Newsletter 8/06/12 ~ "Back to the Basics"

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Newsletter
August 6, 2012
Chiropractic Medicare
"Back to the Basics"

 

The simple fact is "if you do not know how to do Chiropractic Medicare correctly...there is trouble!"  So most important....learn the correct way to do Chiropractic Medicare.

 

We have had the privilege of sharing, with our fellow Chiropractors and their staff, Chiropractic Medicare information for the past 34 years.  We constantly hear remarks like, "I have been in practice for 27 years.  Why didn't someone tell me this before now?" 

 

 You may believe you are doing Chiropractic Medicare correctly.  However, question yourself.  If you receive an audit today in the mail, what does your documentation look like? (Documentation is not S.O.A.P. notes.)  What does your treatment plan look like and does it have all three (3) required elements?

 

Questions? Please call me!  800-MY-CHIRO

"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

Three Important Areas

Newsletter
February 8, 2012
Chiropractic Medicare
Three Important Areas We ALL MUST become Proficient In!

Dear Doctors and Staff,

This is the year for Chiropractors in Medicare.  Last year the Inspector General indicated that out of 100 claims filed to Medicare by Chiropractors, 67 had errors.  They believe they have overpaid Chiropractors by millions. With that in mind, nearly every Chiropractor filing Medicare claims will be audited in 2012.

There are three key areas in which we must be prepared:

First, we must know the correct way to provide great Chiropractic care to our seniors and document by federal standards. You must know the correct way to do Chiropractic Medicare!!! If you don't know the correct way to do Medicare an audit will be devastating.

The second area of our concern is HIPAA (i.e. knowing how to protect personal Health Information in your office, developing your in-house HIPAA policies, procedures and training.)

The third area of concern is becoming Medicare Compliant. By the end of 2012 each and every Chiropractic office must be aware and prepared for the seven (7) areas of compliance set by the Federal Government.

We offer many helpful items to help with these areas to help you get prepared. If you have questions, comments, concerns about Chiropractic Medicare, please give me a call at 618-395-3800.

Warmest regards,
Dr. Street

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

Chiropractic Maintenance Therapy (Medicare Terminology)

Newsletter
October 3, 2011
Chiropractic Maintenance Therapy (Medicare Terminology)

Under the Medicare program, Chiropractic 'maintenance therapy' is not considered to be medically reasonable or necessary, and is therefore not payable.  'Maintenance therapy' is defined as a "treatment plan" that seeks to prevent disease, promote health, and prolong and enhance the quality of life; or "therapy" that is performed to maintain or prevent deterioration of a chronic condition.

When further clinical improvement cannot reasonably be expected from continuous ongoing care, and the Chiropractic treatment becomes supportive rather than corrective in nature, the treatment is then considered "maintenance therapy".  Chiropractic "maintenance therapy" is in direct relation to you as a Chiropractor, either "correcting" vertebral subluxations (vertebral displacements) or "treating" the patient's symptoms.

The Chiropractic Medicare program ONLY reimburses for a Chiropractor to correct vertebral subluxations.  Patients symptoms help Chiropractors locate the causal subluxation, but are not the indicator as to if the subluxation has been corrected.

The Chiropractic adjustment is NOT a "treatment".  The Chiropractic adjustment is a "correction".  A "treatment" becomes supportive rather than corrective in nature, the treatment is then considered maintenance therapy.

The correction of a vertebral subluxation is the only payable service in Medicare for Chiropractors.

Many Chiropractors have fallen for the "treatment" of symptoms in Medicare....the patient marks option #2 on the ABN and Medicare is not billed.  The patient has been cheated from Medicare coverage because the Chiropractor is "treating symptoms".  Even though vertebral subluxations are being found and adjusted, since the patient had NO symptoms, the doctor now believes it is maintenance care.  (The Medicare patient is probably on 10 prescription drugs from the local MD, and can't feel any symptoms.)

If the patient has vertebral subluxations, then there must be "Neuronal Components" or there is NO subluxation.  If the patient has NO symptoms, then a thorough examination of this patient will indicate the prescription drugs the patient consumes for specific symptoms related to malfunction of specific body organs.

Matching the vertebral subluxations to a specific malfunction organ is simple for a Chiropractor.

Locating the subluxation, finding the Neuronal Component to a malfunctioning body organ must be documented by Federal standard "documentation".  This is the way Chiropractic Medicare functions, like real Chiropractors, and not treating patient symptoms.

Maintenance Care? ~Sept 19th

"Maintenance Care" in my Chiropractic office is when a patient enters my office, they are checked, have NO subluxations and they go home.  The Medicare Program has twisted Chiropractic minds so Chiropractors forget that we have but one job in Medicare; find, prove and correct vertebral subluxations (vertebral displacements). That is all that is reimbursed to Chiropractors in the Medicare Program.

