Billing / Insurance / Records

Billing / Insurance / Records tag:typepad.com,2003:weblog-1250480 2008-07-10T09:25:32-07:00 Tips and information. TypePad Congress Pulls Plug on Medicare Fee Cut tag:mpamedia.com,2008:post-54428 2010-01-29T12:00:32-07:00 2010-01-29T12:00:07-07:00

With the holiday recess fast approaching and health care reform legislation its top priority, Congress still managed to do what it has done every year since 2002: prevent scheduled Medicare physician fee cuts from going into effect. In this case, Congress has delayed implementation of the whopping 21.2 percent fee cut until March 1, 2010, and there is wide speculation that the delay sets the stage for a complete overhaul of the current system utilized to determine annual health care provider reimbursement rates for Medicare claims.

By Editorial Staff With the holiday recess fast approaching and health care reform legislation its top priority, Congress still managed to do what it has done every year since 2002: prevent scheduled Medicare physician fee cuts from going into effect. In this case, Congress has delayed implementation of the whopping 21.2 percent fee cut until March 1, 2010, and there is wide speculation that the delay sets the stage for a complete overhaul of the current system utilized to determine annual health care provider reimbursement rates for Medicare claims. How to Retain More of Your Medicare Money tag:mpamedia.com,2008:post-54432 2010-01-29T12:00:32-07:00 2010-01-29T12:00:07-07:00

OK, let's be straight about this: There is no big secret to getting paid by Medicare. Just put an AT modifier after a 98940, 98941 or 98942 in blank 24D on the CMS-1500 form and Medicare will pay you. Of course, getting paid is not the problem; keeping the money after you are paid is the problem. Medicare continues to increase its efforts to review your records and recover money from "overpayments."

By Ronald Short, DC OK, let's be straight about this: There is no big secret to getting paid by Medicare. Just put an AT modifier after a 98940, 98941 or 98942 in blank 24D on the CMS-1500 form and Medicare will pay you. Of course, getting paid is not the problem; keeping the money after you are paid is the problem. Medicare continues to increase its efforts to review your records and recover money from "overpayments." We Get Letters and E-Mail tag:mpamedia.com,2008:post-54445 2010-01-29T12:00:32-07:00 2010-01-29T12:00:07-07:00

Letters from our readers to the editor: Don't Let the Insurance Carriers Drive Away From the Pump; Abusing the Concept of "Wellness"; Cost-Effectiveness Driven by Evidence-Based, Patient-Centered Care. Shifting to a Functional Model in the Digital Delivery of Health Care tag:mpamedia.com,2008:post-54449 2010-01-29T12:00:32-07:00 2010-01-29T12:00:07-07:00

Chiropractic is structure and function, not just symptoms. How many times have you heard a similar phrase used by you or one of your peers? Chiropractors of all practice styles hold a strong conviction that chiropractic is ultimately about functional improvement, regardless of the diversity of ways in which we try to improve that function. And in the near future, we're going to be asked to put our money where our mouth is and prove it to CMS, payer networks and even the federal government. But without adopting the latest technology in clinic management, we won't have the tools to show what we really can do, and that might permanently cut us out of the health care loop.

By Steven Kraus, DC, DIBCN, CCSP, FASA Chiropractic is structure and function, not just symptoms. How many times have you heard a similar phrase used by you or one of your peers? Chiropractors of all practice styles hold a strong conviction that chiropractic is ultimately about functional improvement, regardless of the diversity of ways in which we try to improve that function. And in the near future, we're going to be asked to put our money where our mouth is and prove it to CMS, payer networks and even the federal government. But without adopting the latest technology in clinic management, we won't have the tools to show what we really can do, and that might permanently cut us out of the health care loop. Medicare and the Chiropractic Practice, Part 4 tag:mpamedia.com,2008:post-54387 2010-01-01T12:00:32-07:00 2010-01-01T12:00:07-07:00

Many DCs are unaware (or even unconcerned) about the Medicare medical review (MR) process until they receive notice of audit. This article is to help inform the profession about this process before notice of an audit is received and to give guidance for follow-up. It is strongly encouraged that you retain these articles on file for discussion with your staff and patients.

By Ritch Miller, DC, et al. Many DCs are unaware (or even unconcerned) about the Medicare medical review (MR) process until they receive notice of audit. This article is to help inform the profession about this process before notice of an audit is received and to give guidance for follow-up. It is strongly encouraged that you retain these articles on file for discussion with your staff and patients. Billing Code Updates for the New Year tag:mpamedia.com,2008:post-54390 2010-01-01T12:00:32-07:00 2010-01-01T12:00:07-07:00

Every new year brings about updates and changes to the current coding structures for both diagnosis (ICD-9) and procedure (CPT) codes, and this year does have some changes. However, they are very minor with respect to the common codes and services used by chiropractic providers.

