definition?
Q: Regarding “FL15-Source of Referral for Admission or Visit,” the definition in the UB-04 specifications is, “a code indicating the source of the referral for this admission or visit.” The definition in the UB-92 specifications, that we currently use, is “code indicating the source of this admission or outpatient registration.”
Is there a difference in how we should be using this field or not? Are we reading too much into the difference in verbiage?
A: The NUBC is currently reviewing the Source of Admission or Visit codes. There has been a great deal of confusion around the use of this data element, but it is becoming more important as pay-for-performance initiatives take hold.
The NUBC held a meeting on some proposed language changes for this field. We are planning to clarify how these codes should apply. The NUBC wants to include some further refinements to the proposed language changes for some of the codes and will be revisiting this issue at the May meeting.
At that time we hope to have final agreement on the approach. Fundamentally, we want the codes to represent the point of origin.
Editor’s note: George Arges, senior director of the American Hospital Association, answered this question.