Select the title to see a summary and a link to the full article.
January 21st, 2020
Inadequate Exclusion Screenings Could Put Your Practice at Risk
By Wyn Staheli, Director of Research | Published January 21st, 2020
Exclusion screenings require far more than just checking a name on a federal database at the time you are hiring someone. Far too many providers don’t realize that in order to meet compliance requirements, there is MUCH more involved. There are actually over 40 exclusion screening databases/lists that need to be checked.
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published January 14th, 2020
Many large private payers recognize the potential cost savings and improved health outcomes that telemedicine can help achieve, therefore they are often willing to cover it. While there are several considerations, there could be certain circumstances where telemedicine might apply to chiropractic care.
By Wyn Staheli, Director of Research | Published January 14th, 2020
Can chiropractic offices bill code 99211? Technically it can be used by chiropractors, but in most instances, it is discouraged. Considering that 99211 is a low complexity examination for an established patient, this code is not really made for the physician to use. In fact, in 2021, changes are coming for this code...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published January 7th, 2020
CMS assigns Medically Unlikely Edits (MUE's) for HCPCS/CPT codes, although not every code has an MUE. MUE edits are used to limit tests and treatments provided to a Medicare patient for a single date of service or for a single line item on a claim form. It is important to understand MUE's are ...
ICD-10-CM - Supplement information for E-Cigarette/Vaping Reporting
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published December 9th, 2019
The CDC has released additional information and coding guidance for reporting encounters related to the 2019 health care encounters and deaths related to e-cigarette, or vaping, product use associated lung injury (EVALI).
The update offers coding scenarios for general guidance, poisoning and toxicity, substance abuse and signs and symptoms.
ICD-10-CM Official Coding Guidelines - ...
Clarify the Complexity Please! NDC Codes and Drug Classification Systems
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published December 9th, 2019
Different Drug classification systems are used to categorize drugs to identify the medication, with each system having their own logic. There are four main drug classification systems used in the United States, not to be confused with a class of drugs or "Drug Class". A drug class is the way drugs ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published December 9th, 2019
Have you noticed your LCDs are missing something? CMS is moving codes out of LCDs and into Billing and Coding Articles. MACs began moving ICD-10-CM, CPT/HCPCS, Bill Type, and Revenue codes in January 2019, and will continue through January 2020. Therefore, if there is an LCD with its codes removed, you will find ...
Q/A: Can I Order a TENS unit for a Medicare Patient?
By Wyn Staheli, Director of Research | Published December 3rd, 2019 - Last Review/Update December 4th, 2019
Question
Can a chiropractor order a TENS unit for a Medicare patient? We cannot order X-rays for a Medicare patient so I assume we cannot order a TENS unit either.
Answer
It’s not that you can’t order the TENS unit, it’s just that when it comes to doctors of chiropractic, Medicare only covers ...
Answering the Question: Does my Insurance Cover Chiropractic Care?
By Wyn Staheli, Director of Research | Published December 3rd, 2019 - Last Review/Update December 4th, 2019
The question "Does my insurance cover chiropractic care" is the ongoing question chiropractic offices have struggled with for years. Unfortunately, when it comes to insurance, coverage often varies between payers — even varying between plans for a single payer so there isn't one easy answer.
"What is the ICD-10 code for...?" - Search Smarter With Find-A-Code Tools
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published November 27th, 2019 - Last Review/Update December 3rd, 2019
Do you still find yourself searching the internet for an ICD10 code? Medical coders often type into their search engine, what is the ICD10 code for ... and a specific diagnosis code, to avoid repeatedly dragging out the incredibly large ICD10 codebook. Ironically, some of the most commonly searched ICD10 diagnoses include: ...
By Wyn Staheli, Director of Research | Published November 25th, 2019
In ICD-10-CM, hypertension code options do not distinguish between malignant and benign or between controlled and uncontrolled. What is important for code selection is knowing if the hypertension is caused by or related to another condition. The following table shows some of these options.
Q/A: How do I Code a Procedure for the Primary Insurance so the Secondary Can Get Billed?
By Wyn Staheli, Director of Research | Published November 19th, 2019
Question: How do you modify a code submitted to the primary insurance company to let them know it is not covered by them so you can bill to a secondary?
By Wyn Staheli, Director of Research | Published November 12th, 2019
Final rule eliminates the requirement for health plans to obtain a unique health plan identifier (HPID) and also eliminates the voluntary use of the other entity identifier (OEID). This change becomes effective December 27, 2019.
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published November 11th, 2019
Find-A-Code offers fees and pricing for just about everything, this article will address two of some of the most common payment systems with CMS. (OPPS) -Outpatient Medicare Outpatient Prospective Payment System. (MPFS)- Medicare Physician Fee Schedule The Fees section on each code page is determined on the type of services...
2020 Official ICD-10-CM Coding Guideline Changes Are Here!
By Wyn Staheli, Director of Research | Published October 1st, 2019
It’s that time of year for offices to get ready for the ICD-10-CM code revisions. As part of that process, it’s also good to know what is going on with the ICD-10-CM Official Guidelines for Coding and Reporting. In the examples listed below, strikeout text is deleted and highlighted text ...
By Wyn Staheli, Director of Research | Published October 1st, 2019
When federal employees sustain work-related injuries, it does not go through state workers compensation insurance. You must be an enrolled provider to provide services or supplies. The following are some recommended links for additional information about this program.
Division of Federal Employees' Compensation (DFEC) website
Division of Federal Employees' Compensation (DFEC) provider ...
The New ICD-10-CM Code Updates Are Here — Are You Ready?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published October 1st, 2019
Chapter 1: Certain Infectious and Parasitic Diseases (A00-B99)
A small revision in the description changed[STEC] to (STEC) for B96.21, B96.22, B96.23. Remember, in the instructional guidelines, ( ) parentheses enclose supplementary words not included in the description (or not) and [ ] brackets enclose synonyms, alternative wording, or explanatory phrases.
Chapter 2: ...
CMS and HHS Tighten Enrollment Rules and Increase Penalties
By Wyn Staheli, Director of Research | Published September 30th, 2019
This ruling impacts what providers and suppliers are required to disclose to be considered eligible to participate in Medicare, Medicaid, and Children's Health Insurance Program (CHIP). The original proposed rule came out in 2016 and this final rule will go into effect on November 4, 2019.
There have been known problems ...
Q/A: Is the Functional Rating Index by Evidence-Based Chiropractic Valid?
By Wyn Staheli, Director of Research | Published September 9th, 2019
Question
Is the Functional Rating Index, from the Institute of Evidence-Based Chiropractic, valid and acceptable? Or do we have to use Oswestry and NDI?
Answer
You can use any outcome assessment questionnaire that has been normalized and vetted for the target population and can be scored so you can compare the results from ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published August 20th, 2019
Find-A-Code has created a TOPIC page specifically for Chiropractors. Check it out! We have simplified your search with Articles, Tips, Webinars, and Tools all in one place for your convenience.
Be sure to visit us today. Simply go to Findacode.com then hover over TOPICS at the top of the page, then select Chiropractic.
...
Are You Aware of Medicare Advantage Plans Timely Filing Rules?
By Aimee Wilcox | Published August 20th, 2019
The Medicare Fee for Service (FFS) program (Traditional or Original Medicare) has a timely filing requirement; a clean claim for services rendered must be received within one year of the date of service or risk payment denial.
As any company who has billed Medicare services can attest, the one-year timely filing ...
By Namas | Published August 16th, 2019 - Last Review/Update August 20th, 2019
Medical ID Theft
"So, do you guys think you can do something with that?" John asked angrily at our first meeting with him in August 2017 as he slammed a stack of medical bills, EOBs and collection letters - three inches high - down in front of my partner and I. ...
How to Properly Report Prolonged Evaluation and Management Services
By Aimee Wilcox | Published August 13th, 2019
Have you ever had a patient take more time with the provider than they were scheduled for? Do you understand which codes to report and the rules that govern them to allow for better reimbursement?
Prolonged Service codes were created just for that reason but you must carefully follow the documentation ...
Will Medicare Change Their Rules Regarding Coverage of Services Provided by a Chiropractor?
By Wyn Staheli, Director of Research | Published August 13th, 2019
Two separate pieces of legislation introduced in the House of Representatives (H.R. 2883 and H.R. 3654) have the potential to change some of Medicare’s policies regarding doctors of chiropractic. Find out what these two bills are all about and how they could affect Medicare policies.
The OIG Work Plan: What Is It and Why Should I Care?
By Namas | Published August 9th, 2019 - Last Review/Update August 14th, 2019
The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ...
Q/A: What if my Patient Refuses to Fill out the Outcome Assessment Questionnaire?
By ChiroCode | Published August 6th, 2019
Question:
What if my Medicare patient refuses to fill out the outcome assessment questionnaire?
Answer:
Inform the patient that Medicare requires that you demonstrate functional improvement in order for them to determine if the care is medically necessary. In other words, they may have to pay for the care out of pocket if ...
The Role of Chiropractic in Value Based Payment Systems
By Wyn Staheli, Director of Research | Published July 29th, 2019
Chiropractic care can play a valuable role in overall patient health. It is important to realize that chiropractors can effectively participate in Medicare's new value based payment systems. Read about one organization who has made this transition.
By Evan Gwilliam DC, MBA, BS, CPC, CCPC, CPC-I, QCC, MCS-P, CPMA, CMHP, AAPC Fellow | Published July 29th, 2019
Question: I have a part time mobile clinic. I travel to treat patients at their homes. Are there special considerations when billing for these encounters?
Anthem is Changing their Timely Filing Requirements for All Plans, Including Medicare Advantage
By Namas | Published July 26th, 2019 - Last Review/Update August 8th, 2019
Anthem has been very busy sending out notices stating that, beginning October 1, 2019, all timely filing deadlines for claims will be 90 days. We've seen this letter, or something very similar, sent to doctors and other healthcare providers from California to Kentucky.
In their notice, Anthem states:
"Effective for all commercial ...
Q/A: What do I Need to Document for Periodic Adjustments on a Medicare Patient?
By Evan Gwilliam DC MBA BS CPC NCICS CCPC CCCPC CPC-I MCS-P CPMA | Published July 22nd, 2019
Question:
What type of documentation is required for a Medicare patient with degenerative joint disease who get adjusted once or twice a month for occasional flare-ups of the D. J. D. region? The noted adjustments give good relief of the patient's symptoms.
Answer:
There is no question that these adjustments would be considered ...
By Wyn Staheli, Director of Research | Published July 22nd, 2019
There are many things that can be missed when trying to run an effective and profitable practice. This article covers some important tasks that are often overlooked such as not reviewing your payer contracts or failing to check eligibility.
Act Now on CMS Proposal to Cover Acupuncture for Chronic Low Back Pain
By Wyn Staheli, Director of Research | Published July 17th, 2019
Now is the time to comment on a proposal to cover acupuncture for chronic low back pain. This comment period is the part of the HHS response to the opioid crisis. You only have until August 14th to officially comment.
Q/A: Do I Use 7th Character A for all Sprain/Strain Care Until MMI?
By Wyn Staheli, Director of Research | Published July 15th, 2019
Question:
It is in regards to the Initial and Subsequent 7th digit (A and D) for sprains and strains. Recently, I have been told that I should continue with the A digit until the patient has reached Maximum Medical Improvement (MMI) and then switch over to the D place holder. Is ...
By BC Advantage | Published July 12th, 2019 - Last Review/Update July 30th, 2019
Last year was historic for HIPAA enforcement. The HHS Office of Civil Rights collected a record $23.5 million in settlements and judgments against providers guilty of HIPAA violations. To avoid becoming part of that unwanted statistic, it’s important to pay extra close attention to five key areas of HIPAA vulnerability.
Take ...
Q/A: Can I Put the DC’s NPI in Item Number 24J for Massage Services?
By Wyn Staheli, Director of Research | Published July 8th, 2019
Question:
Are there scenarios in which it is acceptable to put the DC's NPI in box 24j for massage services?
Answer:
While the answer to this is yes, it is essential to understand that there are very limited scenarios. In most cases, Item Number 24J is only for the NPI of the individual ...
Will the New Low Level Laser Therapy Code Solve Your Billing Issues?
By Wyn Staheli, Director of Research | Published July 8th, 2019
Low level laser therapy (LLLT), also known as cold laser therapy, is a form of phototherapy which uses a device that produces laser beam wavelengths, typically between 600 and 1000 nm and watts from 5–500 milliwatts (mW). It is often used to treat the following:
Inflammatory conditions (e.g., Rheumatoid Arthritis, Carpal ...
Helping Others Understand How to Apply Incident to Guidelines
By Namas | Published July 5th, 2019 - Last Review/Update July 16th, 2019
Over the past few months, I have worked with different organizations that have been misinterpreting the "incident to" guidelines and, in return, have been billing for services rendered by staff that are not qualified to perform the services per AMA and CPT. What I found within the variances is that ...
Rules for Rendering Unproven, Investigational or Experimental Procedures
By Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published July 1st, 2019
If you haven’t reviewed your state guidelines or taken a recent look at third-party payer policies on unproven, investigational or experimental procedures, now is the perfect time to make sure you’re up to speed with this important information. Most providers are surprised to see commonly used devices or techniques listed ...
By Wyn Staheli, Director of Research | Published July 1st, 2019
Question:
I heard that I need to have an interpreter if someone who only speaks Spanish comes into my office. Is this really true?
Answer:
Yes! There are both state and federal laws that need to be considered. The applicable federal laws are:
Title VI of the Civil Rights Act of 1964,
Americans with Disabilities ...
2018 Medicare Improper Payment Report Shows Slight Improvement but There's Still Work to be Done
By Wyn Staheli, Director of Research | Published June 27th, 2019 - Last Review/Update July 8th, 2019
The Medicare Improper Payment Report for 2018 is not a measurement of fraud. Rather, it is an estimate of the claims paid by Medicare which did not meet Medicare coverage, coding, and billing rules. The estimated Medicare FFS payment accuracy rate (claims paid correctly) from July 1, 2016 through June 30, 2017, was 91.9 percent. ...
Q/A: Can I Refuse to File a Patient's Medical Insurance for an Auto Accident?
By Wyn Staheli, Director of Research | Published June 25th, 2019
Question:
Can a Chiropractor refuse to file a patients Medical Insurance for an Auto Accident?
Answer:
There isn't a simple answer to this question. It depends on who is responsible and state laws. Who is responsible (the auto insurance or the medical insurance) can depend on state requirements as well as who is ...
By Namas | Published June 21st, 2019 - Last Review/Update June 27th, 2019
Small Breaches Can Be Subject to Large Penalties
We may have heard about the large fines issued by the Office for Civil Rights (OCR) against big organizations like Anthem or the University of Texas MD Anderson Cancer Center. These organizations have been in the news due to privacy breaches that constituted violations ...
Risk Adjustment is a program that was implemented to identify and support Medicare beneficiaries with health conditions, illnesses, or injuries that put them at risk of death or organ system/bodily function failure. Through Risk Adjustment (RA), Medicare ensures their beneficiaries are being followed at least annually for any healthcare conditions ...
By Namas | Published June 14th, 2019 - Last Review/Update June 18th, 2019
A United Approach
As auditors, we all have a different perspective when evaluating documentation. It would be unreasonable to think that we all view things the same way. In my opinion, differing perspectives are what makes a great team because you can coalesce on a particular chart, work it through and ...
What Medical Necessity Tools Does Find-A-Code Offer?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published June 13th, 2019
Find-A-Code is a great resource for individuals working in all aspects of healthcare, from providers and ancillary staff to the attorneys and payers who assess and critique the documentation supporting the services performed. When recently asked what tools Find-A-Code has to help support medical necessity, our response was, "We provide many resources ...
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published June 6th, 2019 - Last Review/Update June 11th, 2019
Have you ever tried to quickly recall the elements required to support a comprehensive ophthalmologic exam versus an intermediate one? Make coding decisions quickly by creating a cheat sheet containing vital information that allows you to quickly select the right code.
According to Article A19881 which was published in 2004 and ...
Noting "Noncontributory" for Past Medical, Family, Social History - Is It Acceptable?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published May 29th, 2019 - Last Review/Update June 4th, 2019
Is "noncontributory" really an unacceptable word to describe a patient whose family history doesn't have any bearing on the condition being evaluated and treated today?
Q/A: For Physical Therapy Claims, What is the Correct Modifier Order?
By Wyn Staheli, Director of Research | Published May 27th, 2019 - Last Review/Update June 6th, 2019
Question
Page 116 of the 2019 ChiroCode Deskbook shows examples for Medicare modifiers. Is this the specific order for the modifiers to be entered? Our practice management software system is advising the GP or GY should be used as Modifier 1 and not as Mod 2 or Mod 3.
Also, it shows the ...
Your New Patient Exam Code Could Determine How Many Visits You Get
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published May 27th, 2019 - Last Review/Update June 6th, 2019
The initial exam is where the provider gathers the information to determine the need for all the care that follows. It is billed most often as an office or outpatient evaluation and management (E/M) code from the 4th edition of the AMA’s Current Procedural Terminology book. There are actually five ...
RT and LT Modifier Usage Change (effective 2019-03-01)
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published May 21st, 2019
According to Noridian Medicare, there are new changes required when reporting the RT and LT modifier(s). In the past, it was appropriate to bill the RT and LT modifier on the same line when it was required for certain HCPCS codes. Noridian released a publication stating claims reported with RT/LT on the same ...
Electrical Stimulation and Electromagnetic Therapy Devices
By Raquel Shumway | Published May 13th, 2019 - Last Review/Update May 20th, 2019
Electrical Stimulation and Electromagnetic Therapy Devices can be used for pain, muscle atrophy, help spinal cord injuries, treat symptoms caused by other medical conditions and can be used in the treatment of wounds. This Regence BC/BS article lists codes and devices and gives guidance on coding from Medicare Advantage viewpoint.
By Wyn Staheli, Director of Research | Published April 29th, 2019
On April 12, 2019, Medicare announced that there will be some changes to their appeals process effective June 13, 2019. According to the MLN Matters release (see References), the following policy revisions in the Medicare Claims Processing Manual (MCPM), Chapter 29 are taking place:
The policy on use of electronic signatures
Timing ...
Q/A: I’m Being Audited? Is There a Documentation Template I can use?
By Wyn Staheli, Director of Research | Published April 29th, 2019
Question: Our Medicare contractor is auditing claims with 98942. Do you have any suggestions for a template for documentation to warrant the use of 98942?
Answer: When you submit a claim with code 98942 you are stating that you have determined that it was medically necessary to adjust all 5 of ...
By Wyn Staheli, Director of Content | Published April 26th, 2019
There are policy revisions in the Medicare Claims Processing Manual (MCPM), Chapter 29 taking place June 13, 2019. This will give you a heads up on those changes.
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published April 23rd, 2019
Have you ever assigned a high-complexity E/M code (e.g., 99205, 99215, 99223, 99233, 99245, etc.) and wondered if it would stand up to further scrutiny? Well, let’s take a closer look at the requirements for reporting high-level E/M services.
Both the American Medical Association and Medicare-published E/M Guidelines agree that a ...
What is Medical Necessity and How Does Documentation Support It?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published April 23rd, 2019
We recently fielded the question, “What is medical necessity and how do I know if it's been met?"
The AMA defines medical necessity as:
It is important to understand that while the AMA provides general guidance on what they consider medically necessary services, these particular coding guidelines are generic and may be ...
By By Evan M. Gwilliam, DC MBA BS CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow Clinical Director, PayDC Chiropractic EHR Software President, Gwilliam Consulting LLC drgwil@gmail.com | Published April 22nd, 2019
Chiropractic is unique from other types of health care and auditors need to be aware of the nuances of this field. Chiropractic has become the focus of more and more audits as doctors seem to struggle to create records that properly support the care provided to the patient throughout the entire episode.