Patient symptoms are used by Chiropractors to help locate the subluxations and/or malfunctions of organs.  Just because the patient has NO symptoms does not mean the patient has NO subluxation and is now "maintenance care".  The patient has either a new condition, exacerbation, accident, neuronal component or chronic state.
To meet Medicare coverage criteria, a chiropractic office visit adjustment should be aimed at correcting subluxations related to acute injuries/reinjures or exacerbations.  The result of the Chiropractic adjustment is expected to be an achievable improvement and with a clearly defined point.  Once the maximum benefit has been achieved for a given condition, on-going maintenance therapy is not considered medically necessary under the Medicare Program.

Maintenance therapy is defined by Medicare as a treatment plan that seeks to prevent disease, promote health and prolong and enhance the quality of life, or therapy that is performed to maintain or prevent deterioration of a chronic condition.  Medicare does not cover maintenance therapy.
The recommendation here is: be a Chiropractor and prove the subluxation.  Document by "Federal Standards".  Listen well to the patient and correct vertebral displacements (subluxations).  Medicare has excellent Chiropractic coverage as long as we practice like Chiropractors.  If you are correcting vertebral subluxations for your Medicare patient and calling that adjustment "maintenance care" because you do not know how to document, then you have just performed a covered service in Medicare, did not "document the Chiropractic necessity of care", and cheated your patient from Medicare reimbursement. 

Remember....correcting the vertebral subluxation is the only covered service in Medicare.....and the only service we Chiropractors are mandated to bill to the Medicare Carrier. Performing a covered service and not billing that service, because of lack of knowledge or thinking it does not have to be documented or billed, is unfair to the consumer, your patient and to Chiropractic in general. As a Medicare provider, you signed a contract with our government so you have the privelige to see Medicare patients.... and that YOU will know and follow the Medicare guidelines.

Chiropractic Medicare X-rays (Newsletter from 8/29)

Chiropractic Medicare X-Rays ~ Newsletter from August 29

Medicare is an excellent Chiropractic program.  No other insurance company, PPO, HMO, etc., requires Chiropractic Philosophy, Science and Art as in the Medicare guidelines. Chiropractic Medicare was written by chiropractors (Dr. Day, Dr. Hulsebus, etc.)

There are two(2) parts to Chiropractic Medicare to make a mandatory claim:
    1.  The Chiropractor must prove a vertebral subluxation.
    2.  The Chiropractor must "document" the chiropractic necessity of care by "federal standards."

I strongly recommend doing x-rays on each Medicare patient.  (P.A.R.T. is weak and can be challenged, where as, using your x-rays, you are the authority in regards to locating subluxations.) 

You must have a minimum of two views of each region you adjust (AP & Lateral).  The films must be of good quality and evidence of collination.  The x-ray films must be on location or in a location the doctor has access too, as the Medicare carrier may request those films as they did at the beginning of Chiropractic Medicare.

I suggest doing the following x-rays on each Medicare patient each year.  (If the doctor proves vertebral subluxation by way of x-rays, then the Chiropractor must have a new x-ray that is not over 12 months old, or the Medicare claim will be denied.)
    1 14x36 AP full spine
    1 8x10 Lat. Cervical (including occipital)
    1 7x17 Lat. Thoracic
    1 7x17 Lat. Lumbar (including Sacrum and coccyx)

Chiropractic x-rays are important in that it helps locate vertebral subluxations, pathologies, etc., and they are mandatory for we Chiropractors that use them to prove a subluxation.

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.

Newsletters from May 2011

May 2011

May 16, 2011

Just because you personally have not been involved in a Medicare audit does not mean you can let your defenses down!  

Palmetto GBA, the Medicare Carrier of California and Nevada issued a letter to Jurisdiction 1 Health Care Providers talking about November 2010 Medicare fee-for-service (FFS) claims error rate on paid claims error rate results nearly TWICE the national average for services rendered by Part B. All Medicare carriers have this information and are doing the same!     

The letter stated "BY FAR, the major component to the claims paid error rate is the lack of adequate documentation to support services billed."  The letter also stated, "You control the documentation describing the services your patient received, and your documentation serves as the basis for the bills sent to Medicare for the services you provided.  If your documentation does not support the services on the claim, then a payment error exists." 

Palmetto and MOST other carriers will be undertaking an AGGRESSIVE approach designed to address the cause of documentation errors.  They will INCREASE the level and frequency or pre-payment and post-payment reviews across all provider types. 

Medically unnecessary services are the result of:  
1.  Undocumented services. 
2.  Improperly documented services. 
3.  Insufficiently documented services.  

If you, as a Chiropractor and/or staff, do not know specifically what documentation is or believe documentation is only your S.O.A.P. notes please consider our Chiropractic Medicare DVD.  These Medicare Carriers are ALL stepping up audits because they are aware most Chiropractors believe Chiropractic documentation is the S.O.A.P. notes....IT IS NOT!
Chiropractors must do Medicare correctly as a Chiropractor which is different than any other healthcare providers in Medicare. DOCUMENTATION IS WITH A FEDERAL DOCUMENT, NOT JUST S.O.A.P. NOTES!

