A New Year to Become Compliant in Chiropractic Medicare

Newsletter
December 20, 2011
A New Year to Become Compliant in Chiropractic Medicare
Dear Doctors and Staff,

1.  We are in the window.
2.  Congress ready for Medicare fee vote.
3.  Three areas to contend with in 2012.
4.  Chiropractic Medicare Compliance Program available.

1. We are in a window:
     The month of December is the window available by our Medicare carrier to change from Participating Provider to Non-Participating or Non-Participating Provider to Participating Provider Part B Medicare effective January 2012.
    For those who have attended our Presentation in the past or have purchased "The Basics" Chiropractic Medicare DVD, the hand-out booklet page 42 contains an example letter that must reach your Medicare carrier prior to the end of the year.  Mail this letter certified mail, this being your proof they have received your request to change your participating status.

2. Congress ready for Medicare fee vote: (Action Step request!)
    At the present time congress is still in session and soon voting on the large package bill that will preserve our present fees in Medicare. (Probably even a small raise.)  National News will report on this package bill as it has to do with withholdings. etc, by the employer.  Please call your Congressmen and Senators asking them to vote for this bill.

3. We Chiropractors have three (3) critical areas we must be prepared for as we go into 2012:
   A.  We must know the correct way to do Medicare so we don't get into trouble.
   B.  We must know how to protect Personal Health Information in our offices.
   C.  We must become Medicare Compliant by the end of 2012.  There are seven (7) areas we must have prepared written policy and procedure training, hiring, self audits and reporting. 

4.  Chiropractic Medicare Compliance Program Book & CD:
   The Book is ready to help you start implementing Medicare Compliance in your practice.  Just add your office name, etc., and follow the instructions and you are well on your way to becoming compliant in Medicare.

Chiropractic Medicare Compliance Guide & CD of Forms ~Newsletter 12/12/11

Newsletter
December 12, 2011

Chiropractic Medicare
Compliance Book & CD Ready for 2012
We are taking orders!

Dear Doctors and Staff,

It is finally completed!  After 2 1/2 months of late nights, hard work, critical thinking and research, "The Basics" Chiropractic Medicare Compliance Guidebook and CD are finished.
Most of my fellow Chiropractors are aware we "must be in Medicare Compliance" by the end of 2012.  Our Medicare Compliance Program is ready. Just add your office data, names, address and a few additional personnel changes, then print the policies, procedures, guidelines, etc., that have already been completed for you.

Knowing the importance of learning the correct way to do Medicare by federal standards and becoming Medicare Compliant is the important thing to do in Medicare in 2012.  We have a program and its ready to be implemented in your office. My Compliance Guide will save you and your staff hours of hard work. (I know that for a fact!)

REMINDER NOTE:  We are presently in the window to change your Medicare provider status. You can change to Participating Provider or to Non-participating Provider, the time to do that is NOW!

Are YOU Knowing the Correct Way to Chiropractic Medicare Compliance? ~Newsletter 11/25/11

Newsletter
November 25, 2011
Chiropractic Medicare Compliance, HIPAA and
Knowing the Correct way to do Medicare

Dear Doctors and Staff,

Having spent hours, this and last month, working on documents, forms, data, office policies,and reports necessary to become Medicare Compliant in 2012, it should be completed and ready to go by November 30th.

Two points of interest:
   1.  After going through ALL the "stuff" required by federal law - I can't imagine very   many offices will prepare this themselves.
   2.  The fee we have set to sell this program is worth every dime!

The manpower, critical thinking and production of the Chiropractic Compliance Program material is staggering, let alone, understanding and producing all the different office policies for all the different categories each office must produce.  If done correctly, the implementation of the Medicare Compliance Program, with self-audits and all the policies, will have a positive effect on the Chiropractic Error Medicare Rate.

Those Chiropractors that do not go through or implement this program will stand out like a sore thumb and I am sure will be in prime position for audits from their specific Medicare carriers.

There are three (3) specific areas we chiropractors must understand and implement in our practices:
1. Learning the correct way to do Chiropractic Medicare ("The Basics" Chiropractic Medicare DVD and Booklet)
2. Protecting patient Personal Health Information (Chiropractic HIPAA book and CD)
3. Chiropractic Medicare compliance with written policies to prevent fraud and abuse in the Medicare program (Chiropractic Compliance Program book and CD)

The most profound problem we Chiropractors face is the lack of knowledge of how the Chiropractic Medicare actually functions and what is specifically  needed to "document" the Chiropractic necessity of care. (Not S.O.A.P. notes)  If you become Medicare compliant, as mandated by 2012, and still make errors in "documentation"....you have gained nothing.

Recommendation: 
For those D. C's and staff that have attended our seminars, or have purchased our Chiropractic Medicare DVD, consider ordering our NEW Chiropractic Compliant CD & book. You are on the safe road for Chiropractic Medicare Compliance!

For those D.C.'s that do not have, or know about "The Basics" Chiropractic Medicare DVD or our Seminars, we have put together a bundle so you can get all the important information at a very good cost. Please call me for more information 618-395-3162 or 800-MY-CHIRO.

Regards,
Dr. Street

IPSCA Medicare Compliance Seminar in Moline, Illinois (Dec. 8th)

On Thursday, December 8th, 2011, the Illinois Prairie State Chiropractic Association (IPSCA) is holding a seminar in Moline, Illinois. Dr. Street will be there to speak on Chiropractic Medicare Compliance.

IPSCA website: http://illinoischiropractors.org/
Link directly to the form below: http://illinoischiropractors.org/uploads/Medicare_Compliance.pdf





No Out-of-pocket, PECOS, CMS-855i, Fees

Newsletter
November 9, 2011
Chiropractic Medicare

Dear Doctors and Staff,

1.  No Out-of-pocket Expense - Medicare
2.  CMS 855i or PECOS
3.  Medicare Fees

1.  It is against the law to practice No Out-Of-Pocket expense in Medicare.  If you are a participating provider, you have signed a contract with the Federal Government that you will "accept assignment" on ALL Medicare patients.  The Medicare reimbursement of 80% always comes to the doctor.  However, the doctor MUST collect the other 20% from either the patient or the patient's supplemental insurance.  Only accepting the 80% of what Medicare pays is called No Out-Of-Pocket expenses, which is a breach of Medicare law.

2.  CMS 855i Application or PECOS must be completed by All Chiropractors.  If you have not gone on line and completed PECOS or downloaded CMS 855i off the CMS website and completed...DO IT NOW!  If you do not, there will be NO Medicare reimbursement in the near future.

3.  Our Medicare fees have been posted for 2012.  All have been decreased by about 21%.  We again wait on Congress to move on this issue, the same as earlier this year.  With any luck, we may have our fees restored with minimal increases over 2011.

Electronic Billing Electronic Health Records (EHR) ~ Newsletter October 31, 2011

Newsletter
October 31, 2011
Chiropractic Medicare
Electronic Billing
Electronic Health Records(EHR)

Dear Doctors and Staff,

Electronic Billing and Electronic Health Records (EHR) are here to stay.  If you have procrastinated and presently still doing paper claims...Listen up!

We are in a window right now that requires an ACTION STEP.  You have ONLY 60 days to call an Electronic Billing Company (contact your Medicare Carrier for references and/or fellow Chiropractors already on billing software), get the program up and running in your practice.  Make sure the software is the certified X12 version 5010 software that can handle ICD-10 Codes.

Those that are using electronic billing, your software company should be preparing to upgrade from 4010 A1 software to x12-5010 software.  They should contact you with the new downloads, do testing to be sure all is functioning like it should, PRIOR to January 1, 2012.  If they have not called or contacted you with a time for update, YOU call them.  Do NOT put it off....Call today!

Electronic Health Records (EHR) is going to take place.....with or without you.  The time is quickly getting here where we must know and follow the Medicare guidelines....Perfectly.  Every Chiropractor will be audited in 2012 and by 2015, audits will be part of the regular Medicare program built into your Electronic Health Records and overseen by your own in house monitoring.  Everything is on a time line.  If your interested in the CMS incentive of up to $44,000.00 and if you plan on being in practice in 2015......you need to get going TODAY!

FIRST....Learn the mandatory rules in Chiropractic Medicare.  You can review our "The Basics" Medicare DVD and booklet or order it today.

