Chiropractors Transitioning from ICD-9 to ICD-10

August 17, 2015
Chiropractic Medicare 2015ICD-10 Change and Easy Transition

     As we approach the ICD-10 deadline, let us do a little preparation so the transition from ICD-9 to ICD-10 is easy. First question..... How many of you wish to become Coding Experts? I suspect NONE want to become Coding Experts.... so you will enjoy this article and it may even take a little pressure off.

     Secondly, to really take a little pressure off, CMS (Centers for Medicare & Medicaid Services Office of the Administrator) presented a letter to all Medicare Providers dated July 7, 2015 that contains a paragraph as follows:

    “For 12 months after ICD-10 implementation, Medicare review contractors will NOT deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a code from the right family.  However, a valid ICD-10 code will be required on all codes starting October 1, 2015” 

     That clearly means that after October 2015 NO ICD-9 codes may be used on any claim, not only to Medicare, but all insurances.  The transition must be 100%.  Prior to October 1, 2015, NO ICD-10 code are acceptable.  Wednesday evening, September 30 will be the end of ICD-9 codes forever.

     To prevent delays in payment, it is important to bill all your Medicare and insurance claims as quickly as possible prior to October 1, 2015.  So Thursday morning, October 1, 2015, all your patient diagnosis must be changed as you see the patient and do their S.O.A.P. notes.  If you bill each day electronically, make sure no ICD-9 codes appear on any claims.

     All certified software have special migration programs making it much easier to switch to ICD-10.  ChiroTouch, as an example, uses ICD-10 wizard in the diagnosis window to practice matching your present diagnosis with the new ICD-10 diagnosis.  Even though you are adding new ICD-10 diagnosis prior to October 1, no permanent changes go into the official records or any claim prior to October 1, as it is designed for practice only.

 As Chiropractors, remember, we are not reimbursed in Medicare to “treat” patient symptoms, but to locate and correct vertebral subluxations.  Your diagnosis should be a Chiropractic diagnosis with subluxations, degenerative joint disease, sprain/strain, neuritis, etc.  Practice makes perfect.....and we will soon get used to it. 

New seminars is September 2013

New seminars is September 2013. See you soon in Washington State and Michigan.
For locations and dates, please see the Seminar Calendar link above or call our office.

Going Paperless

Newsletter
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 writing...it’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:
https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Beginners_Guide.pdf

(EHR) DO IT NOW!!!

Newsletter
March 19, 2013
Chiropractic Medicare
(EHR) DO IT NOW!!!

The Medicare Electronic Health Record (EHR) Incentive Program is still alive and well. Incentive direct deposits are taking place across the country in the amount of up to $18,000.00 for those who have successfully attested for 2012.

The amount of your incentive payment depends on when you began participating in the program. The incentive payment is 75% of your Medicare allowed charges up to a maximum annual cap.
"The total maximum incentive amount that you can be paid under the Medicare EHR Incentive Program is $44,000 over five consecutive years of program participation. As you can see, you receive the maximum incentive by starting in 2011 or 2012 . If you don’t start by 2014, you are not eligible to receive any incentive payment under the Medicare EHR Incentive Program." -Page 15 of "An Introduction to the Medicare EHR Incentive Program for Eligible Professionals" found here: (https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Beginners_Guide.pdf)

Example: If you attested before the end of 2012, you have received up to $18,000.00 incentive money in your checking account. If you continue Electronic Health Records in 2013, you will receive another deposit in your checking account in the amount of up to $12,000.00. When you continue for 2014, you will receive another deposit of up to $4,000.00 and if you continue in 2015, you will receive up to a final $2,000.00 deposit.

If you start now and attest in a timely manner this year, you will receive up to $12,000.00, next year for 2013, and up to $8,000.00 in 2015 form 2014. If you wait to attest in 2014, you have waited to long, and then in 2016 you will begin receiving cuts in your Medicare fees and probably other health insurance fees for the rest of your practicing years. Those that are doing Electronic Health Records presently will continue receiving increases in the fee structure instead of cuts.

How do you begin? First, is your office software certified? If it is, then call your software company and get it going. DO IT NOW! It's later than you think! If your office software is not certified look for one that is and get going. We have used Chirotouch for over one year and love it. If you have an interest in Chirotouch give me a call and I can save you some bucks.

***NEW***

D.D. Palmer wrote "The Chiropractor" booklets each month, 1904 thru 1908. Those are what B. J. Palmer used to create the first Chiropractic Book in 1906. We now have those "The Chiropractor" booklets in two (2) large books. If you like history, these are a must! Call me or send an email for more information.