May 18, 2011

Just like the bill in New Mexico, Illinois Senate Bill 1843 attempts to change the whole meaning of chiropractic by passing a law that does not "broaden the Chiropractic Scope of Practice.... but changes the foundation of chiropractic. Senate Bill 1843 has already passed the Senate and headed to the Illinois House of Representatives. This is NOT an ICA/ACA battle!!!! This is a chiropractic battle to preserve chiropractic as originated. The bill was structured by Dr. Winterstein of National University whose goal is to make chiropractic into Medicine. Illinois, being the only Medical Practices State, has been Dr. Winterstein's dream for changing chiropractic into another health discipline.

Please take a few moments to go online and type in State of Illinois Representatives. Hit search. There you will find a list of Illinois State Representatives. Please call as many as you can and ask them to defeat Senate Bill 1843 or call 1-800-423-4690 for instructions.

ICA Calls for Defeat Illinois Senate Bill 1843 The International Chiropractors Association (ICA) and the International Chiropractors Association Political Action Committee (ICA-PAC), in response to requests from large numbers of members in Illinois, are calling on all Members of the Illinois House of Representatives to vote NO on Senate Bill 1843.   This legislation contains language that states that, “nothing in this Act shall be construed to prohibit a chiropractic physician from providing advice regarding the use of non-prescription products.” The danger in non-prescription drugs being recommended by untrained individuals is of grave concern to ICA and can certainly put the public at risk. Likewise, doctors of chiropractic have no formal training in oxygen therapies that would be authorized by the bill.   The removal of the defining language that expressly states that the practice of chiropractic is without the use of drugs or surgery clearly tips the balance in the direction of the application of drugs and since no additional education or testing or any other qualifications are mandated, this legislation inherently places the public at risk.

We urge you to vote NO on SB 1843 because:

·   It places the public at risk since the new authorities given to chiropractors to advise on “non-prescription products” which incorporates a vast range of over-the-counter substances which if inappropriately used can cause great harm, does not require any additional education or testing.

·   Chiropractic is, by its longstanding educational and definitional history, a drugless profession.

·   The public is entitled to one truly drugless healing profession and chiropractic has filled this role with proven clinical and cost effectiveness for more than 100 years.

At the top of ICA’s concerns regarding this legislation is public safety.  Studies have estimated that as upwards of 300,000 individuals may die each year as a result of pharmaceutical and medical errors. [1] Of this stunning and alarming number, a growing proportion is from non-prescription substances.  According to a 2001 report in the Journal of American Pharmaceutical Association, more than $177 billion in excess costs in the health care supply chain can be attributed to medication errors.  Sadly, estimates indicate that more than eighty percent of life-threatening medication incidents are the result of physician error. [2]   Clearly, this is not an area or an environment in which any practitioner can make a safe and effective contribution with less than a gold standard set of qualifications and credentials.   SB 1843 provides for no additional education and testing as a basis for the expansion of chiropractic scope to include pharmaceuticals.  On this basis and out of other concerns, ICA urges that this bill be defeated.    If you have any questions or would like more information please contact the International Chiropractors Association at 1-800-423-4690 or by e-mail at chiro@chiroprctic.org.
[1] Starfield B. Is US health really the best in the world? Journal of the American Medical Association (JAMA) 2000 Jul 26;284(4):483-5. Starfield B. Deficiencies in US medical care. JAMA. 2000 Nov 1;284(17):2184-5.. [2] Gurwitz, J.H., Field, T.S., Harrold, L.S., et al, “Incidence and preventability of adverse drug events among elderly persons in the ambulatory setting, (JAMA) 2003;289(9) 1107-1116.

May 23, 2011

This past Friday I sent the above ALERT email across the United States in regards to an Illinois Senate Bill 1843 that slipped through the Senate and into the House of Representative for vote. We are asking for chiropractic support to contact all Illinois Representative to either Vote NO for SB 1843 the way it presently stands or vote YES after accepting the amendment to remove language that is confusing and unnecessary.

Illinois House of Representatives are being asked to strike the words "...from providing advice regarding the use of non-prescription products or..."
SB 1843 language creates confusion in that "non-prescription products" is not defined at all.  If the intent is to authorize the Chiropractic provider to provide advice on non-prescription drugs, then extensive additional education and competence testing is absolutely essential, if such authority is desirable at all.  No such educational provisions are included in the bill and this concept has not been thoroughly and forthrightly discussed and debated throughout the legislative process.

If the intent is to authorize advice on such items as braces, pillows, orthotics and related supports, nutritional products and other commonly applied devices, items and products, then the language is unnecessary since such materials and devices have been covered and authorized to be provided by doctors of Chiropractic under the current statutory language for many decades.
Consumers in Illinois are entitled to complete clarity on the professional authorities and qualifications of all health care professionals and without this amendment, SB 1843 represents a step away from this vital goal. 

Ask the Illinois Representative to please support this proposed amendment to SB 1843.

To contact any and all Illinois State representative go to: www.ilga.gov