SECOND....If you are electronic billing presently, call your company asking about the 5010 upgrade.  If your not doing electronic billing....make it happen QUICK!

If you have questions...give me a call!  I will soon have a "Chiropractic Compliance Handbook" ready to help my fellow chiropractors and staff with becoming compliant in Medicare and Electronic Health Records transition.

Understanding Medicare "Replacement" Plans ~Newsletter October 24, 2011

Newsletter
October 24, 2011
Chiropractic Medicare
Understanding Medicare "Replacement" Plans

Dear Doctors and Staff,

Nothing is "simple" including Medicare replacement plans.  The Medicare Carriers are losing "customers" to these plans and are not happy with them.

Just so you know....there are two kinds of replacement plans:

1. Plans that subcontract...in other words, the patient of this plan is still on a contract with Medicare and is still with Medicare.  Which means....when we see this patient in our Chiropractic office, we must follow ALL the Medicare guidelines, even when billing the replacement plan.  Even if the replacement plan has a $35.00 co-pay, we must still bill.
2. If your patient has a "Medicare replacement" and the patient has bailed out of  Medicare and not paying Medicare premiums each month, this person is now in the same category as the rest of your patients.  You do not have to bill the replacement insurance and your fees are the same as your non-Medicare patients....Unless....you bill this replacement insurance one time.  Now you are on contract with the Medicare replacement insurance company to follow ALL the Medicare guidelines, fees and billing. Even though the replacement company has a $35.00 co-pay, and pays nothing on the claims, you must file for your patient.

IMPORTANT:  If your patient tells you they have a Medicare replacement program, you must call your "Medicare Carrier", not the replacement insurance, and ask if your patient is in the federal "Medicare" program or not.  The answer is either yes or no.  You will then know who, what and where to bill.

Audits and Compliance ~Newsletter October 10, 2011

Newsletter
October 10, 2011
Chiropractic Medicare
Audits and Compliance
Dear Doctors and Staff,

The agreement among most Medicare educators is "nearly every Chiropractic office and Chiropractor seeing Medicare patients will be audited prior to 2014."

The audit will either be by C.E.R.T., or a company hired by your Medicare Carrier to audit for money recover (post payment review), or pre-payment review by your carrier.  The pre-payment reviews will soon make up the large majority of audits.  (That way they will have no monies out to collect back.  They simply will not pay future claims.)  Pre-payment reviews will be equal for both participating and non-participating providers.

The Patient Protection and Affordable Care Act (PPACA), signed into law on March 23, 2010, is aimed at curbing fraud, waste, and abuse in the Medicare program.  By January 1, 2012 you MUST be ready to submit claims electronically using the X12 version 5010 to Medicare and other payers.

The ICD-10 diagnosis coding will become effective.  ICD-10 will change the diagnosis codes up to eight (8) digits.  The testing period for ICD-10 diagnosis codes will be from January 1, 2012 to October 1, 2013 when it becomes mandatory.

The Health Information Technology for Economic and Clinical Health Act (HIECH Act) established programs under Medicare and Medicaid to provide incentive payments for the "meaningful use" of Certified Electronic Health Record Technology.  That will be the subject of next weeks Chiropractic Medicare Newsletter.

Since the majority of Chiropractors do not know how to document by federal standards, and all Chiropractors will be audited, a great number of Chiropractors will have to refund money back to the carrier or will be denied future Medicare payments. Our program can help you understand what must be done to prevent this problem. Please contact me with your questions.

~Dr. Street

Chiropractic Maintenance Therapy (Medicare Terminology)

Newsletter
October 3, 2011
Chiropractic Maintenance Therapy (Medicare Terminology)

Under the Medicare program, Chiropractic 'maintenance therapy' is not considered to be medically reasonable or necessary, and is therefore not payable.  'Maintenance therapy' is defined as a "treatment plan" that seeks to prevent disease, promote health, and prolong and enhance the quality of life; or "therapy" that is performed to maintain or prevent deterioration of a chronic condition.

When further clinical improvement cannot reasonably be expected from continuous ongoing care, and the Chiropractic treatment becomes supportive rather than corrective in nature, the treatment is then considered "maintenance therapy".  Chiropractic "maintenance therapy" is in direct relation to you as a Chiropractor, either "correcting" vertebral subluxations (vertebral displacements) or "treating" the patient's symptoms.

The Chiropractic Medicare program ONLY reimburses for a Chiropractor to correct vertebral subluxations.  Patients symptoms help Chiropractors locate the causal subluxation, but are not the indicator as to if the subluxation has been corrected.

The Chiropractic adjustment is NOT a "treatment".  The Chiropractic adjustment is a "correction".  A "treatment" becomes supportive rather than corrective in nature, the treatment is then considered maintenance therapy.

The correction of a vertebral subluxation is the only payable service in Medicare for Chiropractors.

Many Chiropractors have fallen for the "treatment" of symptoms in Medicare....the patient marks option #2 on the ABN and Medicare is not billed.  The patient has been cheated from Medicare coverage because the Chiropractor is "treating symptoms".  Even though vertebral subluxations are being found and adjusted, since the patient had NO symptoms, the doctor now believes it is maintenance care.  (The Medicare patient is probably on 10 prescription drugs from the local MD, and can't feel any symptoms.)

If the patient has vertebral subluxations, then there must be "Neuronal Components" or there is NO subluxation.  If the patient has NO symptoms, then a thorough examination of this patient will indicate the prescription drugs the patient consumes for specific symptoms related to malfunction of specific body organs.

Matching the vertebral subluxations to a specific malfunction organ is simple for a Chiropractor.

Locating the subluxation, finding the Neuronal Component to a malfunctioning body organ must be documented by Federal standard "documentation".  This is the way Chiropractic Medicare functions, like real Chiropractors, and not treating patient symptoms.

Illinois Senate Bill 1843 letter from Dr. Michael J. Hulsebus, FICA, LCP, Member of International Chiropractor AssociationMember of Illinois Prairie State Chiropractic Association

Chiropractic Medicare reimburses chiropractors (or our patients) for only one thing.
Correcting a vertebral Subluxation.
NOT "treating" symptoms.
Medicare is an excellent "Chiropractic" program.
Chiropractic is the ONLY healthcare discipline providing health care without the use of drugs or surgery!
(Is this really true?)
Please take a moment to look at the letter below from Dr. Michael J. Hulsebus, FICA, LCP, Member of International Chiropractor Association, Member of Illinois Prairie State Chiropractic Association.
You will have an accurate idea of what a small unhappy group of chiroprators are attempting to do across state after state.
Best regards,
Dr. Street

Illinois Senate Bill 1843 letter  

After the passage of Illinois Senate Bill 1843, it is appropriate to follow up about what happened, to amplify lessons learned, and to gird ourselves for the inevitability of more far-reaching legislation in the months ahead. 

As many of you know, the recent minor change in the Illinois law (awaiting the governor’s signature) authorizes chiropractors to give advice on “non-prescription products,” including a variety of over-the-counter substances. (Actually, there never was a law forbidding us to do that, but now doing so is protected under Illinois law.) The law also now allows chiropractors to prescribe, dispense and administer oxygen.  

What you may not know—but ought to—is that Bill 1843, as originally crafted evidently by the leadership of the Illinois Chiropractic Society (ICS), changed language in the Illinois Medical Practice Act (IMPA) that defines a chiropractic physician as one “licensed to practice without drugs and operative surgery” to read “…treat human ailments without operative surgery and without the use of prescription drugs….” By inference from that language, chiropractors could legally administer non-prescription drugs, including drugs that initially required a prescription from a medical physician and later sold over the counter.  

That original bill of six pages, which, if passed into law, would have overnight virtually breached the wall in Illinois between medicine and chiropractic, was quickly quashed by medical interests—in fact, so quickly that most Illinois chiropractors didn’t realize the legislation was on the table. Subsequently, Bill 1843 was sent back to the Senate in its diluted form of three pages and slipped into law. The final version, the thin edge of a wedge, just dents the wall between the two health care professions. 

However, we all need to be aware that the original bill is a harbinger of things to come in Illinois and elsewhere.  

