Chiropractic Medicare Good Bye…. May 2019

Chiropractic Medicare Good Bye…. May 2019

After 35 plus years of providing Chiropractic Medicare information, answers to thousands of chiropractic Medicare questions plus lots of printed materials, DVD’s and CDs to help my fellow chiropractors and their Staff with Medicare…. It’s time to retire.

In doing so, I sincerely “thank” those that have attended “The Basics” Chiropractic Medicare Seminars all over America. It has been fun and exciting, plus, we have been in every major and many small towns in America.

“Thank you” to the Chiropractic Colleges, and Chiropractic State Associations who so kindly gave to me speaking engagements for their membership.

I will be ending my broadcast Chiropractic Medicare E-mail in 30 days, however you may have an interest in some Chiropractic Medicare and Chiropractic History materials before they disappear, especially since none of this information will be available for our profession in the future.

We still have considerable items in stock…. when they are gone, they are gone. These items will do me no good upon retirement so I am making them available to my fellow chiropractors so they don’t go to waste and at a great discounted fee (up to 75% off).

Items Remaining…. for 30 days:

1.) “The Basics” Chiropractic Medicare Program booklet and DVD

2.) “The Basics” Chiropractic Office Fundamentals Book 12th. Edition

3.) Chiropractic Medicare Audits and Appeals DVD and booklet

4.) Chiropractic HIPAA Forms and CD ready to use

5.) Medicare Chiropractic Compliance Book and CD ready to implement

SPECIAL:

Bundle #4.)  Chiropractic Medicare DVD and Booklet, The Basics Office Fundamentals Book, HIPAA book and CD, Par or Non-Par CD. 

Bundle #5.) The Basics Chiropractic Medicare booklet and DVD, and The Basic Chiropractic Medicare Compliance Book and CD ready to implement.

Other Specials… Chiropractic History:

D.D. Palmer’s Early Years, The Discovery of Chiropractic Presentation book and CD (includes a copy of “Sweet Home” New Boston, Illinois Historic Tour)

Zarbuck’s Chiropractic History. Collected Chiropractic History collected and written by Merwyn V. Zarbuck, D.C. including the historic Chiropractic Parallax. A real collectors piece for any chiropractor interest in chiropractic history. 

Super Special: Only place this Chiropractic History collectors item is available!

            First, D.D. Palmer put together small paper booklets called “The Chiropractor” and later B. J. Palmer continued publishing “The Chiropractor” that was used to produce the first Chiropractic Green Books (even though it was red). Those Palmer booklets are now available as Volume I and Volume II., “The Chiropractor” 1904 to 1906. (These will never be available again after 30 days)

“The Chiropractor” D.D. Palmer Volume 1 and “The Chiropractor” B. J. Palmer Volume II 1904 to 1906 

To order:

Call  1-800-692-4476   You may use: Visa, MasterCard and Discover or paypal.

All items will be available for 30 days or until stock is depleted.

Thank you everybody!!

Seminar in February 2019

New Seminar date!

Date: Thursday, February 21, 2019 Cancelled
Time: 1:00 PM - 5:00 PM
Location: O'Fallon, Illinois
Location address:
 Hilton Garden Inn O'Fallon

For questions please call: (618) 395-3162

June 2018

     Take a few minutes to go to your specific Medicare Carrier website to review and download your carrier’s Local Coverage Determination (LCD).  Even though you have done that in the past....your carrier may change their guidelines at any time.

      Some have been through audits and may have several patients you need to go through for the Appeals process.  You should have received a letter informing you of the invitation to submit an interest for the Low Volume Appeals Settlement.  So....instead of letting the time line pass and lose your appeal opportunity....go to the website they sent to you and follow their specific guidelines.

      Medicare is a good Chiropractic program as long as you know and follow the rules!

***New Seminar Date for June 2018!***

Date: Thursday, June 28, 2018

Time: 1:00 PM - 5:00 PM

Location: Carmel, Indiana

Location address:

 Holiday Inn Express

 9797 North Michigan AVE

 Carmel, IN 46032

Hotel phone: (317) 735-1687 for direction purposes only

To register or for questions please call: (618) 395-3162

Seminars in Washington and Oregon

Date: Saturday, November 4, 2017

Time: 8:30 AM - 12:30 PM

Location: Portland, Oregon

Location address:

 Radisson Hotel Portland Airport

 6233 NE 78th CT

 Portland, OR 97218

Hotel phone: (503) 251-2000 for direction purposes only

To register or for questions please call: (618) 395-3162

Date: Thursday, November 2, 2017

Time: 8:30 AM - 12:30 PM

Location: Pacific, Washington

Location address:

