Questions from NPP Training
1. Q – FMLA, unpaid leave of absence. Where do you put this time on Time Trex since it is unpaid?
A – This time is not work time and it is not paid time, so it would not be included in Time Trex. If you are
on FMLA that is paid then it is allocated to Line 9.
2. Q – CRNA’s at UNC sign away their billing rights to the Dept of Anesthesiology/UNC Hospitals. We
don’t bill for anything on our own. Why do we have to fill out Time Trex, our department should do it for
us, right?
A – The Time Trex process is not directly related to the billing process. The purpose of these time studies
is to allocate time for cost reporting purposes. The key factors discussed for CRNA’s include any time
training residents and if there is time that should be allocated to activities not directly related to the Health
Care System (e.g. research, medical student education, etc.)
3. Q – My position is funded through a grant through the department of GI Medicine. My position is UNC
Healthcare and I work only in Hospital Based or P&A Clinics. Do I have a Hospital Supervisor?
A – If you are providing Hospital services then you should have a Hospital supervisor.
4. Q – Discharge summaries (update, create, and revise) can at times take hours to complete. Would this go
on Line 2 in Time Trex?
A – In your professional role, this should be allocated to Line 6
5. Q – Coordination of complex medical discharges - arranging multiple appointments, reinforcing teaching,
anticipatory guidance. Would this go on Line 2 in Time Trex?
A – The actual decision to discharge a patient is a professional service that should be included on line 6 in
Time Trex. Managing patient flow on a hospital unit, scheduling appointments and providing patient
education that could be provided by an experienced nurse could all be considered hospital services.
Clinical hospital services would be allocated for inpatients and administrative or support services would
be allocated to Line 4.
6. Q – Instructions to Med Students? How would this be allocated in Time Trex?
A –Academic instruction to medical students would go to Line 8 in Time Trex.
7. Q - Case management in a clinical setting? Where would that get allocated in Time Trex?
A – Case management for hospital patients would typically be placed on Line 4 in Time Trex. Physician
clinic would be allocated to Line 7.
8. Q – Where do you put grant time in Time Trex?
A – Services funded by grants should typically go on Line 8, as they are not clinical activities and should
not be paid by both a third party payor and the grant.
9. Q - Where would you allocate time for Adjunct Faculty for School of Nursing?
A – Faculty services provided to the School of Nursing are not clinical activities and should be allocated
to Line 8 in Time Trex.
10. Q – I provide clinic work one day a week but I am not funded by UNC or P&A. Where do I allocate that
time in Time Trex?
A – Volunteers will need to contact the Reimbursement Office at 966-5032 to discuss their individual
situation.
11. Q - Where do you allocate your time for services that are done in a Hospital Based Clinic?
A – Professional services provided in a Hospital Based Clinic should be allocated to Line 6 in Time Trex.
If the work is considered nurse work then allocate to Line 3.
12. Q – Will it be a problem if we put down the total amount of hours we work?
A – For these time studies Medicare requires that you include all time worked during the weeks of the
study. (12:01 a.m. Sunday – 12:00 p.m. Saturday)
13. Q – How do we document our time in Time Trex if we are working from home?
A – You document the hours work regardless of your location.
14. Q – Where do you allocate your time that you spend doing patient notes?
A – Patient notes are considered part of the clinical services. Documentation of professional services
goes along with the professional services on Line 6.
15. Q – Does it matter if you train a resident in an inpatient or outpatient setting?
A – No, all of it goes on Line 1 in Time Trex.
16. Q – If you are training a resident and giving patient care. Then how do you allocate the time between
resident training and patient care?
A – The split between patient care and resident training is a subjective one but here is an example: A
NPP does a procedure on a patient that typically takes 20 minutes but today he/she has as resident with
them training so the procedure takes 40 minutes. The 20 minutes that it normally takes would be on Line
6-Direct Patient Care and 20 minutes more would be on Line 1-Instruction of residents.
17. Q – Will we know ahead of time what week we will be required to fill out Time Trex?
A – Yes, Reimbursement will notify you prior to the week of the study.
18. Q – Do the resident have to fill out Time Trex?
A – No. The only mechanism to recognize their costs is through the Hospital cost report. There is
another CMS Medicare/Medicaid prescribed mechanism to track resident time.
19. Q – Do we allocate the resident training separate because the hospital gets money for this service?
A – We allocate because it’s a prescribed by CMS Medicare/Medicaid along with other cost.
20. Q - I attend Mortality Morbidity Conference that discusses care coordination for patients. This meeting
consists of residents and we are doing training but there are times where the meeting consist of only
physicians or in other cases a mix of residents and physicians. How do I allocate this time in Time Trex?