That original Illinois bill was reminiscent of one introduced in the New Mexico legislature earlier this year. According to its sponsors, the purpose behind their bill was to address an alleged shortage of primary-care physicians in New Mexico, a situation supposedly worsening with federal health care reform. The New Mexico legislation, which was defeated (at least for now), would have allowed chiropractors to prescribe certain drugs after advanced training. Santa Fe chiropractor Stephen Perlstein, one of the bill’s sponsors, was quoted as saying, “We’re trying to do this within our own profession and expand our profession.” 

As the New Mexico situation makes clear, the more medically oriented elements of our profession, such as the leadership of the ICS, see the perceived need for more primary-care physicians as an opportunity to expand chiropractic’s scope of practice to include dispensing medicine. For example, James Winterstein, D.C., president of National University of Health Sciences in Chicago, has argued along that vein.

 

Of course, meeting a perceived public need is not the only motive. Getting more patients to come to what Dr. Perlstein described as “one-stop-shop” chiropractic offices likely would mean increased revenue for those chiropractors. It would also mean increased revenue for some chiropractic colleges, most notably National University of Health Sciences, who want to offer, toward an advanced degree, education in materia medica and other aspects of medicine and surgery. On the other hand, chiropractic colleges with strong philosophical aversion to mixing in medicine would likely be at a competitive disadvantage. In a relatively short time, chiropractic in Illinois and elsewhere could be transformed into a hybrid, not unlike osteopathy. The pro-drug advocates see a two-tiered chiropractic profession, the upper tier being more like medical physicians and the lower tier filling the traditional chiropractic role. 

So what’s wrong with expanding our profession in this way, especially since it supposedly would put more money into our pockets? What’s wrong is that expanding our professional this way is to invite in a Trojan Horse that could capture the chiropractic profession and diminish much of the good it accomplishes. Not just chiropractors, but also the public we have sworn to serve, would be the victims.  

The Trojan Horse of Greek literature was looked upon as a fortuitous gift, but it turned out to be the vehicle of Troy’s demise. Thus it is said to be the source of the popular warning, “Beware of Greeks bearing gifts.” Likewise, opening our gates to medical practices inevitably would mean the loss of our identity as a separate profession. The loss to society would be the dilution, some would say corruption, of a profession that, in the words of a memo from the International Chiropractors Association (ICA), “has filled this role (as a drugless, non-surgical profession) with proven clinical and cost effectiveness for more than 100 years.” 

The Illinois Prairie State Chiropractic Association (IPSCA) joined with the ICA in opposing the final and weakened version of Bill 1843. In voicing its reasons, the ICA’s Political Action Committee contended that giving chiropractors the right to give advice on “non-prescription products” puts the public at risk. The ICA memo noted that 300,000 people die as a result of pharmaceutical and medical errors and that $177 billion in excess costs in the health care supply chain can be attributed to medication errors, 80 percent of that tagged to physician error. The memo stated that “this is not…an environment in which any practitioners can make a safe and effective contribution with less than a gold standard set of qualifications and credentials.” Observing that the final version of the bill didn’t require any additional education for giving drug advice or prescribing and administering oxygen, the ICA urged that the watered-down bill be defeated. 

All that’s true enough, but how much more public danger would there be if chiropractors get licensure, not just to advise, but to prescribe and inject drugs? The over-prescription of medications with their deleterious side-effects already is an onerous burden on the American health care system. What the system needs today more than ever is strong advocacy on the preventative side of the health care spectrum. Indeed, a ground swell of public opinion clamors for conservative care using natural methods and health care education, not further ingestion of seemingly quick-fix but too-often-deadly chemicals. In fact, many people throughout the country use their chiropractor as a primary care physician because they want conservative care as their point of entry into the health care system. What this country needs is not more primary care medical doctors (although perhaps they could be more equitably distributed throughout the country) but far more primary care chiropractors, who can help people through natural means unless there is a real need to refer them over to a medical physician or surgeon.  

Rest assured that, when any legislation surfaces that puts the public at risk and threatens to erode the dignity and credibility of the chiropractic profession by seeking to include drug prescription/administration rights,  the more centered and less opportunistic majority of chiropractors, represented in Illinois by the IPSCA and nationally by the ICA, will be in the forefront of the fight to secure its defeat. It is so clearly the right thing to do for both the profession and the public. 

Why is it, though, that some in our profession are so desperate to have drug dispensing rights? The reason is simply that they have lost confidence in (or perhaps were never taught) chiropractic’s fundamental principles and have shifted into the medical paradigm. They wish to use whatever therapies they can in the treatment of symptoms, even if that includes drugs or surgery.  The chiropractic profession, as a whole, has never endorsed a mixture of chiropractic and allopathic medicine.  But this does not stop the fringe element that strives for the expansion of the chiropractic scope of practice.  

As an example of this shift to medical thinking, the Website for National University of Health Sciences features a professor who asserts: “You need diagnosis to treat, and a subluxation approach (offered at several other schools) is really a non-diagnostic approach.” Clearly, National University no longer takes seriously chiropractic’s historic mission to correct subluxations in order to help the body heal itself. 

So, with little confidence in the efficacy of the chiropractic adjustment, the graduates of schools like National are left with little more to deliver than physical therapy and other mild forms of treatment. They evidently believe they need to prescribe drugs in order to position themselves as economically viable. 

In his frequent and long-standing arguments that chiropractors ought to be granted prescriptive rights, Dr. Winterstein says that restricting ourselves to historic chiropractic principles allows insurance companies to “paint us into a corner” with coverage limited to musculoskeletal conditions. While that may be true, the fact is that chiropractic has proven effective for far more than musculoskeletal conditions, and we have thousands of satisfied patients to prove it. We also have many prospering cash-only practices as proof of that patient satisfaction.  

It is beyond the scope of this letter to put forth all the powerful arguments against chiropractors’ prescribing drugs. For a good overview of those, check the recent article in Dynamic Chiropractic by James Edwards, D.C., who lists among the dangers:

     ● loss forever of our unique identity as natural healers,

     ● dramatically increased cost of malpractice insurance,

     ● loss of cross-referrals from medical doctors, and

     ● the public relations nightmare (and, we might add, litigation nightmare)

      when somebody dies of a “drug prescribed by a chiropractor.”  

At present, chiropractors pushing to adopt medical practice are a minority. Still, it will require vigilance of the majority to prevent pro-drug legislation from being sneaked into law as the ICS leadership apparently tried to do with the original Illinois Senate Bill 1843.  

And something else. It may seem remote now, but at some point, as the chiropractic profession continues to gain credibility for clinical success, the rich and powerful pharmaceutical industry may see us as another potential revenue stream. Watch for it to start negotiating with medical physicians to share drug prescribing rights, at least for some conditions, with chiropractors. When the pharmaceutical industry puts its lobbying muscle behind legislation to let chiropractors dispense drugs, the medics may not be able to stop it. 

Will some in our profession be seduced by the lure of the almighty dollar? Free samples, trips to the Bahamas, kickbacks for prescribing new me-too drugs—these gifts and more await our profession once new laws are passed. Ironically, many medical doctors are uncomfortable that their practices have been co-opted by the drug industry. Whereas those primary care physicians might prefer to offer more conservative care, they are simply overwhelmed by the billions of dollars spent by the pharmaceutical giant in marketing to them as well as directly to consumers. Will chiropractors, in their naiveté, make a similar mistake? Will all of us suffer—along with a public in desperate need of drugless care—as the lamentable result? 

There, beyond the wall. Is that a giant horse? Our profession ought to beware of Greeks bearing gifts.     

Submitted by: 

Dr. Michael J. Hulsebus, FICA, LCP

Member of International Chiropractor Association

Member of Illinois Prairie State Chiropractic Association

hulsebusm@aol.com 

Self Audits for Chiropractors ~ Sept. 26th

The Question: "How can you be successful in a self audit if you don't know how to do it correctly in the first place?"  The "self audit" concept will help fellow Chiropractors and staff understand the depth of responsibility we are soon to be under.

