Department of Health Care Services Physician and Non-Physician Practitioners

1. Department of Health Care Services Physician and Non-Physician Practitioners Time Study Training 2008

2. Table of Contents • DHCS Goals • Medi-Cal Waiver and State Plan Amendments • Time Study Overview • Purpose of the Time Study • Claiming Time on the Time Study Form • How to Time Study for Best Results • Secondary Documentation • Sample of Time Study Sheet • Best Practices

3. DHCS Goals for this training Today’s presentation will help you: • Understand the purpose for implementing this time study. • Successfully complete the Time Study for Physician and Non-Physician Practitioners. • Stress the importance of the Time Study. • Record time accurately. • Maintain a good audit file to minimize the risk of audit disallowances.

4. Please ask questions as we move through the presentation, if you need clarification.

5. 1115 Medi-Cal Waiver (Demonstration) • CMS approved 1115 Medi-Cal waiver August 31, 2005, which is effective September 1, 2005, through August 31, 2010 for 23 Designated Public Hospitals (DPHs). • Senate Bill (SB) 1100 (Stats 2005, ch.560), commencing with Article 5.2 of Chapter 7, Division 9 of the Welfare and Institution (W&I) Code, was enacted to provide the statutory framework for the “Medi-Cal Hospital / Uninsured Care Demonstration Act (Demonstration).

6. State Plan Amendments (SPAs) • State Plan Amendment 05-021, established Certified Public Expenditures as a basis for reimbursement for the DPHs. Prior to 05-021, DPHs were paid a CMAC negotiated rate. • State Plan Amendment 05-022, established an increase in Medi-Cal payments amounts, and the manner in which Medi-Cal payments for acute inpatient hospital services take into account the situation of hospitals which serve a disproportionate number of low-income patients with special needs--Disproportionate Share Hospitals Fund (DSH).

7. State Plan Amendment 05-023 • State Plan Amendment 05-023, approved by Centers for Medicare and Medicaid Services, on December 21, 2007, provided for the reimbursement of uncompensated physician and non-physician practitioner professional services costs for the DPHs for Medicaid (Medi-Cal) and uninsured care.

8. Time Study Overview The Basics • Physician and Non-Physician practitioners must time study for one week each quarter*. • Uncompensated (unreimbursed) allowable professional services component reimbursable under SPA 05-023 and the Demonstration (1115 federal Waiver). • Those Physicians working at a Non-UC hospital who currently complete a Medicare approved time study for the purpose of reporting and identifying costs for reimbursement on the Medi-Cal 2552 cost report do not need to complete this time study.

9. The Basics - Continued • An appropriate claiming mechanism must be used to accurately capture the time spent for professional and provider services that may receive payment under the Demonstration. • Time Study is the primary mechanism to capture and allocate time spent for services among professional, provider, and non-allowable components.

10. The Basics – Continued • The Time Study form must reflect all of the direct, administrative and teaching, and non-billable activities performed by physician and non-physician practitioners approved for claiming under SPA 05-023. • The Time Study form is considered a legal document which verifies the actual time spent performing the activities used to claim payment for uncompensated professional services costs.

11. The Basics – Continued • The Time Study identifies direct patient care services, hospital administration and teaching services, and other non-billable services activities and ensures that those costs can be properly allocated to programs. • Time study codes distinguish each activity a physician or non-physician is engaged in during a Time Study week.

12. The Purpose of the Time Study What is the purpose of the Time Study? • To identify time spent on the performance of provider, professional, and non reimbursable activities. • For UC physician and non-physician practitioners this may be referred and identified as clinical and non-clinical time. • Results are used to calculate and determine the amount that a Designated Public Hospital may claim under the Demonstration. • To ensure appropriate claiming. • It is a Federal requirement.

13. Who Must Time Study Which employees should time study? • All physicians working in settings for the University of California hospitals that have the status as a Designated Public Hospital. • All non-physician practitioners working in settings for the University of California hospitals that have the status as a Designated Public Hospital.

14. Who Must Time Study -Continued • All physicians working in settings for the Non-University of California hospitals that have the status as a Designated Public Hospital. • All non-physician practitioners working in settings for the Non-University of California hospitals that have the status as a Designated Public Hospital.

15. Who Must Time Study –Continued • This time study will also be performed by those physician and non-physician practitioners providing services at governmental operated entities and their affiliated government-operated physician practice groups that are affiliated with a Designated Public Hospital.

16. Who May Not Be Required To Complete This Time Study • Those Physicians working at a Non-UC hospital who currently complete a Medicare approved time study for the purpose of the hospital reporting and identifying costs for reimbursement on the Medi-Cal 2552 cost report do not need to complete this time study.

