Open Enrollment and ICD-10

Newsletter

December 11, 2014

Chiropractic Medicare

"Open Enrollment and ICD-10"

 

2015 Medicare Participation Enrollment period is open, running from mid-November through January 31, 2015. This Open Enrollment Period gives Medicare Providers the opportunity to change their participation status. You can also access your new 2015 Medicare Fee Schedule by going to your carrier’s website.

If you choose to change your Medicare Participation status, you can do so with a certified letter to your Medicare Carrier indicating your change in the Medicare Part B Program effective January 2015. (Those in possession of our Chiropractic Medicare DVD and booklet, see example letter page 42 in booklet.)

CMS has released their final ICD-10 rule, indicating implementation of ICD-10 will occur October 1, 2015 with no further delays.

The implementation of ICD-10 will require us to change the way we called patient data and document in our charts. The change that must occur deals with being more “specific” to the highest degree. The more specific the data collecting and documentation the easier it will be to find the correct ICD-10 code. If you are using a certified software with all of its parts, when your data collecting is complete, your software should be able to do the conversion automatically from ICD-9 to ICD-10. Please make sure to communicate with your certified software company about getting the new ICD-10 codes and training for correct use.

Insurance companies are determining, with clarification from CMS, which specific codes are to be used and acceptable by providers. The key will be specific data collecting on all preliminary forms so that your software can either do the conversion or prompt you for more specificity to choose the correct ICD-10 code. DO NOT WAIT to review your data collecting for “specific” information. If you wait until October 2015 you could have a long spell of no commercial insurance or Medicare reimbursement.

Remember, while preparing for ICD-10 implementation, we must still be doing Medicare correctly. Also, doing Electronic Health Records or “EHR” (being paperless) is only one part of the seven steps necessary to become Medicare Compliant. You can either write your own Medicare Compliance Policy Book activating the requirements in your office, or you may purchase a Medicare Compliance book like you did with HIPAA.

Newsletters from July 2011

July 2011

July 6, 2011

First, learn the correct way to do Medicare by "Federal Standards". Then, you can take the next step in becoming compliant and going paperless.

Everybody seems to be talking "paperless" and "compliance".  However, before you are successful being paperless and/or compliant in Medicare, you must be successful in learning and applying correct Chiropractic Medicare procedures.
The dangerous part of Chiropractic Medicare is that many Chiropractors assume that they must be doing Medicare correctly because they are being paid. That is the reason most Chiropractors lose in post-payment review audits.  The Medicare Carriers seem to be unable to review each Chiropractic claim when issued, so they hire recovery companies to review claims for money recovery from Chiropractors.

Several small mistakes can produce major problems. For example, item #14 (date of current) over 60 days old, flags the claim. The diagnosis must support the care rendered. X-rays must be no older than 12 months and/or P.A.R.T. form must be completed each and every visit if there are no current x-rays.  S.O.A.P. notes must match the billing as to the regions billed.  And, finally, your "documentation" (not the S.O.A.P. notes) must be indicated in Item #19 along with date of x-rays.

If you have attended one of our presentations or have purchased "The Basics" Chiropractic Medicare DVD, you understand the specific "documentation".

July 11, 2011
"Audit Compliance Plan"

The best way to have the most efficient and effective business management is to place together a written working audit plan for your office.  Your Compliance Officer should place your Audit Plan on a bulletin board in an accessible location so the entire staff and doctors can review.  The process should envelope everyone's ideas and responsibilities.

The Compliance Officer shall develop an education process for all doctors and staff so that everyone involved in your office takes part of the Audit Compliance Plan.  Reviewing this process each 3 to 6 months is necessary for all staff to keep from old habits and to stay in the process of becoming compliant.

Your Compliance Officer (a specific staff or doctor) is responsible in making the Compliance Plan workable, effective, and up-to-date.
NOTE:  We will have a Plan Outline ready for all interested very soon!

July 18, 2011
"S.O.A.P. Notes and Date of Current (Item #14)"

When you file a claim to your Medicare Carrier, date of current #14 indicates to the Medicare Carrier how long you have been seeing this patient for this sequence of care.  If the date of current is over 60 days old, it makes no difference about your diagnosis; your claim will be pulled for review.

The reason is even if your notes indicate an accident or exacerbation, item #14 tells the carrier it is still the same onset date and a chronic condition.  Accidents, exacerbations, etc. always changes date of onset (item #14).

All of your S.O.A.P. Notes whether hand written or dictated, need either a signature log or an attestation of all record entries.  All must be signed and legible.  Unsigned S.O.A.P. Notes are not acceptable.

July 25, 2011
"Four types of Chiropractors in Medicare which one are you?"

Medicare is a controlled program in that both the consumer and the provider have signed a contract agreeing upon specific guidelines and that they both know and follow those specific guidelines.

1. A Chiropractor That Can Not See Medicare Patients:  A doctor that has not completed a CMS 855i application, and does not have a Medicare number.  This doctor, new or old, does not have the privilege to take care of a Medicare patient.  NO, this doctor can not adjust Medicare patients while working for another Chiropractor and NO, this doctor cannot work under another doctor's NPI number.




2. Participating Provider:  A doctor who has signed a Medicare contract that has agreed to provide the Chiropractic adjustment and accept assignment on all Medicare patients.  (The money is deposited into the doctor's checking account.)  This doctor will know and follow all Medicare guidelines.




3. Non-Participating Provider Accepting Assignment:  A Chiropractor who signed a contract to be non-participating in the Medicare Program.  However, they have marked on the claim form that they will accept assignment on a claim so the Medicare carrier reimburses the doctor not the patient. This is the same as being a Participating Provider at the lowest reimbursable fee.




4. Non-Participating Provider That Does Not Accept Assignment:  A doctor who has signed a contract with the Medicare carrier to see a Medicare patient, collect from the patient for those services up to, and including, the limiting charge at time of service, bill Medicare, and the reimbursement goes to the Medicare patient.

Remember, both Participating and Non-Participating Providers must know and follow Medicare guidelines to be safe in the Medicare Program.