Your April edition of the KMCU WOW! Newsletter is here!

As usual, it is packed with useful information, but now it is delivered in a friendly PDF format so you can save it on your hard drive, or print it out and file it in a three-ring folder; we want this newsletter to be another tool you and your team can refer to when needed!

March’s theme is Medicare, and the WOW! Newsletter includes:

1. Kathy’s Opening Message
2. Script of the Month
3. Coding Q&A
4. The Compliance Corner
5. The Reimbursement Room
6. Breaking News
7. Product of the Month
8. Case Study of the Month
9. Upcoming Engagements

Download your copy HERE

From time to time, I come upon a great definition I’d like to share with you to help you understand the WHY behind the rules. This is an excellent reminder!

“The medical record establishes a chronological record of exams, tests and results, treatment, and treatment plans, including the diagnosis and prognosis of the illness or disease. The medical record corroborates the reimbursement request and is requisitioned by most payers for adjudication of claims when reimbursement is in question.”

Keep this in mind as you are careful to record everything necessary in the patient’s record.

Does IRS stand for Internal Revenue Service or, if you are not prepared, does it stand for “It Really Sucks?”

Once a year, you make that agonizing trip to see your tax preparer and start the process of settling up with the IRS. This is about as much fun as a root canal. If you only make this visit once a year, as a business owner, you are missing out on valuable advice and planning. You need communication!  In this very timely webinar, KMC’s own brilliant tax planner Michael Boehrer will share what you should be doing to have great communication with your tax advisors, and how to be prepared and know the rules in advance!.

This FREE webinar includes:

- Five things you have to know before you choose a tax planner/Accountant
- The list of items that you need to keep track of so your Accountant can help you
- How to capture even the smallest deduction on your tax return.  How to turn pennies into dollars.
- Setting up your bookkeeping system and knowing where your income and expenses and money are at all times.
- Why your balance sheet is so crucial!  How did you decide what to keep track of?
- How NOT talking to your tax preparer could cause your biggest loss of the year… Including your taxes!
- What you should never do when the IRS comes knocking.
- The 3 taxes that almost every business owner forgets about until it is too late.

Watch this FREE webinar, and find out these important and timely pieces of information. Help your tax advisor and bookkeeper to help you, with the list you’ll take away from this power hour! You didn’t go into business to be a tax planner and bookkeeper, but Michael did and he works with hundreds of chiropractors!  Learn  how to spend your time excelling at what you do by making sure your tax professional is doing all they can. Then watch your business grow!

WATCH THE WEBINAR HERE

DOWNLOAD THE COMPANION FREE FORM HERE

Your March edition of the KMCU WOW! Newsletter is here!

As usual, it is packed with useful information, but now it is delivered in a friendly PDF format so you can save it on your hard drive, or print it out and file it in a three-ring folder; we want this newsletter to be another tool you and your team can refer to when needed!

March’s theme is Coding, and the WOW! Newsletter includes:

1. Kathy’s Opening Message
2. Script of the Month
3. Coding Q&A
4. The Compliance Corner
5. The Reimbursement Room
6. Product of the Month
7. Breaking News
8. Let’s Implement!
9. Upcoming Engagements

Download your copy HERE

More Q&As and “Did YouKnow” entries from our Facebook page. If you haven’t liked our page yet, you can do it HERE!

Q: When do I need authorization from the patient before I can market to him/her?

A: The HIPAA Privacy Rule requires an authorization for uses or disclosures of protected health information for ALL marketing communications, except in two circumstances:

1. When the communication occurs in a face-to-face encounter between the covered entity and the individual; or

2. The communication involves a promotional gift of nominal value.

If the marketing communication involves direct or indirect remuneration to the covered entity from a third party, the authorization must state that such remuneration is involved.

Q: My patients often have uncovered services that we charge a discounted price for. We are implementing pay plans, and this will cause us to no longer be able to offer the “time-of-service” discount. Is there any way to help the patient get a discount?

A: I would suggest using a DMPO or Discount Medical Plan Organization. The plan will generally provide discounts at certain healthcare providers for medical services. The member is obligated to pay for all healthcare services, but will receive a contracted discount from those health care providers who have contracted with the Discount Medical Plan Organization.  KMC University supports our friends at http://www.chirohealthusa.com/

Q: I’ve heard the term “ABN Modifiers” several times, what are the ABN modifiers?

