ABN Electronic

Newsletter
March 11, 2013
Chiropractic Medicare
ABN Electronic

ABN: Electronic retention of the signed paper document is acceptable. Notifiers may scan the signed paper version of the ABN for electronic medical record retention and, if desired, give the paper copy to the beneficiary (patient) at time of visit.

Centers of Medicare and Medicare Services (CMS) currently does not have a written policy on the electronic issuance of ABN’s. However, it is not prohibited. These are the CMS recommendations offered to provider/suppliers at this time:

a. If an electronic issuance system is used, the beneficiary (patient) must be given the option of requesting paper issuance over electronic, if that is what he/she prefers.

b. ABN’s can be printed for issuance, the paper copy signed by the beneficiary then scanned for electronic health record (EHR) retention, and the original paper copy can be given to the beneficiary.

IMPORTANT: Electronic issuance system can not be located and used at the front desk. The doctor must see the patient, make an assessment, then the patient may sign the ABN prior to any services today.

The ABN or Advanced Beneficiary Notice of Noncoverage link to the form
http://www.cms.gov/BNI/02_ABN.asp

The ABN or Advanced Beneficiary Notice of Noncoverage information
http://www.cms.gov/MLNProducts/downloads/ABN_Booklet_ICN006266.pdf

EHR, CBR, CAQH

Newsletter
February 25, 2013
Chiropractic Medicare
1. EHR-Registration and Attestation System.
( How much will YOU get paid?)
2. CMS A+ Government Solutions – “Comparative Billing Report, CBR Desseminator.
3. CAQH Update Reminder.
1. Meaningful Use:
We can go through the 15 core operatives, the computerized provider order entry (CPOE), drug-drug and drug-allergy checks, up to date problem list of diagnosis, E-Prescripting (eRx), or maintaining active medication list or allergy list....
Wait....it’s better than this!
First impression is that it is very difficult. Not true. It’s much easier than you think. First, you must have a certified “software”. We use “ChiroTouch”. Your certified software will walk you right through the process so you can register and attest. Don’t wait. If you have not moved on this, you are presently in the final window. You are still able to attest and receive $15,000 incentive dollars for 2013.
2. A+ Government Solutions on contract from CMS has faxed again around 5000 Medicare Comparative Billing reports. If you received by fax, this report, then you are now aware you are above your peers in either the number of visits you are seeing your Medicare patients or the CPT Codes used when billing for your Medicare patients. The report is an effort by CMS to educate providers on their billing patterns, this being helpful as an educational tool which may assist you in identifying opportunities for improvement.
Since the Office of Inspector General believes that billing Medicare with the AT modifier over 12 visits per year is medically unnecessary, and that the likelihood of a service being medically unnecessary increases even more significantly after 24 “treatments”, this report should spark your interest.
I recommend reviewing this report very carefully, compare with your in-house records for the report accuracy. If you find the CMS Comparative Billing Report statistics are incorrect, call them for corrections.
3. CAQH – Just a reminder.....the Universal Provider Data Source must be kept up-to-date. If you need to update the CAQH Universal Provider Data Source https://Upd.caqh.org/oas or Provider help desk at (888) 599-1771. Have your CAQH provider ID available.

CAQH, CMS 855i, and Audits

Newsletter
March 4, 2013
Chiropractic Medicare
CAQH Reminder

Another reminder to update your CAQH Universal Provider Data Source credentialing. To update your application, go to CAQH Universal Provider Data Source https://upd.caqh.org.oas. Failure to update your information may jeopardize the relationship between you and your authorized participating plan.

CMS 855i Application, http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-List.html, another timely form, must be completed every 5 years or anytime you have data change (name, address, etc.). Check your records to be sure your CMS 855i application has not surpassed 5 years. You may not receive a notice from your Medicare carrier, just denial of Medicare claims.

NOTE: Now that the EHR Registration and Attestation System comes to an end, I suspect we again will see Medicare audits. It will be interesting to see if the majority of Medicare audits will be with those Chiropractors that went through the Medicare Attestation and received incentive payments or will be done on those Chiropractors that did not become certified.