By Samuel A. Collins Every new year brings about updates and changes to the current coding structures for both diagnosis (ICD-9) and procedure (CPT) codes, and this year does have some changes. However, they are very minor with respect to the common codes and services used by chiropractic providers. We Get Letters and E-Mail tag:mpamedia.com,2008:post-54399 2010-01-01T12:00:32-07:00 2010-01-01T12:00:07-07:00

Fraud? Let's Not Be So Hasty. I am starting to get annoyed by the numerous articles and letters speaking about chiropractors involved in insurance fraud. Allegations of insurance fraud are serious accusations, ones which should not be taken lightly. There are certainly more accusations of insurance fraud against chiropractors by the insurance industry. However, we must realize that insurers' definition of fraud may be a self-serving redefinition of normal chiropractic practices. Obviously, they are on the other side of the fence and want to keep (or have refunded) more of the chiropractor's money.

Our health care system is in crisis, and this crisis is creating remarkable opportunity for the chiropractic profession. In fact, the most notable opportunity is something you probably have never heard of: the patient-centered medical home (PCMH) model. If implemented, the PCMH model could restructure the entire health care delivery system, take chiropractors out of the fringe and place them in an integral role in patient management. But there's a catch: We need to embrace the technology that will make it possible.

By Steven Kraus, DC, DIBCN, CCSP, FASA Our health care system is in crisis, and this crisis is creating remarkable opportunity for the chiropractic profession. In fact, the most notable opportunity is something you probably have never heard of: the patient-centered medical home (PCMH) model. If implemented, the PCMH model could restructure the entire health care delivery system, take chiropractors out of the fringe and place them in an integral role in patient management. But there's a catch: We need to embrace the technology that will make it possible. Insider Secrets About Recovery or Postpayment Audits tag:mpamedia.com,2008:post-54363 2009-12-16T12:00:32-07:00 2009-12-16T12:00:07-07:00

In June 2009, I had the privilege of attaining certified professional medical auditor (CPMA) certification as offered by the National Alliance of Medical Auditing Specialists. In a nutshell, I was trained to think, analyze and act in the role of a professional auditor. Admittedly, my purpose in obtaining this certification was not so that I could begin working for an insurance company or third-party entity that audits chiropractic claims and records. Instead, I sought this certification so that I could better understand what the auditors are looking for, learn the methods auditors are using to identify fraudulent or substandard practices, and then apply this knowledge toward helping chiropractors.

By Tom Necela, DC In June 2009, I had the privilege of attaining certified professional medical auditor (CPMA) certification as offered by the National Alliance of Medical Auditing Specialists. In a nutshell, I was trained to think, analyze and act in the role of a professional auditor. Admittedly, my purpose in obtaining this certification was not so that I could begin working for an insurance company or third-party entity that audits chiropractic claims and records. Instead, I sought this certification so that I could better understand what the auditors are looking for, learn the methods auditors are using to identify fraudulent or substandard practices, and then apply this knowledge toward helping chiropractors. We Get Letters and E-Mail tag:mpamedia.com,2008:post-54367 2009-12-16T12:00:32-07:00 2009-12-16T12:00:07-07:00

"When Asked to Give an Adjustment, Sometimes You Have to Say No" appeared in your Oct. 21, 2009 issue, authored by James Edwards, DC. A pull quote that accompanied the article said, "If you are not licensed in the state or country in which you are visiting, do not subject yourself to criminal prosecution, licensing board discipline and financial damage by performing adjustments."

Insurance companies and others hesitant to expand coverage of chiropractic care should review a copy of a report commissioned by the Foundation for Chiropractic Progress and prepared by Mercer Health and Benefits, a San Francisco-based human resources and financial advisor.

By Peter W. Crownfield, Executive Editor Insurance companies and others hesitant to expand coverage of chiropractic care should review a copy of a report commissioned by the Foundation for Chiropractic Progress and prepared by Mercer Health and Benefits, a San Francisco-based human resources and financial advisor. News in Brief tag:mpamedia.com,2008:post-54353 2009-12-02T12:00:32-07:00 2009-12-02T12:00:07-07:00

The American Chiropractic Association and other members of the Patients' Access to Responsible Care Alliance (PARCA) are hailing new legislation that would permanently repeal the Sustainable Growth Rate (SGR) formula used by Medicare to determine annual health care provider reimbursement rates. The Medicare Physician Act of 2009 (S. 1776), introduced on Oct. 13 by Senator Debbie Stabenow (D-Mich.), would "amend title XVIII of the Social Security Act to provide for the update under the Medicare physician fee schedule for years beginning with 2010 and to sunset the application of the sustainable growth rate formula, and for other purposes."

After a substantial delay, the New Jersey Department of Banking and Insurance (DOBI) has issued its final ruling with regard to the administrative action initiated several years ago by the Association of New Jersey Chiropractors (ANJC) against Horizon Blue Cross Blue Shield of New Jersey.

By Editorial Staff After a substantial delay, the New Jersey Department of Banking and Insurance (DOBI) has issued its final ruling with regard to the administrative action initiated several years ago by the Association of New Jersey Chiropractors (ANJC) against Horizon Blue Cross Blue Shield of New Jersey.