College Clinic Supervisor Clinical Practice Standards

Description

PREREQUISITES:  the Traditional Medicine Clinical Practice Manual Textbook is required.

COURSE DESCRIPTION

This course aims to provide acupuncture college instructors and clinic supervisors with knowledge of modern acupuncture and herbal medicine practice guidelines that comply with the rules and regulations of the United States. The focus of the course is clinical documentation according to CMS 2021 requirements. The current ICD-10 and future ICD-11 Chapter 26 Traditional Medicine standard terminology coding guidelines will be discussed in detail according to the ICD-10-CM Official Guidelines for Coding and Reporting. Legal language and FDA-compliant terminology will be emphasized. The importance of preventing, capturing, and mitigating adverse events will be introduced. The Traditional Medicine care standards to avoid negligence and fraud according to the rules and regulations of the United States healthcare industry will be mastered. The practical skills necessary for successful student oversight, emphasizing gainful employment of graduates, will be reinforced.

COURSE LEARNING OUTCOMES: Through the successful completion of this course, each student will be able to:

Professional Standards:

1. Understand the Credentialing, Institutional Role, Legal Title, Institutional Rights, and Responsibilities of Acupuncturists in the United States Healthcare System
2. Demonstrate Knowledge of Professional Standards, Professional Ethics, and Grounds for Discipline

Care Standards:

1. Demonstrate Understanding of Proper Determination of Care Pathways, such as Medical Necessity.
2. Master the Letter of Medical Necessity
3. Emphasize Referral and Co-management Guidelines
4. Discuss Negligence

Customer Service Standards:

1. Demonstrate knowledge of the EHR Patient Record Components, Including Demographic, Health, Financial, and Legal
2. Demonstrate Understanding of the Insurance Benefit Verification and Payment Reconciliation Process

Evaluation/Management Standards:

1. Review 2021 CMS Evaluation and Management (E/M) Documenting Requirements in the EHR
2. Demonstrate Understanding of the Medical Decision Making (MDM) Complexity and Ability to Select the Appropriate CPT Code for Acupuncture and TCHM Encounters
3. Discuss documenting and billing for No-Show & Left-Without-Seeing
4. Discuss Documenting Phone calls
5. Discuss the Documentation Amendment
6. Reinforce Documentation of Supervision

Acupuncture Standards:

1. Reinforce Documenting Acupuncture Procedure with the Appropriate Number of Acupuncture CPT Units
2. Discuss the Examples of the Follow-Up Acupuncture Procedure Encounter Note

TCHM Standards:

1. Learn Herbal Medicine Regulations in the United States
2. Discuss Herbal Medicine FDA Compliant Language
3. Demonstrate Proper Selection of Evaluation and Management CPT Codes for Traditional Chinese Herbal Medicine (TCHM)
4. Reinforce TCHM Documentation
5. Learn Traditional Chinese Herbal Medicine Adverse Events Identification & Legal Mitigation Strategies

Lab/Test Standards:

1. Review Labs Ordering and Billing Guidelines
2. Reinforce Labs/Test Documentation in the SOAP

Terminology Standards:

1. Reinforce Current ICD-10 Conventional Billable Diagnosis Formulation and Coding Guidelines Applicable to the Practice of Traditional Medicine in the United States
2. Master the Use of ICD-11 Chapter 26 On-Line
3. Reinforce Traditional Medicine Diagnosis Formulation and ICD-11 Ch2 6 Coding Guidelines
4. Understand Adopting Rules of ICD-11 Ch 26 for Non-TCM Acupuncture Styles
5. Learn Documenting Guidelines of ICD Codes in an EHR

Billing Standards:

1. Understand Documentation Specific Requirements for Different Insurances
2. Navigate Letter of Appeal
3. Demonstrate Knowledge of  the SOAP Note Audit Tools
4. Master Audit Tool Practical Application

Legal Standards:

1. Demonstrate knowledge of HIPAA Compliant Patient-Provider and Provider-Provider Communication
2. Discuss Fraud