tag:typepad.com,2003:weblog-1250480 %ISSUE_DATE%T09:25:32-07:00 Tips and information. TypePad tag:mpamedia.com,2008:post-55712 2012-01-15T12:00:32-07:00 2012-01-15T12:00:07-07:00

Congenital anomalies of the spine are common radiographic findings - common enough, in fact, that the developers of the ICD-9-CM coding system thought it necessary to assign diagnosis codes to a small group of them. This select list of anomalies is found in the ICD-9-CM under congenital disorders and codes 756.10 through 756.19.

By K. Jeffrey Miller, DC, DABCO and Ray Tuck, DC Congenital anomalies of the spine are common radiographic findings - common enough, in fact, that the developers of the ICD-9-CM coding system thought it necessary to assign diagnosis codes to a small group of them. This select list of anomalies is found in the ICD-9-CM under congenital disorders and codes 756.10 through 756.19. tag:mpamedia.com,2008:post-55700 2012-01-29T12:00:32-07:00 2012-01-29T12:00:07-07:00

Each year, the Office of Inspector General (OIG) releases its annual Work Plan for the fiscal year, which details new and ongoing reviews that will be conducted in federal programs such as Medicare. In plain English, the annual OIG work plan gives you a pretty good idea of which areas auditors will be looking at in the upcoming year.

By Tom Necela, DC Each year, the Office of Inspector General (OIG) releases its annual Work Plan for the fiscal year, which details new and ongoing reviews that will be conducted in federal programs such as Medicare. In plain English, the annual OIG work plan gives you a pretty good idea of which areas auditors will be looking at in the upcoming year. tag:mpamedia.com,2008:post-55661 2011-12-16T12:00:32-07:00 2011-12-16T12:00:07-07:00

Medicare's increasingly criticized sustainable growth rate (SGR) formula has determined the latest physician fee cut, scheduled to take effect Jan. 1, 2012, and as usual, it's not pretty: a 27.4 percent reduction in fees for health care providers across all disciplines (which is actually an improvement from the 29.5 percent cut originally projected earlier this year). Rather than waiting until the proverbial 11th hour for Congress to stave off the fee cuts and preserve the current reimbursement rate (perhaps with a slight increase, as has been the case in the past), Health and Human Services (HHS) has issued a statement calling for a long-term solution.

By Editorial Staff Medicare's increasingly criticized sustainable growth rate (SGR) formula has determined the latest physician fee cut, scheduled to take effect Jan. 1, 2012, and as usual, it's not pretty: a 27.4 percent reduction in fees for health care providers across all disciplines (which is actually an improvement from the 29.5 percent cut originally projected earlier this year). Rather than waiting until the proverbial 11th hour for Congress to stave off the fee cuts and preserve the current reimbursement rate (perhaps with a slight increase, as has been the case in the past), Health and Human Services (HHS) has issued a statement calling for a long-term solution. tag:mpamedia.com,2008:post-55612 2011-11-04T12:00:32-07:00 2011-11-04T12:00:07-07:00

"I thought my records were excellent," said Doctor Joe. "So I wasn't worried when I got the letter from CMS requesting copies of several patient records. I photocopied all the required records and sent them in. Imagine my shock when I got the results of the audit back from CMS! Here's what they said:

By Ritch Miller, DC and Susan McClelland, Esq. "I thought my records were excellent," said Doctor Joe. "So I wasn't worried when I got the letter from CMS requesting copies of several patient records. I photocopied all the required records and sent them in. Imagine my shock when I got the results of the audit back from CMS! Here's what they said: tag:mpamedia.com,2008:post-55611 2011-11-04T12:00:32-07:00 2011-11-04T12:00:07-07:00

For starters, I agree with cartoonist Walt Kelly on enemy #1: "We have met the enemy and he is us." After that, most DCs would list new patients, the economy, insurance reimbursements, high deductibles, paperwork, patient retention or a variety of other gremlins as their most frustrating daily foil that causes headaches, reduces profitability and decreases the quantity of satisfaction in practice. All those items are valid obstacles, but none is enemy #2.

By Tom Necela, DC For starters, I agree with cartoonist Walt Kelly on enemy #1: "We have met the enemy and he is us." After that, most DCs would list new patients, the economy, insurance reimbursements, high deductibles, paperwork, patient retention or a variety of other gremlins as their most frustrating daily foil that causes headaches, reduces profitability and decreases the quantity of satisfaction in practice. All those items are valid obstacles, but none is enemy #2. tag:mpamedia.com,2008:post-55591 2011-10-21T12:00:32-07:00 2011-10-21T12:00:07-07:00

What must chiropractic offices do to be prepared for the upcoming ANSI 5010 standards, electronic health records and the ICD-10? I have heard this is all a part of the same thing and want to make sure I am not left behind.