17. Who May Not Be Required To Complete This Time Study –Continued • Those Physicians and non-physician practitioners who are under a contract that is specific for services that must be provided do not need to complete this time study. • Those non-physician practitioners for whom a separate bill is not completed or for whom charges are not established do not need to complete this time study.

18. *Exception / Explanation of “One Week” • A one-week time study typically means studying five consecutive paid work days (skipping unpaid work days), starting on a randomly selected day in a quarter. • Should a work interruption occur during the course of the time study (such as a natural disaster), which prevents the participants from completing the time study for five consecutive paid work days, the time study will resume on the first feasible paid work day and continue thereafter until the consecutive five paid work days requirement is met.

19. Exception / Explanation of “One Week” - Continued • Example: • In a randomly selected time study week of Monday through Friday, a time study was conducted on Monday and Tuesday of that week. A disaster occurred on Wednesday through the rest of that week, two consecutive days would have been time studied for that week. • The time study should resume from the next feasible paid work day for three consecutive days to meet the five consecutive paid work days’ requirement. If another event causes a stoppage or results in an interruption/break in between the remaining consecutive days, the remaining time study would start from the next feasible paid work day until the five consecutive paid work days are completed. • In this case, the only break(s) of the required five consecutive paid work week would be the disaster days.

20. Approved Time Study Formats • UC Physician Time Study Report • Non-Physician Practitioner Time Study - UC • Non-Physician Practitioner Time Study – Non-UC

21. Required Training • All physicians and non-physicians who time study MUST participate in time study training annually • Annual time study training cannot be claimed during any time study week. • Physicians and non-physician who are filling out a time study form for the first time must attend training before time study week.

22. Requirements Regarding the Approved Time Study The time study must include a list of activities performed and must include time study activity/object codes to capture all the activities performed by the physician and non-physician practitioners. The time study must account for 100% of the physician and non-physician practitioner’s time.

23. Requirements Regarding the Time Study - Continued Each code must provide a specific description to indicate the type of activity performed for proper allocation to the provider and professional components. Results of the time study will be used as a basis for claims for unreimbursed physician and non-physician practitioner costs applicable for period starting July 1, 2005.

24. Time Study Activities Which Must Be Captured • Direct Patient Care Services • Hospital Administration and Teaching Services • Other Non-Billable Activities Note: For some hospitals, these services may be referred to as clinical and non-clinical activities.

25. Activity Codes Specific to Physicians • The Physician time study includes expanded activity codes for Hospital Administration and Teaching Services to include time spent for supervision and teaching of Intern and Residents and Allied Health Professionals. • Non-physician practitioners may not charge to these Activity Codes.

26. Please Refer to Your Hard copy and Sample Time Study Form

27. Direct Patient Care (Professional Services)

28. Activity / Object Code 00001: Direct Patient Care Services Direct patient care is the care which is medically reasonable, necessary and ordinarily furnished (absent research programs) in the treatment of patients by physicians and providers under the supervision of physicians as indicated by the medical condition of the patients.

29. Activity / Object Code 00001: Direct Patient Care Services This definition intends that the appropriate level of care criteria must be met for the costs of the care to be reimbursable. Such care is represented by items and services (routine and ancillary) which may be diagnostic, therapeutic, rehabilitative, medical, psychiatric, skilled nursing, and other related professional health services.

30. Activity / Object Code 00001: Direct Patient Care Services • Direct patient care services are those services that would give rise to a separate physician bill in a private practice, and involve activities that are identifiable, medical services. • Use this code when performing duties and providing services which include diagnosis, treatment, therapeutic, rehabilitative, medical, psychiatric, etc. • These direct patient care duties may occur in a teaching or non-teaching setting.

31. Activity / Object Code 00001: Direct Patient Care Services • Please distinguish between teaching rounds (where the primary purpose is teaching and the clinical care is incidental) and clinical rounds (where the primary purpose is patient care and teaching is a by product of the activity.

32. Activity / Object Code 00001: Direct Patient Care Services • Clinical research conducted in conjunction with, and a part of, caring for patients is also considered patient care services if the services are considered usual patient care, and are not compensated through research funds. • Routine services that would be provided absent a clinical trial; services required solely for the provision of the investigation item or service; and services needed for reasonable and necessary care for complications resulting from the clinical trial should be included in this Activity/Object Code.

33. Hospital Administration and Teaching Services (Provider Services)

34. Hospital Administration and Teaching Services Generally these are services for which NO PATIENT BILL is prepared or sent. These are usually activities which directly deal with the operation of the hospital, and which affect its operating efficiency.