As I prepare the Chiropractic guidelines for a step-by-step map to help Chiropractors become compliant in Medicare, "Self Audit" stands out as a little unusual in outcome. Because of the Inspector General's report, most carriers "believe" they have over paid Chiropractors large sums of money.  The majority of Chiropractors have no idea how to "document" the Chiropractic necessity of care by "federal standards."  However, nearly all Chiropractors get paid by Medicare (96.4%) and because of that chiropractors "believe" they must be doing Medicare correctly.  Results of audits on Chiropractors have proven otherwise because most Chiropractors having audits lose. They end up paying back that in which the Medicare Carrier paid plus fines.

The Reason:  They believe they know how to do Medicare - but they do not.  And since the majority of Chiropractors do not "document" correctly, the Medicare Carriers due to the Inspector General, have agreed that if there is NO correct documentation for a Medicare patient, it should be a non-covered maintenance care service.  They want, and are getting, the money back.
So doing a "self audit", when you don't know the correct way to document in the first place, is quite questionable.

Here is the Answer:  Those who have attended our Seminars over the past 10 years, and those with "The Basics" Chiropractic Medicare DVD's, review and follow the information you have.  The audit success rate is fabulous as long as you do what the seminar and/or DVD presents.  You are the ones that will be able to do "self audits" successfully.

Maintenance Care? ~Sept 19th

"Maintenance Care" in my Chiropractic office is when a patient enters my office, they are checked, have NO subluxations and they go home.  The Medicare Program has twisted Chiropractic minds so Chiropractors forget that we have but one job in Medicare; find, prove and correct vertebral subluxations (vertebral displacements). That is all that is reimbursed to Chiropractors in the Medicare Program.

Patient symptoms are used by Chiropractors to help locate the subluxations and/or malfunctions of organs.  Just because the patient has NO symptoms does not mean the patient has NO subluxation and is now "maintenance care".  The patient has either a new condition, exacerbation, accident, neuronal component or chronic state.
To meet Medicare coverage criteria, a chiropractic office visit adjustment should be aimed at correcting subluxations related to acute injuries/reinjures or exacerbations.  The result of the Chiropractic adjustment is expected to be an achievable improvement and with a clearly defined point.  Once the maximum benefit has been achieved for a given condition, on-going maintenance therapy is not considered medically necessary under the Medicare Program.

Maintenance therapy is defined by Medicare as a treatment plan that seeks to prevent disease, promote health and prolong and enhance the quality of life, or therapy that is performed to maintain or prevent deterioration of a chronic condition.  Medicare does not cover maintenance therapy.
The recommendation here is: be a Chiropractor and prove the subluxation.  Document by "Federal Standards".  Listen well to the patient and correct vertebral displacements (subluxations).  Medicare has excellent Chiropractic coverage as long as we practice like Chiropractors.  If you are correcting vertebral subluxations for your Medicare patient and calling that adjustment "maintenance care" because you do not know how to document, then you have just performed a covered service in Medicare, did not "document the Chiropractic necessity of care", and cheated your patient from Medicare reimbursement. 

Remember....correcting the vertebral subluxation is the only covered service in Medicare.....and the only service we Chiropractors are mandated to bill to the Medicare Carrier. Performing a covered service and not billing that service, because of lack of knowledge or thinking it does not have to be documented or billed, is unfair to the consumer, your patient and to Chiropractic in general. As a Medicare provider, you signed a contract with our government so you have the privelige to see Medicare patients.... and that YOU will know and follow the Medicare guidelines.

Quitting Medicare

First of all, you must understand that if you continue to provide the payable service of 98940, 98941 or 98942 to any patient that has Medicare coverage, you cannot "Quit" or disassociate yourself from the Medicare Program. 

The only way to avoid the Medicare rules is to provide your covered services for "free" to the Medicare patient, or refer them to other offices that accept Medicare. If you have a Medicare Provider Number, that means you signed a contract giving you privilege to provide Chiropractic adjustments for Medicare consumers, and that you will know and follow all Medicare guidelines.

Chiropractors cannot "OPT-OUT" of Medicare.  You can either adjust Medicare patients and follow the guidelines or provide "free" adjustments or not adjust Medicare patients. How do you get out of paying taxes? You don't. Remember: Medicare is a U. S. Government Program.  Do it correctly or don't do it at all!

If you are correcting vertebral subluxations that is a covered service in Medicare. When you provide a covered service, you must bill Medicare in a reasonable amount of time, one year or less.  Both participating and non-participating providers must collect the 20 % not paid by Medicare, from your patient or their supplemental insurance.  It is against the law to practice "NO out of pocket expenses" with Medicare.

NEW Advance Beneficiary Notice of Non-Coverage (ABN) CMS-R-131(03/11)

NEW Advance Beneficiary Notice of Non-Coverage (ABN)

The centers for Medicare and Medicaid Services (CMS) has released a revised Advance Beneficiary Notice of Non-Coverage (ABN) CMS-R-131 form, http://www.cms.gov/BNI/02_ABN.asp. The ABN is issued by providers where, depending upon a situation, Medicare payment is expected to be denied.  That includes a covered service in which the doctor believes Medicare will not pay and all non-covered services billed to Medicare.

That also includes referral of a Medicare patient for any service by another health care provider including a covered service.

NOTE:  The only differences found on this revised ABN and the prior is the date of issue on the bottom of the form.  CMS-R-131(03/11)
This specific form has a mandatory use date of November 1, 2011.

Option # 2 is the primary change from the original ABN.  Please keep in mind, Option #2 is used ONLY for non-covered service.  Taking a covered service as 98940, 98941 or 98942, calling it maintenance care, with the patient checking Option #2 and not billing the Medicare Carrier for the Chiropractic adjustment is "thin ice" maneuvering.

The Chiropractic adjustment is the only reimbursable service for Chiropractors.  When a Chiropractor adjusts a patient to correct a vertebral subluxation, then that is a covered service in Medicare not maintenance care.

The doctor must learn to honestly and specifically "document" the Chiropractic necessity of care by "federal standards."  The patient who has a subluxation has had either an accident, exacerbation, or a specific "Neuronal Component".  It is the doctors job to prove the subluxation, document the cause of subluxation, and correct the subluxation with an adjustment.  That is a covered service by Medicare.

Chiropractic Medicare X-rays (Newsletter from 8/29)

Chiropractic Medicare X-Rays ~ Newsletter from August 29

Medicare is an excellent Chiropractic program.  No other insurance company, PPO, HMO, etc., requires Chiropractic Philosophy, Science and Art as in the Medicare guidelines. Chiropractic Medicare was written by chiropractors (Dr. Day, Dr. Hulsebus, etc.)

There are two(2) parts to Chiropractic Medicare to make a mandatory claim:
    1.  The Chiropractor must prove a vertebral subluxation.
    2.  The Chiropractor must "document" the chiropractic necessity of care by "federal standards."

I strongly recommend doing x-rays on each Medicare patient.  (P.A.R.T. is weak and can be challenged, where as, using your x-rays, you are the authority in regards to locating subluxations.) 

You must have a minimum of two views of each region you adjust (AP & Lateral).  The films must be of good quality and evidence of collination.  The x-ray films must be on location or in a location the doctor has access too, as the Medicare carrier may request those films as they did at the beginning of Chiropractic Medicare.

I suggest doing the following x-rays on each Medicare patient each year.  (If the doctor proves vertebral subluxation by way of x-rays, then the Chiropractor must have a new x-ray that is not over 12 months old, or the Medicare claim will be denied.)
    1 14x36 AP full spine
    1 8x10 Lat. Cervical (including occipital)
    1 7x17 Lat. Thoracic
    1 7x17 Lat. Lumbar (including Sacrum and coccyx)

Chiropractic x-rays are important in that it helps locate vertebral subluxations, pathologies, etc., and they are mandatory for we Chiropractors that use them to prove a subluxation.

P.A.R.T. Exam, X-ray, and the Demonstration of Subluxation

One of the requirements for the initial visit is the diagnosis of a subluxation that corresponds to the symptoms the patient demonstrates.  In other words, these symptoms must bare a direct relationship to the level of subluxation. The diagnosis of subluxation can be made either by a dated x-ray or by a physical exam noting 2 of the 4 following criteria to support a manually demonstrated subluxation:

1. Pain/tenderness evaluated in terms of location, quality and intensity.


2. Asymmetry/misalignment identified on a sectional or segmental level.


3. Range of motion abnormality (changes in active, passive and accessory joint movements resulting in an increase or a decrease of sectional or segmental mobility.)