By Wyn Staheli, Director of Content | Published April 22nd, 2019
Question: I got a denial on my claim and it said the problem was with the diagnoses codes that I used. I used M54.15 and M79.2. I don’t understand why this is a problem.
By Wyn Staheli, Director of Research | Published April 8th, 2019
Any type of payer review can create some headaches for providers and cause problems for a healthcare office. Even for a practice that has taken administrative steps to try and prevent a prepayment review, it can still happen. A prepayment review means that you must include documentation WITH your claim. ...
Q/A: I Submitted a Claim to the VA and it’s Being Denied. Why?
By Wyn Staheli, Director of Research | Published April 1st, 2019
I submitted a claim to the VA and it’s being denied. Why?
There are several reasons why your claim might be denied by the Veterans Administration (VA). However, without more information about the claim itself (e.g., services billed), we can only provide the following general information about the VA and chiropractic ...
By Wyn Staheli, Director of Research | Published April 1st, 2019 - Last Review/Update April 2nd, 2019
One constant in our industry is change. Policies change, contracts change, and there are updates. Also, people aren’t perfect and mistakes can be made. So this article will cover a variety of topics.
Published Articles
We appreciate feedback from our valued customers. We have received feedback regarding two of our articles which ...
Q/A: Can I Tell a Medicare Patient Which Option to Check on the ABN?
By Wyn Staheli, Director of Research | Published April 1st, 2019 - Last Review/Update April 2nd, 2019
Question
My patient seemed confused about which of the options they should check. Can I just tell them which one they should check?
Answer
No! That could be construed as coercion. The official instructions state “Under no circumstances can the notifier decide for the beneficiary which of the 3 checkboxes to select.”
Now, this ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published March 27th, 2019
When coding with ICD-10-CM, pain codes can be found in different sections:
The Body System affected or site-specific pain codes, such as Low Back Pain M54.5, can be found in Chapter 13. Diseases of the Musculoskeletal system (M00-M99). Other examples might be ocular pain H57.1, found in Chapter 7. Diseases of ...
Clearing Up Some Medicare Participation Misunderstandings
By Wyn Staheli, Director of Research | Published March 25th, 2019 - Last Review/Update April 2nd, 2019
Even though we may think we truly understand what it means to be a participating provider, Medicare doesn’t quite work the way that other insurance plans do. Far too many providers do not understand the difference and get into hot water. To further complicate matters, the rules are different for ...
Q/A: How do we Know Which Codes a Payer Will Allow?
By Wyn Staheli, Director of Research | Published March 22nd, 2019
How do we know which codes a payer will allow?
The best way to determine the codes (CPT, ICD-10-CM and HCPCS) allowed by a payer is to review their payer policy. While it is good to know the official guidelines (e.g., ICD-10-CM Official Guidelines for Coding and Reporting, AMA Guidelines, Medicare ...
The Impact of Medical Necessity on High Level E/M Services
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 21st, 2019
I was recently asked the question, "Does 99233 require documentation of a past medical, family, and/or social history (PFSH)?"
The quick answer is, "it depends."
Code 99233 has the following minimal component requirement:
Subsequent inpatient E/M encounters can meet the code level requirement either by component scoring & medical necessity or time & medical necessity. ...
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 18th, 2019
If you've ever taken piano lessons, you know that the thumb is considered the first finger of the hand. Anatomically, it is also referred to as the first phalanx (finger). However, when you are coding an x-ray of the thumb, images are captured of the thumb, hand, wrist, and all ...
Q/A: Can you Help me Understand the New Medicare Insurance Cards?
By Wyn Staheli, Director of Research | Published March 7th, 2019
As many of you are aware, CMS began issuing new Medicare identification cards last year which required the replacement of social security numbers with a new Medicare Beneficiary Identifier (MBI). All cards have now been mailed out and patient's should have the new cards when they come in. Currently, we are in the transition period until January 2020.
UnitedHealthcare to Discontinue Coverage of Consultations
By Wyn Staheli, Director of Research | Published March 4th, 2019 - Last Review/Update March 7th, 2019
In United Healthcare's March provider bulletin, they announced that beginning on June 1, 2019, they will be phasing out coverage of consultation services (99241-99255).
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 1st, 2019
Medicare creates and maintains the National Correct Coding Initiative (NCCI) edits and NCCI Policy Manual, which identify code pair edits. When performed on the same patient, on the same day, and by the same provider, the secondary code is considered an integral part of the primary code, and payment for ...
Medicare Supplemental Policies (MediGap) and Extremity Adjustments
By Wyn Staheli, Director of Research | Published February 25th, 2019
The nice thing about MediGap policies is that they pay for some of the healthcare costs that an original Medicare plan (Part B) does not cover. So when a patient has Medicare and a Medicare supplement (MediGap) and their condition is related to an extremity (a noncovered service), Medicare must ...
Proposed Rule: Expanded Telemedicine Benefits for Medicare Advantage Beneficiaries
By Aimee Wilcox | Published February 14th, 2019
Telemedicine continues its rise, with new technologies allowing for better communication and access to more aspects of healthcare than ever before. Each year Medicare has made strides, albeit small strides, in their telemedicine coverage while commercial payers continue to make great strides, constantly improving and expanding telemedicine service offerings to ...
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published February 12th, 2019
The Medicare Initial Preventive Physical Exam (IPPE), also commonly referred to as the “Welcome to Medicare Physical”, may seem daunting to many, but when broken out to identify the requirements is fairly straightforward.
Purpose
An IPPE helps the Medicare beneficiary (the patient) get to know their healthcare provider at a time when they ...
By Wyn Staheli, Director of Research | Published February 7th, 2019 - Last Review/Update February 8th, 2019
Question
Are you aware if digital x-ray of the spine requires a different code than plain x-ray? If so, where can I find the information specific to digital x-ray codes?
Answer
There are no separate codes for digital x-rays. However, there may be modifiers that are required to be submitted with the usual ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published February 5th, 2019
State scope of practice laws and regulations will help determine who is considered Clinical staff and Other qualified Health Care professionals.
Physician or other qualified healthcare professionals: Must have a State license, education training showing qualifications as well as facility privileges.
Examples of Qualified Healthcare professionals:
(NOTE: this list is not all-inclusive, please refer to your payer ...
By Wyn Staheli, Director of Research | Published February 1st, 2019 - Last Review/Update February 4th, 2019
Question: How do I code it so that PT services in a chiropractic office don’t count against their PT visit max? Is there a way to code claims so that they are considered chiropractic only? But still get compensated enough? We have been running into some issues as of late ...
Attestations Teaching Physicians vs Split Shared Visits
By BC Advantage | Published February 1st, 2019 - Last Review/Update February 7th, 2019
Physicians often use the term "attestation" to refer to any kind of statement they insert into a progress note for an encounter involving work by a resident, non-physician practitioner (NPP), or scribe. However, for compliance and documentation purposes, "attestation" has a specific meaning and there are distinct requirements for what ...
By Find-A-Code | Published January 28th, 2019 - Last Review/Update January 29th, 2019
BLOG: CMS announced a NEWS release today making it easier to help Medicare Beneficiaries access cost and quality information. CMS announced, "Today, the Centers for Medicare & Medicaid Services (CMS) launched a new app that gives consumers a modernized Medicare experience with direct access on a mobile device to some of ...
Medical Necessity vs. Documentation for Inpatient Services
By NAMAS | Published January 25th, 2019 - Last Review/Update January 29th, 2019
Auditing the documentation of inpatient and observation E/M services can often be challenging. Many of the notes we are provided for review include so much information that the note feels like a short novel instead of documentation for one date of service. This over-documentation can make it difficult to see ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published January 23rd, 2019
We have it all! Search our WK Drug Database for drugs and pharmaceuticals. When it comes to support and guidance the WK Drug Database offers a paramount search and is conveniently presented in one place.
Pricing
GPIs
NDCs
Billing Codes
Indications/Diseases
Packaging Information
Active and Inactive
and more...
Additionally, learn more about drugs and pharmaceuticals that can be used to detect, treat, or monitor ...
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 23rd, 2019
Modifier 62 is appended to surgical claims to report the need for the skills of two surgeons (co-surgeons) to perform a procedure, with each surgeon performing a distinct part of the same procedure, during the same surgical session.
An easy way to explain this is to visualize a patient requiring cervical fusion where ...
By Wyn Staheli, Director of Research | Published January 14th, 2019
As many of you may already be keenly aware, there have been ongoing problems with many payers (e.g., BCBS of Ohio) regarding the appropriateness of reporting an E/M visit on the same day as CMT (CLICK HERE to read article). The AMA recently released an FAQ which renders their opinion ...
Are You Protecting Your Dental Practice From Fraud?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 10th, 2019
With the expansion of dental coverage through Medicaid and Medicare Advantage plans, an ever-increasing number of dental claims have come under scrutiny for fraud. One such payer, Aetna, is actively pursuing dental fraud by employing their special investigative units (SIUs) to identify and investigate providers who demonstrate unusual coding and ...
By Wyn Staheli, Director of Research | Published January 3rd, 2019
The correct coding of dry needling, also known as trigger point needling, has been a subject of confusion for quite some time. The American Chiropractic Association (ACA) and the American Physical Therapy Association (APTA) have been working together for several years to obtain appropriate codes to describe this service. In ...
By Wyn Staheli, Director of Research | Published January 3rd, 2019
Back in August of 2018, as part of the Medicare Shared Savings Program (Shared Savings Program), CMS proposed some sweeping changes for Accountable Care Organizations (ACOs). There has been some controversy over these changes which require ACOs to move to two-sided models. In this Final Rule which was scheduled to be published in the Federal Register ...
By Wyn Staheli, Director of Research | Published January 3rd, 2019
The new year is upon us and so it’s time to double check and make sure we are ready. Those with Premium Membership can use the ChiroCode Online Library and search all the official code sets: ICD-10-CM, CPT, and HCPCS. It also includes the updated NCCI edits and RVUs for ...
By Wyn Staheli, Director of Research | Published December 20th, 2018
Recently we posted a Q/A with stated that Cox-flexion distraction was not billable with code 97012. We received a comment from a customer stating that was not entirely correct because there is an add-on to the standard Cox table which satisfied the mechanical requirements to use code 97012. This article ...
Errors Billing Outpatient Services When Patient is also Inpatient
By Wyn Staheli, Director of Research | Published November 29th, 2018
The OIG recently reported that Medicare inappropriately paid acute-care hospitals for outpatient services provided to patients who were inpatients of another facility including long term care hospitals, inpatient rehabilitation facilities, inpatient psychiatric facilities, and critical access hospitals. CMS suggests using the following resources to ensure compliance:
Medicare Inappropriately Paid Acute-Care Hospitals for ...
By Wyn Staheli, Director of Research | Published November 29th, 2018
While equipment for home strengthening is arguably good for the patient and the prognosis of their condition(s), payers have very strict guidelines as to what is considered medically necessary when it comes to Durable Medical Equipment (DME). While I have seen some workers compensation policies which do pay for DME ...
Q/A: Do Croft Guidelines Apply After Time has Passed Since the Accident?
By Tom Grant Jr. DC | Published November 28th, 2018
Question: Do the Croft Guidelines apply to a patient's condition immediately following the collision or are they applicable to a patient's state when they first come to see you? Whether that has been weeks or months since the collision without treatment?
By Dr. Ray Foxworth, MCS-P, President of ChiroHealthUSA | Published November 28th, 2018 - Last Review/Update January 21st, 2019
You simply need to read the headlines, posts, and tweets, about providers across the healthcare profession being audited, fined, and some even convicted, to see that the costs of non-compliance are real. We tell ourselves, “It won’t happen to me.” The reality is that it easily could. Your license is your livelihood.
Reciprocal Billing and Locum Tenens Arrangements Changes
By Wyn Staheli, Director of Research | Published November 26th, 2018
CMS has made changes to their payment policies for reciprocal billing arrangements and Fee-For-Time compensation arrangements (formerly referred to as locum tenens arrangements). Providers need to be aware of these changes and update their policies as appropriate.
Q/A: Does My LMT need an NPI? How do I Bill Her Services?
By Wyn Staheli, Director of Research | Published October 22nd, 2018 - Last Review/Update December 19th, 2018
Question:
I am setting up an LMT to work as employee under Dr. Clifton, DC. i need to know several things - hoping they are related and can be grouped into this one question.... does she need her own NPI? where does that NPI # go? what box #? if not, ...
Coding Clinic Officially Defines Spondylolisthesis and Disc Disorder
By Wyn Staheli, Director of Research | Published October 19th, 2018 - Last Review/Update December 19th, 2018
The Coding Clinic for ICD-10-CM and ICD-10-PCS is a quarterly newsletter published by the American Hospital Association's Central Office (AHA). The information they publish is a joint effort of several organizations including the Centers for Disease Control and Prevention (CDC), the National Center for Health Statistics (NCHS), the Centers for Medicare and ...
Wolters Kluwer provides unit and package pricing for multiple drug price types: Average Wholesale Price (AWP), Wholesale Acquisition Cost (WAC), Direct Price (DP), Manufacturer's Suggested Wholesale Price (SWP), Centers for Medicare & Medicaid Services, Federal Upper Limit (CMS FUL), Average Average Wholesale Price (AAWP), Generic Equivalent Average Price (GEAP). Average...
Q/A: What Diagnosis Codes Should I Use for TMJ Headache Massage for Coverage?
By Wyn Staheli, Director of Research | Published October 16th, 2018
Question:
We have been receiving several DDS referrals to our massage therapists who do intra-oral work. The only problem is that the referral from the DDS lists code R51 for headaches as the only DX code. Since most plans don't cover massage therapy for headaches alone, are there any codes that can distinguish the headaches as ...
By Wyn Staheli, Director of Research | Published October 16th, 2018
Question:
I am a certified DOT medical examiner and have applied to get my CLIA lab (waiver) for urinalysis, finger prick blood tests for A1c, cholesterol and glucose. I realize I cannot diagnose patients with these tests, but I am using them to make decisions in the DOT process and with ...
2019 Code Changes are Just Around the Corner - Are You Ready?
By Wyn Staheli, Director of Research | Published September 24th, 2018 - Last Review/Update January 28th, 2019
The leaves are beginning to change and it’s time once again for the annual code changes for 2019. ICD-10-CM codes are out and will be effective October 1, 2018. CPT code changes also just came out and will be effective January 1, 2019. The ChiroCode DeskBook and ICD-10-CM Coding for Chiropractic books have been ...
Join QPro Today and Get Certified!
To have a credential in the medical profession shows you have met a minimum standard for professional and ethical standards.
Often employers prefer to hire staff that will be involved with any type of patient information such as coding, to show proof they have met certain ...
Finalized Confidentiality of Alcohol and Drug Abuse Patient Records Regulations
By Wyn Staheli, Director of Research | Published August 31st, 2018
In January, the U.S. Department of Health and Human Services (HHS) issued updates to the privacy regulations regarding the confidentiality of patient information of substance use disorder patients (42 CFR Part 2). This notice included references to better alignment with HIPAA regulations, but did state that Part 2 is more protective ...
By Wyn Staheli, Director of Research | Published August 20th, 2018
Noridian's pilot program Provider Self-Audit with Validation and Extrapolation (PSAVE) has been extended which means that it has been successful for the payer, which means that they are saving money. Historically, when a pilot program is proven to be successful, it isn’t too long before other MACs follow. Before signing up to participate, providers need to carefully evaluate the program. Are the benefits worth the costs?
By Wyn Staheli, Director of Research | Published August 16th, 2018
Why would a chiropractor be concerned about depression screenings when you aren’t trained to be a mental health provider? The answer lies in patient outcomes. Many quality care organizations recommend depression screenings for patients with a chronic condition. According to The National Institute of Mental Health, “People with other chronic ...
By Wyn Staheli, Director of Research | Published August 16th, 2018
Medicare's guidelines for reporting of timed codes is found in Medicare Claims Processing Manual Chapter 5, Section 20.2. Also known as the '8 minute' rule, it describes how to calculate time for appropriate reporting when more than one timed code is performed at the same time.
It should be noted that while ...
By Wyn Staheli, Director of Research | Published August 16th, 2018 - Last Review/Update January 30th, 2019
Are there any alternative procedure codes for billing mechanical massage (e.g., muscle master vibromassage, genie rub, etc)? I know that 'by the book' mechanical devices are not covered under 97124, but wondered if you have suggested a go-around code.
Q/A: How Do I Release a Patient from PI When They Still Have Problems?
By Wyn Staheli, Director of Research | Published August 10th, 2018 - Last Review/Update January 28th, 2019
Once a PI patient is released with symptoms, or without symptoms, and a prognosis of likely exacerbations with a future medical estimation of $1500 over then next 2 years, how am I supposed to release them from care when they still have ongoing needs?
We have discussed this with several different experts. The consensus is....
By ChiroCode | Published June 20th, 2018 - Last Review/Update January 30th, 2019
Question
The code, 97124, Is specifically for massage but I have read that Insurance will more likely pay for 97140. Could we bill for whichever one pays? I believe that we have to indicate which area is used for CMT and which area for massage. Is it enough to document that ...
Q/A: Can a PT Assistant Perform Physical Therapy Modalities?
By Wyn Staheli, Director of Research | Published June 18th, 2018 - Last Review/Update January 30th, 2019
Whether or not a physical therapy assistant (PTA) may perform physical therapy modalities depends on two factors: state law and payer policies. Read here for more.
By Wyn Staheli, Director of Research | Published June 14th, 2018
On May 11, 2018, the Department of Veterans Affairs (VA) released its final rule on the "Authority of VA Health Care Providers to Practice Telehealth." Effective June 11, 2018, VA providers will be able to provide telehealth services across state lines. This move will make it easier for veterans to obtain ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published May 1st, 2018
CEU’s are now available for the following Webinars:
Practice Risk Areas, Presented by Brandy Brimhall (1 CEU)
Secrets of Chiropractic Documentation, Presented by Compliant Coding Systems. (4 CEU’s)
CEUs are available in the following states:
Alaska
Connecticut
District of Columbia
Idaho
Indiana
Iowa
Kansas
Maine
Maryland
Massachusetts
Minnesota
Montana
Nebraska
Nevada
New Jersey
North Carolina
North Dakota
Ohio
Oregon
Rhode Island
South Carolina
South Dakota
Tennessee
Utah
Washington
Vermont
Virginia
Wyoming
Puerto Rico
Nova Scotia
NOTE: "Additional states may be ...
By Wyn Staheli, Director of Research | Published April 30th, 2018 - Last Review/Update January 30th, 2019
As chiropractors we feel the new modifier 97 is more appropriate than 96 for our PT codes such as stim and traction. Yet Carefirst is asking for 96 only. Should we use this code on all the PT codes and for all the other insurance companies?
As per MLN MM8304,
This article is based on Change Request (CR) 8304, which instructs DME MACs to implement requirements, which are effective July 1, 2013, for detailed written orders for face-to-face encounters conducted by the physician, PA, NP or CNS for certain DME items as defined in 42 CFR 410.38(g).
Due to concerns ...
Q/A: Someone Broke into My Office. What do I do Now?
By Wyn Staheli, Director of Research | Published April 23rd, 2018 - Last Review/Update January 24th, 2019
My office was broken into last night. I use electronic health records, but we do store some protected health information for my patients in paper files. These files are not secured, so the burglars did have access to them. It did not appear that the files were touched as the burglars were looking for cash. What responsibilities to I have to my patients in a situation like this? Do I need to contact them and advise them that their PHI could have been compromised?
The PSAVE Pilot Program: Should You Self-Audit Your Medicare Claims?
