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Christopher FETTERS District Sales Manager Point of Care Billing: Yes You Can! Point of Care Billing: Yes You Can! © 2005. All Rights Reserved. Unauthorized.

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Presentation on theme: "Christopher FETTERS District Sales Manager Point of Care Billing: Yes You Can! Point of Care Billing: Yes You Can! © 2005. All Rights Reserved. Unauthorized."— Presentation transcript:

1 Christopher FETTERS District Sales Manager Point of Care Billing: Yes You Can! Point of Care Billing: Yes You Can! © All Rights Reserved. Unauthorized duplication is a violation of applicable laws.

2 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Goal Goal in Point of Care? Goal in the Laboratory? Goal in the Hospital? Golden Rule: Do unto others as you would have them do unto your mother. Golden Rule: Do unto others as you would have them do unto your mother.

3 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) To Err is Human - Building a Safer Health System A Report From The National Academies of Science, Institute of Medicine 44,000 – 98,000 patients killed each year by medical mistakes Key Recommendations Center for patient safety National mandatory reporting Peer review protections Focus greater attention on patient safety FDA should increase attention to safe use of drugs

4 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Nurse training Right Patient Right Drug Right Dose Right Route Right Time 770,000 untoward drug errors

5 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) It is necessary to create a culture of change that embraces patient safety through shared accountability within a blameless culture. Rosina Jones, LHRM, CHRM

6 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Causes of Medical Mistakes 60-80% is human error Active errors Latent errors 15-20% is mechanical failure

7 Newsweek Who is the most important person in Media and Entertainment?

8 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Three approaches to quality Remedial Alleviate the symptoms of the existing problem Corrective Eliminate the cause of existing problems or undesirable situation to prevent recurrence Preventative Eliminate the cause of potential problems

9 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Changing the process er – Season finale Romanos accident Not this one IDIOT

10 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Three phases of laboratory testing Pre-analytical Analytical Post-analytical

11 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) hile point-of-care testing (POCT) has significantly improved the timely delivery of diagnostic information for clinical decision making, the wide range of settings and operators involved in POCT add a layer of complexity to an institutions effort to ensure consistently high-quality results. Gerald J. Kost, MD, PhD. Using operator lockout to improve the performance of point-of-care blood glucose monitoring W

12 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Is 99.9% Good Enough? 1 hour of unsafe drinking water every month; There will be no telephone, electricity or television for 15 minutes each day. 315 entries in Webster's Dictionary will be misspelled 114,500 mismatched pairs of shoes will be shipped/year 811,000 faulty rolls of 35MM film will be purchased this year. 880,000 credit cards in circulation will turn out to have incorrect cardholder information on their magnetic strips 2,488,200 books will be shipped in the next 12 months with the wrong cover. 5,517,200 cases of soft drinks produced in the next year will be flatter than a bad tire. 1,314 phone calls will be misplaced by telecommunications services every minute. 18,322 pieces of mail will be mishandled/hour 22,000 checks will be deducted from the wrong bank accounts in the next 60 minutes. 2,000,000 documents will be lost by the IRS this year Your heart fails to beat 32,000 times each year. Twelve babies will be given to the wrong parents each day. 2,500 newborn babies will be dropped in the next month. 107 incorrect medical procedures will be performed by the end of the day today. 500 incorrect surgical operations each week; 200,000 drug prescriptions will be filled incorrectly in the next 12 months. A typical day would be 24 hours long (give or take 86.4 seconds) Jeff Dewar

13 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Safety is part of quality Process changes ensure long-term benefit Labs have opportunity because of attention to quality issues Examine pre-analytical processes first Use technology to improve processes, address quality & examine data Quality Our healthcare delivery system is NOT safe for the patient

14 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) 82% of Patient Data Still Manually Recorded Source: 1999 EAC US Hospital POC Survey

15 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Point of Care Errors Sensa v. Non-sensa Documentation of ACT Results MD Pocket Developer (distilled water) Documentation of urines Timing urine dipsticks Bad Patient/Operator IDs Timeliness of data (docking) wireless CHANGE THE PROCESS

16 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Your mission… Risk Analysis Brainstorm What tests? Pre-analytical, analytical, post-analytical What steps? List what could go wrong? (Risk Analyis) Prioritize (Severity) Change the process / re-educate Audit