By Samuel A. Collins What must chiropractic offices do to be prepared for the upcoming ANSI 5010 standards, electronic health records and the ICD-10? I have heard this is all a part of the same thing and want to make sure I am not left behind. tag:mpamedia.com,2008:post-55588 2011-10-21T12:00:32-07:00 2011-10-21T12:00:07-07:00

In May 2009, the English agency National Institute for Health and Clinical Excellence (NICE) produced a guideline you're probably not aware of here in the U.S.: Low Back Pain: Early Management of Persistent Non-Specific Low Back Pain.

By Donald M. Petersen Jr., BS, HCD(hc), FICC(h), Publisher In May 2009, the English agency National Institute for Health and Clinical Excellence (NICE) produced a guideline you're probably not aware of here in the U.S.: Low Back Pain: Early Management of Persistent Non-Specific Low Back Pain. tag:mpamedia.com,2008:post-55556 2011-09-23T12:00:32-07:00 2011-09-23T12:00:07-07:00

First convened in September 2007, the Chiropractic Summit represents leadership from some 40 organizations within the profession. The Summit meets regularly to collaborate, seek solutions, and support collective action to address challenges with the common goal of advancing chiropractic. A major focus of the Summit is to improve practitioner participation, documentation, and compliance within the Medicare system. This article, the 10th in an ongoing series on Medicare participation and documentation, answers frequently asked questions regarding Medicare enrollment and the Internet-based Provider Enrollment, Chain and Ownership System (PECOS).

By Ritch Miller, DC and Susan McClelland, Esq. First convened in September 2007, the Chiropractic Summit represents leadership from some 40 organizations within the profession. The Summit meets regularly to collaborate, seek solutions, and support collective action to address challenges with the common goal of advancing chiropractic. A major focus of the Summit is to improve practitioner participation, documentation, and compliance within the Medicare system. This article, the 10th in an ongoing series on Medicare participation and documentation, answers frequently asked questions regarding Medicare enrollment and the Internet-based Provider Enrollment, Chain and Ownership System (PECOS). tag:mpamedia.com,2008:post-55519 2011-09-09T12:00:32-07:00 2011-09-09T12:00:07-07:00

Hartford, Conn.-headquartered Aetna, whose open-access HMO in Connecticut operates as Aetna Health, Inc., made a big mistake - whether accidental or intentional is subject to great speculation - when it partnered with American Specialty Health Networks and began providing chiropractic to plan members: It ignored Connecticut law, which requires that any and all services provided by a medical doctor and eligible for reimbursement be equally reimbursed when provided by a doctor of chiropractic pursuant to their scope of practice.

By Editorial Staff Hartford, Conn.-headquartered Aetna, whose open-access HMO in Connecticut operates as Aetna Health, Inc., made a big mistake - whether accidental or intentional is subject to great speculation - when it partnered with American Specialty Health Networks and began providing chiropractic to plan members: It ignored Connecticut law, which requires that any and all services provided by a medical doctor and eligible for reimbursement be equally reimbursed when provided by a doctor of chiropractic pursuant to their scope of practice. tag:mpamedia.com,2008:post-55516 2011-09-09T12:00:32-07:00 2011-09-09T12:00:07-07:00

Are you letting managed care organizations abuse you and your patients? In early network participation agreements, we were asked to discount our fees for the privilege of becoming a "preferred provider." These were simple financial decisions. How much will you discount your fees for the opportunity to see more patients? Losing some money was frustrating, but the decision did not require that we compromise our principles on patient care.

By Richard L. Cole, DC, DACNB, DAAPM, FIACN Are you letting managed care organizations abuse you and your patients? In early network participation agreements, we were asked to discount our fees for the privilege of becoming a "preferred provider." These were simple financial decisions. How much will you discount your fees for the opportunity to see more patients? Losing some money was frustrating, but the decision did not require that we compromise our principles on patient care. tag:mpamedia.com,2008:post-55494 2011-08-26T12:00:32-07:00 2011-08-26T12:00:07-07:00

Low back pain is a worldwide epidemic in human suffering and as a result, an economic burden to federal, state, public and self-insured risk-takers who insure the injured. In 2009, Russo, Weir and Elixhauser1 reported that 3.9 of every 1,000 people ages 55-64 years require a hospital stay for low back pain - the number-eight reason for hospital stays, closely behind cardiac conditions and degenerative arthritis. While low back pain has been well-chronicled, recurring low back pain and the necessity for chronic care is now beginning to realize results that necessitate the proper approach to mitigate its frequency, duration and economic impact.

