3rd Party Billing and Collections
Your patients will be choosing their 2019 Insurance coverage starting November 1st. We encourage you to keep the dialogue going. Make sure your patients are choosing plans that include coverage for chiropractic services. You may want to take some time to familiarize yourself with your local marketplace plans and coverage limitations. Be proactive!
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There is only one time per year when a provider can make changes to their Medicare participation status. The annual open enrollment period runs from mid-November through December 31. During the open enrollment period, which is approximately 45 days in length, if a par-provider wants to become non-par, he/she must submit notification in writing; otherwise, the par-provider status will renew automatically each year.
Are You a Team Player?
Nicki Brooks, CPPM, KMC University
By all appearances, the future is looking bright for chiropractors who specialize in sports medicine, and travel to sporting events as part of a team to provide care for athletes.
It is reported that the Senate recently approved legislation to protect chiropractors (as well as other medical professionals) who travel with sports teams ensuring that their license and liability coverage remains effective across state lines.
CBRs at the Speed of Technology
By: Rhonda Hodge, MCS-P
Oh, how we’ve longed to hear that a process has been made easier! In this fast paced and ever-changing world, it is certainly music to our ears, especially when it comes to areas such as Insurance, Medicare and Compliance.
Medicare is removing Social Security numbers from Medicare cards
This step is to help prevent fraud, help eliminate identity theft, and to protect program funding and the private healthcare and financial information of our Medicare beneficiaries.
3rd Party Billing and Collections
HIGHMARK has announced an updated list of codes that will require pre-authorization.
3rd Party Billing and Collections
We have all been there… the latest Payer Newsletter comes out with a new policy regarding coverage or reimbursement that you disagree with. It’s frustrating… and oh so hard not to react negatively. That feeling of hopelessness comes over you, and you want to lash out. What can be done?
Vermont Chiropractic Association advocacy leads to lower co-pays for chiropractic care in 2019. Proof that working with state legislation brings results!
“Not Medically Necessary” is among the most common third-party denials in chiropractic. What results is a slew of record requests, audits, refund requests, and denials for care. In many instances, a practice may opt to stand behind those services and take steps to appeal the claim(s) for payment, asserting that care was indeed medically necessary.
What You Need to Know
We are more than a month into the roll out of the new Medicare Beneficiary Identifier (MBI) changes, but some providers and staff (and even the beneficiary) may still have questions about this process. The information provided here should help answer any lingering questions. We will address the following: Who, What, When, Why and How.
This will be Medicare, or the Centers for Medicare & Medicaid Services (CMS), as they are the entity making the change. Also, the...
Find out what this means for you and your practice
Chiropractic has again found itself in the OIG (Office of Inspector General) spotlight. According to OIG records, since 2010 Medicare has paid more than $450 million per year for chiropractic services. An estimated $257 - $304 million per year of this total dollar figure has been identified as estimated overpayments.
And with the rollout of new cards, scammers are attempting to take advantage by calling and telling seniors that they need to provide personal information to the callers to receive their new cards.
According to the Department of Justice (DOJ) and the US Attorney’s office for the Northern District of Iowa, an Iowa chiropractor was penalized $79,919 for violating the False Claims Act. He did what thousands of DCs do every day... provided free therapy to a Medicare patient
There are many definitions and rules around establishing medical necessity. Because there is rarely a standard of documentation more stringent than Medicare, KMC University recommends using Medicare definitions and guidelines to create your standard for documentation. Sometimes, third-party payers will publish their own requirements for medical record keeping, in which case, this more specific standard should be followed. In the absence of such clarity, use the Medicare standard.
It’s the beginning of a new year... a clean, white piece of paper called possibility. It’s natural for practice owners to think about how to increase revenue in the new year and that can start with reviewing fees. Often, when a practice decides to implement changes to its fee system, the first thought is to define discounted fees.
The Foundation for Chiropractic Progress Spotlights Kathy Mills Chang
This Fall, the F4CP spotlighted Kathy Mills Chang, founder and CEO of KMC University, for the continued support she has shown the F4CP and chiropractic profession. They wrote:
While it may not be proper for KMC University to take sides politically, we do feel it is well within our role to provide information about the issues that impact our great profession. We could debate the pros and cons of the Affordable Care Act (aka Obamacare), of which there are many of both. We could debate whether the steps President Trump is proposing are good or bad for healthcare as a whole and chiropractic in general, but we will not.
October 2, 2017 begins the final 90-day period to report the Merit-Based Incentive Payment System (MIPS) data in time to get credit for this year. If you have not yet submitted PQRS data for a consecutive 90-day period in 2017 you MUST start by October 2nd.
Severe disasters, such as we experienced with Hurricane Harvey, impose challenges on health care providers. Questions arose about the ability of healthcare providers and other entities covered by HIPAA privacy rules to share information with family, friends, public health officials and other emergency personnel.
The audits that are taking place at present are small in number, and are being used to determine common deficiencies in physician’s practices. Rest assured, this will only serve to identify where the common weak links are in order to better determine where to invest efforts in the future. These limited audits are being used to identify risks and vulnerabilities that the government is not aware of nor likely to learn about from the complaints being filed.