October 10, 2011
Audits and Compliance
Dear Doctors and Staff,
The agreement among most Medicare educators is "nearly every Chiropractic office and Chiropractor seeing Medicare patients will be audited prior to 2014."
The audit will either be by C.E.R.T., or a company hired by your Medicare Carrier to audit for money recover (post payment review), or pre-payment review by your carrier. The pre-payment reviews will soon make up the large majority of audits. (That way they will have no monies out to collect back. They simply will not pay future claims.) Pre-payment reviews will be equal for both participating and non-participating providers.
The Patient Protection and Affordable Care Act (PPACA), signed into law on March 23, 2010, is aimed at curbing fraud, waste, and abuse in the Medicare program. By January 1, 2012 you MUST be ready to submit claims electronically using the X12 version 5010 to Medicare and other payers.
The ICD-10 diagnosis coding will become effective. ICD-10 will change the diagnosis codes up to eight (8) digits. The testing period for ICD-10 diagnosis codes will be from January 1, 2012 to October 1, 2013 when it becomes mandatory.
The Health Information Technology for Economic and Clinical Health Act (HIECH Act) established programs under Medicare and Medicaid to provide incentive payments for the "meaningful use" of Certified Electronic Health Record Technology. That will be the subject of next weeks Chiropractic Medicare Newsletter.
Since the majority of Chiropractors do not know how to document by federal standards, and all Chiropractors will be audited, a great number of Chiropractors will have to refund money back to the carrier or will be denied future Medicare payments. Our program can help you understand what must be done to prevent this problem. Please contact me with your questions.