4. Tissue, tone changes in the characteristics of contiguous or associated soft tissue, including skin, fascia, muscle and ligament.

**One of the two criteria documented must be either asymmetry or range of motion

         abnormality.

I strongly suggest doing spinal x-rays a minimum of once each year, instead of P.A.R.T.  Using your x-rays to determine subluxation is never challenged, where as anyone can challenge the findings of a subluxation with P.A.R.T.

 

If you have no x-ray of the area you adjusted, less than one (1) year old, you must do a P.A.R.T. form each Chiropractic visit.  Even if some of your examinations consist of the same procedures as in P.A.R.T., you must have a P.A.R.T. form each visit.  When you have current x-rays of your Medicare patient, no P.A.R.T. form is necessary.  P.A.R.T. should be placed in Item #19 on the claim form to tell the Medicare carrier you are using P.A.R.T. with this patient.

Other Payers on a Medicare Patient

There are specific guidelines we all must know and follow as we see Medicare patients that have another primary payer other than Medicare. (e.g., Workers Comp., Auto Insurance, Personal Injury, etc.)  Keep in mind, we are required to bill Medicare for ALL covered services even if there is another payer.

As a Participating Provider, you may bill your normal PI fees on this Medicare patient to all other payers and collect above the Medicare fees from other payers. 

Non-participating Providers, even though they receive the highest reimbursement from Medicare (i.e. the limiting charge), you must NEVER bill or collect from any payer on this Medicare patient above the limiting charge. (The limiting charge is the amount your Medicare carrier has set for your local.)  Item 10a through 10c on the claim form or in the electronic billing format will tell the Medicare Carrier (and other payers) who is responsible for payment.

Make a copy of the claim to the primary payer other than Medicare e.g., Workers Comp., Auto Insurance, Personal Injury, etc., and also, send a copy of the claim to the Medicare Carrier.  Be sure when billing another payer on this Medicare patient, to have the patient sign an ABN each visit, for both covered and non-covered services and use all modifiers, since Medicare will not pay.  (Example:  98941 AT GA)

The advantage of billing Medicare on this PI claim is if the PI claim fails and your patient loses the case, now Medicare will pay most of the claim because it was billed within the year time limit with all the correct modifiers and fees.
 
Questions? Give me a call today at 1-800-MY CHIRO.

Sincerely,
Dr. Street

Chiropractic Audits Gone Wild!

Chiropractic Medicare
Audits...Audits...Audits!

My phone calls are increasing especially from New York, California, Nevada, and now Alabama!

Palmetto Medicare Carrier in California and Nevada broke the ice and requested thousands of Chiropractic records as both pre-payment and post payments audits. Then, the New York Medicare Carrier went wild with requesting records on every patient.

Now the Alabama Medicare Carrier is following suit with audit after audit on Chiropractors, requesting records/documentation for a specific period of time and any portion of the preceding 6 months prior. 

These audits, first, eat up the small profits we get in Medicare. Secondly, they stress both the doctor and the staff effecting the quality of Chiropractic care delivered.  The major problem is that most Chiropractors lose some or all of their audit because of mistakes or lack of knowledge in Medicare procedures. 

Speaking with hundreds of Chiropractors dealing with audits, they all have made the following errors that cost them big time:

1. Date of current (HCFA item #14) must never be over 60 days old.


2. X-ray date must be less than 12 months old (364 days or less), or when no x-ray present, a P.A.R.T. form must be completed each and every visit. 


3. Diagnosis must make sense and match S.O.A.P. Notes to support the care rendered.


4. Lack of complete documentation by Federal Standard to proven Medical Necessity.

S.O.A.P. Notes are not the only Chiropractic documentation necessary to make a claim payable.  (Documentation is a federal document.)

Need help and/or assistance so that you can survive a Medicare audit? Please give me a call at (618) 395-3800 or consider ordering or Chiropractic Medicare DVD and booklet - Dr. Street

Chiropractic Medicare Fees and Collecting Payment

Dear Doctors and Staff,

Chiropractors are the only healthcare providers that CANNOT opt-out of Medicare. When you see seniors with Medicare in your practice you must do Medicare correctly!

Each Medicare carrier provides a fee schedule for the Chiropractors each year in each state local.  You can go to your Medicare Carrier's website search for Physician Fee Schedule (go to about page 245) and you will find 98940, 98941 and 98942 with specific fees for your local for both participating and non-participating providers.  The code with the # sign indicates the fees set for if you adjust this patient in another facility other than your office. The fees without the # sign are your in-office fees.

Participating providers may bill the Medicare Carrier whatever fee they wish.  The Medicare Carrier has the responsibility to know your Medicare fees and will automatically reimburse to the DC 80% of those fees.  The Chiropractor must collect the 20% from the patient or supplemental insurance and NEVER collect from any payor above the set fees by the Medicare Carrier. If you do, and get caught, the fines are up to $10,000.00 per incident.

A non-participating provider must know what the Medicare fees are prior to seeing or billing either the Medicare patient or the Medicare Carrier.  If they don’t and get caught, they may be fined up to $10,000.00 per incident and the same for being paid above the set Medicare fees.  The non-participating provider must never collect or bill any payor above the "limiting" charge, including a Medicare patient in auto accidents, worker’s comp., etc.

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.

Newsletters from June 2011

June 2011

June 3, 2011
Chiropractic Medicare Compliance

What do the typical Chiropractor and their staff need to do to become compliant in the future Medicare arena?

Relax!  Sit back and review materials as they are presented.  I recommend not spending big bucks for software right now.  Remember the rules for becoming compliant are still being discussed with many unanswered questions.

We have two important Medicare issues to understand.  First, learning and doing Chiropractic Medicare so our patients receive their needed Chiropractic adjustments.  Secondly, doing Chiropractic Medicare correctly with proper procedure, S.O.A.P. notes and documenting the Chiropractic necessity of care so when audited, either in house or by your Medicare Carrier, you are successful. By doing Medicare correctly, once you have become compliant, your in-house audits will reveal you do, in fact, know how to do Medicare correctly. 

Most important, be sure you know how to do Medicare correctly.  If you are not sure, consider our Chiropractic Medicare DVD and booklet. Once you are actively improving your record keeping and documentation, now consider becoming Medicare Compliant.  First move, you should appoint a Compliance Officer for your Chiropractic Business. (You or one of your Staff)  The Compliance Officer's job is to start collecting information for implementing proper procedures to make your office compliant.  In the next few weeks we will have a Chiropractic Medicare Compliance Guidelines Booklet available for our fellow Chiropractors and staff.

Remember.....everyone has to do this, so keep it as simple as possible and keep on going. 

June 10, 2011
"Unusual payments and X-ray vs. P.A.R.T"

The past couple of weeks our patients and many doctors are receiving checks and direct deposits from the Medicare carriers in the amounts of around $1.60 for adjustments provided in early 2010.  Those checks and deposits represent the fee changes that occurred in 2010.  Many patients do not understand why they receive this money.

NOTE - We constantly get the question... "Must I take x-rays of the regions of the patient adjusted each 12 months?"

ANSWER - If you use an x-ray to prove a subluxation, YES, you must have x-rays of all the regions you adjust and those films must be less than 12 months old.

If you chose to not take an x-ray on your Medicare patients each 12 months, you can complete a P.A.R.T. form each visit.  Using x-rays to prove the subluxation is by far the best.  You are the authority of information you find on the x-ray.  Using a P.A.R.T. form is not as effective and safe simply because anyone else can review the P.A.R.T. form and may determine something different than you.

June 14, 2011
"PI & Medicare"

When a Medicare patient enters your office that has been in an auto accident, remember, they are still a Medicare patient.

If you are a non-participating provider, you must not bill the PI Insurance Company above the limiting charge set by your Medicare Carrier.  As a participating provider, you can bill your normal PI fee.

