In my last Article, I discussed the two types of Medicare Audits, and a bit about the study published by the Office of the Inspector General, which is a part of the Department of Health and Human Resources.
To reiterate, the key thing to remember when dealing with Medicare, or any government agency, for that matter, is knowing the rules of the game. Later in this Article you'll find some links to help you get more familiar with the Medicare Rules, as they exist right now, at least.
The study published by the Office of the Inspector General can be found by clicking on the link in the Resources Section of this article:
CHIROPRACTIC SERVICES IN THE MEDICARE PROGRAM: PAYMENT VULNERABILITY ANALYSIS
What's the Real Problem with Medicare?
In the last Article I also talked about what Medicare can do if you don't correctly document the treatment of your patients. Remember, it doesn't matter that you did everything ?by the book? if you didn't also document it ?by the book.? And what is the ?book?? The Carriers Manual.
This is what the people who pay the claims use to determine whether or not what they paid you is justified.
First of all, I think we can all agree that the "IRS Rules and Regulations type" manuals used to determine if something you do for your patients is justified is pretty ludicrous when you consider that a medical doctor can get away with spending five minutes with an elderly patient, prescribing 10 different drugs ranging from blood thinners to anti-depressants, and get paid for it, no questions asked.
But, if you see a patient more than 24 times, you're committing health fraud, and that two-thirds of the time when you see a patient more than 12 times, you're a criminal.
And even worse, how in the world do psychiatrists document and get paid by insurance carriers for the goofy 5 minute interviews and drugging of more than 8 million kids in the US alone, because they fidget in class. How can that possibly be considered a medically necessary service?
We definitely live in a topsy turvy world right now, but unfortunately until we change it, you'll need to know the Rules, particularly if you want to play the Medicare Game.
I'm not going to pretend to be an expert in Medicare, as far as what you can and cannot do. My expertise is in the reporting side of the equation, and in the fact that you may be following the Rules to the letter, and still get nailed, if you don't properly document what you did do and why.
What is Covered by Medicare?
Having said that, we can still go over some of the simpler aspects of what is covered by Medicare.
First of all, they only cover ?treatment by means of manual manipulation, i.e., by use of hands. Additionally, manual devices (i.e., those that are hand-held with the thrust of the force of the device being controlled manually) may be used by chiropractors in performing manual manipulation of the spine'No other diagnostic or therapeutic service furnished by a chiropractor or under his or her order is covered.?
Sorry, no extremity work. And they won't pay for you to take X-rays (even though they will pay an MD). However, for ??dates of service on or after 1/1/2000, an x-ray is not needed to document the subluxation.?
They define a subluxation as ??a motion segment, in which alignment, movement integrity, and/or physiological function of the spine are altered although contact between joint surfaces remains intact.? How do you demonstrate it? By x-ray or physical examination.
Demonstrating the Existence of a Subluxation
Physical examination to demonstrate a subluxation involves what you may have heard referred to as PART. The P stands for ?Pain/tenderness evaluated in terms of location, quality, and intensity;? The A stands for ?Asymmetry/misalignment identified on a sectional or segmental level;? The R stands for Range of motion abnormality (changes in active, passive, and accessory joint movements resulting in an increase or a decrease of sectional or segmental mobility);? The T stands for ?Tissue, tone changes in the characteristics of contiguous, or associated soft tissues, including skin, fascia, muscle, and ligament.?
According to the manual, ?To demonstrate a subluxation based on physical examination, two of the four criteria mentioned under ?physical examination? are required, one of which must be asymmetry/misalignment or range of motion abnormality.? So, at a minimum, you need 1) pain and either asymmetry or range of motion, 2) tone and either asymmetry or range of motion, or 3) asymmetry and range of motion. Obviously, you should report as many of these as you find.
As far as how exactly you document these findings, including the acceptable words and phrases, and exactly what needs to be documented initially and during treatment, I will get into that in our next newsletter. However, if you are trying to document all of this by hand, you are probably finding that there aren't enough hours in the day. And if you are trying to remember what you needed to document after the fact, you could be asking for trouble.
If you would like an easy, fast way to have complete, compliant documentation, call 877-742-9215 and speak to one of my consultants.
Summary
If you commit to sending high-quality, professional reports to Medicare, chances are very good that you will never have a problem stemming from documentation.
If you don't own Report Master yet, check out some of the Testimonials on our web site, to see what others are saying about the Report Master Software.
Report Master takes the work out of the Narrative and SOAP Note writing process, so you'll have more time to do the things you would rather be doing, and still maintain the necessary quality in your reports that Medicare and other providers demand.
In closing, if there is anything about narratives or SOAP Notes you would like me to talk about in future Articles, or if you have any questions about the Report Master Chiropractic Report Writing System, write to me directly.