A – Line 5 because you are at a Hospital quality care meeting.
21.
Q – CRNA’s do a lot of training to the students. Since these are not billable services then how is this time
allocated in Time Trex?
A – Assuming that the students are not residents then the time would be allocated to Line 8, as it is not
part of the clinical function for the HCS.
22.
Q - How do you allocate your time if you are providing training to students at a Student Health Action
Coalition (SHAC)?
A – Training for students who have still not graduated from their academic program should be allocated
to Line 8.
23.
Q – How do you allocate your time if you are providing Lamaze classes since this can be done by a nurse
and is not a billable service.
A – If this is a Women’s Health sponsored class then it would be allocated to Line 2.
24.
Q – If I am on vacation the week that Time Trex is due then do I put down PTO or do I pick another
week?
A – You need to pick another week if you are off two or more days.
25.
Q – Where do you allocate patient charting activities in Time Trex?
A – Charting is part of the clinical process, and for professional charting would be allocated to Line 6.
26.
Q – How would you allocate time for teaching classes that are both to residents and nurses (Grand
Rounds)?
A – It is my understanding that Grand Rounds are inpatients only so you could allocate between the
residents and nurses. If residents make up the majority then allocate all to Line 1 in Time Trex or if you
have a mix of residents and nurses then you would separate out between Line 1 and 2 in Time Trex.
27.
Q – I precept Nurse Practitioner students. How do I allocate this time in Time Trex?
A - This allocation would be based on what you are doing with the student. If you are doing
professional patient care then it would be Line 2 in Time Trex, but if you are training students other than
residents this would go to Line 8. If you are training as you perform the clinical activity, then you would
need to allocate accordingly.
28.
Q – How do I allocate time in Time Trex for Order Sets?
A –Creating order sets for individual patients is a professional activity, and would therefore go on Line
6 in Time Trex. Creating an order set for a type of patient would be allocated to line 4 for hospital
services or Line 7 for professional services and physician clinic services. If you are creating an order set
for the system then that is administrative work and would be allocated to Line 6.
29.
Q – There will be times that you will do things that will not be on your Outlook Calendar. How do we
justify this time to an Auditor that may be looking at our Time Trex allocations.
A – Your calendar does not have to have line for line everything you do but it should not contradict
what you are doing either. For example, you cannot put down that you worked 40 hours but your calendar
shows you were on vacation.
30.
Q – Where would you put Ad Hoc Time?
A – Line 8 if Ad Hoc time is work time. Line 9 if it is time off.
31.
Q – If you do the same job from week to week is it ok to fill out your Time Trex in advance?
A – No, if you fill out your time before the week the government could consider that as fraud. It is not
good practice since you could unexpectedly be out due to illness or otherwise be reassigned.
32.
Q – When you say, keep a log of your time, what does that mean?
A – The suggestion of one physician was to track what you do all week when you are completing the
time studies, in order to have a personal account of the activities over the course of the week. This also
gives a source of information should an auditor ask about your time later on.
33.
Q – How long do we need to keep these logs?
A –Normally 7 years would be plenty of time, but the Medicare and Medicaid audits are significantly
behind schedule currently. Ten years might be better until the cost report audits get caught up.
34.
Q – Where would contracted services outside of the Hospital, University and TPN in Time Trex?
A – Services contracted that do not result in any billable activities though P & A would be allocated to
Line 8. If it is billable though P & A, then it would be allocated to Line 6.
35.
Q – On call/on site without direct patient. Would this be Line 6?
A – Yes Line 6, my answer for on call time is that you would only record the time you actually had to
come in and work. Also, for time on call where you were required to be on site, I would include that time
as worked even if the work activities were slow.
36.
Q - Time setting up OR for trauma or emergency surgery.
A – If you are setting up the OR then Line 2. If you are setting up anesthesiology equipment that would
normally set up by a technician then it would be allocated to Line 6.
37.
Q – Training of RN’s – is it formal- or what if you are spending time at the bedside teaching the RN
about the baby. What Line in Time Trex would that go on?
A – Training of hospital staff goes on Line 2, along with services that could be performed by an
experienced RN in an inpatient area. In this case you would not need to allocate anything to another line.
38.
Q – I work four ten hour days in a Hospital Based Clinic. Eight hours are direct medical services to
patients. Two hours are spent doing dictation, reviewing labs, sending letters, calling prescriptions to
pharmacy or returning patient phone calls. Where would this time be recorded in Time Trex?
A – All of the activities described are part of the professional services, and these would be included on
Line 6 in Time Trex.
39.