35. Activity/Object Code 00002: Supervision and Training of Nurses, Technicians, etc. • Use this code for the supervision and training of nurses, technicians, other hospital staff, etc. in a setting that does not involve any of the approved medical education programs. • In addition to supervision and training, activities for this code include review of care related to a specific patient, hospital or departmental administration, involving the supervision of hospital employees.

36. Activity/Object Code 00003: Utilization Review and Other Committee Meetings • Use this code when performing utilization review, participating on committees, or attending meetings. • Activities include meeting preparation and attendance for hospital, medical staff, and departmental meetings. • Activities include preparation and attendance at tumor boards and peer reviews.

37. Activity/Object Code 00004: Quality Control, Medical Review, and Autopsies • Use this code when performing quality control reviews or quality control investigations, or autopsies. Activities include: • Participating individually or as a panel or board member in: quality assurance functions, informal and formal investigations, and medical review functions related to quality improvement. • Autopsies performed at a physician’s request, to advance the knowledge base regarding (deceased) patient conditions.

38. Activity/Object Code 00005: Supervision of Interns and Residents – Physicians Only • Use this code when performing duties related to the direct supervision of Interns /Residents. Activities include: • Providing teaching and guidance during rounds, reviews with Interns/Residents regarding individual patient care. • Time spent managing, planning, and evaluating work of Interns/Residents. Note: This activity code does not include direct patient care.

39. Activity/Object Code 00006: Teaching of Interns and Residents – Physician Only • Use this code when performing duties related to teaching Intern/Residents. Activities include: • Teaching in an approved educational program in a classroom, lecture hall, formal or subject appropriate setting. • Preparation of materials and time spent preparing materials and subject matter for presentation.

40. Activity/Object Code 00007: Teaching and Supervision of Allied Health Professionals-Physicians Only • Use this code when performing duties related to the teaching and/or supervision of Allied Health Professionals. Activities include: • Teaching in an approved educational program in a classroom, lecture hall, formal or subject matter appropriate setting. • Preparation of materials and time spent preparing materials and subject matter for presentation. • Supervision of Allied Health Professionals performing procedures related to specific patients.

41. Activity/Object Code 00008: Other Administrative or Teaching • Use this code to include other time spent, as appropriate, related to other administrative or teaching functions. • Activities must be fully described and explained, and should not be applicable to other teaching activity/object codes.

42. Professional / Provider / Non-Reimbursable Services • Due to the nature of some services under the following categories, the Physician or non-physician practitioner’s time may be coded and/or allocated as professional or provider services, or may be determined to be non-reimbursable.

43. Activity/Object Code 00009: Conferences and Lectures • Use this code when attending conferences and lectures, or similar education forums including continuing medical education classes. Activities include: • Travel and attendance either as a presenter or attendee, planning, and preparation. • Attendance at lectures or similar education forums, including continuing medical education classes and workshops to maintain active licensure status if done during compensation time.

44. Activity/Object Code 00010: Non-Productive Hours – Paid Sick Leave, Paid Vacations, etc. • Self explanatory.

45. Other Non-Billable Activities

46. Activity/Object Code 00011: Research Use this code for non-patient related activities which include: • Research performed for scientific knowledge, planning, preparation of research materials and reports. • Research involving a systematic, extensive study directed at better scientific knowledge of the science and diagnosis, treatment, cure, or prevention of mental or physical disease.

47. Activity/Object Code 00011: Research - Continued • Usually obtained in the laboratory or on chart review, and does not necessarily involve direct individual or collective patient care. • To the extent that this activity is not done on hospital/facility time, (hospital/facility time includes time applicable to a Medical School Operating or Professional Services Agreement and other contracts,) this time should be excluded from your time study report.

48. Catch –All: Professional / Provider / Non-Reimbursable Services • The time reported in this final activity/object code may be for services that fall under the professional or provider component, or may be determined to be non-reimbursable.

49. Activity/Object Code 00012: Other Non-Billable Activities • Use this code for other non-patient care related activities that are compensated by the hospital/County/UC, are not specified under other activity/object codes; and would not ordinarily permit or generate a bill for patient care services, e.g., consulting or medical review that is chargeable to another entity (non-hospital, non-UC, etc.).

50. General Form Requirements • Participant’s Name • Job/Classification / Position / Title • Participant’s Employee Number • Facility / Hospital / Department • Dates Time Study was conducted • Signature / Telephone Number / Date • Descriptions of activities or services performed, if applicable