The Medicare patient should sign an ABN each visit so they are aware Medicare will not pay for any services.  When billed to the PI Insurance, the AT modifier is also used indicating "Active Treatment".  Example:  98941 AT GA.  The GA modifier is used if the patient signs an ABN for a covered service and a GX modifier is used if the patient signs the ABN for any non-covered service in

Medicare. Item 10a thru 10c on the claim, when completed, tells the PI Insurance Company that it is their responsibility.  The Medicare Carrier should pay nothing on this claim, unless the PI Insurance Company wins the case and pays nothing.
You can now take the denial letter from the PI Insurance Company, mail a copy to Medicare, and Medicare will now pay the claim.

IMPORTANT:  If for some reason, Medicare pays on this PI case, and the PI Insurance also pays, if you do not refund the money back to Medicare within a specific time, Medicare will take that money out of your (The Doctors) Social Security account.

June 20, 2011
"Do you have a Medicare Compliance Plan?"

Years prior, violations were limited.  However, now violations are staggering and enforcement carries major disabling fines.  Willful neglect is simply not knowing, or knowing and doing nothing.  The time of sitting back, going with the flow and doing/knowing nothing is over.

It is mandatory to have an in-office compliance program.  Your office will need a HIPPA Privacy Officer, HIPPA Security Officer and a Compliance Officer.  These are the three people asked for in an audit.

Here are the five best ways to come up with an audit:

1. Disgruntled Employee - usually comes with a filed complaint.




2. Patient Complaint - usually from billing error or patient misunderstanding.




3. Doctor Complaint - usually from questionable advertising, waiving copayments, etc.




4. X-ray Practices - most of the time while using outside x-ray facilities.




5. Errors in billing or suspicious billing practices, CMT’s, coding, etc.

If you find an in-office error, do not hesitate refunding the carrier before your carrier finds the error.

Finally, each office must have a written Policy and Procedure Plan for open line in-office communications.

We soon will have an example OIG Compliance Plan that will be available.  In the meantime, be sure you are doing Medicare correctly.  All of this and much more can be found in our Chiropractic Medicare DVD.  Thank you for your interest.

Newsletters from May 2011

May 2011

May 16, 2011

Just because you personally have not been involved in a Medicare audit does not mean you can let your defenses down!  

Palmetto GBA, the Medicare Carrier of California and Nevada issued a letter to Jurisdiction 1 Health Care Providers talking about November 2010 Medicare fee-for-service (FFS) claims error rate on paid claims error rate results nearly TWICE the national average for services rendered by Part B. All Medicare carriers have this information and are doing the same!     

The letter stated "BY FAR, the major component to the claims paid error rate is the lack of adequate documentation to support services billed."  The letter also stated, "You control the documentation describing the services your patient received, and your documentation serves as the basis for the bills sent to Medicare for the services you provided.  If your documentation does not support the services on the claim, then a payment error exists." 

Palmetto and MOST other carriers will be undertaking an AGGRESSIVE approach designed to address the cause of documentation errors.  They will INCREASE the level and frequency or pre-payment and post-payment reviews across all provider types. 

Medically unnecessary services are the result of:  
1.  Undocumented services. 
2.  Improperly documented services. 
3.  Insufficiently documented services.  

If you, as a Chiropractor and/or staff, do not know specifically what documentation is or believe documentation is only your S.O.A.P. notes please consider our Chiropractic Medicare DVD.  These Medicare Carriers are ALL stepping up audits because they are aware most Chiropractors believe Chiropractic documentation is the S.O.A.P. notes....IT IS NOT!
Chiropractors must do Medicare correctly as a Chiropractor which is different than any other healthcare providers in Medicare. DOCUMENTATION IS WITH A FEDERAL DOCUMENT, NOT JUST S.O.A.P. NOTES!

May 18, 2011

Just like the bill in New Mexico, Illinois Senate Bill 1843 attempts to change the whole meaning of chiropractic by passing a law that does not "broaden the Chiropractic Scope of Practice.... but changes the foundation of chiropractic. Senate Bill 1843 has already passed the Senate and headed to the Illinois House of Representatives. This is NOT an ICA/ACA battle!!!! This is a chiropractic battle to preserve chiropractic as originated. The bill was structured by Dr. Winterstein of National University whose goal is to make chiropractic into Medicine. Illinois, being the only Medical Practices State, has been Dr. Winterstein's dream for changing chiropractic into another health discipline.

Please take a few moments to go online and type in State of Illinois Representatives. Hit search. There you will find a list of Illinois State Representatives. Please call as many as you can and ask them to defeat Senate Bill 1843 or call 1-800-423-4690 for instructions.

ICA Calls for Defeat Illinois Senate Bill 1843 The International Chiropractors Association (ICA) and the International Chiropractors Association Political Action Committee (ICA-PAC), in response to requests from large numbers of members in Illinois, are calling on all Members of the Illinois House of Representatives to vote NO on Senate Bill 1843.   This legislation contains language that states that, “nothing in this Act shall be construed to prohibit a chiropractic physician from providing advice regarding the use of non-prescription products.” The danger in non-prescription drugs being recommended by untrained individuals is of grave concern to ICA and can certainly put the public at risk. Likewise, doctors of chiropractic have no formal training in oxygen therapies that would be authorized by the bill.   The removal of the defining language that expressly states that the practice of chiropractic is without the use of drugs or surgery clearly tips the balance in the direction of the application of drugs and since no additional education or testing or any other qualifications are mandated, this legislation inherently places the public at risk.

We urge you to vote NO on SB 1843 because:

·   It places the public at risk since the new authorities given to chiropractors to advise on “non-prescription products” which incorporates a vast range of over-the-counter substances which if inappropriately used can cause great harm, does not require any additional education or testing.

·   Chiropractic is, by its longstanding educational and definitional history, a drugless profession.

·   The public is entitled to one truly drugless healing profession and chiropractic has filled this role with proven clinical and cost effectiveness for more than 100 years.

At the top of ICA’s concerns regarding this legislation is public safety.  Studies have estimated that as upwards of 300,000 individuals may die each year as a result of pharmaceutical and medical errors. [1] Of this stunning and alarming number, a growing proportion is from non-prescription substances.  According to a 2001 report in the Journal of American Pharmaceutical Association, more than $177 billion in excess costs in the health care supply chain can be attributed to medication errors.  Sadly, estimates indicate that more than eighty percent of life-threatening medication incidents are the result of physician error. [2]   Clearly, this is not an area or an environment in which any practitioner can make a safe and effective contribution with less than a gold standard set of qualifications and credentials.   SB 1843 provides for no additional education and testing as a basis for the expansion of chiropractic scope to include pharmaceuticals.  On this basis and out of other concerns, ICA urges that this bill be defeated.    If you have any questions or would like more information please contact the International Chiropractors Association at 1-800-423-4690 or by e-mail at chiro@chiroprctic.org.
[1] Starfield B. Is US health really the best in the world? Journal of the American Medical Association (JAMA) 2000 Jul 26;284(4):483-5. Starfield B. Deficiencies in US medical care. JAMA. 2000 Nov 1;284(17):2184-5.. [2] Gurwitz, J.H., Field, T.S., Harrold, L.S., et al, “Incidence and preventability of adverse drug events among elderly persons in the ambulatory setting, (JAMA) 2003;289(9) 1107-1116.

May 23, 2011

This past Friday I sent the above ALERT email across the United States in regards to an Illinois Senate Bill 1843 that slipped through the Senate and into the House of Representative for vote. We are asking for chiropractic support to contact all Illinois Representative to either Vote NO for SB 1843 the way it presently stands or vote YES after accepting the amendment to remove language that is confusing and unnecessary.

Illinois House of Representatives are being asked to strike the words "...from providing advice regarding the use of non-prescription products or..."
SB 1843 language creates confusion in that "non-prescription products" is not defined at all.  If the intent is to authorize the Chiropractic provider to provide advice on non-prescription drugs, then extensive additional education and competence testing is absolutely essential, if such authority is desirable at all.  No such educational provisions are included in the bill and this concept has not been thoroughly and forthrightly discussed and debated throughout the legislative process.

If the intent is to authorize advice on such items as braces, pillows, orthotics and related supports, nutritional products and other commonly applied devices, items and products, then the language is unnecessary since such materials and devices have been covered and authorized to be provided by doctors of Chiropractic under the current statutory language for many decades.
Consumers in Illinois are entitled to complete clarity on the professional authorities and qualifications of all health care professionals and without this amendment, SB 1843 represents a step away from this vital goal. 