Q – If your position is clinical and research, how do you allocate this time in Time Trex?
A – Services provided for research are typically funded through grants or other outside means, and
should be included on Line 8 of Time Trex. For clinical trials there will typically be a portion of the
services that are part of the standard of care, and can be billed to the insurance company or third party
payors. These services should be allocated to the clinical service, Line 6.
40.
41.
Q – Where do you allocate time that you spend on discharge instructions?
A – Any services that require the professional judgment or licensure of the physician or practitioner
should be included on Line 6 as a professional service. For other services that could be explained by an
experienced nurse or other provider could be included on Line 2.
Q – If you are unit based then how do you allocate your time in Time Trex?
A – This is a judgment. Ask the question, why are you there and what are you doing.
42.
Q – If you are planning a discharge for a patient in an inpatient unit. This is something a nurse can do
but there is no nurse available. What line in Time Trex would this allocate too?
A – If this is part of the professional discharge then it would be allocated to Line 6.
43.
Q – I am on call but I can stay at home unless I get paged. Do I record the time I spend at home in Time
Trex?
A – No, being on call at home cannot be recorded in Time Trex unless you are spending time on the
phone dealing with patient care issues. Otherwise, would record the time that you are at the Hospital.
44.
Q - In our department we “stack” our hours by 66 hours this week and 20 next week and it works out at
the end of the month. How do we allocate this time in Time Trex?
A – You record the number of hours you work for the week that was chosen. We should get a average
of both weeks at the end of the year.
45.
Q – I do pre and post procedure care, is this professional and does it matter if it is global services?
A – Writing discharge orders would be professional. Any part of a bundled services then it is a billable
service, and therefore should be included on Line 6 as a professional service.
46.
Q – How do you allocate when you are with the residents and seeing a patient at the same time.
A – Your time would be allocated between Line 1 and Line 6. This will need to use your judgment to
allocate this time.
47.
Q – Where do you allocate the time you spend on the Commitment to Caring Committee?
A – Commitment to Caring is a UNC Health Care System committee and therefore should be included
on Line 9.
48.
Q – I do a lot of phone time with patients that are not direct care but I am advising and counseling. How
do I allocate my time?
A – Typically the follow on patient care would be allocated to Line 6
49.
50.
Q – Where do you document patient notes?
A – Line 6 for professional services.
Q – Patient comes into a clinic and sees a Physician and the Physician determined that the patient will
need surgery. The patient decides to think about the surgery and schedule another appointment to come in
and discuss. The patient comes back and the Nurse Practitioner sees the patient and discusses the surgery,
scheduling and counseling the patient on the surgery. How would you allocate this time in Time Trex
since the patient has already been seen and told they need surgery then comes back just for the
administrative portion of setting up the surgery. How does this get allocated in Time Trex?
A - Line 6.
51.
Q – I spend a lot of time evaluating babies and part of that time maybe spent changing a diaper which is
nurse care. Do I need to separate this time out of Time Trex?
A – Changing diapers are part of the incidental care of the patient so it would be allocated to Line 6.
52.
Q – How is pre-op time is allocated?
A – This is a professional service so it would be allocated to Line 6.
53.
Q - How would you allocating time you spend with consultants?
A – This is a case by case so contact Reimbursement at 966-5032 to discuss.
54.
Q – If I am doing clinical activities for a patient that is part of a grant then how do I allocate that time
in Time Trex?
A – Typically time paid for by a grant is allocated to Line 8. For clinical services that are defined as
part of the standard of care allocated to Line 6.
55.
Q – I teach a class to residents, medical student and attending physicians. How do I allocate in Time
Trex?
A – Residents Line 1, Nurses Line 2, Medical Students Line 8, Attending Physicians Line 7, Nursing
Students Line 8, Air Care Line 2, EMT’s Line 2 for hospital staff, or Line 8 for outside EMT’s. Outreach
education classes where you are acting on behalf of the Hospital then allocate to Line 2. For outreach
education classes where you are acting on behalf of P&A then allocate to Line 7 for 50/50 (Line 2 or 7) if
representing UNC Health Care System.
56.
Q – I spend time filling out History & Physical (H&P) form for pharmaceutical studies. How do I
allocate this time in Time Trex?
A – Completing the H&P is part of the professional services. If this is done as part of the clinical care
provided by UNC HCS, then it should go on Line 6. If this is a study that is not going through the HCS
and the activity is funded by grants or other research funding, then this should go on Line 8.
57.
Q – Where do you allocate continuing education time?
A – Line 9
58.
Q – How do you allocate your time if you are jointly funded and you are training an ANP student that is
also jointly funded?