By Robert Liles, JD, MBA, MS | Published April 20th, 2018 - Last Review/Update April 25th, 2018
As the Medicare program has grown, the Centers for Medicare and Medicaid Services (CMS) has employed a variety of different claims audit mechanisms to better ensure that the Medicare Trust Fund is protected from waste, fraud and abuse....
Billing Nutrition Counseling in a Chiropractic Setting
By Wyn Staheli, Director of Research | Published April 12th, 2018
Billing nutrition counseling services may not be as straight-forward as you might think. Some providers mistakenly choose Medical Nutrition Therapy (MNT) codes (97802-97804, G0270, G0271) because it states nutrition therapy in the title. However, according to CPT guidelines, when MNT assessment and/or intervention is performed by a physician or qualified healthcare professional ...
By Wyn Staheli, Director of Research | Published April 12th, 2018
Billing nutrition counseling services may not be as straight-forward as you might think. Some providers mistakenly choose Medical Nutrition Therapy (MNT) codes (97802-97804, G0270, G0271) because it states nutrition therapy in the title. However, according to CPT guidelines, when MNT assessment and/or intervention is performed by a physician or qualified healthcare professional who may report evaluation and management ...
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published March 29th, 2018
Find-A-Code presented a webinar on “Coding and Auditing Telemedicine Services,” on March 29, 2018, which did not include the new and updated CMS information published in the MNL Matters Number: MM10393 on January 2, 2018. New and exciting changes were introduced in this article, which is addressed below.
Originating Site Fee
Each ...
When is 97112 Neuromuscular Re-education Billable?
By Dr. Evan Gwilliam, VP for PayDC | Published March 13th, 2018 - Last Review/Update January 31st, 2019
Q: I just received a note from an attorney regarding a patient who was rear ended about 40 mph and ended up with neuropathy in her upper and lower extremities. We treated her for about 3 months after previous care failed to give much relief. I used flexion distraction and deep muscle stimulation to break up adhesions from the injury and used the 97112 code of neuromuscular re-education. The insurance company said that code was not warranted for her spinal sprain diagnosis and denied all of the services. Do you know how I could justify it? It greatly improved her condition with each visit and the patient said we provided the greatest relief she received.
By Wyn Staheli, Director of Research | Published March 13th, 2018 - Last Review/Update January 31st, 2019
Question: I have a provider that provides Department of Transportation (DOT) exams. I have found ICD-10 code Z02.4 (encounter for examination for drivers license) but I am unsure which CPT Code to use. Would I still use 99203 or 99204?
By Wyn Staheli, Director of Research | Published March 1st, 2018
On February 9, 2018, the Bipartisan Budget Act of 2018 was signed into law. There were some changes which will affect Medicare payments. The following is a brief summary, for a more comprehensive summary see the References.
Therapy Caps: Some therapy caps (e.g., occupational, physical therapy, speech-language pathology) were discontinued. However, modifier KX will ...
The opportunities for providers who want to provide telemedicine continue to expand in all sectors of the healthcare market. Even the VA, long a symbol of a fossilized, bureaucratic healthcare entity, has begun to embrace this technology. Though most are familiar with what telemedicine is, many still have questions surrounding ...
By Wyn Staheli, Director of Research | Published February 26th, 2018
The OIG recently released a "Portfolio" regarding chiropractic service which stated (emphasis added):
This portfolio presents an overview of program vulnerabilities identified in prior Office of Inspector General (OIG) audits, evaluations, investigations, and legal actions related to chiropractic services in the Medicare program. It consolidates the findings and issues identified in ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published February 21st, 2018
HCPCS level II codes classify products into categories for the purpose of claims processing. HCPCS level II codes are alphanumeric with a descriptive terminology that identifies the item or service used primarily for billing purposes.
There are several types of HCPCS level II codes such as:
Permanent National Codes
Dental Codes
Miscellaneous Codes
Temporary National ...
HIPAA Breach Settlements and Ransomware Attacks - Is Your Practice Secure?
By Wyn Staheli, Director of Research | Published February 5th, 2018
Two recent reports should make providers stop, take notice and make sure their practice's policies and procedures are up-to-date.
The first one involves a HIPAA Breach settlement of a company with facilities in several states. The OCR memo stated "In addition to a $3.5 million monetary settlement, a corrective action plan ...
By Shannon DeConda, CPC, CPC-I, CEMC, CEMA, CPMA, CRTT | Published February 2nd, 2018 - Last Review/Update February 7th, 2018
This week we had a great question posted to our online forum, and I thought it would be a nice thought- provoking question for our auditing and compliance tip of the week.
By Wyn Staheli, Director of Research | Published February 1st, 2018
Healthcare providers must be vigilant in ensuring that software upgrades, also known as patches, are kept current. Failure to do so can lead to a HIPAA Security Breach with all its associated penalties. For example Windows XP no longer has security updates and should not be used in healthcare settings.
On ...
By Wyn Staheli, Director of Research | Published February 1st, 2018
On January 16, 2018, the OIG released a report of their findings on claims data for Medicare Advantage plans. While it appears that there were not significant issues, they did find that:
"Types of potential errors included inactive or invalid billing provider identifiers; duplicated service lines; missing required data; inconsistent dates; ...
By Wyn Staheli, Director of Research | Published February 1st, 2018
There are differences between the purposes of strapping and taping and using the correct codes depends on the application - literally.
Strapping: This application is for the purpose of immobilizing an area. It is clinically indicated for the treatment of fractures, dislocations, sprains/strains, tendonitis, post-op reconstruction, contractures, or other deformities involving soft tissue.
Coding: ...
By Wyn Staheli, Director of Research | Published February 1st, 2018
CMS and some other payers have adopted policies of reducing payments when certain multiple diagnostic imaging procedures (see Applicable Codes below) are performed in a single session by the same healthcare provider and/or group. They have done the same when there are multiple units for a procedure code. The rationale ...
By Wyn Staheli, Director of Research | Published February 1st, 2018
There has been some controversy over the use of the ICD-10-CM subluxation codes commonly referred to as traumatic (S13.1-, S23.1-, and S33.1-). Are they appropriate for chiropractors to use? The answer to that question is complicated. The problem basically lies in the lack of official guidance and differing opinions on ...
By Ashley Choate | Published January 31st, 2018 - Last Review/Update March 29th, 2018
High Deductible Health Plans (HDHPs) are recent and growing trend in healthcare that is probably here to stay, regardless of the future changes to the national healthcare system or federal regulations.....
Referring and Ordering Physician - CMS-1500 Box 17
By Christine Woolstenhulme, QCC, CMCS, CPC, CMRS | Published January 29th, 2018
Enter the name of the referring or ordering physician if the service or item was ordered or referred by a physician. All physicians who order services or refer Medicare beneficiaries must report this data. Similarly, if Medicare policy requires you to report a supervising physician, enter this information in Item ...
Aftercare visit codes cover situations when the initial treatment of a disease has been performed, and the patient requires continued care during the healing or recovery phase, or for the long-term consequences of the disease. The aftercare Z code should not be used if treatment is directed at a current, ...
By Sean M. Weiss, CHC, CEMA, CMCO, CP MA, CPC-P, CMPE, CPC | Published January 26th, 2018 - Last Review/Update February 7th, 2018
This year (2018), health care organizations (Hospitals, Health Systems and Physician Groups/Practices) must focus on the criticality of creating a culture of compliance to ensure effectiveness and efficiency....
By Ashley Choate | Published January 24th, 2018 - Last Review/Update March 29th, 2018
According to a recent Physicians Practice study, one of the top five reasons for denied medical claims is a lack of adequate documentation. While this might seem like an electronic records issue, the problem may be bigger than that. ...
Revenue Cycle 101: Reduce your Denials with These Tips
By Ranadene Tapio, MBA, CMRS, CMC | Published January 24th, 2018 - Last Review/Update March 29th, 2018
Your practice seems to be doing everything right. You have a team in place, established your RCM process and you’re submitting claim after claim – but your denial rate isn’t going down....
NEW on Find-A-Code...National Coverage Determinations (NCDs)
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 23rd, 2018 - Last Review/Update January 25th, 2018
Medicare limits its coverage of services to those considered to be reasonable and necessary for the diagnosis and treatment of an injury or illness based on coverage guidelines. National Coverage Determinations (NCDs) are created based on research, evidence-based processes, public participation, and other resources, and made available to the public. ...
By Wyn Staheli, Director of Research | Published January 16th, 2018
Section 1848(r)(4) of MACRA requires that claims submitted for items and services furnished by a physician or applicable practitioner on or after January 1, 2018, include codes for the following:
care episode groups
patient condition groups
patient relationship categories
Previously, CMS decided to use procedure code modifiers to report patient relationship codes on Medicare ...
Medicare Requiring Specific Modifiers on Therapy Services
By Wyn Staheli, Director of Research | Published January 15th, 2018
Medicare's MLN Matters Number: MM10176 was recently revised to identify services subject to their therapy cap. The revision became effective on January 1, 2018 and some providers have begun to receive claim rejections because they are not using the appropriate modifier. The article states the following:
Services furnished under the Outpatient ...
By Wyn Staheli, Director of Research | Published January 15th, 2018 - Last Review/Update January 30th, 2019
Q: When patients have a true Medicare secondary insurance we've always billed other Medicare non-covered codes such as G0283 for electric stimulation with modifier GY because we are aware Medicare will not pay for that service but the secondary insurance does. We just were notified by our MAC that GY is not a valid modifier and I have to enter a GP or other therapy modifier. What is the new proper modifier to enter?
Advance Beneficiary Notice of Noncoverage (ABN) Modifier Guidelines
By Find-A-Code | Published January 11th, 2018
The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131 may be used for services which are likely to be non-covered, whether for medical necessity or for other reasons. Refer to CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30, for complete instructions.Effective from April 1, 2010, non-covered services should be billed with modifier GA, GX, GY, or GZ, as ...
Should ROM Testing be Reported with Evaluation and Management Services?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published January 9th, 2018
Reporting the performance of range of motion testing (95851-95852) at the same encounter of an Evaluation and Management (EM) service, produces an NCCI edit resulting in payment for the EM service and denial of the ROM testing. Read the article to learn what other codes ROM testing is considered incidental to.
Modifiers 54-55, split surgical and postoperative care
By Find-A-Code | Published January 4th, 2018
54 -Surgical care only; Surgeon is performing only the preoperative and intra-operative care
55 - Postoperative management only; Physician, other than surgeon, assumes all or part of postoperative care
Modifiers should be placed on the surgical code
Used on 10 day and 90 day surgical procedures
Both the surgeon and the physician providing the postoperative ...
According to the official ICD-10-CM Guidelines, in situations of maltreatment (e.g., adult and child abuse, neglect, etc.), the sequence of coding is important. Regardless of whether it is suspected or confirmed, it is important to document the type of abuse. Use the following sequence:
An appropriate code from category T74- (confirmed) or T76- (suspected)
Any accompanying mental ...
By Kelly Ogle, BSDH, MIOP, CMPM, CHOP | Published December 29th, 2017 - Last Review/Update January 31st, 2018
In each practice, there are patients who present with a multitude of problems. These problems can range from the smallest of symptoms to the more complex illnesses.....
Properly documenting DME orders is crucial for reimbursement. It should be noted that without meeting the payer requirements, the claim will be denied. For Medicare, the beneficiary will not be responsible for paying for the item if the provider and/or supplier do not meet requirements. Commercial payers have similar policies so carefully ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published December 12th, 2017
The exact level of the subluxation must be specified in the documentation to substantiate payment of a claim.
You may document the exact bones such as C3, C3 or the area if it implies only certain bones such as the Occipito-atlantal - Occiput, and C1 (Atlas).
C1 is the first vertebra known as the atlas. The axis-form is ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published December 11th, 2017
CMS posted new Merit-based Incentive Payment System (MIPS) resources on Quality Payment Program Resource Library webpage:
CMS Web Interface: Excel template for uploading sample beneficiary data with corresponding user guide and instructional video
Extreme and Uncontrollable Circumstances Fact Sheet: Overview of the policy established in the interim final rule with comment period to support clinicians affected by the California wildfires and ...
By Wyn Staheli, Director of Research | Published November 30th, 2017 - Last Review/Update February 5th, 2019
Q: In order to code carpal tunnel syndrome G56.01 or G56.02, does there need to be documentation that nerve conduction (EMG testing) has been performed to confirm the diagnosis?
By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC | Published November 17th, 2017 - Last Review/Update January 31st, 2018
I want this story that I am about to share with you to fit with the majority of clients that I represent and work with because I have represented clients with refund demands as small as $1,000 and clients who had demands greater than $30 million. This year has been ...
By Wyn Staheli, Director of Research | Published November 6th, 2017
Fall has always been the season for CMS fee changes and on November 2, 2017, CMS announced the finalization of four rules which directly impact the following payment systems:
Physician Fee Schedule Final Policy, Payment, and Quality Provisions for CY 2018
Hospital OPPS and ASC Payment System and Quality Reporting Programs Changes ...
By Grant Huang, CPC, CPMA | Published November 3rd, 2017 - Last Review/Update January 31st, 2018
With CMS looking to gradually revise its E/M documentation requirements to reduce the burden and complexity they pose to providers, it's a great time to review the trickiest E/M component: medical decision making (MDM)....
By David Klein CPC, CPMA, CHC | Published October 31st, 2017 - Last Review/Update February 5th, 2019
Recent events regarding delegation of services to ancillary personnel have given rise to concerns regarding the delivery of outpatient physical medicine by Chiropractors, specifically regarding the appropriate use of one-on-one codes as opposed to group therapy code CPT 97150 - Therapeutic procedure(s), group (2 or more individuals). This advisory provides guidance on how to properly use one-on-one and group therapy codes, both independently and together.
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published October 23rd, 2017
The Office of the Inspector General was created to protect the integrity of the U.S. Department of Health and Human Services. They investigate fraud, waste, and abuse in HHS programs and make recommendations to various enforcement agencies. Every few years they investigate chiropractic services. Here is a summary of the reports the ...
By Shannon DeConda, CPC, CPC-I, CEMC, CEMA, CPMA, CRTT | Published October 20th, 2017 - Last Review/Update January 31st, 2018
When coding an E/M visit in the emergency department, would you count all PFSH listed even if they don't pertain to the indication as to why the patient arrived?
By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published October 13th, 2017 - Last Review/Update February 5th, 2019
Chiropractors cannot opt-opt of Medicare. Does that only refer to chiropractors that see Medicare patients? Do all Florida chiropractors have to complete Medicare enrollment/credentialing? Bottom line- do ALL chiropractors, no matter where or who, have to complete Medicare enrollment since they cannot Opt-out?
By David Glaser, JD | Published October 13th, 2017 - Last Review/Update January 31st, 2018
An earlier coding tip explained that the oft-repeated "if it isn't written, it wasn't done" is good risk management advice, but not a legal truism.....
Acronyms and Abbreviations: When You Fall into the Grey Area
By Omega Renne, CPC, CPMA, CPCO, CEMC, CIMC | Published October 6th, 2017 - Last Review/Update February 1st, 2018
We've all been there... you are coding or auditing, and then a note comes up that is not like the ones you've reviewed before. The language is unclear, the acronym(s) could mean so many different things, and it's hard to get a straight answer about whether or not it's supported higher or lower....
By Shannon Cameron, MBA, MHIIM, CPC | Published September 29th, 2017 - Last Review/Update January 31st, 2018
Big data and its use in the healthcare spectrum has proven to be an incredible source of the knowledge and has rapidly abetted progress in seemingly all areas of healthcare......
By ChiroCode | Published September 25th, 2017 - Last Review/Update February 5th, 2019
MIPS is a program that allows Medicare to collect data from providers about high quality low cost care that uses technology effectively. There are four categories and providers need to learn about the available measures so that they can pick the ones that make them look the best.
By Shannon DeConda, CPC, CPC-I, CEMC, CMSCS, CPMA, CEMA | Published September 15th, 2017 - Last Review/Update January 31st, 2018
Have you looked for published guidance on cloning/copying and pasting from the Centers for Medicare & Medicaid Services (CMS)? There is one published resource that provides rudimentary guidance.....
Double Dipping in the History of the Evaluation and Management Note
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published September 14th, 2017
There are many rules and guidelines a coder must be aware of when it comes to appropriately selecting an Evaluation and Management (EM) code and avoiding doubling dipping is one of them. Double dipping occurs when the same information is used in more than one of the subcomponents of history.
The subcomponents of history include:
Chief Complaint ...
Auditing Prolonged Evaluation and Management Services
By Aimee Wilcox | Published September 12th, 2017 - Last Review/Update September 18th, 2017
At times, there are patients who require prolonged face-to-face time with the provider to discuss or be counseled about their condition, plan of care, risks, complications, alternative therapies, or other medical issues. When E/M services go wild, taking significantly longer than the typical time associated with it, that direct face-to-face ...
ICD-10-CM Coding Advice for Healthcare Encounters in Hurricane Aftermath
By BC Advantage | Published September 12th, 2017 - Last Review/Update January 25th, 2018
This document is intended to be used as a guide to help coding professionals when coding healthcare encounters of those individuals affected by a hurricane.
Global Surgical Package: When to Bill and When Not to Bill, that is the Question
By Stephanie Allard, CPC, CEMA, RHIT | Published September 8th, 2017 - Last Review/Update January 31st, 2018
The global surgical package is inclusive of the services that would normally be provided to the patient following surgery. Depending on the global period assigned to a CPT code, the pre-operative, intra-operative and post-operative services could be included in the global surgical package.....
Medicare Improper Payment Report for Chiropractic (2016)
By Wyn Staheli, Director of Research | Published September 1st, 2017 - Last Review/Update October 16th, 2017
The Medicare Improper Payment Report for 2016 has been released by the OIG. Please note that the improper payment rate does not measure fraud. Rather, it estimates the payments that did not meet Medicare coverage, coding, and billing rules. The estimated Medicare FFS payment accuracy rate (claims paid correctly) from ...
American Chiropractic Association Comments on MACRA 2018 Proposed Rule
By ChiroCode | Published September 1st, 2017 - Last Review/Update January 30th, 2019
Arlington, Va. - The American Chiropractic Association (ACA) recently submitted comments to the Centers for Medicare and Medicaid Services (CMS) in response to the federal agency's proposed rule changes to the Quality Payment Program (QPP) for 2018.
QPP is a new payment model for physicians, including chiropractors, created by the Medicare Access and CHIP ...
By Wyn Staheli, Director of Research | Published September 1st, 2017 - Last Review/Update October 16th, 2017
NOTICE: This table was created for use by those who have purchased a Find-A-Code specialty specific Reimbursement Guide. Please do not share with others.
Codes in bold are complete codes of the highest specificity.
Codes with ** are listed in the DSM-5 which contains diagnostic criteria.
The underscore ( _ ) means that an ...
Preventive Services: Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD)
By Find-A-Code | Published September 1st, 2017 - Last Review/Update January 31st, 2018
The following information from the Medicare Learning Network provides guidance on Intensive Behavioral Therapy (IBT) for Cardiovascular Disease (CVD)....
By Sean Weiss, CHC, CMCO, CEMC, CPMA, CMPE, CPC-P, CPC | Published August 25th, 2017 - Last Review/Update January 31st, 2018
On June 29th, The Centers for Medicare and Medicaid (CMS) issued the Medicare Program: "Changes to the Medicare Claims and Entitlement, Medicare Advantage and Organization Determination, and Medicare Prescription Drug Coverage Determination Appeals Procedures final rule."
Can They Deny Electrical Stimulation by Saying There is no Evidence that it Works?
By Dr Ronald J. Farabaugh | Published August 24th, 2017 - Last Review/Update February 5th, 2019
Topic: Electrical Stimulation (EMS)
Question: An orthopedic surgeon/IME recommended a denial for all electrical stimulation
(EMS) by stating that "according ODG electrical stimulation is experimental therefore not
medically necessary or eligible for reimbursement." Is that true?
