Newsletter
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. notes...it’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.
Showing posts with label Denials. Show all posts
Showing posts with label Denials. Show all posts
Tuesday, May 7, 2013
Friday, May 3, 2013
Newsletter ~ Two Questions
Newsletter
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. Remember....it 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."
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. Remember....it 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."
Tuesday, August 28, 2012
"The Medicare Claim Tells the Story" ~Newsletter 8/20/12
****
Newsletter
August 20, 2012
Chiropractic Medicare
"The Medicare Claim Tells the Story"
An example: A claim with an acute diagnosis indicating an
acute condition or an exacerbation may have in item #14, Date of Current, a
date over 60 days. This tells the
carrier the condition is chronic so the doctor receives a request for records
to verify the true story on the patient.
Newsletter
August 20, 2012
Chiropractic Medicare
"The Medicare Claim Tells the Story"
Most of my fellow Chiropractors,
when they call about an audit or pre-pay request for records, ask why they
received the record request. Most of the
time they have a request for records because the items on the claim do not
match.
Date of Current on an active patient should NEVER be over 60 days if your are expecting Medicare reimbursement.
Or...the diagnosis only consists
of a subluxation with maybe arthritis.
The carrier knows this patient can be adjusted twice a day for 6 months
and an x-ray indicated a subluxation and arthritis. No improvement and no reimbursement. The diagnosis should have three parts to it. An example: subluxation, arthritis and
sprain/strain if there has been an exacerbation.
If item #19 does not have both
date of x-ray(less than one year) or P.A.R.T., the claim may not be
payable. The carrier may ask for patient
records to verify if the doctor proved a subluxation by either an x-ray less
than one year or a P.A.R.T. form for each visit. X-rays are mandated each year, if the doctor
proves subluxation by way of x-ray. A P.A.R.T. form is mandated each visit if
the doctor does not use x-rays to prove the subluxation.
Some carriers ask for office patient records periodically to verify if
the doctor has a treatment plan with the three key components. The "documentation" provided by our
program consists of both "Federal Documentation" and also a treatment
plan meeting all three components.
Many times the carrier will ask for patient S.O.A.P. notes to verify
the doctor did in fact adjust vertebrae is specific regions in which they
billed Medicare. If you adjust 4 regions on your patient for example, your
billing will match the S.O.A.P. notes as to the number of regions you adjusted
and billed to Medicare.
Generally the information on
each claim should all match.....diagnosis supports the care rendered, Item #14,
date of current, is less than 60 days old, Item #19 contains date of x-ray or
P.A.R.T., and specific terminology indicating any exacerbation and the
"documentation" has been produced.
Once the correct way to do
Medicare is understood, you are half the way.
Wednesday, June 20, 2012
MAY Newsletters 2012
MAY Newsletters
(Sent out May 7th, 14th, 21st and 30th)
Chiropractic Medicare
Sent May 7th, 2012
"Some Medicare Carriers have limited Chiropractic!"
Dear Doctors and Staff,
The Medicare Carrier of Tennessee has posted their draft indicating "Chiropractic limitations" as 25 chiropractic visits per year. The Medicare Carrier in "New Jersey
However, to my knowledge, CMS has issued NO limits on Chiropractic Care as long as the adjustments are medically necessary. That simply means the state Medicare Carriers have posted limitation on Chiropractic illegally. Who's to stop them? CMS does not seem to care that the Medicare Carriers are breaching Federal law by these limitations.
In each state, when the Medicare Carrier creates Chiropractic limitations, the State Chiropractic Associations and Societies should file complaints with their Congressmen and Senators to get it stopped. IT MUST BE STOPPED NOW!!!
Even if there WERE TO BE limitations of 25 or 30 visits per year, we still must know the correct way to do Medicare and we still must become compliant in Medicare by the end of 2012. Because the error rate on Chiropractic billing and documentation has been in the 60% to 99%, those reports were issued by the Inspector General to Congress. If we are to stay in Medicare and also in the new insurance program (Obama Care), we have to prove we are smart enough to be part of the program.
Most Chiropractors and staff believe they are doing Medicare correctly, however, statistics indicate most are not. If you think you are doing Medicare correctly, however, not sure, give me a call and we will talk about it! With 34 years of Chiropractic Medicare experience, those that have learned to do Medicare correctly are having very little trouble with getting paid and are also being successful with audits.
My recommendation is simple....beg, borrow, steal or purchase "The Basics" Chiropractic Medicare DVD and booklet so you know how Medicare works and so you know how to "document" the Chiropractic necessity of care.
