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

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

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

You Must Meet the Requirements for Core Measure #15

I need a Security Risk Analysis? What is that? I get calls from Chiropractors or their staff with this question every week. Here is the information and links to help you better understand Core Measure 15.

But first, from: http://www.healthit.gov/providers-professionals/certification-process-ehr-technologies

“The Office of the National Coordinator for Health Information Technology (ONC) Certification Program provides a defined process to ensure that Electronic Health Record (EHR) technologies meet the adopted standards and certification criteria to help providers and hospitals achieve Meaningful Use (MU) objectives and measures established by the Centers for Medicare and Medicaid Services (CMS).

Eligible professionals and eligible hospitals who seek to qualify for incentive payments under the Medicare and Medicaid EHR Incentive Programs are required to use certified EHR technology.”

Translation: The Certified Software you purchased is required to meet certain criteria in order to be a Certified Technology by the ONC. The job of the software is to help you meet all of the requirements. They are all set up basically the same and have training requirements, video tutorials, how-to documents, and support staff available to you. It is important and necessary to use not only the software but to use the training and support available to your office.

The Core Measure #15, also referred to as “Protect Electronic Heath Information”, or “Security and Risk Analysis”

This Core Measure has been wreaking havoc on Chiropractors. It isn’t a number to report found on your Dashboard. It’s a report or template that should be provided by your software company and completed in your office during the reporting period. A security risk analysis comprises the following parts: Risk Analysis, Risk Management, Sanction Policy, and Information Systems Activity Review. Think of it as an audit of your software and how you and your staff are protecting the fragile information contained therein. It should be easy to get these 4 templates or forms, run the audit, complete the forms, and file them in a safe place. The problem is most offices skip this step, and attest “YES” anyway. Later, when asked by CMS to provide their Risk Analysis they fail to provide and have to pay their incentive back.

The Measure states: “Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308(a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process.”

Going further, below you will find better description of the 4 things you need:

(From: http://www.gpo.gov/fdsys/pkg/CFR-2003-title45-vol1/pdf/CFR-2003-title45-vol1-sec164-308.pdf)

164.308(a)(1)(i) Standard: Security Management Process. Implement policies and procedures to prevent, detect, contain, and correct security violations.
(ii) Implementation specifications:
(A) Risk analysis (Required) - Conduct an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of electronic protected health information held by the covered entity
(B) Risk management (Required) - Implement security measures sufficient to reduce risks and vulnerabilities to a reasonable and appropriate level to comply with 164.306(a). (Link found here: http://www.gpo.gov/fdsys/pkg/CFR-2010-title45-vol1/pdf/CFR-2010-title45-vol1-sec164-306.pdf)
(C) Sanction policy (Required) - Apply appropriate sanctions against workforce members who fail to comply with the security policies and procedures of the covered entity.
(D) Information system activity review (Required) - Implement procedures to regularly review records of information system activity, such as audit logs, access reports, and security incident tracking reports.

*****

More links regarding Core Measure #15. Some are full of long explanations, but still full of information.  

http://www.hitechanswers.net/meaningful-use-measure-and-hipaa/
http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/SecurityRiskAssessment_FactSheet_Updated20131122.pdf
http://www.healthit.gov/sites/default/files/pdf/privacy/privacy-and-security-guide.pdf
http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/rafinalguidancepdf.pdf
http://www.youtube.com/watch?v=ml4okcBxN6c
http://www.youtube.com/watch?v=1fDvzznChhg

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.

Mandatory Revalidation, PECOS, CMS-855, and CMS-588

Newsletter
May 13, 2013
Chiropractic Medicare
Mandatory Revalidation
Many fellow Chiropractors across the states are receiving a Provider Enrollment Revalidation Request from your Medicare Carrier. They are asking us to immediately submit updated Provider Enrollment Paper Application 855 form or Review, Update and Certify information via the internet-based PECOS System.