The Veterans Choice Program, created in 2014, was part of the solution to the extensive waiting times found in the VA system. The program allowed veterans to meet their health care needs from private health care providers. Though the “sunset” of the program was avoided earlier in the year, the ...
VA Patient-Centered Community Care and Veterans Choice Program: Worth it for Providers?
By Jared Staheli | Published August 23rd, 2017
As the opportunities for providers outside the VA system expand in order to meet demand, you may be interested in offering services to veterans and the VA, if you are not already. With overwhelming bipartisan support, the opportunities are not likely to abate, but are those opportunities worth it for ...
By ChiroCode | Published August 17th, 2017 - Last Review/Update January 31st, 2019
Watch this short video, "Secrets of 97140 Manual Therapy," to learn all that you need to know about the proper support for 97140.
ChiroCode_DeskBook_Tips_97140 from Innoventrum on Vimeo.
...
By Dr. Ray Foxworth, Certified Medical Compliance Specialist, President of ChiroHealthUSA, Chiropractor | Published August 16th, 2017 - Last Review/Update February 5th, 2019
While scanning my news feed this morning, a few alarming words caught my eye: "Opioids could kill nearly as many Americans in a decade as HIV/AIDS has killed since the epidemic began in the early 1980s." Across America, people are talking about chiropractic as a safer alternative to opioid medication for pain relief, and yet, I don't think the magnitude of this opportunity has been realized by most doctors of chiropractic in this country.
Delegation to Staff is not Allowed. Can I Bill for Group Exercises if I Supervise?
By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published August 8th, 2017 - Last Review/Update February 5th, 2019
My state does not allow me to delegate the supervision of therapeutic exercises (97110). I am the licensed chiropractor. If I provide the constant attendance myself, can I do it for a group of patients? If so, how do I document and bill for this?
By Wyn Staheli, Director of Research | Published August 4th, 2017
An article by Medical Economics highlights the June report of the Health Care Industry Cybersecurity Task Force. Their report confirmed once again that healthcare providers are not adequately addressing cybersecurity as part of the compliance programs. The threat of hackers is very real and providers need to ensure that they have taken ...
By Wyn Staheli | Published August 4th, 2017 - Last Review/Update October 4th, 2017
Medicare has proposed making some changes to policies regarding telehealth services. They are adding some new codes to their covered list of telehealth services and propose eliminating the requirement to use the GT modifier. Since many payers adopt similar policies, watch for further announcements from other third-party payers.
Proposed Codes
HCPCS code G0296 ...
In 2017, President Trump signed into law changes to the Veteran's Choice program, which allows veterans to seek care from a civilian (privately contracted) healthcare provider, closer to home, when obtaining care through the VA has become burdensome to the veteran or requires the veteran to wait too long for an appointment.
By Wyn Staheli, Director of Research | Published August 1st, 2017
Annual Wellness Visits (AWVs) are a preventive medicine service. It is a comprehensive evaluation and management service which is covered by payers as part of the Affordable Care Act (ACA)'s covered services and there are typically no deductibles or co-pays.
By Valora Gurganious, MBA, CHBA | Published July 7th, 2017 - Last Review/Update January 25th, 2018
Technology is ubiquitous in modern society, and just when we thought that computers could not replace the "human touch" of a healthcare provider, technology is making specialized care accessible to patients anywhere there is an internet connection.
By Liz Wilson, RHIT, CCS, CDIP, CPC, CRC, CEMC | Published June 30th, 2017 - Last Review/Update January 31st, 2018
Evaluation and Management (E/M) codes are defined by the AMA Current Procedural Terminology (CPT®) codebook and while they are the most commonly utilized CPT codes, their code descriptions have not changed in years.
Negotiating Free Rent – For Medical Professional Tenants
By Jeff Grandfield and Dale Willerton – The Lease Coach | Published June 15th, 2017
Free rent is just one negotiable factor in a commercial lease. To be clear, free rent is a period of time where you are not paying the Base or Minimum Rent (but are, typically, paying your Operating Costs) and you are open for business. Many medical professional tenants confuse this ...
By ChiroCode | Published June 13th, 2017 - Last Review/Update January 31st, 2019
Q. Is there a modifier that can be added on to CPT codes to show we performed the service even though they are bundled charges or Medicare doesn't pay for them? For example 97140 billed to BCBS or 99202 billed to Medicare. Is the GY modifier for all insurance companies or just Medicare?
By Dr Evan Gwilliam | Published May 22nd, 2017 - Last Review/Update January 31st, 2019
What is required for documenting a maintenance visit for a Medicare beneficiary?
Watch this video by Dr. Evan Gwilliam for his thoughts.
ChiroCodeQ&A_maintenance visit from Innoventrum on Vimeo.
ChiroCode Q&A "Maintenance Visit Documentation" With Dr. Evan Gwilliam. https://vimeo.com/208521720
...
By ChiroCode | Published April 28th, 2017 - Last Review/Update January 31st, 2019
Q: An insurer told me that chiropractors cannot bill 99204 or 99214 because those exams "require a level of decision making that would typically only occur in an emergency room." Is this true? Do I have any recourse?
By Wyn Staheli, Director of Research | Published April 10th, 2017
On February 3, 2017, the Department of Justice (DOJ) issued a Final Rule to increase the civil monetary penalties assessed under the False Claims Act (FCA), due to inflation for the year 2017, to an all-time high of $10,957 (minimum) to $21,916 (maximum). Thirty years ago, in 1986, Congress amended the False ...
By Wyn Staheli, Director of Research | Published March 29th, 2017
The final sub-component of Medical Decision Making is the Risk of Significant Complications, Morbidity and/or Mortality. The following is the official Evaluation and Management Table of Risk. The level is selected by choosing one element from three criteria (Presenting Problem, Diagnostic Procedures Ordered, and Management Options), with the highest level selected ...
Newly Revised "Common Procedure Codes" section in the 2016 ChiroCode DeskBook
By Evan M. Gwilliam, DC MBA BS CPC CCPC NCICS CPC-I CCCPC MCS-P CPMA | Published March 29th, 2017
The force used to create a degree of tension of soft tissues and/or to allow for separation between joint surfaces. The degree of traction is controlled through the amount of force (pounds) allowed, duration (time), and angle of pull (degrees) using mechanical means. Terms often used in describing pelvic/cervical traction ...
Are There any Alternatives for Code 97112 Neuromuscular Re-education?
By ChiroCode | Published March 24th, 2017 - Last Review/Update January 31st, 2019
Q: Are there any alternatives for code 97112 Neuromuscular Re-education? This code is counted toward both Chiropractic and Physical Therapy visits with BCBS, and we want to preserve the insurance benefits.
By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published March 3rd, 2017 - Last Review/Update February 8th, 2019
Q: If a patient is treated with chiropractic manipulation and it is clinically appropriate but doesn't qualify as medically necessary care, what is the proper way to communicate this when billing the insurance company for the service?
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published March 2nd, 2017 - Last Review/Update July 28th, 2017
The official guidelines for ICD-10-CM have very specific rules in determining principal diagnosis. However, it is imperative to note that it is necessary to be aware of the coding conventions in the ICD-10-CM Tabular List and Alphabetic Index as they take precedence over the official coding guidelines. Also, consider the ...
Z Codes That May Only be Principal/First-Listed Diagnosis
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published March 2nd, 2017 - Last Review/Update July 28th, 2017
The following Z codes/categories may only be reported as the principal/first-listed diagnosis, except when there are multiple encounters on the same day and the medical records for the encounters are combined:
Z00 Encounter for general examination without complaint, suspected or reported diagnosis Except: Z00.6 Z01 Encounter for other special examination without complaint, suspected ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published March 2nd, 2017 - Last Review/Update July 28th, 2017
When the medical documentation submitted is inadequate to support payment for the services billed, it may be determined that the claim contained insufficient documentation. If the claims reviewer is unable to conclude the services, some or all, were actually provided, they may determine the claim is unprocessable or incomplete. There are ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published March 2nd, 2017 - Last Review/Update July 28th, 2017
Effective July 1, 2013, certain DME/HCPCS codes require a valid detailed written order prior to delivery. There are very specific rules and requirements requiring medical necessity and orders/prescriptions. It is also required to keep a copy in the patients chart. If billing CMS and commercial payers payers, the DME prescribed ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published March 2nd, 2017 - Last Review/Update July 28th, 2017
Some Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) items require a detailed Written Order Prior to Dispensing (WOPD), while others require a Detailed Written Order (DWO) prior to billing. The specific requirements for an order are specified in the Medical Policy (Local Coverage Determination and/or Policy Article) for the ...
How to Properly Dispose Protected Health Information (PHI)
By InstaCode Institute | Published February 27th, 2017
HIPAA requires covered entities to properly dispose of Protected Health Information (PHI) in the following manner:
Paper, film, or other hard copy media has been shredded or destroyed such that the PHI cannot be read or otherwise cannot be reconstructed.
Electronic media has been cleared, purged, or destroyed consistent with NIST Special Publication 800-88, Guidelines for Media ...
By Wyn Staheli, Director of Research | Published February 23rd, 2017
In June 2015, the Office of Inspector General (OIG) issued a Fraud Alert focused on physicians and compensation arrangements. Providers need to ensure that these arrangements do not violate the Anti-Kickback Statute. Healthcare providers found to have committed fraud are subject to possible criminal, civil and administrative sanctions.
In this alert ...
By Wyn Staheli, Director of Research | Published February 23rd, 2017
Telehealth is proving to be the wave of the future as the number of practices offering these services continues to grow. An online poll by Medical Economics asked those who visited their site about the implementation of telehealth services implemented by their individual practices this year. As of February 2, 2017, the results were significant:
30% ...
By Wyn Staheli, Director of Research | Published February 11th, 2017
The following modifiers are required when reporting medically necessary routine foot care services per Medicare guidelines:
Q7: One Class A finding
Q8: Two Class B findings
Q9: One Class B and two Class C findings
Appropriate: With foot care (podiatry) codes to indicate covered foot care
Inapproriate:
With any code not related to foot care
When the foot ...
By Wyn Staheli, Director of Research | Published February 8th, 2017
In April of 2015, the Sustainable Growth Rate (SGR) formula which is used to calculate the Medicare Physician Fee Schedule (MPFS) Conversion Factor was repealed as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The conversion factor will increase by 0.5% each year until 2019 and ...
By Wyn Staheli, Director of Research | Published February 6th, 2017
On January 17, 2017, a Final Rule was published in the Federal Register outlining changes to the Medicare Appeals process in an order to streamline procedures and reduce the current backlog of appeals at the third and fourth levels of appeal. This new policy takes effect on March 20, 3017. ...
By Wyn Staheli, Director of Research | Published February 6th, 2017
The Medicare and Medicaid incentive programs are different. The Medicare EHR incentive program has been incorporated into the new Quality Payment Program (QPP). However, providers may be unaware that there is still a Medicaid EHR incentive program. The time period for signing up for the Medicaid EHR incentive program ended in 2016. ...
By Wyn Staheli, Director of Research | Published February 2nd, 2017
Of special interest to all behavioral health practitioners (both Covered Entities and NON-covered entities) is HIPAA's provision for psychotherapy notes. The privacy rule recognizes that psychotherapy notes need more protection than other types of PHI. Even if you are not a covered entity, we recommend understanding and implementing office procedures ...
Clinical Scenario for Coding with ICD-10-CM: Abdominal Pain
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published January 31st, 2017 - Last Review/Update August 2nd, 2017
Chief Complaint
• “My stomach hurts and I feel full of gas.”
History
• 47 year old male with mid-abdominal epigastric pain, associated with severe nausea & vomiting; unable to keep down any food or liquid. Pain has become “severe” and constant.
• Has had an estimated 13 pound weight loss over the past ...
Code Sets - Health Care Provider Taxonomy Code Set Link
By Raquel Shumway | Published January 24th, 2017
Every Provider needs to know their Health Care Provider Taxonomy Codes. The Taxonomy Codes define the provider type, classification, and area of specialization. We have provided a link and instructions to help you locate your code.
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published January 23rd, 2017 - Last Review/Update March 8th, 2017
Deleted Codes for Drug Screening, the following codes are no longer valid for services performed on or after January 01, 2017.
Deleted Codes for 2017
80300
Drug screen, any number of drug classes from Drug Class List A; any number of non-TLC devices or procedures, (eg, immunoassay) capable of being read by direct optical ...
By Wyn Staheli, Director of Research | Published January 23rd, 2017
It is a common misconception that every doctor’s office is (or must become) a HIPAA covered entity; however, the list of those who still qualify for exemption from HIPAA is rapidly shrinking. There are exceptions to the HIPAA requirements; if a practice sends or receives no transactions electronically, it is ...
Alternative Payment Models (APMs) and Advanced APMs
By Wyn Staheli, Director of Research | Published January 16th, 2017
When CMS Released the NPRM regarding the Quality Payment Program (QPP), it included two payment tracks: MIPS and Advanced Alternative Payment Models (APMs). Accountable Care Organizations (ACOs), Patient Centered Medical Homes, and bundled payment models are some examples of APMs. So how do these payment models differ?
According to a fact sheet ...
By ChiroCode | Published January 13th, 2017 - Last Review/Update January 31st, 2019
Whiplash Damages in Rear-end Collisions - The Patient’s Dilemma:
The rear-end collision is a major cause of cervical spine injuries which often require treatment by chiropractors and other health care practitioners. Claims adjusters trivialize soft tissue injuries [it’s “only” a sprain or strain] but whiplash is real and so are the damages that come with it.
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published December 13th, 2016
Risk Adjustment models are used to calculate risk scores used in predicting average beneficiaries healthcare expenditures. Currently Medicare Advantage and Prescription Drug programs include a risk adjustment as a component of the bidding and payment process to standardize bids, compare bids, and adjust plan payments. If you are not familiar ...
By Wyn Staheli, Director of Research | Published December 12th, 2016
Effective March 14, 2016, the CMS Final Rule clarifying the standards for handling
overpayments for both Medicare and Medicaid takes effect. Failure to report and
subsequently return an overpayment within 60 days after the overpayment was
“identified” is a violation of the False Claims Act.
By Wyn Staheli, Director of Research | Published December 7th, 2016
Workers’ Compensation is for work related illness or injuries on the job. The employer pays for insurance which covers medical costs incurred, and replaces lost wages. Fees are based on a specific fee schedule that varies by state.
There are three possible scenarios regarding workers’ compensation: the patient is covered by ...
By Wyn Staheli, Director of Research | Published December 7th, 2016
All healthcare providers need to be aware that there are both appropriate and inappropriate ways to discount your fees. Both state and federal laws can impact your practice financial policy regarding fee discounts. Additionally, we recommend carefully reviewing either Chapter 1.5-Fees of the Behavioral Health DeskBook or the Insurance and Reimbursement chapter ...
Product Wastage Documentation Requirements and Reporting: Using JW Modifier
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published November 28th, 2016 - Last Review/Update August 1st, 2017
When using the JW modifier for Part B drug claims for discarded drugs and biologicals, any amount of wasted material should be clearly documented in the medical record with the following information:
Date, time, and location of treatment
Approximate amount of product unit used
Approximate amount of product unit discarded
Reason for the wastage
Manufacturer’s serial/lot/batch ...
By ChiroCode | Published October 25th, 2016 - Last Review/Update March 5th, 2019
On October 19 the Office of Inspector General for Health and Human Services (OIG) released another report on chiropractic. Oddly enough the Wall Street Journal had an article on that report published the day it was released (I wonder how that happened). Read hear to see the results.
By Wyn Staheli, Director of Research | Published September 17th, 2016
The Department of Health and Human Services (HHS) oversees all government health care programs. They are administered by various agencies such as the Centers for Medicare & Medicaid Services (CMS), the Veterans Administration (VA) and even at the state level. Here are the basic government programs:
Medicare
Federal Workers’ Compensation
Military and Veterans
Medicaid
Federal ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published August 30th, 2016
ICD-10 expands sections on poisonings and toxins.
When documenting injuries, include the following:
1. Episode of Care e.g. Initial, subsequent, sequelae 2. Injury site Be as specific as possible3. Etiology How was the injury sustained (e.g. sports, motor vehicle crash, pedestrian, slip and fall, environmental exposure, etc.)?4. Place ...
Documentating Diabetes Mellitus, Hypoglycemia and Hyperglycemia
By Find-A-Code | Published August 30th, 2016
The Increased Specificity in ICD-10-CM means documentation must more specific to accommodate the complications and combinations used. The diabetes mellitus codes are combination codes that include the type of diabetes mellitus, the body system affected, and the complications affecting that body system.When documenting diabetes, include the following:1. Type e.g. Type 1 ...
Smoking and tobacco cessation counseling, covered indications and # of visits
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published August 23rd, 2016 - Last Review/Update August 2nd, 2017
Nationally Covered Indications:Effective for claims with dates of service on or after August 25, 2010, CMS will cover tobacco cessation counseling for outpatient and hospitalized Medicare beneficiaries1. Who use tobacco, regardless of whether they have signs or symptoms of tobacco-related disease;2. Who are competent and alert at the time that ...
By Wyn Staheli, Director of Research | Published August 3rd, 2016
The Centers for Medicare & Medicaid Services (CMS) recently released the Proposed Rule regarding the updates to the ICD-10-CM and ICD-10-PCS code sets for Fiscal Year 2017 which begins October 1, 2016. Comments regarding the proposed ICD changes are due May 6th and CMS has stated that the Final Rule ...
If the patient’s spouse or parents have an additional insurance plan, there could be multiple insurance plans which could cover the patient. It is very important to correctly determine which is the primary insurance and which is secondary.
The “birthday rule” can be helpful in establishing the proper coverage. Generally, when ...
Employees need to be responsible for obtaining current and correct data. They should also understand that claims with missing or inaccurate patient information are delayed or denied. Some policy examples are:
• Information for the subscriber(s) of the insurance coverage should also be obtained.
• A photocopy of both front and back ...
When the patient arrives, it is important to ensure that all forms are properly completed and signed. If they have not already completed the forms online or in the Welcome Packet, give them time to fill them out. Pay particular attention to the following:
• Make copies of their insurance cards, ...
The 2016 ChiroCode Deskbook teaches you how to write off disallowed amounts!
Once the claim has been adjudicated and an Explanation of Benefits (EOB) has been received, the disallowed amounts (if required by contract or law) should be deducted from the patient account to accurately reflect their “patient portion.” Only bill the patient ...
In the 2016 ChiroCode Deskbook, learn about how the 2014 Patient Protection and Affordable Care Act (PPACA) changed insurance coverage policies!
Beginning January 1, 2014, the Patient Protection and Affordable Care Act (PPACA) changed the rules regarding annual and lifetime limits. Insurance companies can no longer set lifetime limits on “Essential ...
In the 2016 Chirocode Deskbook learn about Health Savings Accounts, Medicare Medical Savings Accounts, health Reimbursement Arrangement, and other things such as the Multiple-Employer Welfare Arrangements (MEWA)!
Multiple-Employer Welfare Arrangements (MEWA).
MEWA is a type of plan, established by ERISA and regulated by the PPACA, in which two or more unrelated employers, including ...
The 2016 ChiroCode Deskbook includes policies from the American Chiropractic Association regarding the difference in healthcare discount programs. It can help you select the right healthcare discount program specific to your needs!
Not all healthcare discount programs are the same. The Federal Trade Commission (FTC) is warning consumers to carefully evaluate these programs. ...
The following rules for the 1500 claim form are excerpts from NUCC and Medicare instructions, but they are generally universal and apply to claims submitted either electronically or on paper. Please note that payment rules can change frequently for any payer, so consult with specific insurance payers for their adaptations.
The ...
The 2016 Chirocode Deskbook offers advice on waivers!
