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
Friday, November 25, 2011
Wednesday, November 16, 2011
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
IPSCA website: http://illinoischiropractors.org/
Link directly to the form below: http://illinoischiropractors.org/uploads/Medicare_Compliance.pdf
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Wednesday, November 9, 2011
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.
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.
Friday, November 4, 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.
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:
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.
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:
- 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.
- 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
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
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