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Wednesday, May 22, 2013

Going Paperless

May 22, 2013
Chiropractic Medicare
"Going Paperless Made Simple!"

If you have not become paperless yet, please consider making that move quickly. The final window of opportunity closes the last day of September, so you have 90 days of "meaningful use" prior to 2014. That means you need to be moving on this NOW. To make the whole thing simple, you must purchase or have a certified software.

A certified software will lead you though the process step by step. We have been using ChiroTouch for 18 months. It’s an excellent software written by Chiropractors for Chiropractors. After 44 years of S.O.A.P note’s wonderful.

We "attested" last year, have received our first incentive payment in January....NO more paper. To make the whole thing simple...The Software. There are several out there for sale. I just know about ChiroTouch. If you have questions in regard to attesting or ChiroTouch, give me a call.

More info on the CMS (Centers for Medicare and Medicaid Services) Medicare EHR Incentive Program:

Tuesday, May 14, 2013

Mandatory Revalidation, PECOS, CMS-855, and CMS-588

May 13, 2013
Chiropractic Medicare
Mandatory Revalidation
Many fellow Chiropractors across the states are receiving a Provider Enrollment Revalidation Request from your Medicare Carrier. They are asking us to immediately submit updated Provider Enrollment Paper Application 855 form or Review, Update and Certify information via the internet-based PECOS System.

The Patient Protection and Affordable Care Act, Section 6401, says all new and existing providers must be reevaluated under the new screening guidelines. Medicare requires all enrolled providers and suppliers to revalidate enrollment information every five (5) years. Upon the CMS request to revalidate it’s enrollment, the provider has 60 days from the postmark date of your official letter from your carrier to submit complete enrollment information using one of the following methods:

1. Internet-based Provider Enrollment, claim, and Ownership System (PECOS).

2. Paper Application Form CMS-855.

The new Electronic Funds Transfer (EFT) authorization form CMS-588 is now required to be part of the revalidation package. (for both participating and non-participating providers.)

CMS-588 form can be found at

Have questions in regards to doing Chiropractic Medicare correctly, or becoming Medicare Compliant? Give me a call at (618) 395-3800. Learn the correct way to "Document The Chiropractic Necessity of Care." WE WILL DO OUR BEST TO HELP YOU.

Tuesday, May 7, 2013

1. Back to the Basics 2. History Book

May 6, 2013
Chiropractic Medicare
1. "Back to the Basics."
2. New Chiropractic History Book Introduced.
Knowing the error rate for we Chiropractors is at 72.9% as determined by CERT....knowing that they believe they have over paid we Chiropractors improper payments....somebody will be catching audits for money recovery! CERT says that the primary reason for the improper payment is "insufficient medical record documentation".

You may believe this has nothing to do with you since all of your claims have been paid. However, the 72.9% error rate is on claims that have been paid....improperly. If you believe S.O.A.P. notes is the documentation they are talking about...that’s a mistake! Documentation is not S.O.A.P.’s a document. That is why it is called documentation. That is the exact information I have been attempting to share with my fellow Chiropractors for the past 34 years.

1. The Basics in Medicare: You must prove a subluxation, x-rays each year or a P.A.R.T. form each visit. Item #14 must be less than 60 days old. Diagnosis must support the care rendered . S.O.A.P. notes in a S.O.A.P. note format. You must have "documentation" in the way of a "document" to prove chiropractic necessity of care. S.O.A.P. notes must indicate and support the CPT Code you billed.

2. NEW CHIROPRACTIC HISTORY BOOK INTRODUCTION: D. D. Palmer & B. J. Palmer started producing "The Chiropractor" booklets in December 1904. "The Chiropractor" were produced and printed each month for four years. We have made those available in two large volumes. They come with Certificate of authenticity of first copies. For those interested in Chiropractic History....these are not available anywhere else. We have a limited number available so please email or call if you are interested.

Friday, May 3, 2013

Newsletter ~ Two Questions

May 3, 2013
Chiropractic Medicare
#1. Who’s going to catch the audits?
#2. Mandatory Payment Reductions.

#1. Catching Audits..............

I have presented, time and time again, information in regards to Chiropractors becoming compliant in Medicare. And yet, only about one third have followed the Federal Mandate and Attested.

