IMPORTANT DEADLINE 12-12-12 FOR PQRS

Newsletter
December 11, 2012
IMPORTANT DEADLINE 12-12-12 FOR PQRS
(Physician Quality Reporting System)

 

The Chiropractors in our Chiropractic profession have worked for over 100 years to help Chiropractic grow and be accepted by the public. We have been very successful in being included into insurance plans, Medicare, Medicaid, PPO's, etc. However, now that we are in Medicare we have to meet qualifications and demands by the Federal Government to take part in reporting certain quality measures due to healthcare reform.

Please see link to the CMS Website for more information about PQRS (Physician Quality Reporting System):
 https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/downloads/2012PQRS_SatisfRprtng-Claims_Final508_1-13-2012.pdf

To determine if you are eligible to participate in PQRS:  
https://www.cms.gov/PQRS

Even though it is a voluntary program with incentives, it is also a program that will take away from your future earnings if you do not participate.

My guess is about 5 Chiropractors out of every 25 are participating in PQRS. This is NOT A GAME! This is serious business! We are going into the final window of opportunity.

The Physicians Quality Reporting System (PQRS), was introduced by the Centers for Medicare and Medicaid Services, and a new part of healthcare reform. The program created in 2007, established a financial incentive to eligible healthcare professionals to participate in a voluntary quality reporting program. Providers who participate and report quality measures receive a 0.5% payment incentive.

Why is it so important? CMS recently ruled that providers not successfully participating in PQRS by 2013 reporting period (January 1 - December 31, 2013), will have their Medicare reimbursement decreased by 1.5% beginning in 2015, and 2% in 2016. The 2012 reporting period is the last opportunity providers have to voluntarily participate.

It is easier than you think. However, it requires a certified software company to walk you through the paces. Please follow the links and get informed.

Treatment Plans

Newsletter

14-Nov-12

"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".

More Compliance

Newsletter

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: http://www.cms.gov/Medicare/Medicare-Contracting/MedicareContractingReform/Downloads/compliance.pdf

 

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

Florida, Oregon, and Washington ~Newsletter 10/29/2012

Newsletter

October 29, 2012

Chiropractic Medicare Seminar Dates:

11-3-12     Wenatchee, WA - Wenatchee Conference Center, 1:00 pm to 5:00 pm.

11-10-12   Chicago, IL - Guest speaker at the Simplify Conference (Chirotouch) Postponed

11-29-12   Pacific, WA -  King Oscar Hotel, 8:30 am to 12:30 pm

11-29-12   Everett-Mukilteo, WA-Staybridge Suites, Mukilteo/Everett, 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

Chiropractic Medicare & Compliance

Florida Chiropractors and Staff:

     Of all the Important Chiropractic issues, Medicare hits the top of your important list.  You have nearly the highest number of seniors residing in your state and they need and deserve Chiropractic care.

     On Saturday, December 8th, I will be at the Clarion Inn and Suites, Orlando, 8:30 am to 12:30 pm covering critical information for Chiropractors and their staff.  In this 4 hour presentation, I will cover everything from the important ABN to becoming Medicare Compliant, going paperless, and the Medicare Electronic Health Record (EHR) Incentive Program to get money back from the government.

     This information is critical if you wish to be in Chiropractic practice in 2015.  The program registration fee is low, the presentation is fun and very informative, plus by attending, you will receive a CD containing important information you can use in your office.

***********************************     

     This coming weekend, Saturday, November 3rd, I will be speaking with Chiropractors and Staff in Wenatchee, Washington for Dr. Brad Summers.  The presentation is from 1:00 to 5:00 pm.  However, I will be back in the state of Washington on Thursday, November 29th, morning in Pacific and the evening in Mukilteo/Everett.

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

Learn, Compliance, Paperless & Attestation

Newsletter
October 22, 2012
Chiropractic Medicare
Learn, Compliance, Paperless & Attestation
Now is not the time to procrastinate!  If you plan on being in Chiropractic practice in 2015....listen up!  You have a choice.  Either get with it or get ready to retire!

Now that I have your attention, here are the steps necessary to wade through this Medicare process.  The process is not as extreme as first impression. 

1. Learn the correct way to do Chiropractic Medicare.  If you do not do Medicare correctly, all else will not be effective.  If you have attended our presentation or have our Chiropractic Medicare DVD & booklet, review the DVD and start doing Medicare correctly.
2. The Federal law says we must become Medicare Compliant. Follow this link: http://www.cms.gov/Medicare/Medicare-Contracting/MedicareContractingReform/Downloads/compliance.pdf  They provide seven (7) categories we must respond to by creating a Medicare Compliance Program and procedures in your practice.
3. Electronic Billing and Going Paperless
1. Nearly all Chiropractic offices are billing Medicare electronically. If you are not, you are going to be left behind and soon will be cut in Medicare reimbursement. Call your Medicare carrier, ask the carrier to help you bill electronically and follow their guidelines. Do not put it it off another day.
2. Going paperless is fabulous as long as you have a good Chiropractic software in your practice. I use Chirotouch software. This software leads you through the process of becoming paperless. I have to say, after doing written notes for forty-four (44) years, it is absolutely great to make a few clicks on the computer and not only have S.O.A.P. notes completed, but also produce "Documentation" by Federal Standards for Medicare, PI, etc.
4. Attestation: Once you have used and learned the software and follow the specific programs in the software, you will be ready to "attest" as to following the guidelines of a paperless practice. The government will now pay you an incentive dollar amount in direct proportion as to the number of Medicare visits you have. Learn more about the EHR Incentive Program. 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

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

      

Chiropractic Medicare Federal Guidelines

Newsletter

October 8, 2012

 Chiropractic Medicare

Federal Guidelines and

Seminar Dates: Washington, Oregon, and Florida!