The Patient Protection and Affordable Care Act, Section 6401, says all new and existing providers must be reevaluated under the new screening guidelines. Medicare requires all enrolled providers and suppliers to revalidate enrollment information every five (5) years. Upon the CMS request to revalidate it’s enrollment, the provider has 60 days from the postmark date of your official letter from your carrier to submit complete enrollment information using one of the following methods:

1. Internet-based Provider Enrollment, claim, and Ownership System (PECOS). https://pecos.cms.hhs.gov.

2. Paper Application Form CMS-855. http://www.cms.gov/MedicareProviderSupeEnroll.

The new Electronic Funds Transfer (EFT) authorization form CMS-588 is now required to be part of the revalidation package. (for both participating and non-participating providers.)

CMS-588 form can be found at http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS588.pdf.

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." WE WILL DO OUR BEST TO HELP YOU.

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"!

(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.

IMPORTANT DEADLINE 12-12-12 FOR PQRS

Newsletter
December 11, 2012
IMPORTANT DEADLINE 12-12-12 FOR PQRS
(Physician Quality Reporting System)

 

The Chiropractors in our Chiropractic profession have worked for over 100 years to help Chiropractic grow and be accepted by the public. We have been very successful in being included into insurance plans, Medicare, Medicaid, PPO's, etc. However, now that we are in Medicare we have to meet qualifications and demands by the Federal Government to take part in reporting certain quality measures due to healthcare reform.

Please see link to the CMS Website for more information about PQRS (Physician Quality Reporting System):
 https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/downloads/2012PQRS_SatisfRprtng-Claims_Final508_1-13-2012.pdf

To determine if you are eligible to participate in PQRS:  
https://www.cms.gov/PQRS

Even though it is a voluntary program with incentives, it is also a program that will take away from your future earnings if you do not participate.

My guess is about 5 Chiropractors out of every 25 are participating in PQRS. This is NOT A GAME! This is serious business! We are going into the final window of opportunity.

The Physicians Quality Reporting System (PQRS), was introduced by the Centers for Medicare and Medicaid Services, and a new part of healthcare reform. The program created in 2007, established a financial incentive to eligible healthcare professionals to participate in a voluntary quality reporting program. Providers who participate and report quality measures receive a 0.5% payment incentive.

Why is it so important? CMS recently ruled that providers not successfully participating in PQRS by 2013 reporting period (January 1 - December 31, 2013), will have their Medicare reimbursement decreased by 1.5% beginning in 2015, and 2% in 2016. The 2012 reporting period is the last opportunity providers have to voluntarily participate.

It is easier than you think. However, it requires a certified software company to walk you through the paces. Please follow the links and get informed.

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.

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

****
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. 

MAY Newsletters 2012

MAY Newsletters

(Sent out May 7th, 14th, 21st and 30^th)

Chiropractic Medicare

Sent May 7^th, 2012

"Some Medicare Carriers have limited Chiropractic!"

Dear Doctors and Staff,

The Medicare Carrier of Tennessee has posted their draft indicating "Chiropractic limitations" as 25 chiropractic visits per year.  The Medicare Carrier in "New Jersey" posted guidelines limiting chiropractic visits to 30 per year.  I am sure other carriers have created "in house" chiropractic limits that I am not aware of presently.

However, to my knowledge, CMS has issued NO limits on Chiropractic Care as long as the adjustments are medically necessary.  That simply means the state Medicare Carriers have posted limitation on Chiropractic illegally.  Who's to stop them?  CMS does not seem to care that the Medicare Carriers are breaching Federal law by these limitations.

In each state, when the Medicare Carrier creates Chiropractic limitations, the State Chiropractic Associations and Societies should file complaints with their Congressmen and Senators to get it stopped. IT MUST BE STOPPED NOW!!!

Even if there WERE TO BE limitations of 25 or 30 visits per year, we still must know the correct way to do Medicare and we still must become compliant in Medicare by the end of 2012.  Because the error rate on Chiropractic billing and documentation has been in the 60% to 99%, those reports were issued by the Inspector General to Congress.  If we are to stay in Medicare and also in the new insurance program (Obama Care), we have to prove we are smart enough to be part of the program.