If you are going to stay in practice after 2013, you also must become compliant in Medicare. You may wish to consider the Medicare Compliance book and CD. It's ready to start you and your staff on the way to becoming compliant. Sooner or later you have to do this. May as well make it sooner and save the trouble and heartache.
Consider "The Basics" Chiropractic Medicare DVD and booklet. And since we also must become Medicare compliant by the end of 2012, consider our bundle which includes the Chiropractic Medicare Compliance CD and booklet. Protect yourself....it's up to you to do it correctly. Don't fool around or procrastinate!!!! Get this information TODAY!!
Have questions? Give Dr. Street a call today at (618) 395-3800.
Post Script NOTE: (Illinois Chiropractors) WPS has lost it's Medicare Carrier contract. The new Medicare Carrier in Illinois
Spring 2012 Seminar Schedule:
*Thursday, May 17, 1:00 pm - 5:00 pm at Hampton Inn-Downtown, Indianapolis , IN
(4 hrs. Risk Management Continued Education - add $35.00 to registration)
*Thursday, May 24, 8:30 am - 12:30 pm at King Oscar Hotel
*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
*Thursday, June 21, 8:00 am - 12:00 pm at Comfort Inn & Suites, Mount Laurel , NJ
*Thursday, June 21, 5:00 pm - 9:00 pm at Holiday Inn, Saddle Brook , NJ
*Saturday, June 23, 8:00 am -12:00 pm at Holiday Inn Express University , Albany , NY
*Thursday, June 28, 8:30 am - 12:30 pm at Holiday Inn Express, Mishawaka , IN
(4 hrs. Risk Management Continued Education - add $35.00 to registration)
Sent May 14th, 2012
Dear Doctors and Staff,
This week, Thursday, we will be in Indianapolis , IN
Next week we will be in the State of Washington at Pacific and Everett on May 24th and Spokane
These presentations are important. Those attending get the idea of the correct way to do Chiropractic Medicare. They return to their offices, correct errors, implement what they learn, and are successful with Medicare....plus sleeping good at night.
To my knowledge, I have not yet met the Chiropractor or staff that was already aware of the "documentation" used successfully in Medicare before attending our presentation or studying or DVD. So when my fellow Chiropractors tell me they are doing Chiropractic Medicare correctly and talk about their S.O.A.P. note documentation....it becomes obvious there is a problem!
After last weeks Medicare article, we received several emails indicating several other state Medicare Carriers have placed limitations on the chiropractic adjustments. That guideline change limiting chiropractic coverage has not officially been adopted by CMS.
The biggest problem is that Chiropractors believe they are doing Medicare right because they are getting paid. (As long as you bill a "clean claim" most Medicare Carriers pay that claim and audit later by request of patient records.) So now many chiropractors are not interested until they have a Medicare audit and fail. (Remember...the Chiropractic Medicare error rate is 67% to 97% of ALL claims.) Now the STAFF is under pressure to make thing happen in Medicare since claims are not being paid and the office has to send patient records to the carrier.
Also, filed claims are denied by the carrier. Even if the claim is billed correctly...some are denied, even first visit. The appeals process should be used. However, the majority of our profession has no idea about the five levels of Appeal and they give up after the first one or two levels are denied by the carrier.
Procrastination is dangerous when dealing with a federal program. You must do it correctly or you either pay back money or lose the program.
Sent May 21st, 2012
"Getting It Right!"
Dear Doctors and Staff,
We are very happy to receive reports back from our fellow Chiropractors in regards to the success with audits and reviews. Those Chiropractors and Staff that have our information, by either attending seminars or the purchase of our DVD and booklet, are very successful. The reason being they are doing Medicare correctly.
Medicare carriers in each state are implementing visit restrictions for chiropractic care. The Federal Law indicates there are NO limits in Medicare for the chiropractic adjustment as long as it is Medically necessary. Since very few chiropractors know the correct way to "Document the Chiropractic Necessity of Care", we are now facing those limits by default. Nobody is challenging the Medicare carriers and they are getting away with unlawful limits.
However, sometimes even if you do Medicare correctly you may receive denials from your Medicare Carrier. When that happens, review your claims for any errors and file an appeal.
Remember, the first two (2) steps of the appeals process is still with your Medicare Carrier. The third step requires a review by an administrative law judge OUTSIDE your Medicare Carrier. Nearly always you will be successful... especially if you have our material since our documentation has been approved by the administrative law judges.
Sent May 30th, 2012
"Do It Correctly - or Lose!"