17 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) operators Three things you MUST DO! 1.Barcode your patients & operators 3. Bill for point of care testing 2.Install Connectivity (not just data management) Christopher Fetters: Video of barcoding a patient. Video of instrument download, data management station, computer room, Bills printing off, money falling, patient accounting department Graphics with poof on previous, then diminishing graphic of current one Find a bite mark for these… Christopher Fetters: Video of barcoding a patient. Video of instrument download, data management station, computer room, Bills printing off, money falling, patient accounting department Graphics with poof on previous, then diminishing graphic of current one Find a bite mark for these…

18 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Fetters POC Device Classes 0 – Manual testing i – Marginally Connectable Instruments ii – Batch Download Connectable Instruments iii – Continuous Connected Instruments (Wired) iv – Continuous Connected Instruments (Wireless)

19 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Standard Data Management Schema POC Device Date/Time Device S/N QC Lot# QC Lockout User ID Patient ID Strip Lot# Result Comment Code Networ k Clinical Data Station

20 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Standard Data Management Schema Networ k Clinical Data Station POC Device

21 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Standard Data Management Schema POC Device Networ k Clinical Data Station Downloading

22 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Standard Data Management Schema Networ k Clinical Data Station POC Device QC in range Valid Patient ID Valid User ID Comment Code Flagged Results

23 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Standard Data Management Schema Networ k Clinical Data Station POC Device Flagged Results

24 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Standard Data Management Schema Networ k Clinical Data Station POC Device QC in range Valid Patient ID Valid User ID Comment Code Flagged Results

25 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Standard Data Management Schema Networ k Clinical Data Station POC Device Flagged Results LIS System HIS System HIS Terminal Cum Report Patient Billing …

26 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Benefits Time savings (up to 1/3 of POCC) Ability to bill Results on EMR QC tracking / regulatory viability Improved user compliance What I do matters to somebody QC/Operator Lockout Early problem detection (liability) CONCLUSION: 1. Ability to bill improves ability to staff to an adequate level and use discretionary time to improve patient care. 2. IMPROVED CONTROL = IMPROVED QUALITY = IMPROVED SAFETY = IMPROVED PT CARE

27 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Challenges Doesnt inherently save *nursing* time Timeline Apparent Price (Sticker-shock) Manual testing Interfaces Multiple devices / multiple DM systems CONCLUSION: Lack of profit, cost of implementation and the challenge of multiple analytes have been a barrier to ubiquitous implementation of connectivity.

28 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Objectives You should bill for point of care testing! Point of care billing is profitable! Billing for point of care improves patient care!

29 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Why bill? Gives credit among admin to program (You get what you pay for) Count workload Ought to be paid for services Recoup costs Continue to upgrade technology Add FTEs to improve control Good for patient care

30 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) We should bill for point of care testing. Q.HOW? Q. WHY? A.The same way we do for all other laboratory testing. A. Because it is laboratory testing.

31 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Point of Care Testing is Lab Testing Clinical Laboratory Improvement Amendments of 1988 (CLIA 88) American Medical Association (AMA) Medicare

32 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) CLIA 88 Certifies testing Agents of the laboratory Human specimens Based on complexity, not setting

33 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) CLIAs View of In Vitro Testing CLIA requires all entities that perform even one test, including waived test on... materials derived from the human body for the purpose of providing information for the diagnosis, prevention or treatment of any disease or impairment of, or the assessment of the health of, human beings to meet certain Federal requirements. If an entity performs tests for these purposes, it is considered under CLIA to be a laboratory and must register with the CLIA program. One Waived Test = Laboratory

34 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) AMAs CPT Codes Defines code for medical procedures Laboratory testing in the range: to CPT Codes for POC Waived Glucose – Urine dipstick – ACT – Fecal occult blood

35 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Medicare Medicare Part A Inpatient Reimbursed by Fiscal Intermediary Medicare Part B Outpatient/POLs Reimbursed by Carrier Alabama(Regional Office: Atlanta) Part A - Blue Cross and Blue Shield of Alabama; Mutual of Omaha Insurance Company Part B - Blue Cross and Blue Shield of Alabama