Also, if you'd like to take the complete working copy of the Report Master System for a Free Test Drive, fill in the Request a Report Master Free Trial Form and Download the Software by clicking on the link in the Resource Box at the end of this Article. One of our Representatives will contact you to set up a time for you to get together, to help you get up and running quickly.
And, of course, you can also simply call us toll-free at 877-742-9215, to set up a demonstration.
Until next time,
Ron Savelo President Report Master, Inc.
In my earlier three Articles, I described a unique method of procuring new patient referrals from MD's.
In this series of Articles I'm going to discuss a relatively new phenomenon in the field of physical healing: The Medicare Audit.
If you accept Medicare patients, or if you are considering taking on Medicare patients, you've likely heard a horror story or two of doctors being "Audited" by Medicare.
This newsletter will cover the different types of Medicare Audits, and how to go through an Audit and come out the other end relatively unscathed. The key, of course, is preventive medicine on your part. The more you know about this area and the governmental requirements involved, the less susceptible you will be to any adverse effects of a Medicare Audit.
Trained by the IRS?
There are primarily two main types of Audits: The Pre-Payment Audit and the Post-Payment Audit.
The potentially most costly Audit is the Post-Payment Audit. This is where Medicare requests complete and thorough documentation covering a specific period of time.
If your documentation does not adequately demonstrate the need for treatment (in the eyes of Medicare, that is), they could "request" that you pay them back what they have already paid you.
This, in effect, could conceivably be much worse than the dreaded IRS Audit. And if you do need to "pay them back," they can extract it from other money they owe you, sort of like money you owe the IRS being garnished from your wages, whether you like it or not.
The Office of Inspector General
So, what are the reasons Medicare Audits are on the increase? Well, most of the reasons are delineated in a study that the Office of the Inspector General, which is a part of the Department of Health and Human Resources, published in June of 2005. This study had the stated objective: "To determine the underlying causes of, and potential ways to reduce, vulnerabilities associated with Medicare payments for chiropractic services."
First of all, keep in mind this is a government report. When it speaks of "vulnerabilities associated with Medicare payments for chiropractic services.", it is referring to their perceived weaknesses in their own system, resulting in what they consider too much money being paid out for chiropractic services.
In my next Article, I'll get into this study in much more detail, in terms of which services are allowed and which ones aren't. This Article is concerned with one aspect of the government study, Documentation.
In 1972, Congress passed a law amending another law which defined chiropractors as "physicians who are eligible for Medicare reimbursement, but only for manual manipulation of the spine to correct a subluxation, or malfunction of the spine."
Another Federal regulation further limited Medicare payment to "treatment of subluxations that result in a neuromusculoskeletal condition for which manual manipulation is appropriate treatment."
The law also requires that "all services billed to Medicare, including chiropractic manipulations, be medically necessary and supported by documentation."
Documenting a Subluxation
One of the findings of the above government study was that: "34 percent of chiropractic services were not supported by an evaluation that met the Manual's (Medicare Carriers Manual) specific requirements for documenting a subluxation.
This lack of proper documentation partially explains the increased scrutiny. But, insufficient or incorrect documentation does not necessarily mean that the doctors involved did not perform a correct evaluation, it just means that they didn't document it well enough.
How bad can a post-payment audit be? One of my Sales Reps talked to a doctor a few weeks ago who had to pay back $38,000. We also know plenty of doctors who have not had to pay back one red cent. In the latter case, their letters from Medicare state to the effect, "I am pleased to inform you that all the services that you submitted were allowed, as the documentation supported the services billed."
Bottom line: A post-payment audit is a risk that is totally manageable. Document your daily visits correctly and you will not have to worry.
And that's where Report Master comes in. The quality of the reports, and their comprehensiveness both being vital in this type of campaign, the next question is how long should it take to produce such reports?
Knowing the Medicare Rules
The above study, which I will further detail in my next Article in this series, can be found online:
CHIROPRACTIC SERVICES IN THE MEDICARE PROGRAM: PAYMENT VULNERABILITY ANALYSIS
If you commit to sending high-quality, professional reports to Medicare, chances are very good that you will never have a problem stemming from documentation.
If you don't own Report Master yet, check out some of the Testimonials on our web site, to see what others are saying about the Report Master Software. And you can also take the entire system for a Free Test Drive.
Report Master takes the work out of the Narrative and SOAP Note writing process, so you'll have more time to do the things you would rather be doing, and still maintain the necessary quality in your reports that Medicare and other providers demand.
If there is anything about narratives or Daily SOAP Notes you would like me to talk about, or if you have any questions about the Report Master Chiropractic Report Writing System, write to me directly.
Ron Savelo has sinced written about articles on various topics from Fitness, Careers and Job Hunting. Ron Savelo is the founder and CEO of ., and the creator of the Report Master Documentation System.?. Ron Savelo's top article generates over 9900 views. to your Favourites.