So....I shall say it again! Do you want to be in Chiropractic practice after 2016? If you don’t......just don’t do anything. If you do, and have not proceeded to becoming compliant, you are in your "Last Window of Opportunity". It’s over prior to 90 days to the end of the year!!

If you believe you do not have to become compliant, you are wrong! Both Medicare and Obama care require your compliance. is against federal law to see a Medicare patient if you are not qualified.

AUDITS: So who’s going to catch the audits? Remember....72.9% of all Chiropractic claims have errors and we Chiropractors are being improperly paid...there will be audits.

Do you think the Chiropractor who has followed the Federal Guidelines, become Medicare Compliant using certified software, has attested, and has records readily available for review...or...the Chiropractor that has not become compliant, is not using certified software and not attested as to becoming Medicare compliant will be audited? The answer is not difficult! You begin with a certified software.

Questions? Give me a call! Don’t procrastinate!! This is important for your future in Chiropractic!

#2. Mandatory Payment Reductions...........

The Budget Central Act of 2011 requires, among other things, mandatory across-the-board reductions in Federal Spending, also known as Sequestration. The American Taxpayer Relief Act of 2012 postponed sequestration for 2 months. The order was set for March 1, 2012. In general, Medicare fees for service claims with dates of service on or after April 1, 2013, will incur a 2 percent reduction in Medicare payment.

Even though beneficiary payments for deductibles and coinsurances are not subject to the 2 percent payment reduction, Medicare payments to beneficiaries for unassigned claims are subject to the 2 percent reduction.

Have questions in regards to doing Chiropractic Medicare correctly, or becoming Medicare Compliant? Give me a call at (618) 395-3800.
Learn the correct way to "Document The Chiropractic Necessity of Care."

Wednesday, May 1, 2013

"Medicare Learning Network" (72.9% Chiropractic Medicare Fail Rate)

April 30, 2013
Chiropractic Medicare
"Medicare Learning Network"
(72.9% Chiropractic Medicare Fail Rate)

Well....we Chiropractors made the Medicare Quarterly Provider Compliance Newsletter again! (Volume 3, Issue 3 – April 2013). The very first report is Comprehensive Error Rate Testing (CERT) Special Study: Provider Types Affected: Physicians and Chiropractors.

Problem description:

The majority of chiropractic services claims errors in this review were the result of insufficient documentation. Note that the Medicare Fee-for-Service 2011 Improper Payment Rate Report’s finding that insufficient medical record documentation was the most common reason (72.9%) for improper chiropractic payment. (See "The Supplementary Appendices for the Medicare Fee-for-Service 2011 Improper Payment Rate Report," released on November 2, 2012 at on the CMS website.)

This type of error occurs when the medical records do not contain enough information for the reviewer to make a decision about medical necessity for the item or service furnished. Some common reasons for insufficient documentation errors were:
  • The documentation submitted did not adequately describe the service defined by the billed CPT code, Healthcare Common Procedure Coding System (HCPCS) code, or HCPCS modifier;
  • The documentation did not include the Date of Service (DOS) or the beneficiary’s name;
  • The was no treatment plan documented to support a plan of care;
  • The signature was illegible.
Other errors in this special study were categorized as medical necessity errors. These errors occur when the medical records contain sufficient documentation for the reviewer to determine that the services billed were not medically necessary based upon Medicare coverage policies.

A common reason for medical necessity errors was that the submitted medical records did not support the need for the service based on the Medicare National Coverage Determination (NCDs) and Local Coverage Determinations (LCDs). The rest of the medical necessity errors were due to claims in which the beneficiary symptoms were not related to the spinal regions manipulated.

Example: Mr. Jones’ medical record shows that he had an injury that led to a subluxation of the spine with acute back pain. However, as required by the chiropractic services LCD, the precise level of the subluxation was not specified by the Chiropractor. This claim was scored as an improper payment due to an insufficient documentation error.

Let’s Get Back to the Basics! The statistics indicate 72 out of every 100 claims filed were paid improperly. If you are going to stay in practice and do Medicare and Obama Care, you simply have to do it correctly!!

Recommendation – Have questions in regards to doing Chiropractic Medicare correctly, or becoming Medicare Compliant? Give me a call at (618) 395-3800. Learn the correct way to "Document The Chiropractic Necessity of Care"!