2013 Spring Seminar Schedule:
March 21 - Kokomo, Indiana at the Courtyard Hotel Kokomo – 1:00 pm to 5:00 pm, EST.
March 23 – Bluffton, South Carolina at Unitarian Universalist Church – 12:30 pm to 5:30 pm EST.

More ABN discussion

Newsletter from February 18, 2013
“ABN Advanced Notice of Non-coverage”

NOTE: This is the only document in your office that can not be stored electronically. It must stay in the original paper form. Either stored per patient or by date for fast recovery if requested by your Medicare carrier.

THE ABN
It has become my conclusion the ABN in it’s origination has but one primary purpose....to cut reimbursement by the Medicare Carrier. It contains rules that supersede the Federal law of mandatory claim submission. It has led many a Chiropractor down the yellow brick road of “Treating Patient Symptoms” instead of locating and correcting vertebral subluxations like Federal Law indicates.
When a Chiropractor calls the chiropractic adjustment that corrected a vertebral subluxation “Maintenance Care”, and had the patient check Option 2 on the ABN to not bill Medicare because it is called “Maintenance Care” since the patient felt no symptoms...and then collected from the patient, the regular office fee (not the Medicare fee) at the time of visit....Who Got Had?
The consumer (patient) just got cheated out of Medicare reimbursement. They pay over $100 dollar premium for Medicare each month. You say the patient had no symptoms. Consider this, as many as 1,800,000 seniors over the age of 65 may be dependent on Medicare-provided prescription drugs. The average number of prescriptions per year for each senior is 38.5 with the average number of different prescriptions daily being 5 or more.
Most of our patients are on 5, 6, 8, 10 drugs each day....they can not feel their symptoms. And yet, if the patient has no symptoms we just call it “Maintenance Care” and then not bill Medicare. I don’t think so! Our job as Chiropractors is quite clear in Medicare. We do not get paid to “treat” symptoms. We are only paid in Medicare to locate and correct vertebral subluxations.
If the patient have a subluxation and no pain symptoms....How about that subluxation of T6 spinal nerve and the trajectory of that nerve to the stomach, altering the normal function of the stomach. They are already on three prescription drugs for a stomach problem. S.O.A.P. notes shall indicate your findings, and your documentation will support the care given. I recommend, when you correct a vertebral subluxation, call it what it is....The primary job you do, and it is covered by Medicare. Help your patients get reimbursed in Medicare for the Chiropractic covered service of correcting a subluxation.

Judge Approves Change to Medicare Improvement Rule, Health Services

Newsletter from February 15, 2013
Medicare Settlement Means No More “Improve or You’re Out”
Originally Posted on 02/6/2013 by Amy Goyer 
Judge Approves Change to Medicare Improvement Rule, Health Services

     A Federal Judge has approved the proposed Settlement Agreement in the Medicare Improvement Standard case, Jimmo vs. Sebelius, clearing the way for thousands of Medicare beneficiaries to receive needed health services to maintain their current level of functioning.
   
     The settlement, which represents a significant change in Medicare coverage rules, ends Medicare’s longstanding practice of requiring people to show a likelihood of improvement in order to receive coverage of skilled care and therapy services.
   
     The Agreement, which is retroactive to the date of the suite was filed, January 18, 2011, includes skilled services covered by Medicare Part A and Part B, such as speech, occupational and physical therapy, nursing and home health services, even when the goal is maintaining the patient’s current condition rather than requiring that the patient improving.
 
     The Medicare law has never supported the “improvement standard.” Nevertheless, for decades beneficiaries have been denied needed services because they are not improving or have “plateaued”, sometimes with devastating results. The Center for Medicare Advocacy says providing maintenance services will save money in the long run, preventing decline, hospitalizations and need for more expensive services.