Learn, Compliance, Paperless & Attestation

Newsletter
October 22, 2012
Chiropractic Medicare
Learn, Compliance, Paperless & Attestation
Now is not the time to procrastinate!  If you plan on being in Chiropractic practice in 2015....listen up!  You have a choice.  Either get with it or get ready to retire!

Now that I have your attention, here are the steps necessary to wade through this Medicare process.  The process is not as extreme as first impression. 

1. Learn the correct way to do Chiropractic Medicare.  If you do not do Medicare correctly, all else will not be effective.  If you have attended our presentation or have our Chiropractic Medicare DVD & booklet, review the DVD and start doing Medicare correctly.
2. The Federal law says we must become Medicare Compliant. Follow this link: http://www.cms.gov/Medicare/Medicare-Contracting/MedicareContractingReform/Downloads/compliance.pdf  They provide seven (7) categories we must respond to by creating a Medicare Compliance Program and procedures in your practice.
3. Electronic Billing and Going Paperless
1. Nearly all Chiropractic offices are billing Medicare electronically. If you are not, you are going to be left behind and soon will be cut in Medicare reimbursement. Call your Medicare carrier, ask the carrier to help you bill electronically and follow their guidelines. Do not put it it off another day.
2. Going paperless is fabulous as long as you have a good Chiropractic software in your practice. I use Chirotouch software. This software leads you through the process of becoming paperless. I have to say, after doing written notes for forty-four (44) years, it is absolutely great to make a few clicks on the computer and not only have S.O.A.P. notes completed, but also produce "Documentation" by Federal Standards for Medicare, PI, etc.
4. Attestation: Once you have used and learned the software and follow the specific programs in the software, you will be ready to "attest" as to following the guidelines of a paperless practice. The government will now pay you an incentive dollar amount in direct proportion as to the number of Medicare visits you have. Learn more about the EHR Incentive Program. Remember....only the use of Certified EHR (those that meet specific federal standards for Meaningful Use) can qualify for incentive payment.  Do you know if your software is qualified? Follow this link: http://oncchpl.force.com/ehrcert

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

      

"Becoming Compliant"~Newsletter 09/17/2012

Newsletter

September 17, 2012

Chiropractic Medicare

     1. Stopping Fraud & Abuse

2. Becoming Compliant

    3. Going For the Incentive

The government strategy of becoming compliant in Medicare, going paperless and getting an incentive to do so, is and will be effective in stopping fraud and abuse in Medicare.

One small problem.  Much of what the government calls abuse is not abuse.  It is the inability of Chiropractors to "Document" the Chiropractors necessity of care by "Federal Standards."

Since Medicare Carriers do not have the ability...(or do not want to)...review Chiropractic claims when they receive them......  ALL clean claims are automatically paid.  However, then companies are hired by the Medicare Carriers to reclaim money from Chiropractors that do not do Medicare correctly.

When doing Medicare you must know how to document the Chiropractic necessity of care by "Federal Standards".  Since most Chiropractors have never been shown or told how to "Document", a lot of money is recovered by these hired groups. The federal government calls this abuse against Medicare because the Chiropractor billed Medicare for a service that did not have documentation for payment that the government believes should have been billed as Maintenance Care.

Money is recovered by the hired firm, the Chiropractor has to pay it back, and statistics call that Fraud and Abuse against Medicare....simply because the Chiropractor did not know the correct way to do Medicare!

FIRST:  Learn how to do Chiropractic Medicare correctly.

SECOND:  Become compliant.

Finally....Contact your software company in regards to receiving incentives. We like Chirotouch.

REMEMBER: You are required to become Medicare Compliant prior to 2013.        December is coming quickly.

Federal Incentive Payments for Implementing Electronic Health Records (EHR)

*****

Newsletter

September 10, 2012

Chiropractic Medicare INCENTIVE

Federal Incentive Payments for Implementing Electronic Health Records (EHR)

Did you know Chiropractors are eligible for up to $44,000.00 each from Medicare? So far $16.5 million has been paid to Chiropractors.  Well over 2000 Chiropractors have been paid, some even the last installment.

You must Attest Meaningful Use in a continuous 90 day period within that calendar year.  In subsequent years, after a providers first year, the reporting period is the entire calendar year. For more information follow this link: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Beginners_Guide.pdf

In other words, you must register this month, so you have October thru December of this year for EHR Meaningful Use.  You can still be eligible to receive the full $44,000.00 incentive by implementing EHR in your practice no later than October 3, 2012 and performing meaningful use for just 90 days in your first year.

