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DATELINE:

2 YEARS AGO
IN MEDICARE

BY YVETTE NOEL CPCO

What’s In Your Box 24J?

There seems to be an epidemic of misinformation these days regarding billing Medicare when more than one DC is in the same clinic. Medicare has very direct guidance regarding the 3 types of providers that must enroll prior to seeing Medicare patients. There is also a requirement to maintain active billing privileges.

Medicare’s Statement Regarding Mandatory Enrollment for Chiropractors:

  • https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf
    • The opt out law does not define “physician” to include chiropractors; therefore, they may not opt out of Medicare and provide services under private contract. Physical and occupational therapists in independent practice cannot opt out because they are not within the opt out law’s definition of either a “physician” or “practitioner”.

Some practices realize that a DC must be enrolled in order to bill for services to Medicare; however, they fail to understand that this isn’t a “group/business” rule, but an individual provider rule. Any DC that touches a Medicare patient must be individually enrolled.

What About Incident To?

Federal law prevents “incident to” for DC (physician) to DC (physician). There is permissiveness for physician to non-physician staff regarding “incident to” services. Therefore, physicians are required to utilize their own NPI in box 24J showing they were the physician that provided the service.

If an office chooses to bill under the Individual NPI (Box 24) for a provider not performing the service, this is a violation under the False Claim Act. Box 24J states that you are certifying that the NPI is that of the physician who completed the service. There are no substitutions or work arounds in a multiple DC office environment.

Now What Do I Do?

If you find yourself in this situation, you must swiftly respond to this detected offense since you have been paid inappropriately for services. Upon discovery of an inappropriate payment, you have 60 days to refund to Medicare and the patient. You must also complete a compliance incident report and record this in a compliance incident log. Written policy and procedure should be developed regarding the offense and an action plan of correction created and properly executed.

This is something not to be taken lightly and should be dealt with in a systematic and methodical process. Many offices  do not properly know how to handle inappropriate payments by Medicare (or any payer). We encourage you to reach out to KMC University to assist you with the proper way to handle this significant compliance risk in your practice. All it takes is one patient or employee innocently saying the wrong thing at the wrong time to put you at risk. Protect your practice!


Call (855) 832-6562 now or click to schedule a 15-minute Solution Consultation at your convenience.

 


Yvette Noel is the Membership Services Manager and conference speaker with KMC University. She is a Certified Professional Compliance Officer (CPCO). She has served the chiropractic community for 13 years and has worked in the medical field since 1988. Through this experience, she has continued to develop her skills of medical coding and billing. Before coming to KMC University, she managed a very successful Chiropractic and Occupational Health business. She remains very passionate about KMC University and takes much pleasure in helping members with their documentation, reimbursement, and compliance needs.

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