A – Line 8 if you are precepting CRNA. If you are training a new employee then record this time by
what you are training the new employee. Ask yourself, why are you there, and what are you doing.
59.
Q – Anesthesiologist spend 2 hours waiting for patients. How do we allocate for this time?
A – There is a component of down time or down time that is part of certain services. If you are being
paid to be there so that you will be ready when you are needed, then this should be included in Line 7.
60.
Q – How do we allocate for the time we spend setting up for an anesthesia case?
A – Given that the Hospital pays for CRNA’s and this is a professional component then the time would
be allocated to Line 6.
61.
62.
Q – I do the History &Physical on the patient but the physician bills under their name. How do I
allocate the professional activities?
A – The H&P is part of the professional service no matter who bills, so this would be included on Line
6 in Time Trex.
Q – How soon we will be notified that we will need to fill out Time Trex?
A – As soon as we can work through the logistics.
63.
Q – If I am doing “meet the midwives” then how do I allocate that time in Time Trex?
A – If you provide professional services in this program then it would be allocated to Line 6.
If the focus of the program is introducing the expectant parents to the hospital and the process they will
go through when they come in, then this would go on Line 4.
64.
Q – Why do we have to do Time Trex if we work in a clinic and our schedules in the computer will
support what we are doing if the government ever audits us?
A – It’s required by the government by CMS (Medicare & Medicaid).
65.
Q – I work one day a week in an evaluation hospital based clinic. I don’t provide services but rather I do
care management beside the physician. I also do the dictation for the physician. How do I allocate this
time?
A – It would be Line 6 because it is a professional service.
66.
Q – Where do I allocate time spent at the Medical Staff meeting?
A – Hospital staff meetings would go on Line 4. Departmental/Clinic staff meetings for the physician
group practice would be allocated to Line 7.
67.
Q – I see research patients in a clinical setting but I don’t bill because their visits are part of the research
grant. How do I allocate this time?
A – Clinical services paid for by a research grant should be allocated to Line 8.
68.
Q – Where do I allocate continuing education time that is mandated by the School of Medicine?
A – Line 9.
69.
Q – I do postpartum visits along with other Nurse Practitioners’ in my group. How do I allocate for this
time?
A – If the postpartum visit is a billable service then your time will get allocated to Line 6.
70.
Q – Did UNC come up with Time Trex?
A – Yes, in response to a government mandate that requires us to follow regulations from CMS
(Medicare/Medicaid)
71.
Q – Do we only need to put the time we spend with Medicare patients in Time Trex?
A – No, you allocate your time for all the patients you see regardless of insurance.
72.
73.
Q – How do I allocate the notes that I do for hospital patients? Is that professional or administrative?
A – The notes you write match the services they document. If you are providing a professional service,
then the notes are part of that services and your time should be included on Line 6 in Time Trex. If you
document in notes a hospital service, then the time to write the note would be allocated to Line 2 or 3
along with the services they document.
Q – How do you allocate your time if you do inpatient and outpatient H&P’s and orders?
A – The H&P is a professional activity and should be included on Line 6.
74.
Q – I work in Neonatal (NICU) is this hospital base and how would I allocate my time?
A – The NICU is a hospital unit, so nursing activities in this unit should be included on Line 2 as
hospital services. Professional services always go to Line 6.
75.
Q – I work for the County Health Department but I am considered a UNC employee. How do I allocate
my time in Time Trex?
A – If your department has a contract with a outside party then you would allocate your time to Line 8.
If your department bills for any portion of your time then you should allocate to Line 6.
76.
Q - I work nights and was told to separate my time on two separate days. Do I still do that?
A – If your work schedule is split between 2 days then your time will be split between these two days.
77.
Q – If you are seeing a patient in a hospital clinic and that patient gets sick and you spend 30 minutes
cleaning them up because the nurse is not available, is that hospital or professional?
A – If it’s in a hospital based clinic or unit, then it would be a hospital service and should be allocated to
Line 3 or 2. For physician clinics this would still be included on Line 6.
78. Q – What does hospital based clinic mean?
A – It means that the facility is owned and operated by the hospital and meets specific Hospital Based
criteria as prescribed by CMS.
79.
Q – Does the new Time Trex change how we fill out encounter forms?
A – No
80.
Q – Training and supervising the residents in a patient setting. How is that allocated?
A – Allocation between training and clinical activities when they are performed simultaneously should be
based on your best judgment of how you spent the time.
81.
Q – If you are acting as a supervisor for the resident. How do you allocated?
A – Any training activities to help them become a practicing physician would be included on Line 1.
All other activities would be included based on the location and services that were being performed.
82.