It is improper and illegal to waive co-payments and/or deductibles. For this reason, if you wish to offer some sort of assistance to a patient, the proper way to do so is through an official “Financial Hardship Policy”.
Caution is advised when implementing hardship waivers. ...
When can I use “unspecified” codes? What about “other”?
By Dr. Evan Gwilliam | Published August 3rd, 2016
The official guidelines for ICD-10-CM define the conventions used in the code set. In section 1.A.6, we learn the following about some common abbreviations in the Tabular List:
By | Published July 28th, 2016 - Last Review/Update January 25th, 2017
Using Liens in PI Cases
When it comes to getting paid on PI cases, few documents and protocols are as important as those relating to a well drafted financial policy, along with a set of unalterable financial protocols (at least not easy to change). With these in place, you are ...
Are There Codes to Idenitfy the Left or Right Side of the Spine?
By Brandy Brimhall | Published June 27th, 2016
Q: We cannot find codes to identify the left or right side of the spine, such as with low back pain. Do we add digits 1 or 2 to the code to clarify left or right?
A: No. Codes pertaining to the spine are not specific to laterality. The codes do ...
Commercial Lease Assignments for Chiropractic Tenants
By Jeff Grandfield and Dale Willerton | Published June 23rd, 2016
When The Lease Coach speaks at chiropractic conventions (such as Parker Seminars in Las Vegas), we are magnets for commercial leasing-related questions. Among the most common are concerns relating to assigning or transferring a Lease Agreement. As we explain in our new book, Negotiating Commercial Leases & Renewals For Dummies, ...
What Are Unproven, Investigational or Experimental Procedures?
By Brandy Brimhall CPC CMCO CPCO CCCPC CPMA | Published June 23rd, 2016
Many specialties, including chiropractors, perform services that may be deemed "experimental, investigational and unproven." Individual payer coverage determinations, as well as state boards, generally offer specific information defining this type of procedure and any other notice or guideline that providers must be aware of and adhere to.The terms "unproven, experimental ...
By Wyn Staheli, Director of Research | Published June 21st, 2016
When a claim has been determined to be paid more than the allowed amount, it is considered an overpayment. The action to be taken depends on how the overpayment is discovered. This article covers voluntary overpayment refund procedures as well as a Voluntary Overpayment Form.
Mastering Medicare: When Opting Out is not an Option
By Dr. Ray Foxworth, Certified Medical Compliance Specialist and President of ChiroHealthUSA | Published June 15th, 2016 - Last Review/Update March 5th, 2019
Unlike MDs and DOs, chiropractors may not opt out of Medicare.
When it comes to Medicare, providers and patients alike feel like beating their heads against the wall. Signing up to be a provider or a patient is confusing, understanding what is covered is confusing and just about the time you think you have it figured out, you receive a notice that suggests you don’t.
The hassles of Medicare certainly validate any sane person questioning whether they should see a Medicare patient, but with the rising number of Medicare patients in the US do you really want to limit your patient base?
Understanding and Using Taxonomy Codes to Maximize Reimbursement
By | Published June 9th, 2016
Taxonomy codes are used by insurers as indicators of legal scope of practice. Scope of practice is key to getting reimbursed under the Affordable Care Act or ObamaCare. However, Most providers will only choose one taxonomy code to describe their training. This limits their scope of practice. To maximize scope ...
The Health Insurance Portability and Accountability Act (HIPAA) has been around for quite some time. There are many misconceptions about HIPAA compliance that our office still gets calls about. This page is to help clear up some of these misconceptions.
By Dr. Ray Foxworth, Certified Medical Compliance Specialist and President of ChiroHealthUSA | Published May 26th, 2016 - Last Review/Update March 5th, 2019
Our team is frequently asked if it is legal for chiropractic offices to offer coupons or Groupons. We’re not allowed, as a profession, to dramatically discount our services, offer free treatments, or provide gifts or free meals for potential patients. Any one of these things can be considered an “inducement.” Practices that improperly induce patients to seek care or services, for example, by providing coupons for care or supplies, may find that they are in violation of the law if they aren’t careful.
So what will that mean to you and your practice? It isn’t pretty.
Your Reasons to Delay Compliance Implementation are GONE!
By Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published May 19th, 2016
ChiroCode has proudly served chiropractic for more than 30 years and continues to work to bring the most necessary, affordable, and user friendly products and services to practices. Increased regulation has hindered practices by creating uncertainty around the nature of guidelines and the expensive penalties that arise from non-compliance with ...
By Omega Renne, CPC, CPCO, CPMA, CEMC, CIMC | Published May 13th, 2016 - Last Review/Update August 16th, 2017
One of the hardest parts when reviewing a medical record for coding or auditing is the determination of what conditions were addressed. Any condition that is taking into account or affects patient care, treatment or management should be documented and ultimately coded. However, the documentation still needs to support that ...
By Wyn Staheli, Director of Research | Published May 3rd, 2016
Screening, Brief Intervention, and Referral to Treatment (SBIRT) services are an effective tool for healthcare providers to identify, reduce, and prevent problematic substance use disorders. Healthcare practices can help their patients and improve their integrated care standards with the proper use of the SBIRT.
Provider/Patient Dynamic Changes as Result of High Deductible Plans
By Wyn Staheli, Director of Research | Published May 3rd, 2016
High-deductible plans are changing the way patients utilize medical services, therefore, providers must also adapt by adjusting both their communication and billing practices to keep pace with these changes.
By Wyn Staheli, Director of Research | Published April 13th, 2016
Telehealth and telemedicine are covered for many payers for services such as consultation, office visits, individual psychotherapy, and pharmacologic management delivered via a telecommunications system.
Lack of Business Associate Agreement (BAA) Costs Non-Profit 1.55 Million
By Wyn Staheli, Director of Research | Published April 13th, 2016
Failure to have a properly executed Business Associate Agreements (BAA) costs one organization $1.55 Million. In today's highly technological environment, it is too easy to skip the necessary precautions and easy for electronic devices to get lost or stolen. Are you prepared?
By Instacode Institute | Published April 6th, 2016
It's not just the names and addresses that matter -- It's the compliance. If you can demonstrate that you are hleping yourself to maintain HIPAA compliance by careful documentation and proper procedures, you can go a long way toward avoiding being fined by the HIPAA squads.
Complete & Easy HIPAA Compliance is a clear, simple “Just help me do what I have to do!” workbook that contains all the things the designated security officer must do to instantiate a robust HIPAA compliance program. It comes complete with over 45 forms and letters which can be used to state the office policies, spell out procedures, and ensure that each patient will be protected in their rights under HIPAA policy. It also can help demonstrate that a compliance program is in progress.
Occasionally providers are faced with the need to assess the option of making a voluntary disclosure to the government. Here are steps that every provider should consider before disclosing information to the government.
Protected Health Information De-Identification Standards
By Instacode Institute | Published March 16th, 2016 - Last Review/Update January 27th, 2017
This article contains detailed information on the OCR guidance regarding the de-identification of Protected Health Information (PHI). Avoid HIPAA violations and learn specifically what de-identification is.
Employee Exclusions Screenings Must be High Priority
By Wyn Staheli | Published February 24th, 2016
Many healthcare organizations are not aware of how critically important it is to screen their employees against ALL state and federal exclusions databases. This article has important information for organization to ensure compliance.
By InstaCode Institute | Published February 15th, 2016
CMS is developing a new Unified Program Integrity Contractor (UPIC) program to consolidate Medicare and Medicaid reviews. This consolidation of the Medicaid Integrity Contractors (MICs) and the Medicare Zone Program Integrity Contractors (ZPICs) could relieve some of the overlap and burdens under the current systems.
Will Incident-To in Your Organization Pass a Compliance Audit?
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published February 1st, 2016
Practices that bill incident to services need to periodically audit compliance with Medicare and private payor guidelines to avoid potential denials or third-party audits.
6 ways to stop filing duplicate Medicare claims - Duplicates could expose your practice to fraud investigation
By | Published January 6th, 2016
Whenever a Medicare Administrative Contractor (MAC) releases a list of the top reasons for claims denials, the list almost never fails to include duplicate claims. When the MAC perceives the claim to be a duplicate, based typically on a match of the patient identifying information, furnishing...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published October 20th, 2015
There has been some confusion on Sprain vs. Strain and how to find them in ICD-10-CM. They are now split in two separate code ranges and Injury is now related to the anatomic location specific to the injury.
It will help to remember the following information when searching for Strains vs. ...
By Wyn Staheli, Director of Research | Published October 5th, 2015
One of the significant coding changes with ICD-10-CM was including laterality within the code itself. This concept should help reduce billing errors and claim denials. Interestingly, CMS issued a statement regarding the reporting of laterality in their provider newsletter (emphasis added).
Implementation of ICD-10-CM will not change the reporting of Current Procedural Terminology ...
By | Published August 19th, 2015 - Last Review/Update January 27th, 2017
By Dr. Evan Gwilliam
Using a Medicare Local Coverage Determination (LCD), and the General Equivalence Mappings (GEMs) as a starting point, I will attempt in this article to predict which ICD-10-CM codes will be approved for the secondary cervical diagnoses which Medicare uses now. (By the way, I just use the ...
Chiropractic Listed as Focal Point in 2015 OIG Work Plan
By Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published August 19th, 2015 - Last Review/Update January 30th, 2017
With the recent release of the 2015 OIG Work Plan, many providers and facilities are reviewing the content to learn which areas of interest pertaining to their specialty will be points of interest for federal auditing programs for the 2015 Fiscal Year. The information contained in this Work Plan addresses the ...
Opting out of Medicare Electing to Order/Certify Items and Services to Medicare Beneficiaries
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published August 10th, 2015
Physicians and practitioners who do not wish to enroll in the Medicare program may “opt-out” of Medicare. This means that neither the physician, nor the beneficiary submits the bill to Medicare for services rendered. Instead, the beneficiary pays the physician out-of-pocket and neither party is reimbursed by Medicare. A private ...
By | Published August 10th, 2015 - Last Review/Update January 27th, 2017
I attended the 2009 AAPC (American Academy of Professional Coders) convention in Las Vegas. Perhaps the most valued lesson relearned there was from Mike Miscoe, CPC, JD. Yes, he is a certified professional coder and an attorney. Mike is one of the most knowledgeable consultants in health care reimbursement that ...
By Melinna Giannini | Published August 10th, 2015 - Last Review/Update January 27th, 2017
This article is coming out before the payers have told us which ICD-10 codes will be used for claim submission. However, we have access to the same code set that they do, therefore this is an educated guess at which codes might used by DCs for the lumbar spine. The ...
Chiropractic Tenants – Choosing the Location Where Your Practice will Thrive
By By Jeff Grandfield & Dale Willerton – The Lease Coach | Published August 10th, 2015
As we explain in our new book, Negotiating Commercial Leases & Renewals For Dummies (Wiley, 2013) and when we recently spoke at Parker Seminars in Las Vegas, finding the right location or property for your practice is one of the most important decisions you can make. It’s not always easy, ...
By ChiroCode | Published August 10th, 2015 - Last Review/Update January 27th, 2017
The following are some of the acronyms you would need to know when communicating with auditors:
National Correct Coding Initiative (NCCI) Edits: Use of codes that should not occur on the same day, effectively treating the same area twice.
Medically Unlikely Edits (MUE): Exceeding the anticipated units of service (time spent) for a given HCPCS or CPT code.
Office of the ...
Can Chiropractors Finally Code a "Subluxation" in ICD-10?
By ChiroCode | Published August 10th, 2015 - Last Review/Update January 27th, 2017
There is a word that has long been held as sacred to the Chiropractic profession. It is the so-called vertebral “subluxation.” Throughout ICD-9, which is the diagnostic code set used on claims for the last thirty years, the term “subluxation” is used to describe a partial dislocation,” which is not how it is defined by many Chiropractors. Medicare ...
By ChiroCode | Published August 10th, 2015 - Last Review/Update January 27th, 2017
It is a common practice for a solo doctor to find someone to cover for them while they are away from the office for a temporary or extended period of time, such as medical leave, or vacation. Some offices fail to code properly for the services rendered by the “fill-in” doctor. When completing the CMS 1500 ...
By ChiroCode | Published August 10th, 2015 - Last Review/Update January 27th, 2017
This code would be used rarely in a chiropractic office. 99211 is a low complexity examination for an established patient. It can be used by chiropractors, but in most instances, it is discouraged.
The 99211 code, also known as the nurse’s code, is not really made for the physician to use. In fact, the AMA, CPT ...
By ChiroCode | Published August 10th, 2015 - Last Review/Update January 27th, 2017
Beginning October 1, 2015 all claims for health care services in the United States must use ICD‑10 diagnosis codes. ICD‑9 has been the standard since 1979, but has outlived its usefulness. Because of its structure, ICD‑10 provides better data for research and statistical analysis than ICD‑9. Although there is no national mandate to report ...
Appointments, Reminders, Text Messaging, and HIPAA
By ChiroCode | Published August 10th, 2015 - Last Review/Update January 27th, 2017
As more and more people are using mobile and wireless devices, a new term - mHealth - has emerged. According to a National Institute of Health consensus group, mHealth is “the use of mobile and wireless devices to improve health outcomes, healthcare services and health research.” Historically, the biggest gaps and HIPAA violations have been linked to ...
By | Published August 10th, 2015 - Last Review/Update January 27th, 2017
Under Promise
Question: When should you recommend the maximum care that a patient might need?Answer: Always
Question: When should you give a patient more care than they need?Answer: Never
I’m standing in line with my five children at a Disneyland attraction called Splash Mountain. After moving slowly forward for about 15 minutes, we get to a sign ...
By ChiroCode | Published August 10th, 2015 - Last Review/Update January 27th, 2017
Stop losing hard-earned dollars. Too often, dollars are left on the table at billing time. Adjunctive codes for associated services should be added when they are appropriate. Here are a few examples of coding that are often overlooked.
97014 & 97032 Electrical Stimulation Supplies
According to the Relative Value Update Committee (RUC), ...
Chiropractors - Negotiate a Mid-term Rent Reduction for Your Commercial Lease
By Jeff Grandfield and Dale Willerton - The Lease Coach | Published August 3rd, 2015
When The Lease Coach spoke at Parker Seminars in Las Vegas, we met a number of struggling chiropractors leasing commercial space. These chiropractic tenants desperately need a rent reduction ... right now.
(Rev. 3086, Issued: 10-03-14, Effective: ICD-10: Upon Implementation of ICD-10, ASC X12: January 1, 2012, Implementation ICD-10: Upon Implementation of ICD- 10; ASC X12: November 4, 2014) The standards adopted under HIPAA include both a transaction standard and an implementation guide. The following are the claims transactions and the implementation ...
Certification of Mammography Facilities (Rev. 1387, 04-07-08)
By Jared Staheli | Published June 25th, 2015
The Mammography Quality Standards Act (MQSA) provides specific standards regarding those qualified to perform screening and diagnostic mammograms and how they should be certified. The MQSA requires the Secretary to ensure that all facilities that provide mammography services meet national quality standards. Effective October 1, 1994, all facilities providing screening ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published June 22nd, 2015 - Last Review/Update August 7th, 2017
The Centers for Medicare & Medicaid Services (CMS) has further defined Chiropractic Maintenance Therapy. Section 2251.3 of the Medicare Carriers Manual (MCM) has been amended to clarify Medicare requirements for treatment of chiropractic therapy.
"MCM 2251.3 Necessity for Treatment.--
A. The patient must have a significant health problem in the form of a neuromusculoskeletal ...
Buying vs. Leasing Commercial Practice Space: Pros and Cons for Chiropractic Tenants
By By: Jeff Grandfield and Dale Willerton – The Lease Coach | Published June 10th, 2015
As we explain in our new book, Negotiating Commercial Leases & Renewals For Dummies, the most common reason tenants lease space instead of buying a location is because 95 percent of all commercial and office space is for lease and not for sale.
If you are in an enviable position ...
Selecting the Best Location for Your Chiropractic Office
By ChiroCode | Published May 12th, 2015 - Last Review/Update May 13th, 2016
By: Jeff Grandfield and Dale Willerton – The Lease Coach
When we do site selection for a chiropractor, we are not looking for the cheapest location we can find, but instead the location that will enable the doctor to maximize his or her patient volume. As we explain in our new ...
By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT, Director of Content | Published May 11th, 2015 - Last Review/Update January 30th, 2017
Modifier 33 for Preventive Care
With the implementation of modifier 33 and its complicated and unique description, many coders have wondered how to properly apply it. Let's review the information we have on the modifier and see if we can better understand how and when to use it.
Modifier 33 was created ...
By Find-A-Code | Published May 7th, 2015 - Last Review/Update June 9th, 2016
Personal Injury is an complicated subject as it relates to medical services. This page contains helpful information as an additional resource to Find-A-Code's specialty-specific Reimbursement Guides.
By Dr. Chris Andersn | Published April 24th, 2015 - Last Review/Update June 9th, 2016
Compliance is an issue that you should look at as an expedition rather than an endpoint. Board complaints can be a terrifying ordeal, especially if you don’t keep up on compliance in your clinic. Board complaints are something that you have to expect to happen but you can turn that ...
Selecting the Best Location for Your Chiropractic Office
By | Published March 30th, 2015 - Last Review/Update June 9th, 2016
By: Jeff Grandfield and Dale Willerton – The Lease Coach
When we do site selection for a chiropractor, we are not looking for the cheapest location we can find, but instead the location that will enable the doctor to maximize his or her patient volume. As we explain in our new ...
By | Published March 24th, 2015 - Last Review/Update April 9th, 2018
Patient Portion
The first part of the form is for the patient to complete. The date, name and age are completed, along with a brief description of why they came in for a visit.
Pain
“X’s” are placed on areas causing pain. Qualify the pain with a letter, i.e., “A“ for “Ache.”
The patient ...
By Raquel Shumway | Published March 17th, 2015 - Last Review/Update June 9th, 2016
We have two different samples for Patient Information Forms. We suggest that you review both and determine which best fits your practice model. Form #2 is editable so it could be easily modified for your organization. Both forms provide the basic information necessary for all types of healthcare practices.
Instructions for: Patient ...
By | Published February 26th, 2015 - Last Review/Update January 27th, 2017
Director of Communications, ChiroCode
In my 20 years of professional bull riding I have had many highs and lows. There were times when the rankest of bulls couldn’t throw me and times when I couldn’t ride a rocking chair. When in a slump, what always worked for me, and for the ...
By | Published February 23rd, 2015 - Last Review/Update March 9th, 2016
Q: We have recently enrolled with Medicare and treat only a few patients. However, those claims are being denied. Can you help me to understand why this might be happening?
A: First, I would recommend you carefully review your Medicare Remittance Advice as that will identify the reason Medicare is denying your ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published February 13th, 2015 - Last Review/Update March 1st, 2016
AETNA
Clinical Policy Bulletin: Chiropractic Services
Number: 0107
http://www.aetna.com/cpb/medical/data/100_199/0107.html
Policy
Note: Some plans have limitations or exclusions applicable to chiropractic care. Please check benefit plan descriptions for details.
Aetna considers chiropractic services medically necessary when all of the following criteria are met:
The member has a neuromusculoskeletal disorder; and
The medical necessity for treatment is clearly documented; and
Improvement is ...
By | Published February 10th, 2015 - Last Review/Update February 18th, 2016
The Centers for Medicare & Medicaid Services (CMS) uses a network of contractors called Medicare Administrative Contractors (MAC) to process Medicare claims, enroll health care providers in the Medicare program and educate providers on Medicare billing requirements. MACs also handle claims appeals and answer beneficiary and provider inquiries. Even though ...
By Wyn Staheli, Director of Research | Published February 9th, 2015 - Last Review/Update June 9th, 2016
How secure is your computer? Do you have a password on your computer? Do you have the automatic log offs turned on? Is your computer encrypted? Are your off-site storage files encrypted?