By Mark Studin, DC, FASBE(C), DAAPM, DAAMLP Low back pain is a worldwide epidemic in human suffering and as a result, an economic burden to federal, state, public and self-insured risk-takers who insure the injured. In 2009, Russo, Weir and Elixhauser1 reported that 3.9 of every 1,000 people ages 55-64 years require a hospital stay for low back pain - the number-eight reason for hospital stays, closely behind cardiac conditions and degenerative arthritis. While low back pain has been well-chronicled, recurring low back pain and the necessity for chronic care is now beginning to realize results that necessitate the proper approach to mitigate its frequency, duration and economic impact. tag:mpamedia.com,2008:post-55486 2011-08-26T12:00:32-07:00 2011-08-26T12:00:07-07:00

With a priority on investing as much of every dollar on patient care as possible, doctors of chiropractic are looking for cost-effective ways to reduce capital expenditures as their practices grow and exit the Internet technology (IT) business. Moving IT services to the cloud offers a compelling alternative to provisioning IT the traditional way. Instead of staffing an IT team and buying and maintaining costly infrastructure and hardware, think of the cloud as "renting" a pre-built infrastructure and IT services. We moved all of our IT to the cloud and it has been the best technology decision we have ever made.

By Jay Greenstein, DC, CCSP, CGFI-L1, CKTP With a priority on investing as much of every dollar on patient care as possible, doctors of chiropractic are looking for cost-effective ways to reduce capital expenditures as their practices grow and exit the Internet technology (IT) business. Moving IT services to the cloud offers a compelling alternative to provisioning IT the traditional way. Instead of staffing an IT team and buying and maintaining costly infrastructure and hardware, think of the cloud as "renting" a pre-built infrastructure and IT services. We moved all of our IT to the cloud and it has been the best technology decision we have ever made. tag:mpamedia.com,2008:post-55455 2011-07-29T12:00:32-07:00 2011-07-29T12:00:07-07:00

I have written many times now about the importance of good, clear, complete documentation. No doubt it is a pain - it takes up time and energy we would all rather put toward patient care. But there is really no choice anymore; the standard of care and the new health care laws require a higher level of documentation. Electronic medical record software will soon not even be an option, but a requirement for being in practice.

By Douglas R. Briggs, DC, Dipl. Ac. (IAMA), DAAPM I have written many times now about the importance of good, clear, complete documentation. No doubt it is a pain - it takes up time and energy we would all rather put toward patient care. But there is really no choice anymore; the standard of care and the new health care laws require a higher level of documentation. Electronic medical record software will soon not even be an option, but a requirement for being in practice. tag:mpamedia.com,2008:post-55452 2011-08-12T12:00:32-07:00 2011-08-12T12:00:07-07:00

Q: I have seen the codes for "consultation," 99241-99245. Are these codes I should be using whenever I consult with a patient about their care? A. These codes are commonly misinterpreted because of the description of the code as consultation. Many will mistake the use of consultation in this coding context to indicate the time during or after an evaluation wherein the patient is given a report of findings, treatment plan and recommendations.

By Samuel A. Collins Q: I have seen the codes for "consultation," 99241-99245. Are these codes I should be using whenever I consult with a patient about their care? A. These codes are commonly misinterpreted because of the description of the code as consultation. Many will mistake the use of consultation in this coding context to indicate the time during or after an evaluation wherein the patient is given a report of findings, treatment plan and recommendations. tag:mpamedia.com,2008:post-55441 2011-07-29T12:00:32-07:00 2011-07-29T12:00:07-07:00

Whether it's Congress vs. the Centers for Medicare and Medicaid Services, CMS vs. health care providers, or any other combination of the three, the latest showdown seems inevitable in the coming months regarding proposed Medicare fee cuts and how they are determined. According to a recently released Congressional Budget Report, a 29.4 percent reduction in reimbursement will take effect Jan. 1, 2012 if Congress doesn't step in – as it has done every year without fail since 2003 – at the last minute to block the fee cuts.

By Editorial Staff Whether it's Congress vs. the Centers for Medicare and Medicaid Services, CMS vs. health care providers, or any other combination of the three, the latest showdown seems inevitable in the coming months regarding proposed Medicare fee cuts and how they are determined. According to a recently released Congressional Budget Report, a 29.4 percent reduction in reimbursement will take effect Jan. 1, 2012 if Congress doesn't step in – as it has done every year without fail since 2003 – at the last minute to block the fee cuts. tag:mpamedia.com,2008:post-55428 2011-07-15T12:00:32-07:00 2011-07-15T12:00:07-07:00

If you treat Medicare beneficiaries, you will in all likelihood eventually meet one of Medicare's Recovery Audit Contractors, otherwise known as RACs Recovery Audit Contractors are Medicare third-party contractors engaged for the sole purpose of identifying services provided by doctors that do not meet the many documentation requirements now required by Medicare for reimbursement.

