Important: Senior Medicare Discounts

Newsletter
April 22, 2013
Chiropractic Medicare
Important: Senior Medicare Discounts

If you have a health fair....or spinal screening....or some type of special offering in your practice for some type of special at a discounted fee, you can not discriminate against your senior patients. In other words....you can give senior Medicare patients the same discounts as you do your regular patients. If the discount is on non-covered services in Medicare, you can give those seniors the same discounts as your regular patients.

If the discounts are on covered services (98940, 98941, 98942), you can give those discounts to the seniors, however, you must pass those discounts on to the carrier. You can not advertise specifically for Senior discounts for non-covered services to Medicare patients, as doing so is a breach of federal law.

You can advertise discounts for covered services (98940, 98941 and 98942) as long as you pass that discount onto the Medicare Carrier.

Have questions in regards to doing Chiropractic Medicare correctly, or becoming Medicare Compliant? Give me a call. WE WILL DO OUR BEST TO HELP YOU.

(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.

ABN Electronic

Newsletter
March 11, 2013
Chiropractic Medicare
ABN Electronic

ABN: Electronic retention of the signed paper document is acceptable. Notifiers may scan the signed paper version of the ABN for electronic medical record retention and, if desired, give the paper copy to the beneficiary (patient) at time of visit.

Centers of Medicare and Medicare Services (CMS) currently does not have a written policy on the electronic issuance of ABN’s. However, it is not prohibited. These are the CMS recommendations offered to provider/suppliers at this time:

a. If an electronic issuance system is used, the beneficiary (patient) must be given the option of requesting paper issuance over electronic, if that is what he/she prefers.

b. ABN’s can be printed for issuance, the paper copy signed by the beneficiary then scanned for electronic health record (EHR) retention, and the original paper copy can be given to the beneficiary.

IMPORTANT: Electronic issuance system can not be located and used at the front desk. The doctor must see the patient, make an assessment, then the patient may sign the ABN prior to any services today.

The ABN or Advanced Beneficiary Notice of Noncoverage link to the form
http://www.cms.gov/BNI/02_ABN.asp

The ABN or Advanced Beneficiary Notice of Noncoverage information
http://www.cms.gov/MLNProducts/downloads/ABN_Booklet_ICN006266.pdf

EHR, CBR, CAQH

Newsletter
February 25, 2013
Chiropractic Medicare
1. EHR-Registration and Attestation System.
( How much will YOU get paid?)
2. CMS A+ Government Solutions – “Comparative Billing Report, CBR Desseminator.
3. CAQH Update Reminder.
1. Meaningful Use:
We can go through the 15 core operatives, the computerized provider order entry (CPOE), drug-drug and drug-allergy checks, up to date problem list of diagnosis, E-Prescripting (eRx), or maintaining active medication list or allergy list....
Wait....it’s better than this!
First impression is that it is very difficult. Not true. It’s much easier than you think. First, you must have a certified “software”. We use “ChiroTouch”. Your certified software will walk you right through the process so you can register and attest. Don’t wait. If you have not moved on this, you are presently in the final window. You are still able to attest and receive $15,000 incentive dollars for 2013.
2. A+ Government Solutions on contract from CMS has faxed again around 5000 Medicare Comparative Billing reports. If you received by fax, this report, then you are now aware you are above your peers in either the number of visits you are seeing your Medicare patients or the CPT Codes used when billing for your Medicare patients. The report is an effort by CMS to educate providers on their billing patterns, this being helpful as an educational tool which may assist you in identifying opportunities for improvement.
Since the Office of Inspector General believes that billing Medicare with the AT modifier over 12 visits per year is medically unnecessary, and that the likelihood of a service being medically unnecessary increases even more significantly after 24 “treatments”, this report should spark your interest.
I recommend reviewing this report very carefully, compare with your in-house records for the report accuracy. If you find the CMS Comparative Billing Report statistics are incorrect, call them for corrections.
3. CAQH – Just a reminder.....the Universal Provider Data Source must be kept up-to-date. If you need to update the CAQH Universal Provider Data Source https://Upd.caqh.org/oas or Provider help desk at (888) 599-1771. Have your CAQH provider ID available.

CAQH, CMS 855i, and Audits

Newsletter
March 4, 2013
Chiropractic Medicare
CAQH Reminder

Another reminder to update your CAQH Universal Provider Data Source credentialing. To update your application, go to CAQH Universal Provider Data Source https://upd.caqh.org.oas. Failure to update your information may jeopardize the relationship between you and your authorized participating plan.

CMS 855i Application, http://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/CMS-Forms-List.html, another timely form, must be completed every 5 years or anytime you have data change (name, address, etc.). Check your records to be sure your CMS 855i application has not surpassed 5 years. You may not receive a notice from your Medicare carrier, just denial of Medicare claims.

NOTE: Now that the EHR Registration and Attestation System comes to an end, I suspect we again will see Medicare audits. It will be interesting to see if the majority of Medicare audits will be with those Chiropractors that went through the Medicare Attestation and received incentive payments or will be done on those Chiropractors that did not become certified.

2013 Spring Seminar Schedule:
March 21 - Kokomo, Indiana at the Courtyard Hotel Kokomo – 1:00 pm to 5:00 pm, EST.
March 23 – Bluffton, South Carolina at Unitarian Universalist Church – 12:30 pm to 5:30 pm EST.

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.

Judge Approves Change to Medicare Improvement Rule, Health Services

Newsletter from February 15, 2013
Medicare Settlement Means No More “Improve or You’re Out”
Originally Posted on 02/6/2013 by Amy Goyer 
Judge Approves Change to Medicare Improvement Rule, Health Services

     A Federal Judge has approved the proposed Settlement Agreement in the Medicare Improvement Standard case, Jimmo vs. Sebelius, clearing the way for thousands of Medicare beneficiaries to receive needed health services to maintain their current level of functioning.
   
     The settlement, which represents a significant change in Medicare coverage rules, ends Medicare’s longstanding practice of requiring people to show a likelihood of improvement in order to receive coverage of skilled care and therapy services.
   
     The Agreement, which is retroactive to the date of the suite was filed, January 18, 2011, includes skilled services covered by Medicare Part A and Part B, such as speech, occupational and physical therapy, nursing and home health services, even when the goal is maintaining the patient’s current condition rather than requiring that the patient improving.
 
     The Medicare law has never supported the “improvement standard.” Nevertheless, for decades beneficiaries have been denied needed services because they are not improving or have “plateaued”, sometimes with devastating results. The Center for Medicare Advocacy says providing maintenance services will save money in the long run, preventing decline, hospitalizations and need for more expensive services.

     The official approval of the settlement means the Center for Medicare and Medicaid Services (CMS) must develop and implement an education campaign to ensure that Medicare providers are not denying coverage for vital maintenance services to those with any chronic illness who meet other qualifying Medicare requirements.
 
    The “maintenance standard” is effective immediately. Even though we have not seen the official documentation that Chiropractic Maintenance Care is included in this settlement, we are presently requesting a specific answer from CMS. If you or someone you are caring for has a chronic illness or needs skilled services to prevent further deterioration, contact your health provider.

Originally Posted on 02/6/2013 by Amy Goyer, see original link below:
http://blog.aarp.org/2013/02/06/amy-goyer-medicare-pays-for-skilled-therapy-for-maintenance-with-chronic-illness/