It makes no difference as to Participating or Non-participating Provider.  If you submit claims for Part B covered services, you are eligible.  If you successfully register and demonstrate meaningful use of a certified Electronic Health Record, your incentive payment will be based on all services allowed under Part B, regardless of your participation status or whether you have accepted assignment on those claims.

Remember....only the use of Certified EHR (those that meet specific federal standards for Meaningful Use) can qualify for incentive payment.  Do you know if your software is qualified? Follow this link: http://oncchpl.force.com/ehrcert

I am so fortunate to be using ChiroTouch software that has it together.  
Questions?  Give me a call (618) 395-3800.

The Federal Incentive Payments Program is helpful, but remember you must know the correct way to do Chiropractic Medicare and also become Medicare Compliant. Once the correct way to do Medicare is understood, you are half the way. 

REMEMBER....
You are required to become Medicare Compliant prior to 2013.        
December is coming quickly.  

Step 3 of the 7 Mandated Steps "Conducting Effective Training and Education"

Newsletter

February 27, 2012

Chiropractic Medicare

"Making the Transition"

Step 3 of the 7 mandated steps

Dear Doctors and staff,

The transition from silent to sound movies was difficult for most silent stars.  In her portrayal of Norma Desmond in "Sunset Boulevard" (1950), Gloria Swanson, once a silent screen actress, captured the bitterness and sadness she and others experienced when talkies emerged. In a famous scene, Norma retorts, "We didn't need voices...we had faces." Charlie Chaplin also clung to the older medium, creating several silent films during the 1930's, a decade otherwise dominated by "talkies."

Silent starlets were Mary Pickford and Lillian Gish, along with Clara Bow and Louis Brooks, never made the "talkies" transition like Greta Garbo, Marlene Dietrich and Jean Harlow.  They just faded away.

All health care providers, including Chiropractors, are facing a transition today. By the end of 2012 we either get with it NOW like Greta Garbo and Jean Harlow or by 2014-15 we will fade away just as Lillian Gish and Clara Bow.  We have known this is coming for several years.  It is here.  It is decision time NOW. Do you plan on being in Chiropractic practice on 2015?

If you do plan on being in a Chiropractic practice, you must become Medicare Compliant and prepare to become paperless in your office functions.

Step #3 in Becoming Medicare Compliant:

Conducting Effective Training and Education

Your Compliance Officer, under the direction of the Contractor (owner/doctor) shall develop training for new employees/staff and doctors.  Refresher training should re-emphasize Medicare statutory, regulatory and contractual requirements and the contractors (Doctor's) Code of Conduct.  Compliance training shall be presented by the Compliance Officer or designated staff in a specific procedure issue.  Specific training subjects for both formal and informal training will be specified by the Compliance Officer under the direction of the Contractor.

The purpose of these seven (7) steps in Chiropractic Medicare Compliance is to stop fraud, abuse and errors.  As you will see the program is extremely effective.  Next week we will cover item # 4, "Auditing and Monitoring Risk Areas" as mandated by the government.

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

Spring 2012 Seminar Schedule:

 *Thursday, March 22, 2012

1:00 pm - 5:00 pm at

 Staybridge Suites - St. Louis, MO

To Register Call:  (618) 395-3800

4010-to-5010 ~ My Filing Nightmares ~ Rejected Claims, Unreadable Reports, and Error Messages, Oh My!

4010-to-5010 My Filing Nightmares
Rejected Claims, Unreadable Reports, and Error Messages, Oh My!

Has the 4010 to 5010 transition confused you or your office staff with rejected claims, unreadable reports, and/or error messages? The following are some helpful websites and information my staff gathered while making the fun transition.

http://www.ama-assn.org/resources/doc/washington/4010-to-5010-claim-data-reporting-comparison.pdf

If you upload your claims using a clearinghouse your should get a human readable electronic report. (If you are getting a human readable report, count yourself lucky!) However, if you upload your claims directly to the Medicare Carrier you might only get a 999 file and a 277CA file. Acknowledgement for Health Care Insurance (999) and Claims Acknowledgements (277CA) will open in Notepad and contain a couple lines of code in your report because they no longer require themselves to send human readable reports. Talk to your software company and ask if they can provide the translation software. There HIPAA EDI Viewer software companies out there. More info about this topic:
http://www.wpsic.com/edi/5010-Readiness.shtml
https://www.cms.gov/Versions5010andD0/Downloads/2nd_National_Provider_Education_Call_HIPAA_Versions_5010_and_D0.pdf

If you have any questions, or suggestions please feel free to post them below. We are always looking for more information to share.

~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





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.

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

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.