A: The ABN is a notice given to beneficiaries to convey that Medicare is not likely to provide coverage in a specific case. Providers must complete the ABN and deliver the notice to affected beneficiaries or their representative before providing the items or services that are the subject of the notice. (from CMS.gov) The following modifiers are used to communicate the status of the ABN concerning a specific patient:

GA – Waiver of liability statement issued, as required by payer policy

GX – Notice of liability issued, voluntary under payer policy

GY – Item or service statutorily excluded or does not meet the definition of any Medicare benefit

GZ – Item or service expected to be denied as not reasonable and necessary (forgot to issue ABN to patient)

Did You Know?

The HIPAA Privacy Rule requires you as a covered entity to provide an accounting of certain disclosures, including certain disclosures by your business associate, to a patient upon request. Your business associate contract must provide that the business associate will make this information available to you in order for you to fulfill your obligation to the patient. The parties can agree through the business associate contract that the business associate will provide the accounting to the patient if this is more appropriate given the protected health information held by, and the functions of, the business associate. Use the link below for more information. (HIPAA rule 45 CFR 164.528)

http://www.gpo.gov/fdsys/pkg/CFR-2002-title45-vol1/xml/CFR-2002-title45-vol1-sec164-528.xml

Q: I would like to use the code 99204 more, how can I document this to get it paid?

A: Code 99204 requires meeting all three key components of the code (comprehensive history, comprehensive exam and medical decision making of moderate complexity), as well as medical necessity for a service of that intensity. CPT describes these services as typically involving problems of moderate to high severity. Keep in mind, the best and most ethical way to choose codes is by doing what is necessary for the treatment of the patient, accurately documenting your treatment and THEN choosing a code that best reflects that treatment. You should never pick a code first then work it into your treatment.

More Q&As and “Did YouKnow” entries from our Facebook page. If you haven’t liked our page yet, you can do it HERE!

Q: I offer free consultations to patients to familiarize them with chiropractic and it also allows us to help a patient determine if they are a good fit for our care. Unfortunately, they occasionally end up turning into “free initial visits”. What can I do to avoid this situation from happening? The patient often wants to move forward with an exam the day of consultation, but they have “free” stuck in their head, and seem shocked when expected to pay for the actual exam.

A: One of the most dangerous compliance violations I see is offering free consultations that turn into free first visits. It’s important to distinguish what will be at no charge on an initial visit and what must be billable. The pre-acceptance interview process is excellent for practices that wish to offer a patient the chance to find out if they are a good candidate for chiropractic care.  Follow the link below for the process and scripting to help you avoid the risky pitfall of inducement.

http://www.kmcuniversity.com/wp-content/uploads/FactSheePreAcceptInterview.pdf

Q: Does the HIPAA Privacy Rule cut off all communications between us as a covered entity and the families and friends of our patients?

A: No, as long as the patient does not object to these communications. With the Privacy Rule you are permitted to share necessary information with family, friends, or anyone else a patient had identified as involved in his/her care. You are also permitted to share the appropriate information even when the patient is incapacitated (if doing so is in the best interest of the patient).

Q: We are currently a non par provider with Medicare. What is the rule about charging patients when an active treatment manipulation has been denied as medically non necessary? Do we as the provider have to eat that charge or can we bill the patient?

A: Since you are a non-participating provider with Medicare, the patient would have already paid that visit at the time of service. Since Medicare is telling you that the visit is seen as “not-medically necessary”, you must refund the patient what they paid you for the CMT code only. If you also collected for other statutorily non-covered services, these do not have to be refunded. As a non-participating provider, you don’t have the right to appeal, unless the patient assigns that right to you. This is a serious problem. If you are having Medicare bills denied, it screams of a much bigger problem. Are you using proper modifiers? Do you understand the difference between acute, chronic, and maintenance visits? Do you know the decision-making process that is required on a visit by visit basis on these kinds of patients? If not, let us help you!! It’s a very serious matter!

Q: Box 21 on the 1500 billing form offers four spaces to insert diagnosis codes. Must all four spaces be used to submit a claim?

A: No. When completing field 21 of the 1500 billing form list the diagnosis you have assigned to the patient. If more than one diagnosis is appropriate, list all the diagnoses that affect the treatment received.

Did You Know?

