Wiki Setting Level Criteria

[bhunt]

It is pointed out that facility and professional services levels do not have to match but CAN they match? I work with a rural critical access hospital with an onsite clinic and the clinic manager is battling with how to set facility E&M level criteria. He is not found of levels by time because he feels his staff does not have the resources to accuratly keep track of this. He would like to set the criteria to be the same as physician criteria. Is this possible? Is it compliant? Will it flag the facility for audits?

Any information you can provide with be very appreciated!

 

[mitchellde]

you should never set facility levels using the same as the physician everytime nor using physician criteria, and actually you are not to use time as the factor for setting facility levels.
Every successful tool I have seen for assessing facility levels is a point system, we determined a point value for every type of resource utilization and created a check sheet with these points.
such as taking vitals signs, uses a nurse or aide so 5 points, transporting a patient to various locals uses a transporter so 10 points, changing dressings was either 5, 10, or 15 points, and so on, if it can be captured with a CPT code then it cannot be captured with points, and since the physician is billing his own E&M, physician activity cannot be captured with points, that is double dipping. e-mail me if you need further help in this area. I may still have a copy of the points we assigned. I will look and see.

 

[bhunt]

why not time?

I would appreciate a copy of the point sheet if you have one. Do you know why you would not use time to determine your facility E&M level? I think a lot of our outpatient clinics set their facility E&M criteria that way because they feel it is easiest; takes the least amount of resources.

Our clinic manager feels there are special rules for rural facilities. I am not aware of any special rules, are you?

Thank You

 

[mitchellde]

Yes there is a list of rules, and it does state that you are not allowed to use time as a criteria for determining the facility level. There are several criterion that must be met and I remember the list was published back in 2000 in an OPPS transmittal, it is what we used to develop our system to be sure we were in compliance with the rules. If you give me your e-mail I will see if I can locate a copy of what we developed. I know my AAPC mailbox is full <sigh> it stays that way most of the time. send me an email at debraawm@yahoo.com so that I can reply.
Oh an no there are not special rule for rural.