“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.
Through this initiative the Centers for Medicare & Medicaid Services (CMS) will prevent fraud, fight identity theft and protect essential program funding and the private healthcare and financial information of our Medicare beneficiaries.
Many chiropractors have gotten letters from their local MAC (Medicare Administrative Contractors) telling them that it is time to revalidate their Medicare provider status. Please take this letter seriously and do not delay in your response. Failure to respond has caused a sizable number of chiropractors to lose their provider status (either par or non-par) and therefore lose their ability to bill for Medicare patients.
Survey ten chiropractors about how to properly complete an ABN, and you will likely get 11 answers. The amount of misinformation regarding the use of the Advance Beneficiary Notice in chiropractic is astounding! Is it that it’s too simple to use it the right way? Once your patient has moved from therapeutic care to wellness care, a single ABN should be signed by the patient.
Medicare Mastery: Minimize Risk and Maximize Confidence
When asked what’s the biggest thorn in the side of DCs, without question the most popular answer is Medicare…from every angle. They report that they don’t feel confident about what exactly needs to be done to stay on the right side of Medicare rules. It’s Medicare-Palooza to the rescue!
Scammers are at it again, and they’re using the OIG Hotline number to freak you out. The scamming callers represent themselves as employees of the Office of Inspector General (OIG) and their caller ID is made to appear as if the call is coming from the OIG Hotline (1-800-HHS-TIPS).
Guidelines for the treatment of patients with low back pain
The second largest physician group in the United States, the American College of Physicians (ACP), recently published guidelines for the treatment of patients with low back pain.
ACP's guidelines, published in the Annals of Internal Medicine, make a progression of recommendations, detailing an array of treatments that doctors should consider during a patient's particuar phase of treatment.
The risks to both patients and health care providers when internal body tissue is exposed to the powder include severe airway inflammation and hypersensitivity reactions.
Chiropractors continue to make the same mistakes after a decade. For a decade, the government has been creating reports on how poorly chiropractor do when it comes to properly treating and documenting care for federally insured patients. A big part of the problem is the disconnect between the chiropractic way of managing healthcare and the allopathic way to manage healthcare. This disconnect includes misunderstandings about definitions of care, medical necessity, and most often a mistake about...