Listserv Q&A

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Date Question Response(s)
2/22/24 How does your health center track Preceptors for UDS reporting? What process does your health center use to manage their preceptor/student relationships, assignments, and documentation?
2/22/24 What health centers currently perform a pregnancy intention screening using a questionnaire or the One Key Question? 2/23/24: Konza Prairie has family planning in their facility. They use templates that include the questions below.

  • Is there any reason you do not want someone in your home to know you are here today? Yes/No
  • Do you want to discuss birth control options at your appointment today? Yes/No
  • Do you have any questions or concerns about your sexual health? Yes/No
  • Have you ever been sexually active? Yes/No
  • Do you or your partner want to become pregnant within the next year?
  • Who is responsible for birth control in your relationship?
  • What kind of birth control are you currently using?
  • Type of contraceptive method at the end of visit:
12/19/23 Regarding the 21st Century Cures Act:

  • Who has enabled the full visit note to be viewed in the portal and are all service lines available (e.g., medical, dental, behavioral health)?
  • Have you had push back from providers?
  • Did you change your documentation style since patients can more easily read the note?
12/19/23 CPT vs. encounter-based UDS reporting:

  • eClinicalWorks – How are health centers on eCW working on their UDS now that the report is not encounter-based but CPT-based? How are you reporting out demographics and are you using CPT groups?
  • NextGen/Athena – Has your UDS changed from visit type to CPT codes and how are you handling this change?
  • Azara – Reporting has gone to CPT. Has this affected your  UDS reporting?
11/28/23 How are clinics managing their clinical practice guidelines? Are they listing each and everything out? Just the priority areas? How do you manage various specificity that may differ from UDS reporting?
11/20/23 What do you use for your HIPAA training; how often do you do it; what topics do you cover and who is in charge of monitoring it is done?
11/20/23 If you use a Learning Management System (LMS) who (title/position) is the administrator of the system, who chooses or has input on the training covered, and has turnover caused disruptions or gaps in training?
11/20/23 What process, system, or tool do you use to track your PDSA or other quality improvement project cycles?
11/14/23 Are there any health centers using or have used Compliatric? What is your feedback on that?
11/14/23 Do you have an outside review for provider or for billing/coding and if so, who do you use? 11/20/23: We use Consultants in Practice Management Patti Frank, CPC for billing and coding reviews once a year.
11/20/23: The Coding Network has done billing & coding reviews in the past and will follow up with each provider to give feedback and discuss the reasons for why the reviewer counted something out of compliance.
11/14/23: We are part of Aledade and they have a department that will review the coding. We also have a consultant that comes in one quarter a year to do coding and billing reviews, they meet with the provider and admin afterward to go over anything that needs to be worked on.
9/20/23 What codes can a Psychologist bill under PPS rate billing? Are you billing standard E&M codes or behavioral health specific codes for their visits?
9/20/23 Are any health centers placing IUDs in clinic and what does that look like for billing and reimbursement regarding both the device and the placement procedure?
9/20/23 How are health centers differentiating inability to pay vs refusal to pay and what documentation are you keeping to maintain compliance? Is there a point where patients’ outstanding bill is “too high” and they are unable to schedule because of non-payment?
9/20/23 We have multiple systems for learning management, credentialing, policy tracking, compliance, grant management, etc – does anyone have a system that is “all in one” or multiple in one? Is anyone using a single log in for these systems?
9/20/23 What policy language are clinics using around patient assistance in transferring between vehicles/wheelchairs/transportation bus/etc. both within the clinic and outside the clinic at their transportation? If staff are allowed to physically assist patients with mobility, what training and what safety PPE are provided?
9/5/23 Do you have a data governance plan or a policy and procedure?
9/5/23 Do you discuss data governance in your QM policies/plan, in a separate policy/plan, are you developing it or is data governance not a priority right now?
8/28/23 Do you have call lights in patient/public bathrooms and what pro’s and con’s have you evaluated in your decision to install or not install these in your facilities? 9/5/23: We do not have call lights. However rooms are in proximity to staff to hear a call for help. There is an “occupied” sign that flips on the lock so we know if occupied. Have not evaluated need for call lights, but we do have sharps containers installed due to the amount of things broken in a bathroom (pens, perfume bottles, needles- especially for insulin dependent patients who may have an all day list of appointments and errands and rely on public transit).
9/5/23: We do not have call lights in the public bathrooms.
8/28/23 What best practice are others using to mark patients inactive when the patient is no longer a patient of the health center due to transfer care, moves away, dismissal of patient, etc? How do you ensure this doesn’t impact the reporting of unique patients and/or patient visit counts? 9/5/23: Our front office coordinator would remove them if they were reported as leaving our care by patient. We need a good workflow for patients who “fall off” (haven’t been seen in 36 months.
