Federal Incentive Payments for Implementing Electronic Health Records (EHR)

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Newsletter

September 10, 2012

Chiropractic Medicare INCENTIVE

Federal Incentive Payments for Implementing Electronic Health Records (EHR)

Did you know Chiropractors are eligible for up to $44,000.00 each from Medicare? So far $16.5 million has been paid to Chiropractors.  Well over 2000 Chiropractors have been paid, some even the last installment.

You must Attest Meaningful Use in a continuous 90 day period within that calendar year.  In subsequent years, after a providers first year, the reporting period is the entire calendar year. For more information follow this link: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Beginners_Guide.pdf

In other words, you must register this month, so you have October thru December of this year for EHR Meaningful Use.  You can still be eligible to receive the full $44,000.00 incentive by implementing EHR in your practice no later than October 3, 2012 and performing meaningful use for just 90 days in your first year.

It makes no difference as to Participating or Non-participating Provider.  If you submit claims for Part B covered services, you are eligible.  If you successfully register and demonstrate meaningful use of a certified Electronic Health Record, your incentive payment will be based on all services allowed under Part B, regardless of your participation status or whether you have accepted assignment on those claims.

Remember....only the use of Certified EHR (those that meet specific federal standards for Meaningful Use) can qualify for incentive payment.  Do you know if your software is qualified? Follow this link: http://oncchpl.force.com/ehrcert

I am so fortunate to be using ChiroTouch software that has it together.  
Questions?  Give me a call (618) 395-3800.

The Federal Incentive Payments Program is helpful, but remember you must know the correct way to do Chiropractic Medicare and also become Medicare Compliant. Once the correct way to do Medicare is understood, you are half the way. 

REMEMBER....
You are required to become Medicare Compliant prior to 2013.        
December is coming quickly.  

"The Medicare Claim Tells the Story" ~Newsletter 8/20/12

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Newsletter
August 20, 2012
Chiropractic Medicare
"The Medicare Claim Tells the Story"

 

 Most of my fellow Chiropractors, when they call about an audit or pre-pay request for records, ask why they received the record request.  Most of the time they have a request for records because the items on the claim do not match.

 

 An example:  A claim with an acute diagnosis indicating an acute condition or an exacerbation may have in item #14, Date of Current, a date over 60 days.  This tells the carrier the condition is chronic so the doctor receives a request for records to verify the true story on the patient. 

Date of Current on an active patient should NEVER be over 60 days if your are expecting Medicare reimbursement.

 

 Or...the diagnosis only consists of a subluxation with maybe arthritis.  The carrier knows this patient can be adjusted twice a day for 6 months and an x-ray indicated a subluxation and arthritis.  No improvement and no reimbursement.  The diagnosis should have three parts to it.  An example: subluxation, arthritis and sprain/strain if there has been an exacerbation.

 

 If item #19 does not have both date of x-ray(less than one year) or P.A.R.T., the claim may not be payable.  The carrier may ask for patient records to verify if the doctor proved a subluxation by either an x-ray less than one year or a P.A.R.T. form for each visit.  X-rays are mandated each year, if the doctor proves subluxation by way of x-ray. A P.A.R.T. form is mandated each visit if the doctor does not use x-rays to prove the subluxation.

 

Some carriers ask for office patient records periodically to verify if the doctor has a treatment plan with the three key components.  The "documentation" provided by our program consists of both "Federal Documentation" and also a treatment plan meeting all three components.

 

Many times the carrier will ask for patient S.O.A.P. notes to verify the doctor did in fact adjust vertebrae is specific regions in which they billed Medicare. If you adjust 4 regions on your patient for example, your billing will match the S.O.A.P. notes as to the number of regions you adjusted and billed to Medicare.

 

 Generally the information on each claim should all match.....diagnosis supports the care rendered, Item #14, date of current, is less than 60 days old, Item #19 contains date of x-ray or P.A.R.T., and specific terminology indicating any exacerbation and the "documentation" has been produced.

 

 Once the correct way to do Medicare is understood, you are half the way. 

"ABN - Important!" ~Newsletter 8/14/12

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Newsletter
August 14, 2012
Chiropractic Medicare
"ABN - Important!"