 Quality Inn & Suites

 415 Ellingson Road

 Pacific, WA 98047

Hotel phone: (253) 288-1916 for direction purposes only

To register or for questions please call: (618) 395-3162

End of Year 2016 Seminars

~~~ End of Year 2016 Seminars  ~~~

Date: Thursday, December 1, 2016

Time: 1:00 PM - 5:00 PM

Location: O'Fallon, Illinois

Location address:

Country Inn & Suites

116 Regency Park

O'Fallon, IL 62269

Hotel phone: 618-622-8600 for direction purposes only

To register or for questions please call: (618) 395-3162

Date: Saturday, November 19, 2016

Time: 8:30 AM - 12:30 PM

Location: Portland, Oregon

Location address:

 Holiday Inn-Portland/Airport

 8439 NE Columbia Blvd.

Portland, OR 97220

Hotel phone: (503) 256-5000 for direction purposes only

To register or for questions please call: (618) 395-3162

Date: Thursday, November 17, 2016

Time: 6:00 PM - 10:00 PM

Location: Mukilteo, Washington

Location address:

 Staybridge Suites

9600 Harbour Place

Mukilteo, WA 98275

Hotel phone: (425) 493-9500 for direction purposes only

To register or for questions please call: (618) 395-3162

Date: Thursday, November 17, 2016

Time: 8:30 AM - 12:30 PM

Location: Pacific, Washington

Location address:

 Quality Inn & Suites

 415 Ellingson Road

Pacific, WA 98047

Hotel phone: (253) 288-1916 for direction purposes only

To register or for questions please call: (618) 395-3162

November 2015 Seminars

Date: Thursday, November 19, 2015

Time: 1:00 PM - 5:00 PM

Location: Indianapolis, Indiana

Location address:

 Hampton Inn - Downtown 

105 S Meridian Street

Indianapolis, IN 46225

Hotel phone: (317) 261-1200 for direction purposes only

To register or for questions please call: (618) 395-3162

Date: Saturday, November 14, 2015

Time: 8:30 AM - 12:30 PM

Location: Portland, Oregon

Location address:

 Holiday Inn-Portland/Airport

 8439 NE Columbia Blvd.

Portland, OR 97220

Hotel phone: (503) 256-5000 for direction purposes only

To register or for questions please call: (618) 395-3162

Date: Thursday, November 12, 2015

Time: 6:00 PM - 10:00 PM

Location: Mukilteo, Washington

Location address:

 Staybridge Suites

9600 Harbour Place

Mukilteo, WA 98275

Hotel phone: (425) 493-9500 for direction purposes only

To register or for questions please call: (618) 395-3162

Date: Thursday, November 12, 2015

Time: 8:30 AM - 12:30 PM

Location: Pacific, Washington

Location address:

 Quality Inn & Suites

 415 Ellingson Road

Pacific, WA 98047

Hotel phone: (253) 288-1916 for direction purposes only

To register or for questions please call: (618) 395-3162

New York Seminar 2015

Date: Thursday, September 17, 2015

Time: 1:00 PM - 5:00 PM

Location:  Farmingdale, New York

Location address: Office of Dr. Beth A. John

341 Conklin Street

Farmingdale, NY 11735

Office phone: (516) 249-2310 for direction purposes only

To register or for questions please call: (618) 395-3162

ICD-10 Migration and Episode Care

Chiropractic Medicare 2015

1.  ICD-10 Migration

2. Episode Care

1.  ICD-10 Migration

     On October 1, 2015 the ICD-9 Code sets used to report medical diagnosis and inpatient procedures will be replaced by ICD-10 code sets.  Those using certified software should be compatible with both ICD-9 and ICD-10. Your software company will provide tools to change over to ICD-10 and have the training for the provider to properly code.  If you have questions about your software being able to "Migrate to ICD-10" please call your software company TODAY.

     If you are not paperless, you may wish to print out the ICD-10 codes for your review.  It will print over 60 pages.  As you review, you will soon see very few of the ICD-10 codes will be used in your practice. Review the list and mark your codes.

     The problem for our profession is real. Somewhere around eleven thousand of the 60 thousand practicing Chiropractors became paperless and Medicare compliant.  For those not using certified software, be prepared for major delays in reimbursement by Medicare and insurance companies.  I strongly recommend having ALL your billing up-to-date prior to October 15th of this year.

2.  “Episode”

     Medicare carriers are now reviewing Chiropractic care by “Episode” units.  I have no problem with that. Our job in Medicare is NOT treating patient symptoms, but correcting vertebral subluxations.  As long as you practice like a Chiropractor in Medicare.....the fewer problems you will have. YOUR SUCCESS AND SECURITY IS UP TO YOU!    

     Be a Doctor of Chiropractic........Remember, always tell the truth!   

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.

Be a Chiropractor in Medicare

Be a Chiropractor in Medicare........Where in the federal law does it say we are supposed to “treat” our patient's pain and symptoms like other health care providers? It doesn't!
The federal law says our job as a Chiropractor is to locate and correct vertebral subluxations. So why do some Chiropractors “treat” their patient's symptoms until the symptoms are gone calling the adjustments “maintenance" or "wellness care” and not bill those adjustments for reimbursement? When the Chiropractor adjusts the Medicare patient, correcting vertebral subluxations, that is the covered service in Medicare. The doctor’s job is to learn how to “document” the need for the Chiropractic adjustment so our senior patients are reimbursed.

