process & timing: 4 phases where are we now? 1 - apda... · commi\ee on educaon in radiologic...

10/2/19

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APDA Membership Webinar

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Presentedby:RosieCrawford,LeighDavi>anandBradKileOctober2,2019

EmailQues>onsto:[email protected]

Presenta3on Outline

• NewFinalRuleonPortableX-rayCondi>onsofCoverage§ Whathappenedandwhereareweintheprocess?

§ Whatdoesitmean?

§ WhatshouldIdonow?

• EnrollmentIssues

• 2019AnnualConference&Expo:APreview

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Condi3ons of Coverage Moderniza3on

 Whathappenedandwherearewenow?

Condi3ons of Coverage Requirements

Process&Timing:4Phases9/17/18:ProposalIssued->11/19/18:CommentsSubmi\ed9/30/19:FinalRule->11/29/19:Implementa>on(60days)TBDbyCMS:Sub-regulatoryGuidanceIssued(e.g.MedicareLearningNetwork)

ProposedRule60-DayCommentPeriod

FinalRule9/20/19

Implementa>onDate11/29/19

CMSSub-regulatoryguidanceTBDbyCMS

Condi3ons of Coverage

SocialSecurityAct

Title42.

PublicHealthChapterIV.

CENTERSFORMEDICARE&MEDICAIDSERVICES,DEPARTMENTOFHEALTHANDHUMANSERVICESSubchapter

G.STANDARDSANDCERTIFICATION

Part486.CONDITIONSFORCOVERAGEOFSPECIALIZEDSERVICESFURNISHEDBYSUPPLIERS

SubpartC.Condi>onsforCoverage:PortableX-RayServicesSec>on

LINK:h\ps://www.law.cornell.edu/cfr/text/42/part-486/subpart-C

Condi3ons of Coverage

FinalRulemakeschangestoTWOSec>ons

 §486.100Condi>onforcoverage:CompliancewithFederal,State,andlocallawsandregula>ons.

 §486.102Condi>onforcoverage:Supervisionbyaqualifiedphysician. §486.104Condi.onforcoverage:Qualifica.ons,orienta.onandhealthoftechnicalpersonnel.

 §486.106Condi.onforcoverage:Referralforserviceandpreserva.onofrecords.

 §486.108Condi>onforcoverage:Safetystandards. §486.110Condi>onforcoverage:Inspec>onofequipment.

LINK:h\ps://www.law.cornell.edu/cfr/text/42/part-486/subpart-C

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Condi3ons of Coverage §486.104Condi.onforcoverage:Qualifica.ons,orienta.onandhealthoftechnicalpersonnel

 CURRENT:ThreeStandardsa)Qualifica.onsb)PersonnelOrienta.onc)EmployeeRecords

 (a)Standard-qualifica.onsoftechnologists.AlloperatorsoftheportableX-rayequipmentmeettherequirementsofparagraphs(a)(1),(2),(3),or(4)ofthissec>on:

 (1)Successfulcomple>onofaprogramofformaltraininginX-raytechnologyinaschoolapprovedbytheJointReviewCommi\eeonEduca>oninRadiologicTechnology(JRCERT),orhaveearnedabachelor'sorassociatedegreeinradiologictechnologyfromanaccreditedcollegeoruniversity.

 (2)ForthosewhosetrainingwascompletedpriortoJuly1,1966,butonoramerJuly1,1960:Successfulcomple>onof24fullmonthsoftrainingand/orexperienceunderthedirectsupervisionofaphysicianwhoiscer>fiedinradiologybytheAmericanCollegeofRadiologyorwhopossessesqualifica>onswhichareequivalenttothoserequiredforsuchcer>fica>on,andatleast12fullmonthsofper>nentportableX-rayequipmentopera>onexperienceinthe5yearspriortoJanuary1,1968.