 

If a patient selects Option #2 on the ABN, the service indicated on the ABN does not then become a non-covered service.  However, the doctor does not have to file a claim to Medicare in that particular instance because the patient indicated that he or she agrees to pay out-of-pocket and does not want a claim submitted to Medicare. (However, the patient can change his or her mind, at a future time, and request the provider to submit a claim to Medicare.)  Both participating and non-participating providers are permitted to ask for payment from the patient at the time of service if either Option 1 or Option 2 is selected on the ABN.

 

It is my opinion that the purpose of the ABN, a rule that supersedes the Mandatory Claims Submission Law, is a simple attempt to supply a process to not bill Medicare for our seniors so the carrier's do not have to reimburse for Chiropractic adjustments.  That is a deceiving way to cheat our seniors from reimbursement in Medicare in which they have already paid, plus they pay a Medicare premium each month for coverage.  I strongly recommend we Chiropractors provide great Chiropractic care to the seniors, learn the correct way to do Medicare and bill Medicare so our seniors get their due reimbursement.

 

Remember...the ABN should only be presented to patients when the service in question may be denied by Medicare due to medical necessity.  It is not appropriate for the provider to present a patient with an ABN for a service that is expected to be covered.

 

The Chiropractic adjustment is ALWAYS a covered service by Federal Law and it is the responsibility of the Chiropractor to learn and provide "documentation" so the covered service is payable.

Newsletter 8/06/12 ~ "Back to the Basics"

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Newsletter
August 6, 2012
Chiropractic Medicare
"Back to the Basics"

 

The simple fact is "if you do not know how to do Chiropractic Medicare correctly...there is trouble!"  So most important....learn the correct way to do Chiropractic Medicare.

 

We have had the privilege of sharing, with our fellow Chiropractors and their staff, Chiropractic Medicare information for the past 34 years.  We constantly hear remarks like, "I have been in practice for 27 years.  Why didn't someone tell me this before now?" 

 

 You may believe you are doing Chiropractic Medicare correctly.  However, question yourself.  If you receive an audit today in the mail, what does your documentation look like? (Documentation is not S.O.A.P. notes.)  What does your treatment plan look like and does it have all three (3) required elements?

 

Questions? Please call me!  800-MY-CHIRO

"Audit....Notes of Interest" ~Newsletter 7/31/12

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Newsletter

July 31, 2012
Chiropractic Medicare
"Audit....Notes of Interest"

 

"Documentation" requirements for Chiropractic Care following the initial visit, these include:

1.       History:  Review of chief complaint.

a.       Changes since last visit.

b.      System review - if relevant.

2.       Physical Exam:

a.       Examination of area of spine involved in diagnosis.

b.      Assessment of change in patient condition since last visit.

c.       Evaluation of treatment effectiveness.

3.       Documentation of treatment given on day of visit.

 

NOTE:    Documentation cannot be used to substantiate medical necessity retrospectively.  In other words, documentation for medical necessity of care must be produced at time of visit.  Medicare guidelines require that medical need be established prior to providing the service at issue.  The medical record must stand on its own with original records supporting that the billed services is medically necessary and reasonable.

 

Those of you using our information, be sure to complete the "documentation" at time of visit.  If audited, include, with your documentation, the additional requirements listed at the first of this article.

ABN Discussion

Newsletter
July 23, 2012
Chiropractic Medicare

The basic purpose of Section 1879 of the Social Security Act, the limitation of liability provision (ABN) is to protect the beneficiaries (Patients) from liability in denial cases under certain conditions when items they receive are found to be excluded from coverage as NOT reasonable and necessary under section 1862 (a) (1) (A) of the Federal Security Act.

Where items or services are denied because they are determined to be not reasonable and necessary, the Medicare program makes payment when neither the beneficiary (patient) nor physician or supplier knew, and could not reasonably be expected to know, that the items or services were excluded.

When the beneficiary did not have such knowledge, but the physician or supplier knew, or could have been expected to know of the exclusion of items or services, the liability for the charges for the denied items or services rests with the physician or supplier.

If an ABN is not presented to the patient for those services or supplies that day prior to those services, the doctor will not be reimbursed by the Medicare Carrier if a participating provider and can not receive payment from the patient, or as a non-participating provider, the denial EOB will tell the patient to return to the doctor for a refund of what they paid at time of services. 

http://www.cms.gov/BNI/02_ABN.asp
http://www.cms.gov/MLNProducts/downloads/ABN_Booklet_ICN006266.pdf

The bottom line....the ABN is your friend.  You should make an assessment each office visit.  If you determine any service, covered or not, that you bill to Medicare may be denied today, you have the privilege of asking the patient to take financial responsibility by them signing an ABN today.