This document is designed to give some basic information about making your office a little more secure. It is not ...
By Wyn Staheli | Published February 4th, 2015 - Last Review/Update June 9th, 2016
Sometimes called "disposable," "temporary," or "one-time use" numbers, a virtual credit card number is "like putting a wall" between your transaction and your regular account, says Steve Kenneally, vice president of the American Bankers Association. Although these cards can protect the cardholder from fraud, the use of virtual cards as ...
By ChiroCode | Published February 3rd, 2015 - Last Review/Update February 1st, 2017
Personal Injury is an complicated subject for all healthcare providers, including chiropractic physicians. This page contains helpful information as an additional resource to the ChiroCode DeskBook.
See Chapter 1-Insurance of the ChiroCode DeskBook for explanations and definitions of important terms and subjects related to Personal Injury.
By Wyn Staheli, Director of Research | Published February 3rd, 2015 - Last Review/Update June 9th, 2016
Even though the health care system in the United States is one of the most expensive per capita in the world, we have a dismally low quality of care ranking. Healthcare reform (HCR) in its simplest terms is addressing these shortcomings in order to improve healthcare coverage, delivery, policies, or ...
By | Published January 30th, 2015 - Last Review/Update June 9th, 2016
Conducting a job interview for potential new employees is a common occurrence, yet is often done in a manner of disorganization. Employers are frequently asking questions that shouldn't be asked and neglecting to ask those questions that may be more essential for conducting a proper interview. Federal and state laws ...
By ChiroCode | Published January 26th, 2015 - Last Review/Update January 30th, 2017
Documentation is essential to establishing medical necessity and the level of services provided to the patient. Treatment plans and outcome assessments are crucial elements to thorough documentation.
This page is only a general listing of documentation resources for chiropractic. More thorough and detailed explanations are found in Section D-Documentation in the ...
Chiropractic Listed as Focal Point in 2015 OIG Work Plan
By | Published January 23rd, 2015 - Last Review/Update January 30th, 2017
With the recent release of the 2015 OIG Work Plan, many providers and facilities are reviewing the content to learn which areas of interest pertaining to their specialty will be points of interest for federal auditing programs for the 2015 Fiscal Year. The information contained in this Work Plan addresses ...
By ChiroCode | Published January 8th, 2015 - Last Review/Update January 30th, 2017
All healthcare providers need to be aware that there are both appropriate and inappropriate ways to discount your fees. Both state and federal laws can impact your practice financial policy regarding fee discounts. Additionally, we recommend carefully reviewing Section F-Fees of the ChiroCode DeskBook for important information on fee schedules and ...
Chiropractors - Negotiate Your Commercial Lease “For Dummies”
By | Published January 8th, 2015 - Last Review/Update March 9th, 2016
By: Dale Willerton – The Lease Coach
For many chiropractors, negotiating a good lease or lease renewal against an experienced agent or landlord can be a challenge. While a chiropractor focuses on patient care, savvy real estate agents and brokers are specialized sales people. Their job is to sell chiropractic tenants ...
By | Published December 30th, 2014 - Last Review/Update March 9th, 2016
Time-of-Service (TOS) discounts are a common occurrence in chiropractic. What is often assumed is that if insurance isn't involved, there are no rules that apply.
Unfortunately, this is a myth that can become costly to practices and damage provider/patient relationships. So read on to learn the facts about TOS discounting and ...
OIG Reports Success in Efforts to Prevent Fraud, Waste, and Abuse
By | Published December 15th, 2014 - Last Review/Update January 30th, 2017
The HHS OIG Work Plan for the 2015 Fiscal Year has recently been released. In this publication, the OIG addresses the accomplishments made from the previous year's Plan as well as the objectives that will be of interest for the coming new year. Accomplishments for the 2014 Fiscal Year are ...
By | Published December 3rd, 2014 - Last Review/Update January 30th, 2017
The Rule of Coding: Service Codes define "what" you do; diagnosis codes define "why" you're doing it. Billing for laser or any other service must be properly defined and supported by both a service code and a diagnosis code.
Coverage for laser, as with any other service, is strictly dependent upon the ...
Q & A: Establishing a Multi-Disciplinary Practice and Being Legal
By | Published December 1st, 2014 - Last Review/Update January 30th, 2017
Q: How do you add another provider type such as a Nurse Practitioner to your practice to provide additional services to patients and legally bill for those services under their license?
A: Multi-disciplinary practices are under scrutiny at the moment by ZPIC, CMS and State Boards. For your reference, just below, there ...
Have you checked your QRUR to find out if you qualify for a CMS bonus (or penalty)?
By | Published November 25th, 2014 - Last Review/Update January 30th, 2017
What? You've never heard of a QRUR?
You have probably heard about Meaningful Use (MU) and penalties that kick in for those who did not attest. And the Physician Quality Reporting System (PQRS) with penalties for those who did not successfully report on at least one patient. The new one ...
Conducting a Gap Analysis for Your Documentation & Billing Systems
By | Published November 24th, 2014 - Last Review/Update January 30th, 2017
What is a Gap Analysis?
A Gap Analysis is a process by which a practice conducts a baseline assessment of the company's coding, billing, operations, and business practices. The objective of a Gap Analysis is to ensure that the practice is in full compliance with applicable legal and ethical requirements. This ...
By Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published November 21st, 2014 - Last Review/Update January 30th, 2017
The Rule of Coding: Service Codes define "what" you do; diagnosis codes define "why" you're doing it. Billing for laser or any other service must be properly defined and supported by both a service code and a diagnoses code.
Coverage for laser, as with any other service, is strictly dependent upon the ...
By Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published November 21st, 2014 - Last Review/Update January 30th, 2017
Time-of-Service (TOS) discounts are a common occurrence in chiropractic. What is often assumed is that if insurance isn't involved, there are no rules that apply.
Unfortunately, this is a myth that can become costly to practices and damage provider/patient relationships. So read on to learn the facts about TOS discounting and ...
A Practice's Responsibility in Managing Medical Expenses
By Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published November 21st, 2014 - Last Review/Update January 30th, 2017
Medical expenses are one of the largest expenses in many United States households. Medical bills and insurance remittance are also possibly the most difficult of all bills for patients to interpret and understand.Â
Of course, this lack of understanding often has a negative impact on many things, such as: provider/patient relationship, provider ...
Establishing a Multi-Disciplinary Practice and Being Legal
By Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published November 21st, 2014 - Last Review/Update January 30th, 2017
Q: How do you add another provider type such as a Nurse Practitioner to your practice to provide additional services to patients and legally bill for those services under their license?
A: Multi-disciplinary practices are under scrutiny at the moment by ZPIC, CMS and State Boards. For your reference, just below, there ...
By Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published November 19th, 2014 - Last Review/Update January 30th, 2017
Recovery Audit Contractors, also known as RAC, is a program that seeks to identify and correct improper payments for services provided to Medicare Parts A & B beneficiaries. This includes both recoupment of overpayments and corrected distribution of underpayments made by CMS.  RAC began in 2005 as a three-year demonstration project consisting ...
Conducting a Gap Analysis for Your Documentation & Billing Systems
By Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published November 17th, 2014 - Last Review/Update January 30th, 2017
What is a Gap Analysis?
A Gap Analysis is a process by which a practice conducts a baseline assessment of the company's coding, billing, operations, and business practices. The objective of a Gap Analysis is to ensure that the practice is in full compliance with applicable legal and ethical requirements. This ...
By | Published November 7th, 2014 - Last Review/Update January 30th, 2017
Is it appropriate to use 97022, whirlpool, to report dry hydromassage?
The CPT code 97022 is defined simply as “Application of a modality to 1 or more areas; whirlpool”. The CPT book does not expand on the code. However, in 2002, the CPT manual added this phrase to the general guidelines:
Do not select a ...
By | Published November 5th, 2014 - Last Review/Update January 30th, 2017
Anyone who uses modifier 59 needs to be aware that due to problems with the incorrect usage of this modifier (which by the way is also revised for 2015,) CMS has added four new HCPCS modifiers. An announcement by CMS stated that "CMS is establishing four new HCPCS modifiers to define subsets of the -59 modifier, a modifier used to define a “Distinct Procedural Service.”
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published October 24th, 2014 - Last Review/Update January 30th, 2017
Straight from the Office of Civil Rights:
Q: Does the HIPAA Privacy Rule permit health care providers to use e-mail to discuss health issues and treatment with their patients?
A: Yes. The Privacy Rule allows covered health care providers to communicate electronically, such as through e-mail, with their patients, provided they apply ...
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published October 22nd, 2014 - Last Review/Update January 27th, 2017
Is it appropriate to use 97022, whirlpool, to report dry hydromassage?
The CPT code 97022 is defined simply as “Application of a modality to 1 or more areas; whirlpool”. The CPT book does not expand on the code. However, in 2002, the CPT manual added this phrase to the general guidelines:
Do ...
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published October 16th, 2014 - Last Review/Update January 23rd, 2017
In October of 2000 in the Federal Register the Office of the Inspector General (who investigates fraud against the federal government on behalf of the Department of Health and Human Services) offered general guidelines for health care facilities to set up a “Compliance Program”. This advice has long been pushed ...
Chiropractic is Listed as a Priority in the 2014 OIG Work Plan...Find Out Why
By Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published October 16th, 2014 - Last Review/Update January 30th, 2017
Each year the Office of Inspector General (OIG) issues an updated work plan which outlines the objectives and enforcement priorities for each new year. For Medical providers, including Chiropractic, this information is necessary to review and be familiar with so we may evaluate our own practice systems to ensure compliance ...
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published October 16th, 2014 - Last Review/Update November 29th, 2017
What is the ABN form used for?
The Advanced Beneficiary Notice of Non-Coverage (ABN) is the Notice of Liability that is required to be provided to Medicare patients in the event that the service(s) rendered to them are expected to not be covered. For chiropractic, reason for non-coverage is generally due ...
By | Published October 3rd, 2014 - Last Review/Update January 27th, 2017
A “good” lawyer could be a “bad” lawyer when it come to your unique problem(s). Never ask or expect any professional person (doctor or lawyer) to perform beyond their scope of practice or ability. A college law degree and passing the state bar, is only a license which permits them ...
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published September 26th, 2014 - Last Review/Update January 30th, 2017
MEASURE COMPLIANCE - Meeting the Patient Electronic Access Objective
Starting in 2014, CMS requires that providers participating in both Stage 1 and Stage 2 of the EHR Incentive Programs must meet the Patient Electronic Access objective, which gives patients access to their health information in a timely manner. Providers participating in ...
By Wyn Staheli, Director of Research | Published September 15th, 2014 - Last Review/Update July 12th, 2016
Many procedure codes are considered "timed codes," that is, the number of units are determined by the amount of time spent performing the service. Medicare Claims Processing Manual, Chapter 5 clarification included here.
By | Published September 15th, 2014 - Last Review/Update January 30th, 2017
This code would be used rarely in a chiropractic office. 99211 is a low complexity examination for an established patient. It can be used by chiropractors, but in most instances, it is discouraged.
The 99211 code, also known as the nurse's code, is not really made for the physician to use. In fact, the AMA, ...
According to HIPAA, who are my Business Associates?
By Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published September 11th, 2014 - Last Review/Update January 30th, 2017
Providers work with many different groups and many of them have some interaction with Protected Health Information (PHI). In an effort to help us understand who qualifies as Business Associates the Department of Health & Human Services has provided some resources.
But first … what is PHI or individually identifiable health information? ...
Total Practice Resources LLC is now part of ChiroCode Inc.
By | Published September 9th, 2014 - Last Review/Update January 30th, 2017
Total Practice Resources LLC is now part of ChiroCode Inc.
CONTACT: Dr Evan Gwilliam , Vice President ChiroCode Inc, 602-944-9877 ext 117 drg@chirocode.com
CONTACT: Brandy Brimhall, owner of Total Practice Resources, 602-944-9877 ext 120 brandy.brimhall@chirocode.com
FOR IMMEDIATE RELEASE - Sept 10, 2014
Spanish Fork, Ut.— ChiroCode Inc announces today Total Practice Resources will become ...
Compliance specialists are responsible for monitoring health and human services program operations for compliance with federal and state regulations and standards in order to promote health and safety, assure that public services are delivered properly, or prevent fraud. Areas assessed may include service delivery, eligibility determination and payment, medical reimbursement, ...
By | Published August 28th, 2014 - Last Review/Update January 30th, 2017
A “good” lawyer could be a “bad” lawyer when it come to your unique problem(s). Never ask or expect any professional person (doctor or lawyer) to perform beyond their scope of practice or ability. A college law degree and passing the state bar, is only a license which permits them ...
Q & A: What is the Definition of "New Patient" for Billing Evaluation and Management (E/M) Services?
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published August 26th, 2014 - Last Review/Update August 9th, 2017
Q: What is the definition of "new patient" for billing evaluation and management (E/M) services?
A: Interpret the phrase "new patient" to mean a patient who has not received any professional services, i.e., evaluation and management service or other face-to-face service (e.g., surgical procedure) from the physician or physician group practice ...
Durable Medical Equipment, Prosthetics, Orthotics and Supplies
By Chris Woolstenhulme, QCC, CMCS, CPC, CMRS | Published August 7th, 2014 - Last Review/Update January 25th, 2017
Reimbursement for most Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) is established by fee schedules. Payment is limited to the lower of the actual charge or the fee schedule amount.  We have given you some basic information to get you started including modifiers and how CMS views DMEPOS, please ...
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published July 31st, 2014 - Last Review/Update January 25th, 2017
It is a common practice for a solo doctor to find someone to cover for them while they are away from the office for a temporary or extended period of time, such as medical leave, or vacation. Some offices fail to code properly for the services rendered by the “fill-in” ...
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published July 31st, 2014 - Last Review/Update January 25th, 2017
This code would be used rarely in a chiropractic office. 99211 is a low complexity examination for an established patient. It can be used by chiropractors, but in most instances, it is discouraged. The 99211 code, also known as the nurse's code, is not really made for the physician to use. ...
By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published July 31st, 2014 - Last Review/Update January 25th, 2017
The -GP modifier needs to be appended to physio-therapy codes when submitting Medicare claims. However, be aware of differing policies for different types of payers. Chiropractors typically use the following Physical Medicine codes from the CPT book: 97010 thru 97799 (except for 97597-97610 for active wound care management). The current ...
By | Published July 24th, 2014 - Last Review/Update January 29th, 2016
Are Medicare fees going up? Or down? Results for the following:
Sequestration
Chiropractic Demonstration Project
Electronic Health Record/Meaningful Use
Physician Quality Reporting System - PQRS
Value-Based Modifier
By | Published July 24th, 2014 - Last Review/Update January 25th, 2017
PAMA (up 0.5%)
On April 1, 2014, President Obama signed into law the Protecting Access to Medicare Act of 2014 (PAMA). Within this law, Congress instituted changes that went into effect on July 1, 2014. The law provided for a 0.5% update for claims with dates of service on or after ...
By Wyn Staheli, Director of Research | Published July 16th, 2014 - Last Review/Update January 25th, 2017
For anyone who is not a computer techie, the announcement by Microsoft about discontinuing support for Windows XP may not mean much. However, from a HIPAA perspective, this is very important information because Section 164.308(a)(5)(ii)(B) of the HIPAA Security Rules includes an 'addressable' requirement of Protection from Malicious Software where ...
By Wyn Staheli, Director of Research | Published May 28th, 2014 - Last Review/Update January 25th, 2017
This article contains information from OSHA which outlines the penalty structure for OSHA violations. It includes a list of different types of violations that may be cited and the penalties that may be proposed by the area director. Also listed are additional violations for which citations and proposed penalties may be issued upon conviction.
These are the types of violations that may be cited and the penalties that may be proposed
By | Published April 17th, 2014 - Last Review/Update January 25th, 2017
January 1, 2014 was the required date for adoption of standards for both Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA). The Centers for Medicare & Medicaid Services (CMS) recently announced that the implementation of these new standards has resulted in benefits for both providers and CMS. Not surprisingly, ...
By | Published February 19th, 2014 - Last Review/Update January 27th, 2017
As more and more people are using mobile and wireless devices, a new buzzword has emerged: mHealth. According to a National Institute of Health consensus group, mHealth is "the use of mobile and wireless devices to improve health outcomes, healthcare services and health research." Historically, the biggest gaps and HIPAA violations ...
By | Published February 12th, 2014 - Last Review/Update January 27th, 2017
The following information is from the Centers for Medicare & Medicaid Services (CMS) regarding the Electronic Health Records (EHR) payment reduction hardship exemption.
ICD-10 Guidelines that Chiropractic Physicians Should Remember
By | Published January 28th, 2014 - Last Review/Update January 27th, 2017
Depending on the publisher, there are about 30 pages of guidelines in the ICD-10-CM code set. The bulk of these guidelines, from section 1.C, are chapter-specific.
Chiropractic physicians typically use codes from just four or five of the 21 chapters available in ICD-10-CM. These include, but are not necessarily limited to, ...
By Wyn Staheli, Director of Research | Published January 1st, 2014 - Last Review/Update October 4th, 2017
There are numerous types of behavioral health screening tools for healthcare providers. Some, like the AUDIT and SBIRT are especially applicable to primary care providers caring for Medicare beneficiaries.
This page includes some general information and resources for some of these screening tools. Let us know if you would like others included ...
By | Published September 30th, 2013 - Last Review/Update January 27th, 2017
September 23rd, 2013 was the deadline for HIPAA Omnibus Final Rule compliance. It seems to have just snuck up on everybody. ChiroCode has spoken with some clincis who say that they don't need to worry about it because ”they are just a small practice.” Please, do not wait any longer to ...
By | Published September 24th, 2013 - Last Review/Update January 27th, 2017
Be aware of the possible monetary results and enforcement actions imposed for fraud. This is the annual report of the Department of Justice Health Care Fraud and Abuse Control Program for FY 2012
ICD-10 Coding Possibilities for Chiropractic Physicians
By Evan M Wsilliam, DC, CPC, CCPC, NCICS, CCCPC, CPC-I, MCS-P, CPMA | Published September 11th, 2013 - Last Review/Update January 27th, 2017
Right now, it’s hard to say which ICD-10 codes third-party payers will select as medically necessary, but we can make an educated guess based on information from a few sources. More detail is expected from Medicare before the end of 2013. For doctors of chiropractic (DCs), the natural place to start is with the relatively short list of frequently used ICD-9-CM codes for submitting claims. We’ll investigate a handful of diagnosis codes that Medicare recognizes as medically necessary and explore ICD-10-CM code possibilities.
By | Published July 25th, 2013 - Last Review/Update January 27th, 2017
A notice in the July 19, 2013 Federal Register, has a VERY important clause for all Doctors of Chiropractic! The Centers for Medicare and Medicaid Services (CMS) has asked for comment on whether or not Doctors of Chiropractic should be paid for Evaluation and Management (E/M) services. Keep in mind ...
Denials for 97140 (Manual Therapy)? Here's the story.
By | Published July 8th, 2013 - Last Review/Update January 27th, 2017
The ChiroCode Institute has received several inquiries over the last few months regarding a denial for 97140 (Manual therapy—such as myofascial release or trigger point therapy) when billed with 98940-98942 (Chiropractic Manipulative Treatment - CMT) on the same visit. Most payers follow Medicare’s guidelines for the use of this code, ...
Chiropractic Coding & Billing Training - Which Course Is Right For You?
By | Published April 12th, 2013 - Last Review/Update January 27th, 2017
Often times we get calls at ChiroCode from offices looking for training. Sometimes it is due to employee turnover and other times it is from a new office trying to get started. And everyone is looking for affordable help!
There are hundreds of seminars and clinics available for training if you ...
