"The Medicare Claim Tells the Story" ~Newsletter 8/20/12

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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.

 

 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. 

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. 

Beginning of JUNE Newsletters 2012

Beginning  of JUNE Newsletters

(Sent out June 4th, 12th and 18^th)

Chiropractic Medicare

Sent June 4^th, 2012

Dear Doctors and staff,

Those using our recommendations in doing Medicare are having great success when addressing pre and post payment reviews and audits.  I do not know another Chiropractic Medicare training program that uses the "documentation" we suggest.  The documentation used with our program is Federal Documentation and supports the Chiropractic truths in caring for seniors.  Once you see and understand our presentation you will realize its the truth and the way it is with seniors.

Until you understand how Chiropractic works with Medicare, several items on your claims will indicate to the Medicare carrier you do not have it together, which usually brings on reviews and audits.  We chiropractors do not "treat" patient symptoms.  Our only job is to locate and correct vertebral subluxations.  The lack of documentation (and documentation is not S.O.A.P. notes), date of current over 60 days old and/or a diagnosis that does not support the care rendered and this claim will "pop" out of the carrier's computer for review.

If the review reveals the doctor does not know how to document and/or has a patient on a program of care for a condition that is over 60 days old or more than 12 visits, the carrier will now ask for more records as they now believe they can get some money recovery from this doctor.

It is critical to understand the "philosophy" of Chiropractic Medicare, to deal with Medicare like a Chiropractor and "STOP" treating patients in regards to their symptoms.  Revisit your thinking when doing Medicare.  Evaluate your Medicare patients as a Chiropractor.  Nearly all your Medicare patients do not have new conditions and new diagnosis.  They have exacerbations in direct relation to chronic predisposed arthritic subluxations.

Hardly ever do you see a new condition with a senior patient.  That should spark your thinking.  Once you understand chiropractically how Medicare works, learn the correct way to "document", understanding the honest "diagnosis", you will find Medicare an excellent Chiropractic program.

With an understanding of the correct way to do Chiropractic Medicare, now you can use your energy in becoming Medicare Compliant by the end of 2012.

      

Spring 2012 Seminar Schedule:

*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)

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

Sent June 12^th, 2012

“ABN Option #2 - Covered and Non-Covered Service”

Albany, New York, Mount Laurel and Saddle Brook, New Jersey and Mishawaka, Indiana are upcoming Chiropractic Medicare Seminars for the month of June.  In those seminars I will cover the "Basics" Chiropractic Medicare information and review the steps on becoming Medicare Compliant.  If you have not attended one of our presentations, please call and register.  I promise you will receive information you will be happy to have… plus have fun.

ABN Option #2

For the Chiropractors that are "treating" patient symptoms, Option #2 on the ABN is dangerous.  Many Chiropractors "believe" when a patient has no symptoms, just call the Chiropractic adjustment "Wellness Care" or "Maintenance Care" and that way they "believe" they do not have to bill Medicare for the Chiropractic adjustment.

The patient signs Option #2 on the ABN and the doctor believe the adjustment is now a "non-covered service" in Medicare.  So not only does the doctor NOT bill Medicare for the Chiropractic adjustment. the doctor also collects from the patient at time of service for the Chiropractic adjustment, even though the doctor is a participating provider.

As a Participating Provider, your Federal Contract says that you can NEVER collect the 80% of the set Medicare fee for the adjustment at time of visit. You must ALWAYS accept assignment on a Medicare patient.  The Chiropractic adjustment is ALWAYS a covered service by Federal Law.  It may not be payable, however, by Federal Law, it is the only covered services for we Chiropractors.

Option #2 is for ONLY a non-covered service.  Simply, the Chiropractic adjustment must always be billed to the Medicare Carrier and Option #2 has nothing to do with a covered service. 

Remember: the fines are up to $10 thousand dollars per incident when not billing a covered service.

Sent June 18^th, 2012

“Audits, Appeals and Record Requests”

All Chiropractors and staff first must know the correct way to do Chiropractic Medicare.  When done correctly, your Medicare Carrier will recognize you are doing it correctly on your claim form and will stop asking for your records.

As far as I know, our Chiropractic Medicare Program is the only one presenting "documentation" by federal standards.  That information is entered in Item #19 on the initial claim, so the Medicare Carrier recognizes you have the "Documentation."  This information will cut most of the records requests.

The Appeals Process is fair; however, the first two steps of the Appeals Process (Request for Redetermination and Reconsideration) are still with the Medicare Carrier.  Due to the hassle and time frame dealing with Step 1 and Step 2, most Chiropractors either have done Chiropractic Medicare wrong or simply "give up"!

The third step in the Appeals Process (Request for Administrative Law Judge Hearing) is outside your carrier. If you have "documented by Federal Standards" you will be successful.

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

"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, 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