Ask the Illinois Representative to please support this proposed amendment to SB 1843.

To contact any and all Illinois State representative go to: www.ilga.gov

Chiropractic Medicare Diagnosis (newsletter from 4/11/11)

April 11, 2011

Chiropractic Medicare Diagnosis

There are two factors involving the diagnosis of great importance. The diagnosis must be an honest diagnosis and that diagnosis must support the care rendered.

The first part of our Chiropractic diagnosis will always be a vertebral subluxation. It is our privilege and responsibility to determine the primary subluxation. Item 21, section #1 on the CMS-1500 form, will begin with the primary subluxation, either 739.1, 739.2, 739.3, 739.4 or 739.5.

After determining the primary subluxation, now you must determine the second part of the primary diagnosis. Since we are speaking about seniors over the age of 65, after doing x-rays (x-rays are mandatory each 12 months if the Chiropractor "proves" the subluxation by x-ray) the second diagnosis, since the subluxation has been present for the past 30 years, is degenerative joint disease. (You can see this condition on x-rays less than 12 months old.) This diagnosis goes in Item 21 section #2.

The third part of the diagnosis is usually why the patient came to your office. An exacerbation is any event, great or small, that has insulted pre-disposed soft tissue creating pain that the patient can place and exact time and date. Soft tissue in a predisposed degenerative joint has been insulted, stretched, torn, twisted and may be bleeding called sprain/strain.  That is the third part of the diagnosis entered into item 21 section #3.

The fourth part of item 21 will probably be your next important subluxation.

NOTE:  Each time there is a new exacerbation, date of current, item #14 is updated to date of exacerbation.     

Understanding Medicare Fees as a Chiropractor

(for Providers that are Participating or Non-Participating, Accepting Assignment or Not)
I know you are very busy.... but please read and understand the importance of this message! It may save you "big bucks"!
We do have a dual fee schedule in our Chiropractic offices. They are our normal customary fees and the fees set for you in your state local by your Medicare Carriers. DO NOT MIX THEM UP!

As a participating provider, even though your Medicare Carrier has a set fee for you, you may bill your Medicare Carrier for a payable service (98940, 98941 and 98942) whatever fee you wish. Your Medicare Carrier has the responsibility to reimburse back to you 80% of the Medicare fee only. Not the amount you billed. You must collect from the patient the other 20%, either from the patient or supplemental insurance, not one penny above the Medicare fee set by your Medicare Carrier.

As a non-participating provider, marking the box you accept assignment (money sent to the doctor), you can NOT bill the Medicare Carrier above the non-par fee set for you by your Medicare Carrier. You also must collect the 20% from your patient or supplemental insurance. You can never receive payment from Medicare or your patient above the non-par fees set for you by your Medicare Carrier.

As a non-participating provider, NOT accepting assignment (running business like it should be run.....patient comes in, gets a great Chiropractic adjustment, goes to the front desk and pays for everything), you can collect from your patient, at time of visit, for the adjustment the "limiting charge" (113% higher than participating provider fees). You bill Medicare the "limiting charge" and the Medicare Carrier pays, to your patient, 80% of the non-par fee and their supplemental insurance pays 20% to your patient.

If either participating or non-participating providers collects money from anyone above the set fees of your Medicare Carrier, the fines begin at $10,000.00 per incident. If a non-participating provider bills the Medicare Carrier or any payer (PI, WC) on a Medicare patient above the limiting fees set by your Medicare Carrier on a Medicare patient, the fines begin at $10,000.00 per incident.

Who is responsible for Chiropractic Medicare Coverage?

Fellow chiropractors…. Please lend me your ears, eyes, and Chiropractic Medicare Commitment!

To my knowledge, Medicare is the only health care reimbursement program that recognizes and has a specific accurate chiropractic understanding. The chiropractors in the early seventies that wrote the chiropractic Medicare Guidelines did it correctly. They worked hard for us to have the privilege to be providers in Medicare and to assure that seniors also had the privilege of Medicare reimbursement for freedom of choice. Yes, chiropractic Medicare is a privilege and 98.6% of all Chiropractors do receive Medicare reimbursement for correcting vertebral subluxations. I agree, the reimbursement is not the dollar value of the adjustment, but many chiropractic practices across America receive large sums of dollars from Medicare.
You may be upset Medicare does not pay for other services by chiropractors, but the non-coverage of x-rays and exams are our fault…. not Medicare. One of our national Chiropractic associations decided we did not need x-rays. And then came the Demonstration Project. A test program by the government to see if we Chiropractors could save Social Security money. This project took place in Scott County, IA. 33 counties in Northern Illinois, Maine, New Mexico and 33 counties in West Virginia. All services by a Chiropractor were reimbursed by Medicare. X-rays, exams, therapy, referrals for MRI’s, CT scans, etc. The result is devastating. Every State EXCEPT ILLINOIS showed zero cost factor…. costing the Medicare program nothing. The Chiropractors in Illinois racked up the bills so much….The Demonstration Project was a MAJOR failure.  Even worse…. The Inspector General said they want money back and implemented audits on the entire Chiropractic Medicare providers.
The last Inspector General’s Report indicated that out of 100 claims filed by Chiropractors, 68% have errors and were inappropriately paid. Again… they want the money back. Presently New York State and two other states have pre-payment reviews on ALL claims billed to their Medicare carrier. The Inspector General’s report went to your Senator and Congressman. The IG thinks we chiropractors are not to bright.
The latest IG report indicated they believe we should only see our patients on Medicare 12 visits each year…. And if you adjust your Medicare patient up to 24 visits, they believe you have committed fraud.
WHY?
Because a large majority of Chiropractors have breached their contract with Medicare! We all signed a Federal Contract to KNOW AND FOLLOW the Medicare rules. Yet, the majority of Chiropractors do not know the rules and do not even know the correct way to DOCUMENT THE CHIROPRACTIC NECESSITY OF CARE BY Federal Standards.  If we don’t straighten up and do Medicare correctly we will lose the privilege of seeing Medicare patients because we will lose Chiropractic Coverage in Medicare!
Take a moment and evaluate your practice. There are 700 plus new Medicare recipients each day in America and that number is increasing. Chiropractors are not intentionally doing Medicare wrong. The simple fact, if you do not DOCUMENT THE CHIROPRACTIC NECESSITY OF CARE BY Federal Standards, that adjustment becomes now considered "maintenance care", a non-covered in Medicare. (AND S.O.A.P. Notes is not documentation!!)
 Either you or your chief Staff must learn to do Medicare correctly. We have shared our information with thousands over the past 33 years. The Chiropractors that have our information and used it correctly have lost NO audits. The reason being, our presentation shows the correct way chiropractors should be doing Medicare. 
If you have questions please give me a call. If you believe you are doing it correctly, give me a call before you receive a request for your records. 618-395-3800.
Best regards and protect chiropractic Medicare for the senior consumer freedom of choice and for chiropractic.

Chiropractic Medicare Patients with Other Payors

A Medicare patient is always a Medicare patient, even if they have another payor. When a Medicare patient has been in an auto accident for example, they are still a Medicare patient and all Medicare rules apply.
When billing another payer on this Medicare patient, remember to use the "AT" modifier after the Medicare covered services. This Medicare patient should be signing an ABN each visit as they should be aware Medicare probably will not pay for the covered services of the adjustments, and also non-covered services, like exams and x-rays.
The non-covered services, when billed, will be followed with the "GX" modifier and the Medicare covered services will have both the "AT" and "GA" modifiers, indicating active treatment but not paid by Medicare, so patient signed the ABN. Items #10A thru 10C on the claim form will indicate a PI case or WC case.
When the claim is completed, before mailing to PI insurance company, make two copies. One copy will be your office copy and the second copy will be sent to Medicare indicating to the Medicare Carrier of the PI case with this Medicare patient and telling the Medicare Carrier not to pay.
If you are a non-participating provider in Medicare you must remember not to bill any payer on this Medicare patient above the "limiting" charge Medicare has set for you. Mandatory Claim Submission says you must bill Medicare for covered services within one year of services.
If your patient for some reason loses the PI case, now Medicare should be notified and Medicare will pay to you 80% of the covered services that you have already billed. The only time Medicare should pay on a PI case is if the case has been lost. If Medicare pays on a PI or WC case to the doctor, when the case is settled the doctor must refund that in which Medicare paid, or the Medicare Carrier will take whatever was paid from the doctor's Social Security Retirement Fund.