My Congressman's office called this morning.... Still waiting on CMS to give to me the official usage of option #2 on the ABN... keep watching.

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It is my goal to help Chiropractors and their staff understand Chiropractic Medicare so they are successful with Medicare, keep out of trouble, provide the adjustments our Medicare patients NEED, and bill claims correctly so we, not only stay in Medicare, but so Chiropractic will be included in future governmental health plans.

I am not a paid consultant.  I have excellent products containing information that may be purchased at a reasonable price.  I also believe in follow-up, so if you purchase some of our products, I will be available by phone or email to do my best to answer any questions you may have.
Thanks,
Dr. Street

If you do not have our information, you can visit our website or give us a call.  You will be so happy you have this information.

Still waiting on CMS to give to me the official usage of option #2 on the ABN... keep watching.

Remember....we all must become Medicare Compliant by the end of this year.

ABN Option #2 ~ Newsletter 7/2/2012

NewsletterJuly 2, 2012Chiropractic MedicareABN Option #2

Since posting my prior newsletters about ABN there has been considerable interests and questions  in regard to Option #2.

Option #2 on the ABN states, "I want the (Blank) listed above, but do not bill Medicare.  You may be asked to be paid now as I am responsible for payment.  I cannot appeal if Medicare is not billed.”

Option #2 is for ONLY non-covered services.

The Chiropractic adjustment is the only covered service for Chiropractors.

 National Government Services issued a "What's New" article on 6/27/12 with their explanation of the understanding of Option #2 as follows:

1. Option #2 of the ABN is to be used when a Chiropractor is providing a service to a Medicare beneficiary that is not going to be covered by Medicare.  The confusion has come in from some that believe Option 2 can only be utilized by the Chiropractor for the patient when the service is statutorily non-covered.  However, that is not the case.

2. The description for Option #2 indicates that the provider has told the beneficiary that Medicare will not cover the service because it does not meet policy criteria; therefore, it will be a non-covered service.  By selecting Option #2 the patient is authorizing that they still want the service to be performed and that they will pay the practitioner for the service.  Option #2 also alerts the beneficiary that a claim will not be filed to Medicare and that they have no appeal options.

3. The misunderstanding is that since the Chiropractic service is a Medicare benefit, just not covered for this specific scenario, that Option #2 should not be used.  The belief is that the Chiropractic adjustment is always a covered service; however it is not always covered, it is simply recognized as a Medicare benefit.  This also leads to the misunderstanding that Chiropractic adjustments must always be billed to the Medicare carrier for consideration.  With the implementation of the new ABN form, this is no longer the case.  Providers are allowed to provide a service to a beneficiary that they know will be non-covered by Medicare according to policy and the patient has the right to still have that service, pay the provider for that service and waive the filing of a claim to Medicare.

4. The Centers of Medicare & Medicaid Services (CMS) Internet-only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 30, Section 50.14.1 (1.07 MB) states that in this situation the provider will not be violating "Mandatory Claim Submission" guidelines:

"Note:  Providers will not violate mandatory claims submission rules under Section 1848 of the Social Security Act when a claim is not submitted to Medicare at the beneficiary's written request in choosing Option #2 on the revised ABN."

If this is true, now the patient has the authority to mark Option #2 and it supersedes "Mandatory Claims Submission" and the "Participating Provider Contract" of not collecting the 80% of the fees at time of visit.  This also denies the patient from reimbursement for the covered service of the adjustment.  It also is another way cut Chiropractic reimbursement.

I am awaiting official explanation from CMS that I shall share as quickly as I receive.

Remember, we all must become Medicare Compliant by the end of this year!

Have questions? Give Dr. Street a call today at (618) 395-3800.

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Keep in mind, Medicare is the only insurance type program that if done incorrectly is fraud, a felony, a fine and/or jail.

Resources and further reading:

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Chiropractors_fact_sheet.pdf

NGS pdf document  "869c_910_Notices_of_Noncoverage.pdf"

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM7821.pdf