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

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

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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.

ABN Discussion

Newsletter
July 23, 2012
Chiropractic Medicare

The basic purpose of Section 1879 of the Social Security Act, the limitation of liability provision (ABN) is to protect the beneficiaries (Patients) from liability in denial cases under certain conditions when items they receive are found to be excluded from coverage as NOT reasonable and necessary under section 1862 (a) (1) (A) of the Federal Security Act.

Where items or services are denied because they are determined to be not reasonable and necessary, the Medicare program makes payment when neither the beneficiary (patient) nor physician or supplier knew, and could not reasonably be expected to know, that the items or services were excluded.

When the beneficiary did not have such knowledge, but the physician or supplier knew, or could have been expected to know of the exclusion of items or services, the liability for the charges for the denied items or services rests with the physician or supplier.

If an ABN is not presented to the patient for those services or supplies that day prior to those services, the doctor will not be reimbursed by the Medicare Carrier if a participating provider and can not receive payment from the patient, or as a non-participating provider, the denial EOB will tell the patient to return to the doctor for a refund of what they paid at time of services. 

http://www.cms.gov/BNI/02_ABN.asp
http://www.cms.gov/MLNProducts/downloads/ABN_Booklet_ICN006266.pdf

The bottom line....the ABN is your friend.  You should make an assessment each office visit.  If you determine any service, covered or not, that you bill to Medicare may be denied today, you have the privilege of asking the patient to take financial responsibility by them signing an ABN today.

My Congressman's office called this morning.... Still waiting on CMS to give to me the official usage of option #2 on the ABN... keep watching.

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It is my goal to help Chiropractors and their staff understand Chiropractic Medicare so they are successful with Medicare, keep out of trouble, provide the adjustments our Medicare patients NEED, and bill claims correctly so we, not only stay in Medicare, but so Chiropractic will be included in future governmental health plans.

I am not a paid consultant.  I have excellent products containing information that may be purchased at a reasonable price.  I also believe in follow-up, so if you purchase some of our products, I will be available by phone or email to do my best to answer any questions you may have.
Thanks,
Dr. Street

If you do not have our information, you can visit our website or give us a call.  You will be so happy you have this information.

Still waiting on CMS to give to me the official usage of option #2 on the ABN... keep watching.

Remember....we all must become Medicare Compliant by the end of this year.

ABN Option #2 ~ Newsletter 7/2/2012

NewsletterJuly 2, 2012Chiropractic MedicareABN Option #2

Since posting my prior newsletters about ABN there has been considerable interests and questions  in regard to Option #2.

Option #2 on the ABN states, "I want the (Blank) listed above, but do not bill Medicare.  You may be asked to be paid now as I am responsible for payment.  I cannot appeal if Medicare is not billed.”

Option #2 is for ONLY non-covered services.

The Chiropractic adjustment is the only covered service for Chiropractors.

 National Government Services issued a "What's New" article on 6/27/12 with their explanation of the understanding of Option #2 as follows:

1. Option #2 of the ABN is to be used when a Chiropractor is providing a service to a Medicare beneficiary that is not going to be covered by Medicare.  The confusion has come in from some that believe Option 2 can only be utilized by the Chiropractor for the patient when the service is statutorily non-covered.  However, that is not the case.

2. The description for Option #2 indicates that the provider has told the beneficiary that Medicare will not cover the service because it does not meet policy criteria; therefore, it will be a non-covered service.  By selecting Option #2 the patient is authorizing that they still want the service to be performed and that they will pay the practitioner for the service.  Option #2 also alerts the beneficiary that a claim will not be filed to Medicare and that they have no appeal options.

3. The misunderstanding is that since the Chiropractic service is a Medicare benefit, just not covered for this specific scenario, that Option #2 should not be used.  The belief is that the Chiropractic adjustment is always a covered service; however it is not always covered, it is simply recognized as a Medicare benefit.  This also leads to the misunderstanding that Chiropractic adjustments must always be billed to the Medicare carrier for consideration.  With the implementation of the new ABN form, this is no longer the case.  Providers are allowed to provide a service to a beneficiary that they know will be non-covered by Medicare according to policy and the patient has the right to still have that service, pay the provider for that service and waive the filing of a claim to Medicare.

4. The Centers of Medicare & Medicaid Services (CMS) Internet-only Manual (IOM) Publication 100-04, Medicare Claims Processing Manual, Chapter 30, Section 50.14.1 (1.07 MB) states that in this situation the provider will not be violating "Mandatory Claim Submission" guidelines:

"Note:  Providers will not violate mandatory claims submission rules under Section 1848 of the Social Security Act when a claim is not submitted to Medicare at the beneficiary's written request in choosing Option #2 on the revised ABN."

If this is true, now the patient has the authority to mark Option #2 and it supersedes "Mandatory Claims Submission" and the "Participating Provider Contract" of not collecting the 80% of the fees at time of visit.  This also denies the patient from reimbursement for the covered service of the adjustment.  It also is another way cut Chiropractic reimbursement.

I am awaiting official explanation from CMS that I shall share as quickly as I receive.

Remember, we all must become Medicare Compliant by the end of this year!

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

Please subscribe to my blog to have the latest newsletter and all my archived newsletters at your fingertips. Comments are encouraged!!

Keep in mind, Medicare is the only insurance type program that if done incorrectly is fraud, a felony, a fine and/or jail.

Resources and further reading:

http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Chiropractors_fact_sheet.pdf

NGS pdf document  "869c_910_Notices_of_Noncoverage.pdf"

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/MM7821.pdf

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.

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