 (3)ForthosewhosetrainingwascompletedpriortoJuly1,1960:Successfulcomple>onof24fullmonthsoftrainingand/orexperienceofwhichatleast12fullmonthswereunderthedirectsupervisionofaphysicianwhoiscer>fiedinradiologybytheAmericanCollegeofRadiologyorwhopossessesqualifica>onswhichareequivalenttothoserequiredforsuchcer>fica>on,andatleast12fullmonthsofper>nentportableX-rayequipmentopera>onexperienceinthe5yearspriortoJanuary1,1968.

 (4)ForthosewhosetrainingwascompletedpriortoJanuary1,1993,successfulcomple>onofaprogramofformaltraininginX-raytechnologyinaschoolapprovedbytheCouncilonEduca>onoftheAmericanMedicalAssocia>on,orbytheAmericanOsteopathicAssocia>onisacceptable.


 CURRENT(con.nued):

 b)Standard-personnelorienta.on.ThesupplierofportableX-rayserviceshasanorienta>onprogramforpersonnel,basedonaproceduralmanualwhichis:Availabletoallmembersofthestaff,incorporatesrelevantpor>onsofprofessionallyrecognizeddocuments,andincludesinstruc>oninallofthefollowing: (1)Precau>onstobefollowedtoprotectthepa>entfromunnecessaryexposuretoradia>on; (2)Precau>onstobefollowedtoprotectanindividualsuppor>ngthepa>entduringX-rayproceduresfromunnecessaryexposuretoradia>on; (3)Precau>onstobefollowedtoprotectotherindividualsinthesurroundingenvironmentfromexposuretoradia>on; (4)Precau>onstobefollowedtoprotecttheoperatorofportableX-rayequipmentfromunnecessaryexposuretoradia>on; (5)Considera>onsindeterminingtheareawhichwillreceivetheprimarybeam; (6)Determina>onofthe>meintervalatwhichtocheckpersonnelradia>onmonitors; (7)Useofthepersonnelradia>onmonitorinprovidinganaddi>onalcheckonsafetyofequipment; (8)Properuseandmaintenanceofequipment; (9)Propermaintenanceofrecords; (10)Technicalproblemswhichmayariseandmethodsofsolu>on; (11)Protec>onagainstelectricalhazards; (12)Hazardsofexcessiveexposuretoradia>on. (c)Standard:Employeerecords.Recordsaremaintainedandincludeevidencethat- (1)Eachemployeeisqualifiedforhisorherposi>onbymeansoftrainingandexperience;and (2)Employeesreceiveadequatehealthsupervision.


 CHANGE:a)Qualifica.ons

 (a)Standard-qualifica.onsoftechnologists.AlloperatorsoftheportableX-rayequipmentmeettherequirementsofparagraphs(a)(1),(2),(3),or(4)ofthissec>on:

 (1)Successfulcomple>onofaprogramofformaltraininginX-raytechnologyinaschoolapprovedbytheJointReviewCommi\eeonEduca>oninRadiologicTechnology(JRCERT),orhaveearnedabachelor'sorassociatedegreeinradiologictechnologyfromanaccreditedcollegeoruniversity.

 (2)ForthosewhosetrainingwascompletedpriortoJuly1,1966,butonoramerJuly1,1960:Successfulcomple>onof24fullmonthsoftrainingand/orexperienceunderthedirectsupervisionofaphysicianwhoiscer>fiedinradiologybytheAmericanCollegeofRadiologyorwhopossessesqualifica>onswhichareequivalenttothoserequiredforsuchcer>fica>on,andatleast12fullmonthsofper>nentportableX-rayequipmentopera>onexperienceinthe5yearspriortoJanuary1,1968.

 (3)ForthosewhosetrainingwascompletedpriortoJuly1,1960:Successfulcomple>onof24fullmonthsoftrainingand/orexperienceofwhichatleast12fullmonthswereunderthedirectsupervisionofaphysicianwhoiscer>fiedinradiologybytheAmericanCollegeofRadiologyorwhopossessesqualifica>onswhichareequivalenttothoserequiredforsuchcer>fica>on,andatleast12fullmonthsofper>nentportableX-rayequipmentopera>onexperienceinthe5yearspriortoJanuary1,1968.

