Coding, documentation, and compliance... Oh My! RSS 2.0
# Thursday, November 12, 2009
For those of you who hang on my every word (I think that's 3 of you. :) I told you last week that I would be doing an in depth detailed review of the 1900+ pages in the 2010 OPPS Final Rule which was published on 10/30/2009.  Considering some of what I've researched, it may have been more appropriately released a day later, but I digress.

One of the 'treats' that you my kind reader can expect for 2010 is in the “direct supervision” requirement for on-campus and off-campus Hospital Outpatient Departments (HOPD). I'll get to some of the 'tricks' next week.

You should remember (or lets hope you do) that the 2009 OPPS Final Rule greatly affected wound clinics that were operating without any direct physician supervision.  Those which were directly supervised by non physician practitioners (NPPs, Nurse Practitioners, Physicians Assistants, etc) or, worse yet, those which were staffed by wound care nurses without any direct supervision could not bill a facility fee.  Go ahead, do a double-take.  If this is *still* the way you practice, PLEASE STOP.  You are committing fraud. If a physician was not present in the 'footprint' of the wound care department, not the hospital campus, the doctors' lounge doesn't count, its been clear for over a year that you out of compliance with the regulation if you drop the facility fee.  Now, if a NPP provided the service, they could still bill for their professional fee, but the hospital could not bill the facility fee.

Well, this 2009 clarification to the 2000 rule was not well received by the industry.  You made your voices heard and listening occurred.  From the Final Rule:

"We considered a wide variety of potential modifications to our physician supervision policies in response to this information about current health care delivery practices and challenges. The dialogue with interested stakeholders provided us with sufficient information to develop proposals for certain changes to the supervision policies for hospital outpatient services for CY 2010 in order to take into full consideration current clinical practice and patterns of care, the need to ensure patient access, the associated hospital and physician responsibilities, consistency among requirements for different sites of services, and other important factors."

Translation:  We listened, we changed things.

Remember, for the full text of the Final Rule, browse on over to http://federalregister.gov/OFRUpload/OFRData/2009-26499_PI.pdf.  If reading 2000 pages of dry text isn't your thing, head on over to http://www.Intellicure.com and give our sales team a ring.  We have some great options on our Business Consulting Services.  Ok, enough with the shameless plug, back to Direct Physician Supervision.

Great, so what's that mean to me?
So, in summary, there are three points of clarification in this rule pertaining to direct supervision all of which will be effective January 1, 2010:

1. Physicians Orders
"Services and supplies must be furnished on a physician’s order and delivered under physician/non physician supervision.  Each occasion of a service does not need to also be the occasion of the actual rendition of a personal professional service by the physician responsible for the care of the patient. However, during the course of treatment rendered by auxiliary personnel, the physician/non physician practitioner must personally see the patient periodically and sufficiently often enough to assess the course of treatment and the patient’s progress and, where necessary, to change the treatment regimen."

2. On-Campus Supervision
"For services provided in the hospital or on-campus PBD of the hospital, the supervisory physician or non physician practitioner must be present on the same campus and immediately available to furnish assistance and direction throughout the performance of the procedure."

Ok, so it can be a NPP, big change, but what's the first question on most people's minds? Exactly, what does immediately available mean? Those of you who have been operating hyperbaric departments for more than a few years will remember that "immediately available" most directly translates into that person cannot be performing another procedure or service that he or she could not immediately interrupt. 

"The physician or non physician practitioner must be prepared to step in and perform the service, not just to respond to an emergency.  This includes the ability to take over the performance of a procedure and, as appropriate to both the supervising physician or non physician practitioner and the patient, to change a procedure or the course of treatment being provided to a particular patient. The physician or non physician practitioner is not required to be in the room where the procedure is performed."

Still looking for it to be spelled out more clearly in black and white?

"For 2010, non physician practitioners (clinical psychologists, licensed clinical social workers, physician assistants, nurse practitioners, clinical nurse specialists, and certified nurse midwives) may directly supervise all hospital outpatient therapeutic services that they may perform themselves within their State law and scope of practice and hospital-granted privileges, provided that they meet all additional requirements, including any collaboration or supervision requirements, as specified in the regulations at §§410.74 through 410.77."

3. Off-Campus Direct Supervision
Ok, for those of you operating a HOPD off-campus, don't expect any miracles.  Medicare only made a minor modification to also allow NPPs to provide direct supervision of the services that they may perform themselves in those locations.
 
"For off-campus PBDs of hospitals or CAH’s, the physician or non physician practitioner must be present in the off-campus PBD, and immediately available to furnish assistance and direction throughout the performance of the procedure. This requirement does not mean that the physician or non physician practitioner must be in the room when the procedure is performed."

That's all for this week.  Check back next week to hear what is being planned for enforcement for those HOPDs not in compliance for the last decade.

Thursday, November 12, 2009 6:35:09 AM (Central Standard Time, UTC-06:00)  #    Comments [3] -
Coding | Compliance | Government
Thursday, November 12, 2009 7:06:16 PM (Central Standard Time, UTC-06:00)
So where to the nurse run wound clinics fall. We have MD orders to follow but they are not onsight. If we have problems with patients, we sent them to our emergency room and notify the PCP of what is going on with the patient. We call the PCP if problems or questions arise with the patient's wounds. Does this mean, we cannot bill procedural codes such as debriding, vac application, etc. at all? Thanks
Elisabety Harvey
Monday, November 16, 2009 3:35:32 PM (Central Standard Time, UTC-06:00)
Thank you DAvid for sharing this. We are investigating the potential of broadening our WOC services to more oupt opportunities and your article helped clarify some of the regulations. Keep it coming. Mary
Mary Beshara
Thursday, November 19, 2009 12:19:10 PM (Central Standard Time, UTC-06:00)
keep the info coming. I appreciate it.
Eileen Curry
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Who Is This Guy?
For my day job, I'm the CEO of Intellicure, a wound care software company in The Woodlands, TX. We're proving to the world that an electronic medical record can be easy to use and affordable.

We make IntelliTrak, an electronic medical records system that actually works and can be used to manage everything your wound care team does, from clinical documentation to front desk activities to clinic management to inventory and so much more.

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