Billing / Insurance / Recordstag:typepad.com,2003:weblog-12504802008-07-10T09:25:32-07:00Tips and information.TypePadA Warning That Bears Repeatingtag:mpamedia.com,2008:post-545292010-03-12T12:00:32-07:002010-03-12T12:00:07-07:00In talking with doctors and some new vendors, I've discovered that a disturbing trend appears to be re-emerging. While you probably already know about this, it is worth repeating, even if it only serves as a reminder.
Early in the last decade, a Canadian company began selling Web sites with an e-commerce component. The package was very attractive in that a doctor didn't need to do anything to manage the e-commerce portion of their site. The Web site company had already created a relationship with one of the top chiropractic distributors and was going to sell its products to doctors' patients through each doctor's site. The doctor would receive a percentage of every sale simply for giving the Web site company the ability to sell on their site. The commissions from the sales were expected to more than pay for the Web site.By Donald M. Petersen Jr., BS, HCD(hc), FICC(h), PublisherIn talking with doctors and some new vendors, I've discovered that a disturbing trend appears to be re-emerging. While you probably already know about this, it is worth repeating, even if it only serves as a reminder.
Early in the last decade, a Canadian company began selling Web sites with an e-commerce component. The package was very attractive in that a doctor didn't need to do anything to manage the e-commerce portion of their site. The Web site company had already created a relationship with one of the top chiropractic distributors and was going to sell its products to doctors' patients through each doctor's site. The doctor would receive a percentage of every sale simply for giving the Web site company the ability to sell on their site. The commissions from the sales were expected to more than pay for the Web site.A Billion Dollar Opportunity for Chiropractorstag:mpamedia.com,2008:post-545322010-03-12T12:00:32-07:002010-03-12T12:00:07-07:00Truck driver exams, Department of Transportation (DOT) and non-DOT alcohol and drug testing are the vehicle for all chiropractic physicians to significantly increase their income and fill open appointments. The chiropractic profession has a significant competitive edge over all other providers. That competitive edge will cause a detour in where upwards of $1 billion per year will be spent.By Michael Megehee, DCTruck driver exams, Department of Transportation (DOT) and non-DOT alcohol and drug testing are the vehicle for all chiropractic physicians to significantly increase their income and fill open appointments. The chiropractic profession has a significant competitive edge over all other providers. That competitive edge will cause a detour in where upwards of $1 billion per year will be spent.Biomechanics: The Swiss Army Knife of Forensic Evaluationtag:mpamedia.com,2008:post-545382010-03-12T12:00:32-07:002010-03-12T12:00:07-07:00One of the most frustrating aspects of patient care is watching your patient's legal claim go down in flames. Often they become saddled with your medical bill and others they expected the responsible insurer would pay. Adding insult to injury, many states have a statutory offer system in place whereby one party must pay the other party's legal fees if they fail to recover more than what was offered to them prior to an arbitration or trial. This is just one of the factors driving plaintiffs to accept low settlement offers. The fallout often affects the treating doctors, who are then asked to take a cut in their fees.By Arthur Croft, DC, MS, MPH, FACOOne of the most frustrating aspects of patient care is watching your patient's legal claim go down in flames. Often they become saddled with your medical bill and others they expected the responsible insurer would pay. Adding insult to injury, many states have a statutory offer system in place whereby one party must pay the other party's legal fees if they fail to recover more than what was offered to them prior to an arbitration or trial. This is just one of the factors driving plaintiffs to accept low settlement offers. The fallout often affects the treating doctors, who are then asked to take a cut in their fees.How Patients Are Taking Charge of Their Own Health Recordstag:mpamedia.com,2008:post-545022010-02-26T12:00:32-07:002010-02-26T12:00:07-07:00Ever have one of your patients enter your office with a binder of medical paperwork? They have old X-rays, MRIs, and reports, articles downloaded from the Internet, and copies of correspondence between their GP and four different specialists. They've been through it all, and rather than just tell you their history, they're actually bringing along the data to prove it. Now imagine this same scenario not with one complex patient every once and awhile, but with every new patient, every single day. The day is coming with personal health records (PHRs). It could transform your practice, because PHRs are well on their way to transforming our patients.By Steven Kraus, DC, DIBCN, CCSP, FASAEver have one of your patients enter your office with a binder