“Office of Inspector General recently reached settlements with eight physicians who violated the Civil Monetary Penalties Law by causing the submission of false claims to Medicare from physical medicine companies. Specifically, these physicians reassigned their Medicare payments to various physical medicine companies in exchange for Medical Directorship positions. While serving as Medical Directors, the physicians did not personally render or directly supervise any services. There was evidence that the services the physical medicine companies claimed the physicians performed were not actually performed or were not performed as billed.” (from oig.hhs.gov)   If you have reassigned your right to bill the Medicare program (by signing the CMS-855R application) you may be liable for false claims submitted by entities who you reassigned your Medicare benefits to. Make sure you monitor any entity’s use of your information!

Q. If I do more than one modality, for example; Heat applied to the thoracic region, stretching applied to the hamstrings, and lateral stretching to the cervical spine for the traps, do they all have to be done in a minimum of 8 minutes?  If they are not, do I still bill or list them and should I only submit the code for the one done in the area not adjusted?

A. Heat doesn’t require any special billing considerations and is not timed. Here is what the ACA has to say about this code and may be helpful to add to your compliance policy about WHY you do this service:

Coding Clarification: 97010, Hot/Cold Packs

It is the position of the American Chiropractic Association (ACA),that the work of hot/cold packs as described by CPT code 97010 is not included in the CMT codes 98940-43 in instances when moist heat or cryotherapy is medically necessary in order to achieve a specific physiological effect that is thought to be beneficial to the patient.

Indications for the application of moist heat include, but are not limited to, relaxation of muscle spasticity, induction of local analgesia and general sedation, promotion of vasodilation, and increase of lymph flow to the area.¹

Indications for the application of cryotherapy included, but are not limited to, relaxation of muscle spasticity, local analgesia, localized vasoconstriction, and decrease of exudates.²

Passive stretching is really not a great covered service. If you can incorporate an active component, such as the patient doing more of the work themselves, it can be billed as 97110, assuming that you are personally attending the patient.  If you are doing passive stretching, that’s usually a part of Manual Therapy (97140) and of course that can’t be done in the same body region.  Don’t count the time for this, and don’t bill it.

Did You Know?

HIPPA requires that all of your business associates sign a business associate agreement with you. You business associates are now held to the same HIPPA privacy and security standards concerning a patients protected health information (PHI).

Q. I’m curious to understand the value in bundling each day’s EOBs and saving/filing them by date? When would I reference this information or is it just for record keeping compliance?

A. The main reason that you want to know the date is in case you have to go back and reference that EOB later. You can correspond this date to the date the item was posted in your billing software. And then cross reference to any deposit slip that matches that date. Should anyone ever have to forensically follow the money, it makes a great paper trail. And trust me, there have been many times I’ve had to go back to an EOB and pull it to see if it was entered correctly, or to do some follow up after the fact. Some offices choose to copy all EOBs and put them into patient folder. This is so 1980′s! Not necessary any more, and mostly because of the bulk checks that come in. Filing them by date, and even taking that full daily bundle and scanning it to make it an electronic copy, just makes sense to keep from all that filing. There is really no compliance issue, mostly just convenience.

Did You Know?

If you are sending postcards to patients for their upcoming or missed appointment, you can list the patient’s name, the doctor’s name and time of appointment but you cannot list what service the appointment is for.

Q. I wanted to know when billing Medicare, is there any other modifier we can use besides the AT modifier for an adjustment code? In order to receive payment for other line items?

A. You’d use the GA if you had an ABN form signed.  Remove the AT modifier if you are not providing active care, and the care is maintenance. The combination of the lack of an AT modifier and the addition of the GA modifier signifies maintenance care. Use GY and/or GP if you are also billing any other service, if you want to receive a denial so you can bill a secondary.

Q: Medicare is denying my claims, and the remark code is saying level of service not justified. Help!

A: Medicare only pays for chiropractic adjustments. Because of this, the level of service they are referring to is your adjustment codes (98940, 98941, 98942). Check to see if your objective findings match your level of service billed. For example: if you bill a 98942 but your objective findings only show two regions, Medicare will down-code and more likely simply deny the claim for lack of medical necessity.

Q: I have noticed more patients refusing to sign the acknowledgement of receipt of Patient Privacy Practices. Can I get in trouble for not having this in the patient chart? Does this have to be signed before treatment?

A: HIPPA does not require that notice of privacy practices be signed, but don’t take that to mean you can ignore this policy! HIPPA does require that the patient receive the notice, and that you make meaningful effort to get the acknowledgement signed. To cover yourself, if a patient refuses signing, notate the date, time and reason if given. This will show that the effort was made.

Did you know?

Medicare has a new ABN for 2012. It is almost IDENTICAL to the previous version, but it is required that your office use the new, updated form.

Q: What can I give away or discount to my Medicare patients?