Q – How do you allocate your time for training nurses in an in-service?
A – Line 2
83.
Q – For patient quality activities (patient & family education) done in a hospital based clinic. How do
you allocate this time?
A –Patient quality activities for hospital areas are typically put on line 4, but patient and family
education, or specific issues to address a hospital based clinic would be allocated to line 3.
84.
Q – How do you allocate if you are doing an educational program along side with physicians as an inservice?
A – For education of hospital staff Line 2 is appropriate. For residents the in-service education would
go to line 1. For physicians and physician clinic staff, this would be allocated to Line 7. If the group was
a mix of the above, then you should allocate using your best judgment and reasonable methods such as
numbers from the different groups.
85.
Q – What is a physician clinic?
A – Clinics that are owned and operated by Physician and Associates. This includes clinics run be the
different departments or divisions of the School of Medicine.
86.
87.
88.
Q – Administrative activities for scheduling group time to work in ICU?
A – Split your time 50/50 between Line 7 and Line 2.
Q - Where would I allocate my time traveling from clinic to clinic?
A – I would recommend that you split the time between the clinic you are leaving and the one you are
going to.
Q – If I see a patient then I do labs then would I allocate this time as professional?
A – Yes this is considered professional time so it would go to Line 6.
89.
Q – If the physician asks for the NP to call the patient and give lab results. How would you allocate this
time?
A – This would be a shared professional so it would be allocated to Line 6.
90.
Q – We have weekly meetings to discuss departmental issues that may or may not include patient
information. How would I allocate this time?
A – Line 6 for the issues specific to patients or Line 7 if it is related to broad clinic issues. For School of
Medicine academic or research issues, the time would go to Line 8.
91.
Q – My entire job is research. There is no billing done at all. Do I need to complete Time Trex?
A – If you entire job is research then you would allocate your time to Line 8. Time Trex is required
regardless if you are billing or not.
92.
93.
Q – How do I allocate lectures and teaching that I do for the School of Nursing?
A – Line 8
Q – How would I allocate for Division and Department Grand Rounds?
A – If you are doing clinical activities then allocate to Line 7. Departmental activities that are nonclinical would be allocated to Line 8. Any specific patient issues that are addressed would be allocated to
line 6.
94.
Q – I work solely on a patient database. How would my time be allocated?
A – This would allocate to Line 4 if it is a database the Hospital is required to keep. If this is a
database for a physician clinic it would go on Line 7. If the database is not required, but is intended to be
used for research, then it would go on Line 8.
95.
Q – How would you allocate the time spent working on improving patient care (ex.
programs/guidelines).
A – Line 7 if these are patients in a professional setting. Line 3 if they are in a Hospital Based Clinic.
Line 4 if they are in a Hospital setting.
96.
Q - I work in Medical Oncology and Radiation Oncology. Not sure if these are Hospital or Physician
Based but on paper I am employed only by Radiation Oncology. How do I determine which activities
reflect which clinic in Time Trex?
A – Call Reimbursement at 966-5032 to discuss your specific situation.
97.
Q – Is Time Trex to be hour based or minute based? I may have one activity that last 60 minutes but
may have 3 separate components. How would I allocate?
A – Time Trex record time in fifteen minute segments or quarter of an hour units. So an hour and 15
minutes would be 1.25 hours.
98. Q – I am a CRNA. How do I allocate my time getting the patient ready for the OR, looking up clinical
data, talking and consenting, exam the patient, starting IV’s when another RN is accountable to the
patient as well. I also take the patients to the Recovery Room and deal with the patient until the RN
accepts responsibility. What line would I allocate this time?
A - Line 6.
99. Q – Where do I allocate direct medical care provided to patients in a Hospital Based Clinic?
A- For professional services this would be included on Line 6. If you are working a nursing shift, or
providing other hospital services in the hospital-based clinic, then that time would go on Line 3.
100. Q – I believe it is illegal for PA’s to “train residents”.
A – PA’s may not “supervise”, but APN’s and PA’s may assist in training residents. APN’s and PA’s
may not bill for services performed by residents.
101. Q – It is unclear – Hospital based clinic vs. Physician clinic. How is this sorted & how does it affect us?
A – A list is being provided identifying hospital-based clinics. Nursing & administrative services for a
hospital based clinic should be put on Line 3 in Time Trex. Similar services in a physician clinic should
go on Line 6. All professional services “in the shoes of the physician” should be put on Line 6 in Time
Trex.
102. Q - Where do I allocate my time if I tell a resident how to get to the bathroom?
A – You only document the time you spend training a resident on becoming a physician. You would not
allocate the time you spend directing them to the bathroom.