of medical paperwork? They have old X-rays, MRIs, and reports, articles downloaded from the Internet, and copies of correspondence between their GP and four different specialists. They've been through it all, and rather than just tell you their history, they're actually bringing along the data to prove it. Now imagine this same scenario not with one complex patient every once and awhile, but with every new patient, every single day. The day is coming with personal health records (PHRs). It could transform your practice, because PHRs are well on their way to transforming our patients.The "Perfect" SOAP Note: A Chiropractic Holy Grailtag:mpamedia.com,2008:post-545072010-02-26T12:00:32-07:002010-02-26T12:00:07-07:00Following my last column ("Insider's Secrets About Recovery or Postpayment Audits," Dec. 16, 2009), I received a boatload of e-mail inquiries in regards to audit protection or prevention strategies. The most common question in this regard was an interesting variation of the quest for the chiropractic Holy Grail: the "perfect SOAP note." Much like the Holy Grail of Arthurian legend, the assumption by many DCs is that such an instrument, example or software program (if it exists) would make the chiropractor invincible from all documentation denials or audits.By Tom Necela, DCFollowing my last column ("Insider's Secrets About Recovery or Postpayment Audits," Dec. 16, 2009), I received a boatload of e-mail inquiries in regards to audit protection or prevention strategies. The most common question in this regard was an interesting variation of the quest for the chiropractic Holy Grail: the "perfect SOAP note." Much like the Holy Grail of Arthurian legend, the assumption by many DCs is that such an instrument, example or software program (if it exists) would make the chiropractor invincible from all documentation denials or audits.How to Retain More of Your Medicare Money, Part 2tag:mpamedia.com,2008:post-545152010-02-26T12:00:32-07:002010-02-26T12:00:07-07:00The next step in keeping the money Medicare pays you is documenting medical necessity. The key element that Medicare is looking for regarding medical necessity is the treatment plan. The May 2009 OIG report stated that the treatment plan was an area of deficiency. Twenty four percent of the records didn't even contain a treatment plan. Of those that did, 43 percent lacked treatment goals, 17 percent lacked objective measures and 15 percent lacked the recommended level of care.By Ronald Short, DCThe next step in keeping the money Medicare pays you is documenting medical necessity. The key element that Medicare is looking for regarding medical necessity is the treatment plan. The May 2009 OIG report stated that the treatment plan was an area of deficiency. Twenty four percent of the records didn't even contain a treatment plan. Of those that did, 43 percent lacked treatment goals, 17 percent lacked objective measures and 15 percent lacked the recommended level of care.Billing for Modalitiestag:mpamedia.com,2008:post-544742010-02-12T12:00:32-07:002010-02-12T12:00:07-07:00Question: I am concerned about billing for modalities, as they seem more likely to be denied than paid. What can I do to get paid, and is there something else I should be doing to help the process?By Samuel A. CollinsQuestion: I am concerned about billing for modalities, as they seem more likely to be denied than paid. What can I do to get paid, and is there something else I should be doing to help the process?Congress Pulls Plug on Medicare Fee Cuttag:mpamedia.com,2008:post-544282010-01-29T12:00:32-07:002010-01-29T12:00:07-07:00With 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 StaffWith 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 Moneytag:mpamedia.com,2008:post-544322010-01-29T12:00:32-07:002010-01-29T12:00:07-07:00OK, 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, DCOK, 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-Mailtag:mpamedia.com,2008:post-544452010-01-29T12:00:32-07:002010-01-29T12:00:07-07:00Letters 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.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 Caretag:mpamedia.com,2008:post-544492010-01-29T12:00:32-07:002010-01-29T12:00:07-07:00Chiropractic 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, FASAChiropractic 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 4tag:mpamedia.com,2008:post-543872010-01-01T12:00:32-07:002010-01-01T12:00:07-07:00Many 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 Yeartag:mpamedia.com,2008:post-543902010-01-01T12:00:32-07:002010-01-01T12:00:07-07:00Every 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. CollinsEvery 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-Mailtag:mpamedia.com,2008:post-543992010-01-01T12:00:32-07:002010-01-01T12:00:07-07:00Fraud? 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.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.Using Technology to Manage Patients in the Medical Home Modeltag:mpamedia.com,2008:post-544062010-01-01T12:00:32-07:002010-01-01T12:00:07-07:00Our 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, FASAOur 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.