Inappropriate Medicare Payments for Chiropractic Services
By | Published August 30th, 2012 - Last Review/Update January 27th, 2017
OIG released two reports critical of the way chiropractic handled documentation and coding. Their findings are included in this article. Read further to see what documentation is needed for proper payment.
As required by the Social Security Act, Medicare pays only for reasonable and necessary chiropractic services, which are limited to active/corrective manual manipulations of the spine to correct subluxations. A chiropractic service must have a direct therapeutic relationship to the patient’s condition and provide reasonable expectation of recovery or improvement of function.
August 29th, 2019 — ICD-10-CM Changes Effective October 1, 2019
Are you aware of the ICD-10-CM code changes set take effect as of October 1, 2020? Do any of them apply to your organization? Which of them will be assigned as an HCC? What are the documentation and coding guidelines applicable to them and which guidelines are changing or being ...
The Evaluation and Management service is an important part of an episode of care.
It is the initiation of care and determines the scope and severity of the patient’s
condition. Dr. Ron Short will review the levels of Evaluation and Management
codes and which are appropriate in the chiropractor’s office. In this webinar you
will learn:
What constitutes a new patient
Which Evaluation and Management codes should not be used
When to use the consultation code
What changes are coming to Evaluation and Management coding
Chiropractic Manipulative Treatment and Medicare - Part 2
In this CE webinar, Dr. Gwilliam will continue his discussion from the webinar delivered Dec. 18 about chiropractic manipulative treatment. But this time, it is all about Medicare. If you don't treat Medicare beneficiaries, you should probably listen anyway. Usually whatever Medicare wants is the same thing as all the other payers. Find out the difference between acute, chronic, and maintenance, as well as when to use certain modifiers.
Chiropractic Manipulative Treatment (CMT) Coding and Documentation (Part 1)
The most used codes in chiropractic are 98940, 98941, 98942, and 98943. In this webinar, Dr. Gwilliam will go over the fundamentals of these codes and make sure you are proficient with them. They probably play a bigger part of your practice than any other code, so it is worth it to make sure you are reporting them correctly. By the end of this presentation you will be able to diagnose, document, and code properly for CMT, as well as avoid common mistakes.
The #1 most overlooked injury in PI, and it is found in over 90% of all cases
Presented by Tom Grant Jr. DC
December 11, 2018 Tuesday @ 10:15 AM PT, 11:15 AM MT, 12:15 PM CT, 1:15 PM ET *How to recognize this injury *The most effective documentation terms to use *The best combination of ICD-10 codes to validate it
Register here: https://attendee.gotowebinar.com/register/8562161323381676035
...
Documenting Treatment Plan and Goals That Actually WORK - November 20th, 2018
Dr. Friedman will discuss the need to document Treatment Plan and Goals and what we MUST document and what we SHOULD document. He'll also demonstrate how we can do this in the least amount of time and with the least amount of effort.
Chiropractic Practice For Sale - When, Where, Why & How Much?
Dr. Tom Necela of The Strategic Chiropractor will share tips & tactics to help you with some of the biggest decisions every doc faces towards the end of their career: when to sell, where to find buyers, why sell (and what other options are available) and of course, how much is your chiropractic practice worth. If you are considering a chiropractic practice sale or transition within the next few years, this is a webinar you won't want to miss!
Success with Out-of-Network Billing in Today's Environment Part 2
In this webinar Maxine will be presenting information and tips for understanding and billing Employment Retirement Income Security Act (ERISA) insurance plans. She will explain the rules and regulations concerning ERISA plans, as well as procedures for handling/appealing "adverse denials" of claims. Coders and Insurance Billing Specialists should not miss this informative presentation.
Success with Out-of-Network Billing in Today's Environment Part 1
In this webinar Maxine will be presenting information and tips for understanding and billing Employment Retirement Income Security Act (ERISA) insurance plans. She will explain the rules and regulations concerning ERISA plans, as well as procedures for handling/appealing "adverse denials" of claims. Coders and Insurance Billing Specialists should not miss this informative presentation.
In this webinar, Brandon will review the bones and major joints of the upper extremities (arm, forearm, wrist, hand, and digits), as well as their supporting structures and how they are affected by injury, disease, and other conditions.
The Most Expensive Documentation Mistakes Chiropractors Make
Notes need to give payers the information they need in order to adjudicate your claims. Do your notes include what they need to see? Can you standardize and simplify your note taking process to decrease your administrative burden? In this webinar, Dr. Gwilliam, Certified Coder, Certified Professional Medical Auditor, and Clinical Director for PayDC Chiropractic EHR Software, will show you how to make it easy. He will review examples and boost your confidence that you are doing things correctly.
Coding and Documenting Physical Therapy Treatment Modalities
Presented by Evan Gwilliam DC MBA BS CPC NCICS CCPC CCCPC CPC-I MCS-P CPMA May 22nd, 2018 Tuesday @ 10:15 AM PT, 11:15 AM MT, 12:15 PM CT, 1:15 PM ET Ever wonder how to get paid for that e-stim or ultrasound? Do payers give you a hard time and ...
Total knee replacement now acceptable ASC procedure also, not auditing for a year.
Knee replacement coding, knee joint injections, auditing using FAC, LCDs, drugs, modifiers.
Are you responsible for selecting or reviewing Evaluation and Management service levels? Do you wonder how well you know the rules and how to apply them? Join Aimee in this webinar to review and then applly the rules of E/M coding. She will also do a live demonstration of the new Find-A-Code E/M Calculator Tool to assess the level of E/M service for two office visits, one new (99201-99205) and the other established (99212-99215).
Do you report or audit Telemedicine services now or are you considering offering them? Come and learn more about the rules and guidelines surrounding Telehealth services including, documentation requirements, eligible CPT and HCPCS Level II codes, modifiers, and the newest updates to Medicare Telehealth policies.
Diagnosis coding is difficult when clinician documentation does not match up with the definitions found in the ICD-10-CM code set. Find-A-Code's anatomy images educate both coders and students - bridging the gap between coders and clinicians while simplifying code selection.
FAC Updates Plus Tools for HCC Coding Chart Review February
Join Taylor to see how you can access free CEUs in 3 clicks, included with top-tier Find-A-Code subscriptions! Also highlighting our New and Improved NCDs system, and how to use the WK Drug Database for HCC Coding/Chart Review
In this webinar, Dr. Marty Kotlar (certified coding and compliance expert) will discuss how to add
Acupuncture services to a Chiropractic office. Topics include how to find and employ acupuncturists, CPT/ICD-10 coding, 15 minute increments vs the 8 minute rule, how to bill for office visits on same day as acupuncture and how to create an acupuncture billing and coding policy manual.
Learn How to Optimize Your Subscription, Searching and More
Be more productive, work smarter not harder using Find-A-Code. With so much to offer, it is important to understand how to navigate our site to get the most out of your subscription.
Documentation Mistakes that Can De-value your Personal Injury Case
Don't make mistakes that will cost you money. In this presentation Dr. Gwilliam will show you how to avoid documentation errors that attorneys and IMEs can use to decrease the value of your personal injury case. Learn how to show medical necessity through the codes you assign and support it properly in the documentation. Create goals that tell the story and establish the need for care. Avoid cloned records. All this and more in this fun-filled presentation.
Proving Medical Necessity and Functional Improvement
Medicare is required by law to pay for care that is medically necessary. Medicare considers functional improvement to be the primary indicator of medical necessity for chiropractic care. It is up to you, the doctor, to prove functional improvement and medical necessity with your documentation. Dr. Short will show you how to use common practice tools to document functional improvement, medical necessity and maximum medical improvement. You will learn:
What is Medicare’s definition of medical necessity.
How to prove medical necessity.
How to report this information to Medicare.
How to determine Maximum Medical Improvement.
The Phased Transition: How to Slow Down Without Killing Your Profits or Potential Chiropractic Practice Sale
Many retirement age chiropractors whose numbers are decreasing feel the need to retire before their practice slips even more. Others enjoy chiropractic and want (or need) to keep working but would like to a more relaxed pace. In either case, the timing and logistics of your transition are critical to your success -- if you want to retain the value of your practice .In this webinar, Dr. Tom Necela of The Strategic Chiropractor will share strategies how you can slow down, plan for your future and maximize the value of your practice and avoid costly mistakes too many chiropractors make in their practice sale or transition.
As part of a good compliance plan, and just because it is smart, you should be conducting at least annual audits in your office. If done right, you should be able to catch problems before some insurance company comes after you and demands money back. In the new 2018 DeskBook, we have provided you with self audit forms that you can copy and place in your Compliance Manual as evidence of your efforts to improve. Solutions for identified deficiencies are also right at your fingertips. In this presentation, Dr. Gwilliam will teach you how to audit yourself and keep the external auditors away.
In this webinar, Dr. Friedman will explain why more and chiropractic cases will be cut off from treatment after only 4 weeks and why you'll be seeing 6 visit maximums in the near future. He'll explain what you need to do get past this and how to determine when more treatment is justified with confidence.
Have you been told that you have to spend many hundreds, if not thousands of dollars to become HIPAA compliant? While HIPAA is complex and there is a lot to learn, anyone can do it with the right tools. In this presentation, Dr. Gwilliam will introduce you to some of these tools from the newly updated HIPAA book available in the ChiroCode store. If you are a do it yourself type, and you don't want to spend a lot of money, and you are overdue for an update to your HIPAA Compliance Manual, this webinar is for you.
Earlier this year the Medicare Administrative Contractors revised their Local Coverage
Determinations. There are some changes that will affect how you document your Medicare
visits. Medicare requires that you have a treatment plan with measurable goals. The treatment plan also serves the purpose of providing you and your patient with a roadmap of care. In this
webinar Dr. Short will show you:
What specific elements Medicare requires in each treatment plan.
How to use common clinical tools to develop effective treatment plans.
Why the treatment plan is critical to proving medical necessity and overall patient care.
This webinar will give you practical information that you can apply in your office the next day.
You can obtain the notes for this webinar by subscribing to my e-mail updates at http://www.chiromedicare.net/mailing-list- signup/ or by following the link provided in my e-
mail update. They will be available by the Monday prior to the webinar presentation.
Which is the Most Profitable E/M Code for PI: 99203 or 99204?
There is a lot of myth surrounding the use of the E/M codes. Dr. Grant will discuss how to best use these codes in a PI case to avoid the potential for a fraud claim by an insurer or a malpractice action by your patient.
So much to do and keep track of for all the departments and requirements for your practice. ChiroCode has developed checklists to help you keep organized and on track. Learn the value of a checklist as well as get a free ChiroCode checklist by joining this helpful webinar.
In this webinar, Dr. Gwilliam will go over code updates for 2018. He will show you some new ways to look at Episodes of Care, which is critical for Medicare. You'll learn how to use self audit checklists to make sure you survive the inevitable third party audit. Confession: This webinar is really just a pitch for all of the cool new things we are adding to the 2018 DeskBook, which will be released in October. We will give you the low down on what you need to be successful next year.
If eligible, you need to start reporting for MIPS by October 2th, 2017. Do you know who is exempt? Are you familiar with the quality measures that apply to chiropractors? Do you understand how to report on the Advancing Care Information or Improvement Activities? Don’t worry, Dr. Gwilliam has done all your homework and, in this presentation, you will get the crib notes containing just what you need to know. You don’t need to feel overwhelmed with Medicare regulations, you just need to know what to do.
Join Dr. Brent Kesler for a special ONE HOUR SPECIAL webinar presentation on Tuesday September 19th at 11:00 Mountain Time. In this hour presentation, Dr. Kesler will share financial tips and strategies that have been used by the wealthy, generation after generation.
This educational segment is full of information that can change or improve your financial outlook for 2017 and beyond, no matter what it looks like now! Rest assured, this is not an investing or sales related webinar. It is pure facts, strategies, tips, and real life examples that you can take note of and begin to implement right away. To learn more about this webinar presentation and to register, visit the webinars tab at https://chirocode.com/webinars.
The New Local Coverage Determinations and What They Mean to You
Earlier this year the Medicare Administrative Contractors revised their Local Coverage Determinations. There are some changes that will affect how you document your Medicare
visits.
In this webinar, Dr. Ron Short will explain the changes to the Local Coverage Determinations and how to utilize them in your practice.
You will learn:
What has changed and how it will affect you
What has stayed the same
How to document Medicare Visits
Learn the benefits and use of full spectrum, phytocannabinoid rich, hemp oil and taking advantage of the ground breaking information that is coming out on the medical benefits of hemp oil. There are new reports each and everyday and health practitioners all over are adopting the use of hemp oil and suggesting its use to their clients. Meet a practicing Chiropractor that is using the full spectrum, phytocannabinoid rich hemp oil in their practice and recommending it to their clients.
In-Network or Out-of-Network....Which is Best for You?
Join this webinar to learn the facts and fiction of In and Out-of-Network status for your providers and practices. Gather information to make the best decision for you and your practice. Learn some of the contract "tricks" that payors like to include which can be costly to you if you aren't sure what to look for or what questions to ask. Making the decision to be In-Network or Out-of-Network isn't the same for every practice. Find out also your risk of audits as it pertains to network status.
Finally, learn about payor guidelines that you must be aware of in order to minimize your risk of audit, review, denial, recoupment and other penalties.
Payors often will say that care is denied due to lack of medical necessity. Wouldn't it be nice if there was a simple formula or litmus test to ensure that each service billed met the criteria? Well, there is and Dr. Gwilliam will show you how to establish a clear "Chain of Medical Necessity" in this webinar. Remove the cloud of confusion and define, once and for all, what medical necessity really is.
How to Launch Your Associate Into Instant Success and Profit
Win-Win Associate Development: Get the help you need, the freedom you desire and the extra income you deserve. Most associateships don’t work out and end badly. But it doesn’t have to be that way. Dr. Lloyd has discovered strategies, systems, processes and techniques for hiring and developing successful motivated associates who produce their own new patients, make more money than they cost, and are great to work with in long-term relationships.
How to Document Subsequent Visits for Medicare and Everyone Else REALLY REALLY FAST Without Driving Yourself Crazy in the Process
Everyone seems to want to know how to document WELL, but FAST. Dr. Friedman will explain and demonstrate how this is not only POSSIBLE to do for Medicare, but for everyone else, too. We just need to find that ONE format of documentation that will work for EVERYONE, so there's ONE LESS THING for us to think about. Believe it or not, Medicare has actually made it EASY for us to document well and fast. Dr. Friedman will take you through the steps, from his perspective of practicing for more than 30 years and from reviewing records, performing IMEs and teaching documentation seminars nationally for years
The so-called perfect SOAP note is a little like Sasquatch, or the Chupacabra. Does it really exist? In this groundbreaking presentation, Dr. Gwilliam will finally show the world a perfect SOAP note template that will always work for all payors at all times. And it will be easy to create in almost no time. Okay, actually, he will just get as close as he can by combining years of ChiroCode wisdom, Medicare guidance, and private payor preferences. Bring your opinion to this webinar because, odds are, it will differ in some way, and perhaps, as a group, we will be able to come to a consensus.
Keys to a Successful Chiropractic Practice Sale or Transition
In this webinar, Dr. Tom Necela will discuss how to maximize the value of your practice so you can sell on top or transition well to meet your goals - as well as how to avoid the costly mistakes chiropractors make in selling, pricing their practice, finding their prospect, or in the financing of their business sale or transition.
In this special webinar for the Kentucky Association of Chiropractors, we will review the latest evidence available about effective care plans for chiropractors. More information is found in Chapter 4.5 of the 2017 ChiroCode DeskBook, which is all about creating care plans that are evidence-based and focused on measurable goals. Proper care plans still allow the doctor to take care of patients based on their clinical skill, but also show medical necessity to outsiders. This presentation is based on an updated article published last year, and available free here: http://www.jmptonline.org/article/S0161-4754(15)00184-0/fulltext
Contusion Confusion - PI's Great Overlooked and Misused Finding
Each injury has a set of confirmatory symptoms that can be used to convey severity. Contusions are one of the easiest to report, but not always the easiest to find. Most contusions are not being recognized. The truth is that they are very prevalent and they are not being documented properly by DC's.
This webinar will help you expand your diagnostic skills for contusion discovery and give you insight on how to document, validate, treat and code for contusions.
How to Convert Your Medicare Patients to Cash to Avoid the Penalties of MACRA
The #1 concern reported by CMS about chiropractors is that, as a profession, we do a poor job of understanding maintenance care. Of course, that is THEIR definition of maintenance care. When you better understand the rules of medical necessity in Medicare, you begin to see what they are talking about. The truth is that there is a “gray” area between the distinct “white” of active treatment and the “black” of maintenance treatment, and that gray area is confusing when defining “covered” vs. “not covered” chiropractic care in Medicare. Join us to find out the following critical information in time for the MACRA Section 514 implementation January 1, 2017:
Find out exactly what Medicare deems as maintenance care and how to recognize it with our patients
Learn what your options are for treating your Medicare patient’s maintenance care for cash
Hear scripting that is vital to your patient understanding what’s going on with their coverage, or lack thereof
Properly document the difference between active and maintenance care
Better manage those little incidents that come up for chronic, Medicare patients
There are many considerations when determining if your fees are in that sweet spot: not too high, not too low, and not breaking any laws. In this presentation, Dr. Gwilliam, a Medical Compliance Specialist, will help you find that magical place where you are following all the rules and still making a decent living.
Medicare has increased their review of chiropractors recently. What are they looking for? Medicare regulations are specific in what they want in your documentation. In the second of this two part series Dr. Ron Short will review the regulations regarding the subsequent (daily) visit documentation and translate them into practical actions that you can take in your office. In this webinar you will learn:
What Medicare needs to see documented during the daily visit
How to best capture the required information
What element to have on each visit
When to re-examine the patient.
You can obtain the notes for this webinar by subscribing to my e-mail updates at http://www.chiromedicare.net/mailing-list- signup/ or by following the link provided in my e-mail update. They will be available by the Monday prior to the webinar presentation.
Practices find that too much of their revenues are slipping through the cracks! This is too costly to practices and must be addressed! Though there are many reasons and areas in your practice that can have an impact on your cash flow, your Over-the-Counter Collections is one of them! Let's take a closer look at your OTC Collections, identify trouble areas, implement more seamless systems, and all around look at ways you can improve your collections over-the-counter.
In this webinar, Dr. Friedman will discuss the initial new patient exam and how it doesn't do what we THINK it does for our documentation. He'll also discuss what establishes the NEED to begin care and justifies the NEED to continue care. Understanding this concept is CRITICAL for ALL patients, regardless who is paying for the care.
Join Dr. Brent Kesler for a special one hour webinar presentation on May 30, 2017 at 11:15 Mountain Time. In this one hour session, Dr. Kesler will share financial tips and strategies that have been used by the wealthy, generation after generation.
This educational segment is full of information that can change or improve your financial outlook for 2017 and beyond, no matter what it looks like now! Rest assured, this is not an investing or sales related webinar. It is pure facts, strategies, tips, and real life examples that you can take note of and begin to implement right away. To learn more about this webinar presentation and to register, visit the webinars tab at https://chirocode.com/webinars.
Recently, Medicare stated that they expected chiropractic care to be “episodic” in nature. Find out what Medicare expects from your treatment plan to justify medical necessity. How many treatments is too much? What are they looking for in your care? Medicare and ICD-10 Guideline changes in 2017 have resulted in massive audits taking place across the country. Many calls are coming in pertaining to denials and audits. Most are because the doctor and staff are unaware of the regulation changes. Mario Fucinari, DC, CCSP, CPCO, MCS-P, MCS-I is uniquely qualified as being still in active practice, a Certified Medical Compliance Specialist, Certified Compliance Officer and a member of the Carrier Advisory Committee.