9/5/23: If you patient has been seen in the last 12 months but moves, marking inactive or deceased shouldn’t affect the measure. As long as they were seen in your health center with a qualifying encounter, they are in your denominator. eCW mapping has confirmed this is true as well as BPHC support response.
9/5/23: I monitor the accounts, when they have not been seen in 12 months there is an alert placed on the patients account stating that they are inactive, or transferred, etc. Once there has been no activity on the account for 2 years, then the account will be inactivated. This makes sure that there is no impact on the reporting at the end of the year. If there is ANY activity on the account within the year, then the account will not be inactivated.
8/1/23 Are any clinics using MFA (multi factor authentication)? If so, what systems are in place and what are you using for the “other factor” – a fob, cell phone, etc? If using a cell phone, are staff provided with a one or with a stipend when using their personal cell phone? 8/15/23: We use the Authenticator app; staff have it downloaded to their phone; no stipend.
8/15/23: Yes, we use MFA. Downloaded to personal Cell phones. No, we do not provide them or reimburse for them as of today, but we have talked about it briefly. I think it would be wise to have managers/supervisors/department leads to have them provided. A lot of work must be done on phones if something is not working properly.
7/27/23 What IT vendor do other clinics use? What tasks, activities, and responsibilities do they cover? 8/15/23: UVS underground. High level I.T. work including servers, device management (computers, hardware, software updates) and higher level I.T. issues that our people can not do.
7/27/23 What tools, methods, and/or frequency do clinics use for measuring staff satisfaction and/or clinic morale? 8/1/23: One person reported that they are doing a biannual employee survey created on google forms that has a point system they rate different things on. It’s 10 questions and they rate from not satisfied to very satisfied and then average the points for each question from each person and then average all the scores as a whole to get overall satisfaction. The questions are in areas the clinic struggles with such as sufficiency of education, teamwork, and facility cleanliness. They are implementing changes in response to items with low points.
7/27/23 Are any clinics coding for or billing SBIRT; if so, have you had any issues or problems come up? 8/15/23: We have the codes built in to our EHR- but have not used them.
8/15/23: We have not billed these codes.
7/19/23 Is anyone a member of KanRen and, if yes, what are the benefits of membership?
7/19/23 Are there any clinics that see patients from across the state line and vaccinate with VFC?  Are they having issues with the vaccines for non-Kansas patients going through the WebIZ interface?
6/1/23 I would be interested in what statements from other clinics that use eCW look like and what clearinghouse they use. 6/7/23: eCW set up the statement format in eCW and we (Cowley County) print it on plain paper. We use Trizetto for our clearinghouse, it works well with eCW.
5/24/23 eClinicalWorks users – is there a way to include a standing order on a template? 5/24/23: Yes, there is a way to add standing orders to a template.  When creating the template, add the test (usually an In House test) to the template. We leave ours under “future orders” when adding to the template.  A written procedure does need to be created for the standing orders by the Medical Director/CHO/CMO also as eCW will not call the order a “Standing Order”.
5/18/23 Does any dental clinic utilize nitrous oxide? What are your training protocols for different staff doing this procedure (dentist, hygienist, dental assistant, etc.)? 5/24/23: We (Health Partnership) do utilize nitrous oxide in our dental clinic. Please have the clinic reach out to our dental director Nader Rastgoftar at nrastgoftar@hpcks.org.
5/18/23 Have you expanded your collection of race/ethnicity categories per the 2023 UDS PAL? If so, how and what impacts, questions, etc. have you or your staff experienced? 5/24/23: We started our expanded race/ethnicity on January 2nd. We have had no comments or questions regarding the expansion in that area.
5/3/23 Is anyone successfully doing CCM for veterans through the VA? If so, can you describe the billing process?
5/3/23 Has any clinic implemented suicide prevention or a zero suicide initiative and if so, can you provide some information on how you got staff engaged and steps to implement your program? 5/24/23: We do the zero suicide training with orientation and annually at our clinic.
4/2523 What is your process/workflow/tool/etc. for coordinating case management or care management with payors (e.g. Medicaid case management).
4/10/23 Is anyone using SPECT or any other retinal scanning device? If so, how is it going for your clinic and how do costs/charges balance out? 5/3/23: RetinaVue is in use at one center for their diabetic patients but the billing/charges process is under evaluation and review.
3/21/23 There was an ECHO colon cancer presenter from a FQHC using a template in eClinicalWorks – we are looking for them to find out how to add an order for the future to a template. If this was you, or you know how to do that please let us know!
3/21/23 Peer review: 1. What providers participate/are reviewed/do reviews? 2. How are charts selected? 3. How many on what frequency are reviewed? 11/20/23: We have used KFMC in the past for peer review and they have a wide range of specialties. They prefer to be given a guide of what you want the reviewer to look at so they provide the feedback that the health center is looking for but can also perform fully independently without that. They are accredited for independent review. https://www.kfmc.org/health-services-clinical-care-review/