Dear Doctors and Staff,
The Medicare Carriers that have placed limits on the number of Chiropractic adjustments per patient per year have demanded we Chiropractors do it right....or we lose.
There are NO limits for the Chiropractic adjustments in the Medicare program. However, each Medicare Carrier may establish in-house limits that we can exceed if we do Chiropractic Medicare correctly and challenge the carrier through the Appeals Process.
If you are actually doing Chiropractic Medicare correctly and wade through the Appeals Process to the Administrative Law Judge Appeals level, you should win each challenge.
(The problem with the Appeals process is that the first two stages are still with the Medicare carrier and usually denied. Most chiropractors give up before it goes to the third step with the Administrative Law Judge.) If you are NOT doing Medicare correctly, you will lose in the Appeals, even through the Administrative Law Judge (ALJ).
If you still believe your S.O.A.P. notes are “documentation” in Medicare, then you will learn the hard way which will cost you some big bucks.
I strongly suggest that you consider three important items we have to offer:
1. "The Basics" Chiropractic Medicare DVD and booklet. This contains everything you and your staff must know to do Medicare correctly.
2. The Audit and Appeals Process DVD and booklet. If you are going to know how to defend yourself in an audit, this item walks you through the Appeals Process so you don't "give up" before you win.
3. Chiropractic Medicare Compliance CD and booklet. We all must become compliant by the end of 2012. We have it completed. It is ready for you to implement it into your practice. The faster the better to become compliant.
A couple of notes from fellow Chiropractors:
May 14, 2012
Hey Doc,
Just wanted to let you know that I won my ALJ decision for my audits going back to end of 2010 and early 2011! You said I would, and I must say, I had my doubts the way things are going here in NY. They found 100% in my favor. Thanks for your help throughout the process. I truly appreciate it.
All the best,
Ed Casper, DC
May 22, 2012
To Whom It May Concern:
It was a great blessing running into Dr. Street 7 years ago.
He was like a prophet with his predictions about where Medicare and Chiropractic would go.
We have followed his recommendations to a T. It is nice for patients to know what their financial responsibility is and which services are the responsibilities of Medicare.
His procedures are efficient and ethical with no "gimmicks".
Outside of cumbersome paperwork, Medicare audits go through like a breeze by following Dr. Street's procedures.
If you are a Chiropractor who is a Medicare provider, you cannot afford to not attend this seminar.
Sincerely,
Dr. Joseph Clauss
Dr. Carolyn Clauss
Have questions? Give Dr. Street a call today at (618) 395-3800.
Tuesday, May 1, 2012
"Everything Has To Match!"
Newsletter
April 30, 2012
Chiropractic Medicare
"Everything Has To Match!"
Dear Doctors and Staff,
The phone is ringing more and more from fellow Chiropractors dealing with audits and requests for records. Many times that phone call happens BEFORE they mail their records. However, many times it is after they have sent records and now the carrier is requesting money back.
If that phone call I get is before they mailed records, or better yet, prior to the carrier requesting records, we can review and help you correct errors.
NO, I am not a hired consultant and NO, I do not get paid for my recommendations.
My only request is that the doctor consider our "Chiropractic Medicare DVD and booklet" and “Chiropractic Medicare Compliance CD and booklet” so they learn the correct way to do Medicare and are compliant by the end of this year!
Things must match on the claim:
1. If item #14 Date of Current is over 60 days, you have told the Medicare Carrier this is a "Chronic Condition” therefore, this claim will be pulled for review.
2. If your diagnosis does not "support" the adjustments billed, this claim will be pulled for review.
3. If your number of visits does not match your diagnosis and/or Item #14 Dates of Current, this claim will be pulled for review.
4. If you are not collecting Exacerbation Data and documenting that data on a "Document", then you have not "documented the necessity of care”. This claim will fail an audit.
5. If item #19 does not contain the date of x-ray or indicate a P.A.R.T. form was completed for that visit, this claim will be pulled for review.
6. If item #19 does not contain the terminology indicating you have "documentation", this claim will be pulled for review.
7. If the information you send to the carrier about a service does not have "Documentation" and a "Treatment Plan", you lose and they will ask for more records. (S.O.A.P. notes are NOT documentation.)
Protect yourself! It's up to you to do it correctly. 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 17, 1:00 pm - 5:00 pm at Hampton Inn-Downtown, Indianapolis , IN
*Thursday, May 24, 8:30 am - 12:30 pm at King Oscar Hotel
*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
Wednesday, April 18, 2012
"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 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.
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
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
*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
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