A: Coupons, exam specials, or other similar discounts should not exceed $10 individually or $50 annually per patient. Most likely, your exam is not going to fall into this $10 range, and if it does, we have a lot more to work on!

More information:

http://oig.hhs.gov/fraud/docs/alertsandbulletins/SABGiftsandInducements.pdf

Did you know?

The implementation of ICD-10 is taking us from about 17,000 codes to approximately 140,000 codes. The implementation date is 10.01.2013. Start learning now and make the transition easy on your practice!

Did you know?

There are many off-site data back-up services available for real-time reliable data back-up. Keep in mind as you move toward or continue with EHR, you may no longer have a paper copy of patient health data in the event of a server crash, corruption of data or accidental erasure. Keep in mind that the  HIPAA Security Final Rule (CFR 164.308(a)(1)) state “Ensure the confidentiality, integrity, and availability of all electronic protected health information the covered entity creates, receives, maintains, or transmits.” AVAILABILITY means a complete back-up!

Q. The chiropractor in our office is adjusting three areas of the thoracic spine. We disagree on if this should be billed as a 98940 or 98941. My understanding is if it’s THREE areas it is a 98941, right?

A. This is where reading the descriptions of codes must be done very carefully! A 98941 is when the provider is adjusting three or four REGIONS of the spine. Regions are described as Cervical, Thoracic, Lumbar, Sacral & Pelvic. Adjusting 3 areas in one region is still billed as a 98940.

Did you know?

When a Medicare patient moves from active treatment to maintenance care, you must get a new ABN formed signed. If that same patient re-injures themselves or has a new injury, a new active care phase of treatment would begin. At this time, you would acquire a new ABN and you must do an updated evaluation to determine how you would manage the condition. Your documentation will support the new diagnosis with a new start date for treatments.

Q: I’m a little frustrated…Medicare requires x-ray for documentation but does not pay on x-ray. How can they require something and not pay for it?

A: According to Medicare:

“An x-ray is not required to demonstrate subluxation. An x-ray may, however, be used for this purpose if the chiropractor so chooses. If the chiropractor chooses to use an x-ray to demonstrate the subluxation, then the documenting x-ray must have been taken at a time reasonably proximate to the initiation of a course of treatment.

Unless Medicare concludes that more specific x-ray evidence is warranted, an x-ray is considered reasonably proximate if it was taken no more than 12 months prior to or 3 months following the initiation of a course of chiropractic treatment.”

Q:  I am very confused concerning modifiers -25 and -59. Can you help me out?

A:  Modifiers can be a little tricky but keep in mind that improper use of modifiers can cause underpayment or accidental overpayment on your claims. The modifier -25 is described as a Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Day of a Procedure: The chiropractor would need to indicate that on the day a procedure or service was performed, the client’s condition required a significant, separately identifiable E&M service above and beyond the usual care associated with the procedure that was performed. In this instance this can be reported by adding the modifier 25 to the appropriate level of E&M service.

The modifier -59 is described as a Distinct Procedural Service. In certain circumstances, the chiropractor would need to indicate that a procedure or service was distinct or independent from other services performed on the same day. Modifier 59 is used to identify procedures/services that are not normally reported together, but are appropriate under the circumstances. The 59 modifier is required when billing 97124, 97140 and 97112.

Your February edition of the KMCU WOW! Newsletter is here!

As usual, it is packed with useful information, but now it is delivered in a friendly PDF format so you can save it on your hard drive, or print it out and file it in a three-ring folder; we want this newsletter to be another tool you and your team can refer to when needed!

February’s theme is Collections, and the WOW! Newsletter includes:

1. Kathy’s Opening Message
2. Script of the Month
3. Coding Q&A
4. The Compliance Corner
5. The Reimbursement Room
6. Product of the Month
7. Breaking News
8. Upcoming Engagements
9. Case Study of the Month

Download your copy HERE

These 11 free videos and audio podcasts (averaging about four minutes each) cover major health care fraud and abuse laws, the basics of health care compliance programs, and what to do when a compliance issue arises. This is the latest from OIG’s award-winning Health Care Fraud Prevention and Enforcement Action Team (HEAT) Provider Compliance Training initiative.

It was great to be with you at the Northwestern University of Health Sciences Homecoming!

As promised, here are the notes for you to download and review at your leisure.

Don’t hesitate to email if you have questions:  info@kmcuniversity.com.

We’re starting 2012 with a brand new KMC University’s WOW! Newsletter!