11/14/23: We have also just signed on with Peerspectiv (http://www.peerspectiv.com/) and are using them one quarter a year, they do peer reviews for all departments.

3/21/23 Are any health centers providing child care or exploring this for their staff?
3/7/23 Is anyone using RVU as a part of physician reimbursement, if so what is your process for that? If you have used it in the past, what worked and what didn’t work for your clinic and why was it discontinued? 5/3/23: One center has done this reporting in eCW. It requires a little setup, but is achievable.
3/7/23 If you are on eClinicalWorks, have you gone to version 12, if not, when do you anticipate doing this? If yes, any comments on the version? 5/24/23: We noticed some menu changes but overall it has not had a significant impact.

5/24/23: We are using it in our test environment and are not noticing anything significant.

5/3/23: No centers have transitioned. One center has it in a test environment but hasn’t noticed significant changes other than menu locations. Centers that have upgraded their EBO which has caused reports to break the email distribution and issues with custom field reports.

3/7/23 Is anyone billing for TCM (Transition Care Management) under codes 99495 or 99496 for face-to-face hospital follow-up visits? If so are you getting payments? Does anyone have any info on this? 5/3/23: Both 99495 and 99496 work. The TCM first contact has to be right after discharge with the visit to follow. A TCM does have a window of 7-14 days that must be met may be a reason for not receiving a payment as well as trying to tack some additional visit type with it.

3/14/23: We have no issues with it. Both 99495 and 99496 work within the 7-14 day window. It will not work with an AWV.

2/28/23 What process or template are you using to routinely do ER follow-ups with your patients?  How does this work in your health center? 3/7/23: We use the ACO tool which includes the ADT feed from hospitals. The template from the ACO includes a survey and we used that to create a smart sheet. The ACO patients are only about 1/3 of our total so we get info from the local hospital for the other 2/3 and call those patients also.

2/28/23: The Care coordinators make these ER follow up calls based off of reports and patient documentation from SRHC Meditech or respective ED.

2/28/23 Are you performing lead screening in your pediatric populations?  If so, how did you set this up and what reporting is required? 3/7/23: We screen with the KBH questionnaire and if the screening questions are positive we draw the blood and send to the lab. The lab reports to the health department.

2/28/23: Yes we do perform lead screens on our pediatric populations.  These screens are sent out to LabCorp and they process the results.  We were unable to reach anyone who knows the process for reporting the state of Kansas.  Our lab director at SFHC states that in the past when lab processed lead levels in house, they were responsible to report elevated levels to the state via a set up portal.