36 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Inpatient Medicare Billing Process Patient discharged Physician discharge summary and diagnoses Medical Records Coder ICD-9 codes Grouper DRG code Upload to Medicare Payment under Prospective Payment System (PPS) Upload hospital cost report Christopher Fetters: Set this up as an animation or video Christopher Fetters: Set this up as an animation or video codes - Clinically cohesive groups Similar consumption of hospital resources Similar length of stay patterns - 30,000 codes - Standardized codes for diagnosis - Formulated by the World Health Organization (WHO) - ICD-10CM is coming…

37 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Use of the cost report Globally PPS based on averages Set next years DRG reimbursement schedule Locally Cost to charge ratio Christopher Fetters: Illustrate the averages going down because point of care testing is absent. Illustrate the cost to charge ratio Illustrate the lump sum payment at the end of the year. Illustrate the Part A to Part B Rollover Christopher Fetters: Illustrate the averages going down because point of care testing is absent. Illustrate the cost to charge ratio Illustrate the lump sum payment at the end of the year. Illustrate the Part A to Part B Rollover

38 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Example DRG Primary Diagnosis: ICD – Bypass, aortocoronary Medicare Average Reimbursement: $37,000 DRG 106: Coronary Bypass with Cardiac Catheterization Secondary Diagnoses: Valvuloplasty, Atherectomy, Catheterization, Angiocardiogram, or Arteriogram ICD-9 DRG $$ Christopher Fetters: Set this up as a flow chart. Get video of medical records, picture of discharge notes, doctor writing discharge notes Christopher Fetters: Set this up as a flow chart. Get video of medical records, picture of discharge notes, doctor writing discharge notes

39 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Medicare contractors QUESTION Part A - Coverage Is CPT a covered service for inpatients? ANSWER Inpatient claims submitting for Glucose, blood by glucose monitoring device(s) cleared by the FDA (Food and Drug Administration) specifically for home use is a covered procedure and reimbursed DRG for hospitals or RUG for Skilled Nursing Facilities (SNF). [http://www.trailblazerhealth.com/faqs.asp?action=print&id=1561] CHISOLM BCBS TRAILBLAZER 12 QUESTION Is CPT a covered service for inpatient claims? ANSWER Inpatient claims submitted for Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home use, is a covered procedure and reimbursed as a portion of the Prospective Payment System for Hospital and Skilled Nursing care inpatient services. [http://www.bcbsok.com/chisholm/frequently_asked_questions.html] QUESTION Part A - Coverage Is CPT a covered service for inpatients? ANSWER Inpatient claims submitting for Glucose, blood by glucose monitoring device(s) cleared by the FDA (Food and Drug Administration) specifically for home use is a covered procedure and reimbursed DRG for hospitals or RUG for Skilled Nursing Facilities (SNF). [http://www.trailblazerhealth.com/faqs.asp?action=print&id=1561] QUESTION Part A - Coverage Is CPT a covered service for inpatients? ANSWER Inpatient claims submitting for Glucose, blood by glucose monitoring device(s) cleared by the FDA (Food and Drug Administration) specifically for home use is a covered procedure and reimbursed DRG for hospitals or RUG for Skilled Nursing Facilities (SNF). [http://www.trailblazerhealth.com/faqs.asp?action=print&id=1561] Waive d Test

40 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Covers procedures in CPT Range Set reimbursement rate (Medicare Part B) Update yearly by Medicare Medicare Clinical Laboratory Fee Schedule

41 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Setting charges for analytes Using the Clinical Lab Fee Schedule DONT Glucose (82962) $3.27 Use lab/hospital Charge Master Suggest CLSI (NCCLS) GP-11A Basic Cost Accounting for Clinical Services Calculate using worksheets (Direct cost + Indirect cost) X Hospital multiplier X

42 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Medicare Payment Policies National National Coverage Decisions 23 lab analytes In effect Nov, 2002 Final Rule: Federal Register 11/23/2001 Administered by Federal Law Local LMRP (Local Medical Review Policy) Administered by Carrier

43 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Medicare National Coverage Decision Specifically addresses glucose testing Lists ICD-9 for medical necessity Lists reasons for denial Also covers CPT Christopher Fetters: Picture of someone putting a grey top on a core lab instrument Christopher Fetters: Picture of someone putting a grey top on a core lab instrument