 (4)ForthosewhosetrainingwascompletedpriortoJanuary1,1993,successfulcomple>onofaprogramofformaltraininginX-raytechnologyinaschoolapprovedbytheCouncilonEduca>onoftheAmericanMedicalAssocia>on,orbytheAmericanOsteopathicAssocia>onisacceptable.


 CHANGE:a)Qualifica.ons (a)Standard-qualifica.onsoftechnologists.AlloperatorsoftheportableX-rayequipmentmeettherequirementsofparagraph(a)(1)or(2)ofthissec>on.

 (1)Successfulcomple>onofaprogramofformaltraininginX-raytechnologyatwhichtheoperatorreceivedappropriatetraininganddemonstratedcompetenceintheuseofequipmentandadministra>onofportablex-rayprocedures;

 or (2)Successfulcomple>onof24fullmonthsoftrainingandexperienceunderthedirectsupervisionofaphysicianwhoiscer>fiedinradiologyorwhopossessesqualifica>onswhichareequivalenttothoserequiredforsuchcer>fica>on.

Condi3ons of Coverage§486.106Condi.onforcoverage:Referralforserviceandpreserva.onofrecords

 CURRENT:ThreeStandards(a)referralbyaphysicianornonphysicianprac..oners(b)recordsofexamina.onsperformed(c)preserva.onofrecords.

 (a)Standard-referralbyaphysicianornonphysicianprac..oners.PortableX-rayexamina>onsareperformedonlyontheorderofaphysicianlicensedtoprac>ceintheStateorbyanonphysicianprac>>onerac>ngwithinthescopeofStatelaw.Suchnonphysicianprac>>onersmaybetreatedthesameasphysicianstrea>ngbeneficiariesforthepurposeofthisparagraph.Thesupplier'srecordsshowthat:

(1)TheportableX-raytestwasorderedbyalicensedphysicianoranonphysicianprac>>onerac>ngwithintheStatescopeoflaw;and

(2)Suchphysicianornonphysicianprac>>oner'swri\en,signedorderspecifiesthereasonaportableX-raytestisrequired,theareaofthebodytobeexposed,thenumberofradiographstobeobtained,andtheviewsneeded;italsoincludesastatementconcerningthecondi>onofthepa>entwhichindicateswhyportableX-rayservicesarenecessary.


 CURRENT(con.nued): (b)Standard-recordsofexamina.onsperformed.Thesuppliermakesforeachpa>entarecordofthedateoftheportableX-rayexamina>on,thenameofthepa>ent,adescrip>onoftheproceduresorderedandperformed,thereferringphysicianornonphysicianprac>>oner,theoperator(s)oftheportableX-rayequipmentwhoperformedtheexamina>on,thephysiciantowhomtheradiographwassent,andthedateitwassent.

 (c)Standard-preserva.onofrecords.Suchreportsaremaintainedforaperiodofatleast2years,orfortheperiodof>merequiredbyStatelawforsuchrecords(asdis>nguishedfromrequirementsastotheradiographitself),whicheverislonger.

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 CHANGE:(a)referralbyaphysicianornonphysicianprac..oners (a)Standard-referralbyaphysicianornonphysicianprac..oners.PortableX-rayexamina>onsareperformedonlyontheorderofaphysicianlicensedtoprac>ceintheStateorbyanonphysicianprac>>onerac>ngwithinthescopeofStatelaw.Suchnonphysicianprac>>onersmaybetreatedthesameasphysicianstrea>ngbeneficiariesforthepurposeofthisparagraph.Thesupplier'srecordsshowthat:

(1)TheportableX-raytestwasorderedbyalicensedphysicianoranonphysicianprac>>onerac>ngwithintheStatescopeoflaw;and

(2)Suchphysicianornonphysicianprac>>oner'swri\en,signedorderspecifiesthereasonaportableX-raytestisrequired,theareaofthebodytobeexposed,thenumberofradiographstobeobtained,andtheviewsneeded;italsoordermeetstherequirementsat§ 410.32ofthischapter,andincludesastatementconcerningthecondi>onofthepa>entwhichindicateswhyportableX-rayservicesarenecessary.


