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Wednesday, November 14, 2012

Treatment Plans

"Treatment Plan"
Seminar Dates:
11-29-12 Pacific, WA - King Oscar Hotel, 8:30 am to 12:30 pm
11-29-12 Everett-Mukilteo, WA -Staybridge Suites, 6:00 to 10:00 pm
12-1-12 Portland, OR - Holiday Inn, Airport, 8:30 am to 12:30 pm
12-8-12 Orlando, FL - Clarion Inn & Suites, 8:30 am to 12:30 pm
As we review audit after audit reports, the "treatment plan" seems to be high in failure rate by fellow Chiropractors. Without a treatment plan, reimbursement can be a failure, especially after record requests by both Medicare Carriers and Insurance Companies.
"Treatment Plan to Consider"
Scenario: A new patient enters your office, his age is 79, raking leaves and receives a sharp shooting low back pain upon lifting a bag of leaves.
The patient completes all new patient forms and seated across from you for consultation. He indicates he is basically healthy and hardly ever has back pain. You have decided to accept this patient and proceed doing a case history, examination, spinal x-rays (1-14x36 AP, 1-7x17 Lat. thoracic, 1 7x17 Lat. lumbar and 1-8x10 Lat. cervical) and perform a scan prior to the patient reporting to your appointment area to set an appointment for a report of findings in 2 hours or tomorrow. The patient pays for today's services and leaves.
To prepare the report of findings, x-rays are developed and analyzed, examinations reviewed, reports are completed and a treatment plan is now produced. For this Medicare patient, we will have a dual treatment plan developed.
1. The Original Treatment Plan, to see this patient 3 times a week for 3 weeks, 2 times a week for 4 weeks and 1 time a week for 5 weeks and a re-evaluation in 90 days.
2. The Documentation Treatment Plan can also be used because this patient experienced an exacerbation in which soft tissue in a predisposed old arthritic subluxated joint was injured, torn, stretched, bleeding, etc. This finding, supported by x-rays, is an exacerbation that when "documented" correctly, is worth 1 to 6 visits as approved by Administrative Law Judges.
*You will most likely use the Documentation Treatment Plan for 1 to 6 visits. However, our senior patients are the most active patients in our practice. About their 5th visit, they have a new exacerbation. You will again produce "Documentation" indicating 1 to 6 visits on the new treatment plan. This process continues with this Medicare patient and many times the original treatment plan is never used. This "Document" which is critical in Medicare, can be produced with many software  programs as we work our way to becoming "paperless".

Tuesday, November 6, 2012

More Compliance

November 6, 2012
Chiropractic Medicare & Compliance

Just a small reminder:

No matter where I speak, in the Eastern States or Western States, North or South...I still run into fellow Chiropractors who do not seem to be aware that it is a federal law as per Social Security Act (Section 1848(g)(4)) that when they adjust a Medicare patient, it is  mandatory claims submission in a reasonable amount of time (one year or less).

If you have no Medicare number and/or have not completed a CMS 855i application, you are not qualified to file a Medicare claim to a Medicare Carrier. This also means you are not qualified to take care of a Medicare patient. If you are adjusting Medicare patients and not billing Medicare for your patient, you have breached the federal law and may be fined up to $10,000.00 per adjustment.

The simplest of all rules in Medicare is being overseen by a surprising number of chiropractors. If you know any that are not billing Medicare, please confront them, as you may save them big dollars and embarrassment.

We all must keep in mind that our seniors in the Medicare program pay premiums each and every month. It is our job to document and bill Medicare so correct reimbursement is part of the normal Medicare process.

NOTE: We must know how to do Medicare to keep out of trouble and make sure our seniors are reimbursed. We also must become Medicare Compliant to stop fraud and abuse. Your compliance in your office should be nearly completed by now. For the required seven (7) categories we must respond to by creating a Medicare Compliance Program and procedures in your practice, follow this link:
Have questions? Give Dr. Street a call today at (618) 395-3800.