Chiropractic Medicare - Modifiers AT GA GX

When billing for the Chiropractic adjustment and non-covered services,
modifiers are a must.  When billing 98940, 98941 and 98942, the "AT"
modifier is necessary to tell the Medicare carrier - this is "active
treatment" and to consider payment for this service.  This does not
mean they will automatically pay. If the doctor, after making an assessment of the patient each and
every visit, believes Medicare may not pay for this covered service
he may ask the patient to sign an ABN. All payable services 98940,
98941 or 98942 will be followed by "AT" and "GA" modifiers.
The lack of "AT" modifier after a payable service means the doctor is
asking the Medicare Carrier to consider this service as a nonpayable
service and telling the carrier NOT to pay. That is usually a mistake
because the adjustment to correct a subluxation is the only thing
Medicare reimburses.
The doctor also needs to learn to document so the
covered services in Medicare are reimbursed.
The "GX" modifier is only used when non-covered services are billed to
Medicare. This is done to receive a denial EOB for supplemental
insurance.

Question: Do I have to bill Medicare for a Medicare patient with a Personal Injury Case?

A. FEES: All Medicare Carriers have posted the "NEW" fees for 2011. Go to your Medicare Carrier web page, click FEES. Go to 98940, 98941,98942 to find your fees in your specific local. Remember....the 98940, 98941, and 98942 WITHOUT the (#) sign are your fees in your office for your Medicare patients. The codes with the pound (#) sign are your fees if you adjust your Medicare patient in a facility other than your office.

B. Medicare PI, WC, or other payor than Medicare: When you have a Medicare patient with another payor than Medicare....remember, this is still a Medicare patient and you must follow Medicare Guidelines including billing to Medicare.

When you bill the PI insurance company for this Medicare Carrier, use all modifiers. Example: 98941 AT GA. The AT is active treatment and the GA tells Medicare carrier the patient signed the ABN because Medicare will not pay. Non-participating providers must also remember to NEVER bill the PI or WC insurance above your limiting fees. Participating providers may bill their regular PI fees on this Medicare patient.

Make a copy of the claim to the PI Insurance, one for your records and one you will mail to the Medicare Carrier. Item 10A thru 10C will indicate to the PI insurance that it is their responsibility and will also indicate to the Medicare Carrier NOT to pay this claim. It is billed to Medicare along with a bill to the PI...first because it is the federal law. Secondly, if the patient looses the PI case, now a copy of denial from the PI is sent to Medicare and now Medicare will pay.

NOTE: If you receive money from Medicare on a PI case.....and it is not paid back in a timely manner.....Medicare will take that amount out of your Social Security! This and much more is covered in our Chiropractic Medicare DVD and booklet.

Are Medicare Audits Triggered?

As long as we file a "clean" claim, most all Medicare carriers simply pay. However, there are a few things that "pop" out in a claim and lines us up for audits.

1. Item #14, Date of Current:
If date of current does not change in 60 days and the claim is with an "AT" modifier, an audit is probable. Date of Current #14 should change for any accidents, exacerbations, exams, x-rays, evaluations, etc.

2. Diagnosis must support care rendered:
The diagnosis for a patient with an exacerbation may be something like...Subluxation of L5, degenerative joint disease (if you have an x-ray less than one year) and sprain/strain, all in the same spinal region.

3. Patient Notes Review:
When asked to send one or two patient visit notes to your Medicare carrier and your patient notes only include S.O.A.P. notes and NO other "documentation" for the necessity of Chiropractic care, there is a problem. Now the Medicare carrier knows you do not know how to "document" and will do a full audit for money recovery.

Those are the three most prevalent reasons for an audit. Audits can be rough, however, if you know the correct way to do Chiropractic Medicare, after winning that first audit they will leave you alone.

The ABN Form

Your first impression about an ABN is "What a hassle!" However, an ABN is your friend. Both participating and non-participating providers have signed a contract with the federal government that you know and follow all Medicare guidelines.... including ABNs.

If the patient does not sign the ABN:
For participating providers, when receiving a denial EOB for a payable service, they can not get paid for that denied service from anyone including the patient. For the non-participating provider, who receives a denial EOB, will be instructed by the Medicare carrier to provide a refund to the patient if the patient paid at the time of visit.

ABN: Each patient visit, the doctor must see the patient prior to any services and make an assessment as to if the doctor believes Medicare will pay for all or part of the services that will happen today. If the doctor believes Medicare will reimburse for all services, the patient is not asked to sign the ABN.

However, if after the doctors assessment, after seeing this patient today, that Medicare may deny payment for all or part of the services that will be billed to Medicare, either the doctor or staff member will ask the patient to sign an ABN for today's services, give a copy of the completed signed ABN to the patient, and then provide the services.

The basic purpose of the ABN is to give the patient the choice that if Medicare will not pay for the service, the patient can either, sign the ABN and take financial responsibility, or leave the doctors office having NO services. The ABN, and all other important Chiropractic information, including documenting by Federal standards, are in the Chiropractic Medicare DVD.

Maintenance Care vs. Chiropractic Necessity of Care

Chiropractic Medicare was put together by Chiropractors in 1972-73. They did an excellent job of preserving the Chiropractic principles, even though the Medicare Carriers have done their best to twist it around so they can deal with us like other health care disciplines.

The only service payable for Chiropractic is the reimbursement for the correction of the vertebral subluxation. Not the "treatment" of pain or any other symptoms. For years, the Medicare Carriers have lead us down the "Yellow Brick Road" of treating patients symptoms, so when the symptoms are gone they want us to call the adjustment "maintenance care."

The consumer (our patient) gets cheated when the Chiropractor stops using the "AT" modifier because the patient's symptoms have decreased or are gone, even though they still are being adjusted for the payable service of correcting a vertebral subluxation because they still have subluxations.

The pressure is upon the Doctor of Chiropractic to learn the correct way to "document" the Chiropractic Necessity of Care if there is a vertebral subluxation. Not doing so, cheats the consumer, your patient, from Chiropractic reimbursement. Chiropractic maintenance is a patient that is checked, has NO subluxation, and is NOT adjusted.

When a patient is checked, has a subluxation and is adjusted, that is the primary job we Chiropractors perform and is a payable service in Medicare as long as the doctor "documents" the Chiropractic necessity of care. It is the Doctor of Chiropractic's responsibility to prove the subluxation, "document", and do it all correctly. If we Chiropractors do the job correctly Medicare is an excellent Chiropractic program.

Newsletters for February 2011

02/08 Important Notes

02/14 Our Medicare DVD

02/22 A. Fees B. Medicare PI, WC, etc.

02/28 P.A.R.T exam vs. X-ray

Newsletters for January 2011

01/03 Chiropractic Medicare Notes
2011

01/10 Chiropractic Medicare
Fees, Documentation & Florida Requests

01/11 Chiropractic Medicare Fee Schedule

01/17 The ABN (Advance Beneficiary Notice of Non-Coverage)

01/31 What "Triggers" the Medicare Audit

Archived Newsletters for 2010

We just recently started putting our newsletters on our website in 2010. For archived newsletters, please visit the link below.
http://www.chiropracticmedicare.com/newsletterARCHIVES2010.htm

2010
July Pre-payment Treatment Plan in Medicare
June Fees in Medicare
August CERT National Chiropractic Review
September Documenting Chiropractic Necessity of Care
September 27 Protect Yourself (What to send for a Medicare CERT Audit)
October 4 Perfectly Clear
October 13 A Better Understanding of the ABN
October 18 Audit Wise
October 28 CMS, Comparative Billing Report (CBR)
November 1 Error Rate
November 10 Medicare Audits and Your Response
November 15 Veterans Chiropractic Bill and Medicare Executive Summary
November 22 A Call For Action
November 29 Participating Medicare Provider Window
December 6 Everyday's a New Day!
December 13 End of the Year
December 20 Medicare Fee Cut One Year Extension Plus (RAD) "Requests for Additional Documentation Missing Percentages"
December 27 Chiropractic Medicare Notes
Ending 2010