1. Back to the Basics 2. History Book

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.

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

Newsletter

April 30, 2013

Chiropractic Medicare

"Medicare Learning Network"

(72.9% Chiropractic Medicare Fail Rate)

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

Problem description:

The majority of chiropractic services claims errors in this review were the result of insufficient documentation. Note that the Medicare Fee-for-Service 2011 Improper Payment Rate Report’s finding that insufficient medical record documentation was the most common reason (72.9%) for improper chiropractic payment. (See "The Supplementary Appendices for the Medicare Fee-for-Service 2011 Improper Payment Rate Report," released on November 2, 2012 at http://www.cms.gov/research-Statistics-Data-and-Systems/Monitoring-Programs/CERT-Reports-Items/Nov2011Appendix.html on the CMS website.)

This type of error occurs when the medical records do not contain enough information for the reviewer to make a decision about medical necessity for the item or service furnished. Some common reasons for insufficient documentation errors were:

• The documentation submitted did not adequately describe the service defined by the billed CPT code, Healthcare Common Procedure Coding System (HCPCS) code, or HCPCS modifier;
• The documentation did not include the Date of Service (DOS) or the beneficiary’s name;
• The was no treatment plan documented to support a plan of care;
• The signature was illegible.

Other errors in this special study were categorized as medical necessity errors. These errors occur when the medical records contain sufficient documentation for the reviewer to determine that the services billed were not medically necessary based upon Medicare coverage policies.

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

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

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

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

More ABN discussion

Newsletter from February 18, 2013
“ABN Advanced Notice of Non-coverage”

NOTE: This is the only document in your office that can not be stored electronically. It must stay in the original paper form. Either stored per patient or by date for fast recovery if requested by your Medicare carrier.

THE ABN
It has become my conclusion the ABN in it’s origination has but one primary purpose....to cut reimbursement by the Medicare Carrier. It contains rules that supersede the Federal law of mandatory claim submission. It has led many a Chiropractor down the yellow brick road of “Treating Patient Symptoms” instead of locating and correcting vertebral subluxations like Federal Law indicates.
When a Chiropractor calls the chiropractic adjustment that corrected a vertebral subluxation “Maintenance Care”, and had the patient check Option 2 on the ABN to not bill Medicare because it is called “Maintenance Care” since the patient felt no symptoms...and then collected from the patient, the regular office fee (not the Medicare fee) at the time of visit....Who Got Had?
The consumer (patient) just got cheated out of Medicare reimbursement. They pay over $100 dollar premium for Medicare each month. You say the patient had no symptoms. Consider this, as many as 1,800,000 seniors over the age of 65 may be dependent on Medicare-provided prescription drugs. The average number of prescriptions per year for each senior is 38.5 with the average number of different prescriptions daily being 5 or more.
Most of our patients are on 5, 6, 8, 10 drugs each day....they can not feel their symptoms. And yet, if the patient has no symptoms we just call it “Maintenance Care” and then not bill Medicare. I don’t think so! Our job as Chiropractors is quite clear in Medicare. We do not get paid to “treat” symptoms. We are only paid in Medicare to locate and correct vertebral subluxations.
If the patient have a subluxation and no pain symptoms....How about that subluxation of T6 spinal nerve and the trajectory of that nerve to the stomach, altering the normal function of the stomach. They are already on three prescription drugs for a stomach problem. S.O.A.P. notes shall indicate your findings, and your documentation will support the care given. I recommend, when you correct a vertebral subluxation, call it what it is....The primary job you do, and it is covered by Medicare. Help your patients get reimbursed in Medicare for the Chiropractic covered service of correcting a subluxation.

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.

      

Chiropractic Medicare Federal Guidelines

Newsletter

October 8, 2012

 Chiropractic Medicare

Federal Guidelines and

Seminar Dates: Washington, Oregon, and Florida!

 

 Medicare carriers across America, with the approval of CMS, have and are doing the job on chiropractic care. First, they have led chiropractors away from that inwhich chiropractic is all about, locating and correcting vertebral subluxations.

 