44 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) AACC Conference Call Poll (2003) Q: For which POCT procedures does your institution receive reimbursement? Glucose only (22%) Coagulation (PT/INR) only (30%) Glucose and coagulation only (22%) All POCT charges are billed (26%)

45 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) lab tests? What is required to bill lab tests? CLIA Number Physician order Reasonable and necessary (SSA 1862(a)(1)(A)) Physician must use to manage pt care (42 CFR , ) Result to physician promptly (implicit)

46 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Medicare National Coverage Decision Specifically addresses glucose testing CPT Codes ICD-9 for medical necessity Reasons for denial Absence of signs or symptoms Routine physical (such as employee physical or community health fair) Failure to provide medical necessity Not ordered by physician Failure to have CLIA certificate Testing performed on device not FDA approved

47 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) How do I bill? Manual Billing Christopher Fetters: Video of someone filling out a lab card, video of someone docking each type of instrument, video of nurse with stickers on uniform, video of using a pyxis, video of using a data management workstation – Add slide to show increased revenue with data management. Christopher Fetters: Video of someone filling out a lab card, video of someone docking each type of instrument, video of nurse with stickers on uniform, video of using a pyxis, video of using a data management workstation – Add slide to show increased revenue with data management % Missed charges Data management

48 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) AACC Conference Call Poll (2003) Q: What are your major stumbling blocks to POC billing? Too great an investment to set up infrastructure (24%) The lab director or finance department has told us we cannot bill (34%) Consultant told us we cannot bill (8%) We are waiting for connectivity (34%)

49 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Laboratory Trends Profits Costs

50 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) US Testing Market The US Laboratory testing market totaled ~$35.4 billion (5.63 bn tests) in 2001 (including commercial, hospital, physician office & other labs) Hospitals/IHNs = > 4.1 bn tests Commercial other & labs = ~ 1.53 bn POCT is almost $4 billion and GROWING!

51 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Payor mix (typical) Medicare / Medicaid (45-60%) Managed care (20-40%) Fee for Service (15-25%) Other (remaining)

52 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) As many as 168,000 hospital positions are unfilled in six selected job categories. Three out of four vacancies are nursing positions Note: Other hospital professions include pharmacists, radiological technologists, laboratory technologists, billing/coders, and housekeeping/maintenance staff. Healthcare Personnel Shortages Other Hospital Professions 25% Registered Nurses 75%

53 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Staff Shortages Continue For U.S. Hospitals Northeast A Shortage of Medical Technologists Mean Vacancy Rate (in percent) Midwest South West

54 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Billing can improve patient care More FTEs = Better quality More leverage with physicians and nurses Show ROI on Data Management Financial and clinical justification for new point of care analytes POC Billing creates more nursing positions Christopher Fetters: Picture of a discontented nurse with her arms crossed. Picture of doctor signing patient chart. Illustrate data management Show form with clinical and financial justification request. Christopher Fetters: Picture of a discontented nurse with her arms crossed. Picture of doctor signing patient chart. Illustrate data management Show form with clinical and financial justification request.

55 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Potential Your mission… POC Committee Create an impact worksheet Pt volumes X Charges = Gross Charges Gross Charges X Fee for service % = Net Revenue Potential Billing investigation committee (Ad hoc) POC Coordinator (& Staff) Medical Director Lab Manager / Administrative Director Lab Business Operations Mgr LIS Supervisor Patient Accounting Nursing Admin Managed Care Contracts

56 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Conclusion You should bill for point of care testing! Point of care billing is profitable! Billing for point of care improves patient care! Christopher Fetters: Include montage of point of care, data management, money, instruments, downloading, nurse taking care of patients. Build the montage with lots of dissolved shots… Needs to create a picture of something as it builds. Like a dollar sign or fade into the face of a patient or something… Christopher Fetters: Include montage of point of care, data management, money, instruments, downloading, nurse taking care of patients. Build the montage with lots of dissolved shots… Needs to create a picture of something as it builds. Like a dollar sign or fade into the face of a patient or something…

57 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006)

58 Point of Care Optimization Alabama Point of Care Coordinators (27 Apr 2006) Questions? Christopher Fetters Nova Biomedical (781) x293 (781) Fax Christopher Fetters: Include stylized Nextivity Logo, Picture of me…etc. Christopher Fetters: Include stylized Nextivity Logo, Picture of me…etc.


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