2/28/23: We are working on the SOP’s for lead screening.  I recommend that other health centers reach out to KDHE for specifics on reporting.  The MCO’s can be very helpful too.  The state of Kansas has always been in a bit of a disagreement between universal screening and targeted screening for blood lead testing.  As it is, we always do the paper screen and if indicated follow-up with ordering blood lead testing.  However, we do not have it in house as the equipment we have is expired.

2/28/23: Reference lab is responsible for reporting to KDHE and the provider calls the health department locally to discuss with family.

2/28/23 Is anyone using eCW able to pull a report of referrals for non-medical referrals or a way of tracking the patients sent to a community resource?  For example; X number of people sent to the food bank, connected to transportation, etc. 2/28/23: No, we document and track Community Resources through Athena template.

2/28/23: Community referrals.  This is hard because you would have to tie the Z codes to a referral to use it formally like this, which can really slow the process down as teams aren’t as familiar with them at this time.  We are really hoping to leverage a resource like UniteUs, which is quickly expanding across the state of Kansas or a CHW team as this would take the number of referrals to exponential growth and really surpass the capacity we have with current staffing ratios.  Also, many local resources don’t have the ability to accept a referral through eCW through fax, and this would take double work on a referral coordinator to ensure that eCW matched what they may be communicating verbally or through email.

2/28/23 For patients who reside in a different state, are they able to see providers via telehealth who aren’t licensed in those states? 2/28/23: These are from HHS – https://telehealth.hhs.gov/licensure/licensing-across-state-lines/,
https://telehealth.hhs.gov/licensure/licensure-policy-during-covid-19-public-health-emergency/.2/28/23: Here is the start of the Kansas telehealth act.  It appears to primarily apply to the behavioral health side of things – https://www.ksrevisor.org/statutes/chapters/ch40/040_002_0210.html.2/28/23: It seems like pre-pandemic, legally the patient and provider had to be in the same state but there were flexibilities added in during the pandemic.  There was a requirement that the out of state provider had to adhere to the other states rules which adds some complexity to the situation.  There are also considerations for insurance coverage.  The answers to the question of “what is legal” and “what is reimbursable” are not necessarily the same.  As I understand things, during the PHE it is legal to provide most care across state lines, but it is not required to be covered.  I do not think that it is covered by Medicaid.  As I understand things, the behavioral health flexibilities were made more permanent, but the medical flexibilities will end when the PHE ends.2/28/23: It hinges on licensure requirements in the state where the patient is physically located. License reciprocity, which essentially recognizes that a provider licensed in one state can also practice in another state, increased during COVID. Some states, like Kansas, had an application/registration for a waiver to practice telemedicine to treat patients located in Kansas; however, our license reciprocity expired on 01/20/2023 per House Bill 2477.2/28/23: The Center for Connected Health Policy’s Cross-State Licensing site (https://www.cchpca.org/topic/cross-state-licensing-professional-requirements/) is a resource I use often.2/28/23: Another resource, the Federation of State Medical Boards (https://www.fsmb.org/siteassets/advocacy/pdf/states-waiving-licensure-requirements-for-telehealth-in-response-to-covid-19.pdf).2/28/23: Reimbursement is a separate but related issue. Since insurance coverage is very state-based, you should reach out to the patient’s health insurance to determine the patient’s coverage if they reside in another state, even if they are coming to your clinic for services.
12/15/22 A member discovered that the Align glucometer requires a 3.5mm headphone jack which is not compatible with some of their patients devices. Does anyone have a solution/adaption to this; or would be interested in a trade of glucometers? 12/16/22: A 3.5 mm jack is not compatible with the latest iPhones for example. On the glucose monitors is the cable supplied?

12/16/22: Apple sells a 3.5MM (female) to lightning adaptor. Not sure how well it passes the data would need to be tested.

11/17/22 Contacts/resources for eClinicalWorks training and technical assistance. 12/6/22: Ask eCW to come out for optimization and/or training

12/6/22: Medical Advantage

12/6/22: Have trained in-house staff