Most Chiropractors and staff believe they are doing Medicare correctly, however, statistics indicate most are not.  If you think you are doing Medicare correctly, however, not sure, give me a call and we will talk about it! With 34 years of Chiropractic Medicare experience, those that have learned to do Medicare correctly are having very little trouble with getting paid and are also being successful with audits.

My recommendation is simple....beg, borrow, steal or purchase "The Basics" Chiropractic Medicare DVD and booklet so you know how Medicare works and so you know how to "document" the Chiropractic necessity of care.

If you are going to stay in practice after 2013, you also must become compliant in Medicare.  You may wish to consider the Medicare Compliance book and CD. It's ready to start you and your staff on the way to becoming compliant.  Sooner or later you have to do this. May as well make it sooner and save the trouble and heartache.

Consider "The Basics" Chiropractic Medicare DVD and booklet.  And since we also must become Medicare compliant by the end of 2012, consider our bundle which includes the Chiropractic Medicare Compliance CD and booklet.  Protect yourself....it's up to you to do it correctly. Don't fool around or procrastinate!!!!  Get this information TODAY!!

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

Post Script NOTE: (Illinois Chiropractors) WPS has lost it's Medicare Carrier contract. The new Medicare Carrier in Illinois is CIGNA. Each will be notified.

      

Spring 2012 Seminar Schedule:

*Thursday, May 17, 1:00 pm - 5:00 pm at Hampton Inn-Downtown, Indianapolis, IN

  (4 hrs. Risk Management Continued Education - add $35.00 to registration)

*Thursday, May 24, 8:30 am - 12:30 pm at King Oscar Hotel, 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

*Thursday, June 21, 8:00 am - 12:00 pm at Comfort Inn & Suites, Mount Laurel, NJ

*Thursday, June 21, 5:00 pm - 9:00 pm at Holiday Inn, Saddle Brook, NJ

*Saturday, June 23, 8:00 am -12:00 pm at Holiday Inn Express University, Albany, NY

*Thursday, June 28, 8:30 am - 12:30 pm at Holiday Inn Express, Mishawaka, IN

  (4 hrs. Risk Management Continued Education - add $35.00 to registration)

Sent May 14^th, 2012

Dear Doctors and Staff,

This week, Thursday, we will be in Indianapolis, IN, 1:00 pm to 5:00 pm for a four hour Continued Education credited Chiropractic Medicare presentation.  Those attending will receive 4 hours CE credits certificate, examples in our Seminar booklet and Chiropractic Compliance Guidelines booklet.

Next week we will be in the State of Washington at Pacific and Everett on May 24th and Spokane on May 26th.  All three are sponsored by South King County Chiropractic Society and WCA with 4 CE credits.

These presentations are important.  Those attending get the idea of the correct way to do Chiropractic Medicare.  They return to their offices, correct errors, implement what they learn, and are successful with Medicare....plus sleeping good at night.

To my knowledge, I have not yet met the Chiropractor or staff that was already aware of the "documentation" used successfully in Medicare before attending our presentation or studying or DVD.  So when my fellow Chiropractors tell me they are doing Chiropractic Medicare correctly and talk about their S.O.A.P. note documentation....it becomes obvious there is a problem!

After last weeks Medicare article, we received several emails indicating several other state Medicare Carriers have placed limitations on the chiropractic adjustments. That guideline change limiting chiropractic coverage has not officially been adopted by CMS.

The biggest problem is that Chiropractors believe they are doing Medicare right because they are getting paid.  (As long as you bill a "clean claim" most Medicare Carriers pay that claim and audit later by request of patient records.) So now many chiropractors are not interested until they have a Medicare audit and fail. (Remember...the Chiropractic Medicare error rate is 67% to 97% of ALL claims.) Now the STAFF is under pressure to make thing happen in Medicare since claims are not being paid and the office has to send patient records to the carrier.