By Jennifer Kirschenbaum, Esq. and Rachel Weinrib, Esq. If you treat Medicare beneficiaries, you will in all likelihood eventually meet one of Medicare's Recovery Audit Contractors, otherwise known as RACs Recovery Audit Contractors are Medicare third-party contractors engaged for the sole purpose of identifying services provided by doctors that do not meet the many documentation requirements now required by Medicare for reimbursement. tag:mpamedia.com,2008:post-55427 2011-07-15T12:00:32-07:00 2011-07-15T12:00:07-07:00

An unfortunate sign of the times in our present health care mess is the ever-increasing tendency for insurance companies to discover new and creative strategies to avoid paying your claims or minimize reimbursements on the ones they do pay. While this is certainly disturbing, what's worse is that many chiropractors tend to miss the finer details, which can add up to a big mess.

By Tom Necela, DC An unfortunate sign of the times in our present health care mess is the ever-increasing tendency for insurance companies to discover new and creative strategies to avoid paying your claims or minimize reimbursements on the ones they do pay. While this is certainly disturbing, what's worse is that many chiropractors tend to miss the finer details, which can add up to a big mess. tag:mpamedia.com,2008:post-55419 2011-07-01T12:00:32-07:00 2011-07-01T12:00:07-07:00

Unless you've been hiding under a rock for the past decade, you know all too well the perpetual frustrations caused by the Resource-Based Relative Value Scale, which is used to determine annual Medicare reimbursement rates. Every year, the scale seems to mandate reductions in the rate of reimbursement, and every year, congressional intervention - usually at the 11th, if not 12th hour - is required to prevent the cuts from taking effect.

By Editorial Staff Unless you've been hiding under a rock for the past decade, you know all too well the perpetual frustrations caused by the Resource-Based Relative Value Scale, which is used to determine annual Medicare reimbursement rates. Every year, the scale seems to mandate reductions in the rate of reimbursement, and every year, congressional intervention - usually at the 11th, if not 12th hour - is required to prevent the cuts from taking effect. tag:mpamedia.com,2008:post-55413 2011-07-01T12:00:32-07:00 2011-07-01T12:00:07-07:00

If you are sick and tired of trying to get your Medicare number, having your application rejected or claims denied, don't give up! Recently I have received a flood of calls from chiropractors asking me how they can get out of Medicare. The reasons they give generally have to do with their applications being "rejected" or claims being denied after spending several months – or in many cases years – trying to get their Medicare number or get their number reactivated or revalidated through their Medicare Administrative Contractor.

By Lisa Bilodeau, CA If you are sick and tired of trying to get your Medicare number, having your application rejected or claims denied, don't give up! Recently I have received a flood of calls from chiropractors asking me how they can get out of Medicare. The reasons they give generally have to do with their applications being "rejected" or claims being denied after spending several months – or in many cases years – trying to get their Medicare number or get their number reactivated or revalidated through their Medicare Administrative Contractor. tag:mpamedia.com,2008:post-55386 2011-06-17T12:00:32-07:00 2011-06-17T12:00:07-07:00

I am spending a considerable amount of time with phone calls, particularly with physicians to whom I have referred or from whom I have been referred a patient. There are also instances that I may spend 15-30 minutes with a patient on the phone to discuss specific issues of their care or case. Is there any way to bill for this time spent on the phone?

By Samuel A. Collins I am spending a considerable amount of time with phone calls, particularly with physicians to whom I have referred or from whom I have been referred a patient. There are also instances that I may spend 15-30 minutes with a patient on the phone to discuss specific issues of their care or case. Is there any way to bill for this time spent on the phone? tag:mpamedia.com,2008:post-55355 2011-05-19T12:00:32-07:00 2011-05-19T12:00:07-07:00

The American Chiropractic Association (ACA) is pleased to announce that Anthony Hamm, DC, FACO, president of the ACA Council of Delegates, is the first doctor of chiropractic to be elected co-chair of the American Medical Association's (AMA) Health Care Professionals Advisory Committee Review Board (HCPAC). The HCPAC develops recommendations on relative values for new and revised CPT codes for non-MD/DO services. Dr. Hamm's two-year term begins in September.