     The official approval of the settlement means the Center for Medicare and Medicaid Services (CMS) must develop and implement an education campaign to ensure that Medicare providers are not denying coverage for vital maintenance services to those with any chronic illness who meet other qualifying Medicare requirements.
 
    The “maintenance standard” is effective immediately. Even though we have not seen the official documentation that Chiropractic Maintenance Care is included in this settlement, we are presently requesting a specific answer from CMS. If you or someone you are caring for has a chronic illness or needs skilled services to prevent further deterioration, contact your health provider.

Originally Posted on 02/6/2013 by Amy Goyer, see original link below:
http://blog.aarp.org/2013/02/06/amy-goyer-medicare-pays-for-skilled-therapy-for-maintenance-with-chronic-illness/

PQRS “WE ARE IN THE FINAL WINDOW!!!”

Newsletter
January 11, 2013
Chiropractic Medicare
“WE ARE IN THE FINAL WINDOW!!!”

So many calls about PQRS. So many of my colleagues not taking this seriously. Becoming Medicare Compliant is a “voluntary” process they say. Let us understand what the government means by “voluntary”.

You voluntarily pay your income taxes. Oh, so you don’t have to if you don’t want to! However, your life as you now know it “will change!” The same for Medicare Compliance, becoming paperless and following the Physicians Quality Reporting System (PQRS). If you wish to be in Chiropractic practice in 2017, you better make use of this “final” window we are now in.

Who has to do this? Everyone and anyone seeing and billing Medicare patients. It’s that simple. If you adjust a Medicare patient, federal law requires you to bill Medicare within one year. You must become Medicare Compliant, use electronic billing and record keeping, and apply the PQRS Codes.

For more helpful links to information about PQRS and other Medicare related click here, or follow this address:  http://chiropracticmedicare.blogspot.com/p/blog-page.html

2013 Fees and PQRS Information

Newsletter
January 2, 2013
Chiropractic Medicare
"Opening the Final Voluntary Window"



To my fellow Chiropractors.........
Congress passed, just last night, Section 1848(d) of the Social Security Act (42 U.S.C. 1395w-4(d)) that amended by adding a paragraph that updated the single conversion factor for such year shall be zero percent. In other words, our fees are the same as last year and we again escaped a nearly 24% cut in our Medicare reimbursement fees for 98940-98942. Below, find the website for your interest.

http://www.gpo.gov/fdsys/pkg/BILLS-112hr8eas/pdf/BILLS-112hr8eas.pdf


January 1, 2013 is the beginning of the final voluntary window to do PQRS. So lets talk about "voluntary " window. You can compare voluntary window with paying your income taxes. You have a voluntary time factor to pay your income taxes. If you pass up the voluntary window to pay your taxes, it is going to cost you more in the long run and you begin to lose privileges.

Now you are beginning to get the idea of "voluntary". PQRS is exactly the same. You have a choice. You can voluntarily implement the PQRS program and even receive an incentive for doing so in this final window....or you can pass this FINAL window of voluntary opportunity, don't do anything in regards to PQRS and get prepared to receive financial cuts in, not only Medicare, but nearly all insurance companies from now on.

Plus, you will begin to lose privileges of even dealing with some insurance companies and probably a dollar cap on any patient having insurance that you adjust for cash. And, since we Chiropractors can not opt out of Medicare and are required to bill Medicare for all covered services, your Medicare fees will continue to drop, making NO difference whether you are a participating or non-participating provider.

For the Chiropractor who says, "We don't do Medicare. We adjust the Medicare patient, collect cash from the patient and don't bill Medicare." Hold on for the ride! When you get caught...and you will get caught...the fines are up to $10,000.00 per adjustment. Just like not paying your income taxes.

I am guessing only about 35% of my fellow Chiropractors are prepared for PQRS. I strongly recommend, as I have for the last 18 months, BITE THE BULLET and make it happen NOW!

Here are some helpful links about PQRS:
https://www.cms.gov/PQRS
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/downloads/2012PQRS_SatisfRprtng-Claims_Final508_1-13-2012.pdf