Also, filed claims are denied by the carrier.  Even if the claim is billed correctly...some are denied, even first visit.  The appeals process should be used.  However, the majority of our profession has no idea about the five levels of Appeal and they give up after the first one or two levels are denied by the carrier.

Procrastination is dangerous when dealing with a federal program.  You must do it correctly or you either pay back money or lose the program.

Sent May 21^st, 2012

"Getting It Right!"

Dear Doctors and Staff,

We are very happy to receive reports back from our fellow Chiropractors in regards to the success with audits and reviews.  Those Chiropractors and Staff that have our information, by either attending seminars or the purchase of our DVD and booklet, are very successful.  The reason being they are doing Medicare correctly.

Medicare carriers in each state are implementing visit restrictions for chiropractic care. The Federal Law indicates there are NO limits in Medicare for the chiropractic adjustment as long as it is Medically necessary. Since very few chiropractors know the correct way to "Document the Chiropractic Necessity of Care", we are now facing those limits by default. Nobody is challenging the Medicare carriers and they are getting away with unlawful limits.

However, sometimes even if you do Medicare correctly you may receive denials from your Medicare Carrier. When that happens, review your claims for any errors and file an appeal.

Remember, the first two (2) steps of the appeals process is still with your Medicare Carrier. The third step requires a review by an administrative law judge OUTSIDE your Medicare Carrier. Nearly always you will be successful... especially if you have our material since our documentation has been approved by the administrative law judges.

Sent May 30^th, 2012

"Do It Correctly - or Lose!"

Dear Doctors and Staff,

The Medicare Carriers that have placed limits on the number of Chiropractic adjustments per patient per year have demanded we Chiropractors do it right....or we lose.

There are NO limits for the Chiropractic adjustments in the Medicare program.  However, each Medicare Carrier may establish in-house limits that we can exceed if we do Chiropractic Medicare correctly and challenge the carrier through the Appeals Process.

If you are actually doing Chiropractic Medicare correctly and wade through the Appeals Process to the Administrative Law Judge Appeals level, you should win each challenge.

(The problem with the Appeals process is that the first two stages are still with the Medicare carrier and usually denied. Most chiropractors give up before it goes to the third step with the Administrative Law Judge.)  If you are NOT doing Medicare correctly, you will lose in the Appeals, even through the Administrative Law Judge (ALJ).

If you still believe your S.O.A.P. notes are “documentation” in Medicare, then you will learn the hard way which will cost you some big bucks.

I strongly suggest that you consider three important items we have to offer:

1.      "The Basics" Chiropractic Medicare DVD and booklet.  This contains everything you and your staff must know to do Medicare correctly.

2.      The Audit and Appeals Process DVD and booklet.  If you are going to know how to defend yourself in an audit, this item walks you through the Appeals Process so you don't "give up" before you win.

  3. Chiropractic Medicare Compliance CD and booklet.  We all must become compliant by the end of 2012.  We have it completed.  It is ready for you to implement it into your practice.  The faster the better to become compliant.

A couple of notes from fellow Chiropractors:

May 14, 2012

Hey Doc, 

Just wanted to let you know that I won my ALJ decision for my audits going back to end of 2010 and early 2011!  You said I would, and I must say, I had my doubts the way things are going here in NY.  They found 100% in my favor.  Thanks for your help throughout the process.  I truly appreciate it.

All the best,

Ed Casper, DC

May 22, 2012

To Whom It May Concern:

It was a great blessing running into Dr. Street 7 years ago.

He was like a prophet with his predictions about where Medicare and Chiropractic would go.

We have followed his recommendations to a T.  It is nice for patients to know what their financial responsibility is and which services are the responsibilities of Medicare.

His procedures are efficient and ethical with no "gimmicks".

Outside of cumbersome paperwork, Medicare audits go through like a breeze by following Dr. Street's procedures.

If you are a Chiropractor who is a Medicare provider, you cannot afford to not attend this seminar.

Sincerely,

Dr. Joseph Clauss

Dr. Carolyn Clauss

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

"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