Treatment Plan in Chiropratic Medicare

Newsletter

April 23, 2012

Chiropractic Medicare

"Treatment Plan"

Dear Doctors and Staff,

I am certain everybody has about had it with Medicare and the constant threat of audits.  However, think about this the Chiropractors in Kentucky had a 99.7% fail rate on their last audit.  Southern California fail rate was 77%.

The bottom line, we either learn how to do Chiropractic Medicare correctly or we are going to lose big bucks with Medicare audits and then lose the whole Chiropractic Medicare Program.  With such huge error rates, we have already lost from "No limits in Medicare for the Chiropractic adjustment" to a "25 Chiropractic Medicare limit per patient per year.  I project if we do not improve our ability to do Chiropractic Medicare correctly, we will be out of the Medicare program.  (That also means our inclusion in Obama Care will be challenged.)

The 99.7% fail rate in Kentucky and "across the rest of the country", is because none or poor "treatment plans".  There must "always" be a "treatment plan", whether acute, chronic or an acute exacerbation on a chronic condition.

What goes into a "treatment plan"? 

Here it is: both short and long term goals, your patient protocol as to what you will adjust and how and on what frequency, any contraindications and/or complicating conditions.  What, where, who, time of any modalities/therapies, home care instructions, lifestyle modifications, outcome assessment and re-examinations.

Remember...you have to know the correct way to do Chiropractic Medicare and you must become "Compliant" in Medicare by producing "documents" in seven (7) "specific" areas.

Don't fool around or procrastinate!!!!  Get informed TODAY!!

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

Spring 2012 Seminar Schedule:

*Thursday, May 24, 8:30 am - 12:30 pm at King Oscar Hotel, Pacific, WA

*Thursday, May 24, 6:00 pm - 10:00 pm at Staybridge Suites, Mukilteo, WA

*Saturday, May 26, 8:30 am - 12:30 pm at Quality Inn Oakwood, Spokane, WA

To Register Call:  (618) 395-3800

"Areas of GREAT Concern" (Requests for Patient Records, Denials, Redetermination and Reconsideration aka The Appeal Process)

Newsletter

April 17, 2012

Chiropractic Medicare

"Areas of GREAT Concern"

Dear Doctors and Staff,

A huge area of concern is the Error Rate established by the Medicare Carriers across the United States.  67% of all claims billed to Medicare Carriers contained errors.  Some states the error rate is worse.  In Southern California the error rate is 77%!

After speaking with hundreds of DC's and their staff by phone I can assert that these people are not dumb.  The Inspector General, with "special" reports to our Senators and Congressmen, has given Congress an impression that Chiropractors are not too bright.

The First Problem is the incentive to learn. When (for example) the reimbursement for a 98940 is $24.56, the incentive to study and know all the Medicare Federal Guidelines seem pretty small.  Since about 96% of all Chiropractors in the U. S. are participating providers, either you don't get paid, or if you do get paid, there is always the fear of a Post-payment Audit and you end up paying everything back to the carrier.

To make the problem worse, more and more Medicare Carriers are simply denying all claims, first patient visit or 10th patient visit, whatever.  They know most Chiropractors do not know what to do next and the carrier wins.  A few Chiropractors who know a little of the Audit and Appeals process request a “Redetermination”.  This is performed by an individual at the Medicare Carrier not involved with the original determination.

At no surprise, usually the redetermination agrees with the original denial.  Usually 45 days have passed and the second denial is received.  Now the Chiropractor may request a “Reconsideration".  This is done by a "Qualified Independent Contractor" similar to first level of appeal.

Another 45 days pass and here comes another denial.  No surprise because it's from the same Medicare Carrier.  By now the Chiropractor has wasted 80 plus days, messed with patient records two or three times, all for $24.56.  Most DC's toss up their hands and give up.

If you will take those reviews and appeals to the next step and having done Medicare correctly, you have a great chance of winning.  When your appeal finally gets to the Administrate Law Judge (away from your Medicare carrier) you will most always win.  Just be sure you are doing Chiropractic Medicare correctly.

The Second Problem:  In several states like New York, New Jersey, Tennessee, California, Wyoming, etc., the Medicare Carriers consistently ask for all patient records that are billed by a Chiropractor.  Some states back log of patient records is unbelievable, however, they continually keep asking for records, and until they are reviewed, not one claim is reimbursed.

There seems to be some loss of government control with these specific carriers.  I recommend the State Chiropractic Associations in these states contact their Congressmen and Senators and file formal complaints against this action as quickly as possible. It is very possible the system is being abused by the Medicare carriers.

Most Important:  You have to know how to do Medicare correctly and become Compliant!

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

Spring 2012 Seminar Schedule:

*Thursday, April 19, 1:00 pm - 5:00 pm at the Chariot Hotel - Louisville, KY

*Thursday, May 24, 8:30 am - 12:30 pm at King Oscar Hotel, Pacific, WA

*Thursday, May 24, 6:00 pm - 10:00 pm at Staybridge Suites, Mukilteo, WA

*Saturday, May 26, 8:30 am - 12:30 pm at Quality Inn Oakwood, Spokane, WA

To Register Call:  (618) 395-3800

"Think Like a Chiropractor"

Newsletter

April 9, 2012

Chiropractic Medicare

"Think Like a Chiropractor"

Dear Doctors and staff,

Many times, when speaking of Medicare, HIPAA, or becoming "compliant" in Medicare, it comes off as a "negative" and a "downer". 