The Federal Guidelines click or follow this link to CMS (Medicare) website:

 http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/bp102c15.pdf

 

The Federal Guidelines indicate the primary and ONLY job of a chiropractor in Medicare is to locate and correct vertebral subluxations. Back in 1973 we were mandated to take x-rays to prove the subluxation and once proven, we were reimbursed to adjust those subluxations. There was and still are NO limits in Medicare for the chiropractic adjustment.


Over the years the Medicare carriers have led the chiropractors down the yellow brick road of “treating” patients symptoms. Developing a “treatment plan” specifically related to the patient’s symptoms and NOT related to the correction of a vertebral subluxation which is indicated by Federal  guidelines.


Now the past years statistics on chiropractors indicate chiropractors treating patient symptoms are doing a poor job of documenting the necessity of treatment care so the Medicare carriers believe we are billing for maintenance care since most chiropractors have no idea the correct way to “document” the chiropractic care necessary.


Chiropractors should practice like chiropractors. Use the patient’s symptoms for diagnosis, locating the problem and decision making, but do not “treat” patient symptoms. There are plenty of other health care provider that ONLY treat symptoms.


Consider this scenario: New 74 year old patient comes into your office for chiropractic care after picking up a box at home hurting his low back. You do the workup including exam and x-rays and find a subluxation of L5. It has only been there 35 years….. you know that because it has proliferating arthritis that has been developing for the past 34 years because he never got it corrected. The L5, S1 articulations has soft tissue insult, swelling, etc., indicating sprain/strain. (diagnosis: 739.3, arthritis, sprain/strain)

This is an exacerbation on a new patient, soft tissue tear in a predisposed chronic subluxated, degenerative joint. By “documenting” this specific event correctly, this exacerbation is worth up to 6 visits. However, if chiropractors listen to our patients and understand the most active patient’s in your practice are your seniors, you will soon find your seniors have all kinds of exacerbations. Your job is to locate the subluxation, document the exacerbation by Federal Guidelines and correct subluxations.

 

Many Medicare carriers across America have stepped up and set specific visit guidelines for Medicare patients. Even though the Federal chiropractic guideline says there are no limits in Medicare for the chiropractic adjustment.

 

If you are in one of these states, (Tennessee, New Jersey, etc.) and you do chiropractic Medicare correctly and meet your carrier limit, go through the appeals process. Once you get to the Administrative Law Judge, if you have done your job like you have learned in our presentation or DVD, you should have a positive return from the ALJ.

 

QUESTIONS OR COMMENTS? Please give me a call.

 

Warmest regards,

Gary R. Street, D.C.

400 S. West Street

Olney, IL 62450

1-800-MY CHIRO

drgrstreet@nwcable.net

www.chiropracticmedicare.com

www.youtube.com/DrGRStreet 
 

Fall Seminar Schedule:

 

11/29/12

King Oscar Hotel, Pacific, WA 8:30 am to 12:30 pm

 

11/29/12

Staybridge Suites Mukilteo-Everett, Mukilteo, WA, 6:00 to 10:00 pm

 

12/1/12

Portland, Oregon Medicare Presentation 8:30 am to 12:30 pm

 

12/8/12

Orlando, Florida Medicare Presentation 8:30 am to 12:30 pm

"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.

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

  ****

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

"Audit....Notes of Interest" ~Newsletter 7/31/12

****

Newsletter

July 31, 2012
Chiropractic Medicare
"Audit....Notes of Interest"

 

"Documentation" requirements for Chiropractic Care following the initial visit, these include:

1.       History:  Review of chief complaint.

a.       Changes since last visit.

b.      System review - if relevant.

2.       Physical Exam:

a.       Examination of area of spine involved in diagnosis.

b.      Assessment of change in patient condition since last visit.

c.       Evaluation of treatment effectiveness.

3.       Documentation of treatment given on day of visit.

 

NOTE:    Documentation cannot be used to substantiate medical necessity retrospectively.  In other words, documentation for medical necessity of care must be produced at time of visit.  Medicare guidelines require that medical need be established prior to providing the service at issue.  The medical record must stand on its own with original records supporting that the billed services is medically necessary and reasonable.

 

Those of you using our information, be sure to complete the "documentation" at time of visit.  If audited, include, with your documentation, the additional requirements listed at the first of this article.

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.