 

 Medicare carriers across America, with the approval of CMS, have and are doing the job on chiropractic care. First, they have led chiropractors away from that inwhich chiropractic is all about, locating and correcting vertebral subluxations.

 

The Federal Guidelines click or follow this link to CMS (Medicare) website:

 http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf

 

The Federal Guidelines indicate the primary and ONLY job of a chiropractor in Medicare is to locate and correct vertebral subluxations. Back in 1973 we were mandated to take x-rays to prove the subluxation and once proven, we were reimbursed to adjust those subluxations. There was and still are NO limits in Medicare for the chiropractic adjustment.


Over the years the Medicare carriers have led the chiropractors down the yellow brick road of “treating” patients symptoms. Developing a “treatment plan” specifically related to the patient’s symptoms and NOT related to the correction of a vertebral subluxation which is indicated by Federal  guidelines.


Now the past years statistics on chiropractors indicate chiropractors treating patient symptoms are doing a poor job of documenting the necessity of treatment care so the Medicare carriers believe we are billing for maintenance care since most chiropractors have no idea the correct way to “document” the chiropractic care necessary.


Chiropractors should practice like chiropractors. Use the patient’s symptoms for diagnosis, locating the problem and decision making, but do not “treat” patient symptoms. There are plenty of other health care provider that ONLY treat symptoms.


Consider this scenario: New 74 year old patient comes into your office for chiropractic care after picking up a box at home hurting his low back. You do the workup including exam and x-rays and find a subluxation of L5. It has only been there 35 years….. you know that because it has proliferating arthritis that has been developing for the past 34 years because he never got it corrected. The L5, S1 articulations has soft tissue insult, swelling, etc., indicating sprain/strain. (diagnosis: 739.3, arthritis, sprain/strain)

This is an exacerbation on a new patient, soft tissue tear in a predisposed chronic subluxated, degenerative joint. By “documenting” this specific event correctly, this exacerbation is worth up to 6 visits. However, if chiropractors listen to our patients and understand the most active patient’s in your practice are your seniors, you will soon find your seniors have all kinds of exacerbations. Your job is to locate the subluxation, document the exacerbation by Federal Guidelines and correct subluxations.

 

Many Medicare carriers across America have stepped up and set specific visit guidelines for Medicare patients. Even though the Federal chiropractic guideline says there are no limits in Medicare for the chiropractic adjustment.

 

If you are in one of these states, (Tennessee, New Jersey, etc.) and you do chiropractic Medicare correctly and meet your carrier limit, go through the appeals process. Once you get to the Administrative Law Judge, if you have done your job like you have learned in our presentation or DVD, you should have a positive return from the ALJ.

 

QUESTIONS OR COMMENTS? Please give me a call.

 

Warmest regards,

Gary R. Street, D.C.

400 S. West Street

Olney, IL 62450

1-800-MY CHIRO

drgrstreet@nwcable.net

www.chiropracticmedicare.com

www.youtube.com/DrGRStreet 
 

Fall Seminar Schedule:

 

11/29/12

King Oscar Hotel, Pacific, WA 8:30 am to 12:30 pm

 

11/29/12

Staybridge Suites Mukilteo-Everett, Mukilteo, WA, 6:00 to 10:00 pm

 

12/1/12

Portland, Oregon Medicare Presentation 8:30 am to 12:30 pm

 

12/8/12

Orlando, Florida Medicare Presentation 8:30 am to 12:30 pm

"Becoming Compliant"~Newsletter 09/17/2012

Newsletter

September 17, 2012

Chiropractic Medicare

     1. Stopping Fraud & Abuse

2. Becoming Compliant

    3. Going For the Incentive

The government strategy of becoming compliant in Medicare, going paperless and getting an incentive to do so, is and will be effective in stopping fraud and abuse in Medicare.

One small problem.  Much of what the government calls abuse is not abuse.  It is the inability of Chiropractors to "Document" the Chiropractors necessity of care by "Federal Standards."

Since Medicare Carriers do not have the ability...(or do not want to)...review Chiropractic claims when they receive them......  ALL clean claims are automatically paid.  However, then companies are hired by the Medicare Carriers to reclaim money from Chiropractors that do not do Medicare correctly.

When doing Medicare you must know how to document the Chiropractic necessity of care by "Federal Standards".  Since most Chiropractors have never been shown or told how to "Document", a lot of money is recovered by these hired groups. The federal government calls this abuse against Medicare because the Chiropractor billed Medicare for a service that did not have documentation for payment that the government believes should have been billed as Maintenance Care.

Money is recovered by the hired firm, the Chiropractor has to pay it back, and statistics call that Fraud and Abuse against Medicare....simply because the Chiropractor did not know the correct way to do Medicare!

FIRST:  Learn how to do Chiropractic Medicare correctly.

SECOND:  Become compliant.

Finally....Contact your software company in regards to receiving incentives. We like Chirotouch.

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