The American Chiropractic Association (ACA) is pleased to announce that Anthony Hamm, DC, FACO, president of the ACA Council of Delegates, is the first doctor of chiropractic to be elected co-chair of the American Medical Association's (AMA) Health Care Professionals Advisory Committee Review Board (HCPAC). The HCPAC develops recommendations on relative values for new and revised CPT codes for non-MD/DO services. Dr. Hamm's two-year term begins in September. tag:mpamedia.com,2008:post-55332 2011-05-20T12:00:32-07:00 2011-05-20T12:00:07-07:00

I recently had the opportunity to attend a provider compliance training conference hosted by the Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint effort by the Centers for Medicare and Medicaid Services, the Department of Justice and the Office of the Inspector General for Health and Human Services.

By Ronald Short, DC, MCS-P I recently had the opportunity to attend a provider compliance training conference hosted by the Health Care Fraud Prevention and Enforcement Action Team (HEAT), a joint effort by the Centers for Medicare and Medicaid Services, the Department of Justice and the Office of the Inspector General for Health and Human Services. tag:mpamedia.com,2008:post-55330 2011-05-20T12:00:32-07:00 2011-05-20T12:00:07-07:00

Politics often makes great theater. A good example of that is the situation in Wisconsin, where the governor recently signed legislation limiting state workers' rights to collectively bargain. My intent here is not to enter into this political debate, but to note that thousands of state workers have descended upon the capitol in Madison over the past several months to protest the governor's action. Why weren't they working? From some news reports, it appears that many had a doctor's excuse from work. They were "out on disability."

By Stephen M. Perle, DC, MS Politics often makes great theater. A good example of that is the situation in Wisconsin, where the governor recently signed legislation limiting state workers' rights to collectively bargain. My intent here is not to enter into this political debate, but to note that thousands of state workers have descended upon the capitol in Madison over the past several months to protest the governor's action. Why weren't they working? From some news reports, it appears that many had a doctor's excuse from work. They were "out on disability." tag:mpamedia.com,2008:post-55327 2011-05-20T12:00:32-07:00 2011-05-20T12:00:07-07:00

Gone are the days of pegboards and reams of paper – or are they? Many offices are going paperless and soon electronic health records (EHR) will be required; for those offices that have not embraced the new technology, it is time to get on board.

By Lisa Bilodeau, CA Gone are the days of pegboards and reams of paper – or are they? Many offices are going paperless and soon electronic health records (EHR) will be required; for those offices that have not embraced the new technology, it is time to get on board. tag:mpamedia.com,2008:post-55306 2011-04-22T12:00:32-07:00 2011-04-22T12:00:07-07:00

The American Chiropractic Association's (ACA) Board of Governors has voted to join an existing class-action lawsuit against UnitedHealthcare (United) initiated by the Ohio State Chiropractic Association, the Congress of Chiropractic State Associations and others. ACA's involvement will expand the litigation to include problems with United's claims review, tiering and payment policies.

The American Chiropractic Association's (ACA) Board of Governors has voted to join an existing class-action lawsuit against UnitedHealthcare (United) initiated by the Ohio State Chiropractic Association, the Congress of Chiropractic State Associations and others. ACA's involvement will expand the litigation to include problems with United's claims review, tiering and payment policies. tag:mpamedia.com,2008:post-55300 2011-05-20T12:00:32-07:00 2011-05-20T12:00:07-07:00

On March 28, South Dakota legislators overrode Governor Dennis Daugaard's veto of H.B. 1146, legislation designed to prohibit health insurers from establishing higher co-payments for chiropractic services than co-payments for same or similar services by primary care physicians. The final text of H.B. 1146 reads as follows: "No health insurer may impose any copayment or coinsurance amount on an insured for services rendered by a doctor of chiropractic licensed pursuant to chapter 36-5 that is greater than the copayment or coinsurance amount imposed on the insured for the services of a primary care physician or practitioner for the same or a similar diagnosed condition even if a different nomenclature is used to describe a condition."

By Editorial Staff On March 28, South Dakota legislators overrode Governor Dennis Daugaard's veto of H.B. 1146, legislation designed to prohibit health insurers from establishing higher co-payments for chiropractic services than co-payments for same or similar services by primary care physicians. The final text of H.B. 1146 reads as follows: "No health insurer may impose any copayment or coinsurance amount on an insured for services rendered by a doctor of chiropractic licensed pursuant to chapter 36-5 that is greater than the copayment or coinsurance amount imposed on the insured for the services of a primary care physician or practitioner for the same or a similar diagnosed condition even if a different nomenclature is used to describe a condition."