Most people have no idea the Medicare Chiropractic section was written by Chiropractors Dr. Bill Day of Washington, Dr. Bob Hulsebus of Illinois, etc. 

“If we do Chiropractic Medicare as Chiropractors instead of acting like another health discipline, as your Medicare Carriers want you to be, you will have little to no problem with Medicare.”

The Chiropractic Medicare guidelines do not say we are reimbursed for "treating" our patient’s symptoms. It says we are only paid in Medicare for “correcting a vertebral subluxation”.

The vertebral subluxation is the only "covered service" in Medicare for Chiropractors.  The vertebral subluxation is "always" a covered service in Medicare; however, it may not be a payable service if we cannot document the Chiropractic necessity of care. It is always the covered service which is the reason we must bill all Chiropractic adjustments to correct a vertebral subluxation.  For the patient to mark Option #2 on the ABN, calling it maintenance care when the Chiropractor corrects a vertebral subluxation, is very questionable and dangerous.  The adjustment to correct a vertebral subluxation is the only covered service in Medicare and must be billed within one year.

For the Chiropractor to call the Chiropractic adjustment to correct a vertebral subluxation "maintenance care," patient signs Option 2 on the ABN, creates several problems.

1. The patient pays a monthly premium in Medicare for the healthcare that will not reimburse the patient if the Chiropractor does not bill or bill correctly.  The patient is cheated.
2. When a Chiropractor provides a covered service (98940, 98941 or 98942) in Medicare, they are required to bill Medicare within one year.  You may call it Maintenance Care, however, if you corrected a vertebral subluxation that is a "covered service" and should be billed and documented for Medicare reimbursement.
3. Just because a patient has NO obvious symptoms does not make this "maintenance care."  The patient may be on seven (7) prescription drugs and feel no symptoms.
4. When a patient has a "vertebral subluxation", they must have a related "Neuronal Component" or it is not a Subluxation.
1. Example...Subluxation of T6 with the neuronal trajectory of T6 spinal nerve to the stomach altering the function of the stomach. They are probably on three prescription drugs for a stomach problem   from their MD.

Think and be a Chiropractor in Medicare.  That is how the Medicare Program was developed in 1973.

Do you know the importance of learning the correct way to do Medicare by federal standards and becoming Medicare Compliant?

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

Spring 2012 Seminar Schedule:

*Thursday, April 19, 1:00 pm - 5:00 pm at the Chariot Hotel - Louisville, KY

*Thursday, May 24, 8:30 am - 12:30 pm at King Oscar Hotel, Pacific, WA

*Thursday, May 24, 6:00 pm - 10:00 pm at Staybridge Suites, Mukilteo, WA

To Register Call:  (618) 395-3800

Audits and Compliance in Medicare "It All Fits Together!"

Newsletter

April 2, 2012

Chiropractic Medicare

"It All Fits Together!"

Dear Doctors and Staff,

It all fits together....however....first things first!

I have the privilege of speaking to many Chiropractors and Chiropractic staff daily.  We do have Chiropractic Medicare problems in the Chiropractic field of practitioners.

It is obvious the Inspector General is close to correct, that of every 100 claims filed by Chiropractors, 67 have errors!  That is not even the worst part.  All "clean" claims are automatically paid.  Then the carrier hires a special agency to do audits to get the money back.

Some states, New Jersey, New York, California and Nevada, audit nearly every claim, asking for hundreds of patients notes.  Most all are denied with first Review Determination.  When the Chiropractor goes to the second Level of Review Reconsideration (still with the Medicare Carrier) it nearly always is denied again.  Most DC's give up at this point and lose.

We cannot afford to not be paid or have to send money back to the Medicare Carriers.  We have to know the correct way to do Chiropractic Medicare.  I suggest considering our "The Basics" Chiropractic Medicare DVD and booklet.  It covers everything we Chiropractors and staff must know when doing Chiropractic Medicare.

Becoming compliant in Medicare is something totally different.  The Federal Government now has a mandated program set up to stop fraud and abuse in the Medicare program.  Having prepared the Chiropractic Compliance program....it will stop fraud and abuse.

We Chiropractors are required to implement this program by the end of 2012. (9 months to go!)  If you decide to put it off or not do this program, by 2014 - 2015 you will have major difficulty being in Chiropractic practice. Having the Compliance Program already completed for you is a giant step forward.  All you have to do is place your office data on all the documents and you are well on your way to Chiropractic Medicare Compliance.

HIPAA and OSHA are two more areas that chiropractors and staff must be proficient. I will discuss those next week.

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

Spring 2012 Seminar Schedule:

*Thursday, April 19, 1:00 pm - 5:00 pm at the Chariot Hotel - Louisville, KY

*Thursday, May 24, 8:30 am - 12:30 pm at King Oscar Hotel, Auburn, WA

*Thursday, May 24, 6:00 pm - 10:00 pm at Staybridge Suites, Mukilteo, WA

*Saturday, May 26, 8:30 am - 12:30 pm at Quality Inn Oakwood, Spokane, WA

To Register Call:  (618) 395-3800