 CHANGE:Focuson(a)(2)

(2)Suchphysicianornonphysicianprac>>oner’sordermeetstherequirementsat§ 410.32ofthischapter,andincludesastatementconcerningthecondi>onofthepa>entwhichindicateswhyportableX-rayservicesarenecessary.


 Whatdoesitmean?

Condi3ons of CoverageThefinalruleinCMS’ownWords

 “PortableX-RayServices Removingthefourtrainingandeduca>onrequirements,whichfocusontheaccredita>onoftheschoolwherethetechnologistreceivedtraining,andreplacingitwithastreamlinedqualifica>onthatfocusesontheskillsandabili>esofthetechnologist;and

 

Allowingforportablex-rayservicestobeorderedinwri>ng,bytelephone,orbyelectronicmethods,streamliningtheorderingprocess.”


 WhatshouldIdonow?


 1)Technologist◦ Policyisexpectedtoprovidegreaterflexibility(e.g.militarytrainedpersonnel;statecreden>alrequirements.◦ Thoroughreviewofeachtechnologistby11/29/19.2)Orders◦ Reviewchangesthroughthelensofyourorderanddocumenta>onprocedures.◦ Review:The5resourcesonthefollowingslide.

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Condi3ons of CoverageResourcesforAPDAMembers

 Sec.on486(PXRRequirements):h\ps://www.law.cornell.edu/cfr/text/42/part-486/subpart-C 42CFR410.32(Diagnos.cx-raytests,diagnos.claboratorytests,andotherdiagnos.ctests:Condi.ons.):h\ps://www.govinfo.gov/content/pkg/CFR-2011->tle42-vol2/pdf/CFR-2011->tle42-vol2-sec410-32.pdf

MedicareLearningNetworkFactSheet(signaturerequirements,documenta.oninmedicalrecordentries,andelectronicsignatures):h\ps://www.cms.gov/Outreach-and-Educa>on/Medicare-Learning-Network-MLN/MLNProducts/downloads/Signature_Requirements_Fact_Sheet_ICN905364.pdf

MedicareLearningNetworkFactSheet(complyingwithdocumenta.onrequirementsforlaboratoryservices):h\ps://www.cms.gov/Outreach-and-Educa>on/Medicare-Learning-Network-MLN/MLNProducts/Downloads/ProviderComplianceLabServices-Fact-Sheet-ICN909221.pdf

MedicareProgramIntegrityManual(sec>on3.3.2.4SignatureRequirements):h\ps://www.cms.gov/Regula>ons-and-Guidance/Guidance/Manuals/downloads/pim83c03.pdf

Condi3ons of Coverage Requirements

APDANextSteps• APDArequestedCMSissueanMedicareLearningNetworkguidance.•  Specificemphasisontelephoneorders,documenta>oninmedicalrecords,andelectronicrecords.

• MemberEduca>on•  AnnualConference&ExpoProgramming,Nov5-7atBally’sLasVegas• Webinarsandinforma>onaldocuments

Caveats•  Changesintendedtoreduceriskofunpaidclaims,recoupments,andauditor

confusion.•  Limita>onsoftradegroupinterpreta>ons•  Eachcompanyshouldevaluateprocedureswithunderstandingofinheritrisks

associatedwithac>ons.

APDA 38th Annual Conference and Expo

2019 Annual Conference and Expo 2019

Dates:November5-7,2019

Loca)on:LasVegas,Nevada

Venue:BALLY'sLasVegas

Benefits:

CEU-Educa*onalSessions

Networkingwithkeyindustryvendors

SocialEventsforallA=endees

Newly Renovated

Renovated Rooms

10/2/19

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Renovated Mee3ng Venue

But its all about the educa3onal sessions …

process & timing: 4 phases where are we now? 1 - apda... · commi\ee on educaon in radiologic...

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