Medicare has increased their review of chiropractors recently. What are they looking for? Medicare regulations are specific in what they want in your documentation. In the first of this two part series Dr. Ron Short will review the regulations regarding the initial visit documentation and translate them into practical actions that you can take in your office. In this webinar you will learn:
-What Medicare needs to see documented during the initial visit
-How to best capture the required information
-What you need to make a good treatment plan
-When to start a new episode of care
Nutritionist Represents Healthy Eating and Exercise Plan
What are the ONLY two things every Health Professional from MD’s, Chiropractors, and all others agree with that if worked on will reverse illness, lengthen lifespan and give great energy?
Tune into this webinar that addresses the elephant in the room with EVERY patient. How to improve daily eating and exercise habits that research shows will do the most for your health than ANYTHING ELSE YOU CAN DO.
This webinar will introduce an easy to follow healthy eating and exercise plan overseen and administrated by professional trainers and nutritionists for YOU and your patients.
At the end of the webinar, you will receive the ability to get a personalized eating and exercise plan from a professional trainer and nutritionist. You will get coached every step of the way every day helping you achieve your health goals. After you achieve greater health, you can recommend this program to your patients to improve their recovery and longevity while at the same time increasing your revenue dramatically.
You will hear from Douglas Grant who has trained 1,000’s of professional athletes, doctors and every day people over the last 20 years. He is a nutritionist to many NBA teams and his team currently creates nutrition, exercise and supplement programs for people all over the globe.
2017 is a year of changes in some areas as well as a year for improvement and catch-up in others. This ChiroCode webinar is going to discuss some of these changes, what it means to your practice as well as need-to-know details and strategies to help you improve upon and catch-up in those other areas.
Bring your questions to this webinar session as well as our presenters will address as many of your questions as possible!
May is Posture Month- "Be A Posture ACE" Communications and Marketing Campaign
May is Posture Month, and this year’s “Be a Posture ACE” campaign is your strategy to get patients engaged and promote your practice!
Join Dr. Steven Weiniger, the posture expert, and learn how the annual public health effort from PostureMonth.org is an opportunity to help people understand bio-mechanical problems through a postural lens, and help themselves stand taller and move better… as well as appreciate the benefits of your care.
ACE stands for creating posture Awareness; taking Control of your body; and optimizing your posture Environment- ACE. ACE is for patients and the public, as well as fellow health care providers. It’s a way for DCs to engage patients and their community towards better posture awareness and habits, and position themselves to other professionals as the posture specialist.
You’ll learn to
~~Raise Posture Awareness
~~Communicate posture with words and a picture (Free PostureZone® app is really helpful, but not required)
~~Marketing Strategy- in office and online
Learn from Dr. Steven Weiniger, author of Stand Taller~Live Longer and creator of the StrongPosture® Protocols, PostureZone® app and CPEP® Posture Exercise Professional certification to observe, communicate and promote posture.
New for 2017: Dr. Weiniger will provide free PostureMonth.org listings for DCs offering the public free posture pictures this May. Use any technology from desktop software to your cameraphone, or even a polaroid camera and crayons. Our mission is building social posture awareness, and we invite you to join us.
Also, get the PostureMonth.org 2017 health and practice toolkit with timeline and access to free flyers and social media strategy and tools.
In this webinar, get a sneak peak at how ChiroCode audits a typical evaluation encounter. Do you document functional loss? Are you using outcome assessment tools appropriately? Does your treatment plan include measurable goals? Do you document complicating factors? Answer all these questions and more in this action-packed half hour with Dr. Gwilliam.
Strategies for better managing and taking control of your financial future
Often times today in business and even with our personal finances, most people find themselves having to find ways to work more or work harder in effort to maintain or improve their lifestyle and/or having to give up or delay obtaining those things that are important to us.
This webinar special is bringing to you invaluable information and tools that will not only enable you to take control of your own personal and business finances, show you how your money can grow more quickly and work better for you, be an instrument in debt reduction, and more.
One audit trap that is sure to reveal lack of evidence for Medical Necessity could be found in your current coding and billing systems, and of course, your patient documentation. This common billing practice in chiropractic frequently results in claim denials and requests for refund of payment. When expecting third party payment, support of Medical Necessity must be in the manner defined by 3rd party payors and not only according to provider rationale.
Let Dr. Gwilliam, ChiroCode's Vice President, walk you through Chapter 5.2 on all the common procedure codes used in chiropractic. This is part 2 of 7.
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Chapter 5.2 - Part 2 Modality Coding (97014, 97012)
Let Dr. Gwilliam, ChiroCode's Vice President, walk you through Chapter 5.2 on all the common procedure codes used in chiropractic. This is part 3 of 7.
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Let Dr. Gwilliam, ChiroCode's Vice President, walk you through Chapter 5.2 on all the common procedure codes used in chiropractic. This is part 4 of 7.
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Chapter 5.2 - Part 4 Therapeutic Procedure Coding (97140)
Let Dr. Gwilliam, ChiroCode's Vice President, walk you through Chapter 5.2 on all the common procedure codes used in chiropractic. This is part 5 of 7.
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Let Dr. Gwilliam, ChiroCode's Vice President, walk you through Chapter 5.2 on all the common procedure codes used in chiropractic. This is part 6 of 7.
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Let Dr. Gwilliam, ChiroCode's Vice President, walk you through Chapter 5.2 on all the common procedure codes used in chiropractic. This is part 7 of 7.
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Chapter 5.2 - Chiropractic Manipulative Therapy Coding and Documentation
Let Dr. Gwilliam, ChiroCode's Vice President, walk you through Chapter 5.2 on all the common procedure codes used in chiropractic. This is part 1 of 7.
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Chapter 4.3 - Evaluations 3: Diagnosis and Treatment plans
Let Dr. Gwilliam, ChiroCode's Vice President, walk you through the rest of Chapter 4.3 on documenting for evaluations and re-evaluations. This is part 3 of 3.
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The Latest Comparative Billing Report and What it Means to You
Medicare recently sent out Comparative Billing Reports to 8500 chiropractors. These reports give these chiropractors information on how their billing patterns compare to their peers both state-wide and nation-wide. In this webinar Dr. Short will explain:
- What was measured in this Comparative Billing Report
- What your numbers should look like
- What action to take if you received a Comparative Billing Report
Dr. Friedman has been practicing for 28 years and performs record reviews and IMEs for attorneys and insurance companies for personal injury, workers comp and malpractice cases. In this webinar, Dr. Friedman will explain that the typical Independent Medical Exam looks like and why it really is normal on 90-95% of the cases we see, but why the conclusions are the problem. Dr. Friedman will discuss why he cuts off 99% of the chiropractic cases he reviews after only 4 weeks of care, and how you can beat that. He'll show you what he looks for in your records and how to properly document in the least amount of time and with the least amount of effort.
Proper Use of Modifiers for Maximum Reimbursement and Reducing Audits
Modifiers are two-digit codes appended to procedure codes and/or HCPCS codes to provide additional information about the billed procedure. In some cases, addition of a modifier may directly affect payment and incorrect use can result in audits and potential recoupment. In this webinar, certified coder and auditor David Klein will review the “do’s” and “don’ts” of proper modifier usage to help maximize reimbursement and reduce the likelihood of an audit.
Posture and Mood: How you Stand, Sit and Move Affects How you See the World?
When people are unhappy or have a bad attitude, their posture shows it. There’s good reasons why body language expresses our mood and attitude. Posture is the external manifestation of our physicality, and can literally be the window to mood.
From pain to pessimism, posture affects (and is affected by) your outlook on life. Learn how accumulating research is demonstrating how links between body and mind are a two way street, and the consequences of excessive sitting on mind and body .
Palpating function by touch and visually reading subtle posture cues can provide valuable insight into bio-mechanic function, health and attitude. Which is why DCs can be the posture specialists for people suffering the burgeoning health effects of sitting, texting and modern technology on their bodies and minds.
Learn about:
- The sensori-motor mood connection
- Studies correlating posture habits with mood and disease
- Strategies for the posture specialist
The Future of Reimbursement: Medicare's Quality Payment Program
You may have heard rumblings about MACRA, MIPS, MU, PQRS, VBM, and some other acronyms from CMS (Medicare.) Don't get overwhelmed, Dr. Gwilliam will take you through the basics and let you know what you need to do in 2017 to avoid a payment adjustment (penalty), and maybe even qualify for incentives (up to 5%! woohoo!) Even if you don't treat Medicare beneficiaries, this model could be the future of payment for healthcare. This is a webinar that you won't want to miss.
Ransomware. Are You a Target? What You Need to Know to Protect Your Patients and Your Practice
Recently, there have been a number of reports of doctors being held hostage by ransomware. Ransomware is malicious software that hackers use to prevent you from accessing your critical data, and then demanding ransom to regain access to it.
Themos Pentakalos, Chief Operating Officer for ChiroTouch will discuss:
-What are the major security threats to chiropractors
-Why healthcare providers like chiropractors make perfect targets for ransomware attacks
-How to devise a plan to protect your practice and your patient data from ransomware and other security threats
Time is Running Out for Your Annual Security Risk Analysis!
The Security Risk Assessment is not only required for HIPAA Security but is also a required element to Meaningful Use attestation. Practices that have not completed the annual Security Risk Assessment per these guidelines are frequently assessed with hefty financial penalties.
In this webinar, you will learn:
What the Security Risk Analysis is and why it's necessary
How NOT doing the Security Risk Analysis can impact your cash flow
How your practice can perform the Security Risk Analysis efficiently, effectively, and in a time manageable fashion
What your practice can learn from your annual Security Risk Analysis
Presented by Evan Gwilliam DC MBA BS CPC NCICS CCPC CCCPC CPC-I MCS-P CPMA & Brandy Brimhall CPC CMCO CPCO CCCPC
October 11, 2016
Tuesday @ 10:15 AM PST, 11:15 AM MST, 12:15 PM CST, 1:15 PM EST
In this special webinar, Dr. Gwilliam, VP of ChiroCode, and Brandy Brimhall, Director of Education for ChiroCode, will have no presentation prepared for you. Bring you most pressing questions and get free, unfettered access to two of the most highly credentialed coders/auditors in chiropractic. This is your chance to pick their brains and figure out how to get paid properly for the work you do.
When, Where, Why & How to Go Out Of Network With Insurance Payers
Presented by Tom Necela DC, CPC, CPMA, CCP-P
October 4, 2016
Tuesday @ 10:15 AM PT, 11:15 AM MT, 12:15 PM CT, 1:15 PM ET
Although most chiropractors are 80%+ insurance based, not all payers are created equal. For some, there is little reward to be an in-network provider (and maybe a lot of risk and hassles).
If you've been considering getting out of network, don't miss this webinar where Dr. Tom Necela of The Strategic Chiropractor will discuss specific strategies for why, when, where and how!
New ICD-10 Codes for Chiropractors and the Beginning of ICD-10 Audits
Presented by Evan Gwilliam DC MBA BS CPC NCICS CCPC CCCPC CPC-I MCS-P CPMA
September 27, 2016
Tuesday @ 10:15 AM PT, 11:15 AM MT, 12:15 PM CT, 1:15 ET
The ICD-10 documentation grace period ends on October 1st 2016. Are your records good enough? Do you know what the new codes are the chiropractors need to use? Have you got rid of the codes that have been deleted for 2017? Find out about all this and more in this webinar.
Don’t Leave Money on the Table-Maximize Collections!
We'll review the key indicators to measure your Billing operation and if it is delivering maximized collections. We'll then breakdown the keys to managing successful Biller(s).
You'll leave this webinar with practical tools you can implement immediately regardless of the size or type of your practice. This webinar is for the Chiropractor, not the Billing staff.
Spine Month (October) is your chance to amplify the value of chiropractic! It’s easy to engage people with simple tools you have on hand that show why getting adjusted and spinal health are crucial to overall health and wellbeing.
Whether your focus is people with back, neck and NMS pain, or you focus primarily on keeping people healthy, active and pain free, Spinal Health month is a golden opportunity to draw interest to your practice. Register today to learn how to assess and demonstrate spinal function with a posture picture and get the essential concepts and protocols for ongoing care of spinal health.
~ Build your practice during Spinal Health Month
~ Concepts that lead to referrals and new patients
~ Demos to improve compliance and referrals
Top 5 Reasons Your Clinic Should Consider Outsourcing it’s Billing and Collections Process
Presented by Jeff Smith
September 6, 2016
Tuesday @ 10:15 AM PT, 11:15 AM MT, 12:15 PM CT, 1:15 ET In his presentation “Top 5 Reasons Your Clinic Should Consider Outsourcing it’s Billing and Collections Process,” Jeff Smith, Director of Revenue Cycle Management Services at CoreSolution Billing will identify five areas of ...
Presented by Ron Short DC, MCS-P, CPC
August30, 2016
Tuesday @ 10:15 AM PT, 11:15 AM MT, 12:15 PM CT, 1:15 PM ET
In this special webinar presentation Dr. Ron Short is hosting Dr. Rick Kuhlman as he tells his story of how he was investigated, fined, and jailed for healthcare fraud. This presentation is not intended to scare you but rather to demonstrate that some business procedures that were common to the profession in the past have very different consequences today. Join us and learn what Dr. Kuhlman was doing and what happened as a result of his actions.
What does it have to do with a DC anyway?
Who decides the value of DC care?
Impairment vs. disability, how do I choose?
ADL losses, which are the most important?
Emotional damages, do DC’s have any input?
Over the last 30 years, little has changed in attorney management of PI cases, but insurers have been upping their game every day since then! Can the same be said about DC care in PI cases?
This lag in updating case management strategies has led to a 65% loss in claim value since 1985, yet premiums and cost of care have steadily increased! Are you ready to up your game?
Tom Grant Jr., DC of Grant Professional Strategies will be presenting a webinar on “How Do Insurers Value an Injury Claim?”, a glimpse into a portion of liability insurers training and directives, including action steps you can take gain an insider's advantage to improve your patient's loss recovery through strategic doctoring.
In this webinar, Dr. Gwilliam, a certified professional medical auditor will show you how he audits a record.
You will see what elements are important and which deficiencies are red flags.
How to Satisfy Medical Necessity for a Daily Encounter
Meeting Medical Necessity through our daily documentation is a source of confusion and frustration for many DCs. We will help you navigate the ever-evolving world of documentation guidelines and you'll walk away with an understanding of what medical necessity is, regardless of the payer.
During this presentation, we will cover:
· Key Components Needed to Satisfy Medical Necessity
· Tools You Can Utilize to document response to care and justify the need for continued care
· Common Mistakes DCs Make in Establishing Medical Necessity
If you are using canned treatment plans, or no treatment plans at all, be prepared to pay every visit back in it's entirety. Treatment plans, as well as the associated treatment goals are one of the most important parts of an initial chiropractic visit. In this webinar, join Dr. Alan Bergquist, CEO of Chiropractic Compliance Solutions, LLC, as he explains the details required in an effective treatment plan.
Presented by Ron Short DC, MCS-P, CPC
Tuesday @ 10:15 AM PT, 11:15 AM MT, 12:15 PM CT, 1:15 PM ET
Last October 1 saw the implementation of ICD-10. This coming October 1 will see the end of the grace period where Medicare will start denying claims for improper codes. In this webinar Dr. Ron Short will cover some of the specifics that you will need to consider with the ICD-10 coding and billing the claims to Medicare. In this webinar you will learn:
• What Medicare expects to see in your coding
• Why accuracy in your coding is more important than ever
• What comes next for Medicare reviews and audits
Presented by Tom Necela DC, CPC, CPMA, CCP-P Tuesday @ 10:15 AM PT, 11:15 AM MT, 12:15 PM CT, 1:15 PM ET In this webinar, Tom Necela, DC, CPC, CPMA, CCP-P will show you TWO simple steps to put a stop to the mystery, the anxiety and the confusion over ...
Documenting a Thorough New Patient First Visit Quickly
Presented by Gregg Friedman DC
July 5, 2016
Tuesday @ 10:15 PM PT, 11:15 PM MT, 12:15 PM CT, 1:15 PM ET
Dr. Friedman will discuss the importance of starting the documentation process with the new patient correctly and how to get the most thorough information in the least amount of time.
Presented by Brandy Brimhall CPC CMCO CPCO CCCPC
March 1, 2016
Tuesday @ 10:15 AM CT, 11:15 AM MT, 12:15 PM CT and 1:15 PM ET
What you need to know about insurance participation, the enrollment process, what to look for in payor contracts and policies, and more. Many practices make mistakes because they didn't know what to look for or what questions to ask when considering enrolling as a participating provider with a particular payor. Save your practice time and money by learning these details before beginning the enrollment process.
Presented by Gregg Friedman DC
June 14, 2016
Tuesday @ 10:15 PM PST, 11:15 PM MST, 12:15 PM CST, 1:15 PM EST
Dr. Friedman will discuss the 3 parts of the patient examination and why only ONE part is actually for medical necessity. This ONE thing is critical for determining if more chiropractic treatment is justified or not and if treatment has been effective or not.
Presented by Evan Gwilliam DC MBA BS CPC NCICS CCPC CCCPC CPC-I MCS-P CPMA
June 7, 2016
Tuesday @ 10:15 AM PST, 11:15 AM MST, 12:15 PM CST, 1:15 EST Now that the year is almost half over, it is a good time to remember that PQRS needs to be reported on ...
Presented by Ron Short DC, MCS-P, CPC
May 31, 2016
Tuesday @ 10:15 AM PT, 11:15 AM MT, 12:15 PM CT, 1:15 PM ET
Section 514 of the Medicare Access and CHIP Reauthorization Act of 2015 (MARCA) required CMS “develop educational and training programs to improve the ability of chiropractors to provide documentation … in a manner that demonstrates that such services are … reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.” On December 23, CMS uploaded a 20 minute video to the CMS YouTube channel as a response to this requirement.
Presented by Evan Gwilliam DC MBA BS CPC NCICS CCPC CCCPC CPC-I MCS-P CPMA
May 10, 2016
Tuesday @ 10:15 AM PST, 11:15 AM MST, 12:15 PM CST, 1:15 EST
Documentation can be used against you, or it can be you best defense when someone tries to deny your claims or you get audited. Chapter 4 of the ChiroCode DeskBook covers all the basics, and some of the advanced stuff too. In this training, learn what makes solid documentation for Assessment Visits, and what is necessary for Treat
Presented by David Klein, CPC, CPMA, CHC
May 17, 2016
Tuesday @ 10:15 AM PT, 11:15 AM MT, 12:15 PM CT, 1:15 PM ET
For several years the chiropractic profession has been inundated with warnings, rumors, and other anecdotes about audits - some true, and others, not so much.
This webinar cuts through the rhetoric and presents the basics: what are audits and how are they conducted; what should a practice do if subjected to an audit; and how you can prepare before an audit occurs.
Proactive Steps to prepare for a Meaningful Use Audit
Presented by Dorel Radivoj, D.C. CPC
May 10, 2016
Tuesday @ 10:15 PM PST, 11:15 PM MST, 12:15 PM CST, 1:15 PM EST
During this presentation, Dr Radivoj will provide insight into the meaningful use audit process, point out potential problem areas and outline the documentation requirements to address an audit.
Non-Traditional Exit Strategies: How to Leave Chiropractic WITHOUT Giving Your Business Away
Presented by Tom Necela DC, CPC, CPMA, CCP-P
Dr. Tom Necela of The Strategic Chiropractor will discuss how to avoid the mistakes that most chiropractors are making when transitioning out of their practice and reveal "non-traditional" strategies to help you maximize the value of your exit strategy and chiropractic practice sale or transition.
Alert!! THOUSAND$ at Risk for Chiropractors in 2016
Presented by Alan D. Bergquist, D.C., MCS-P, CCPC and Jeff Smith
Tuesday @ 10:15 AM PT, 11:15 AM MT, 12:15 PM CT, 1:15 PM ET
Join this group of compliance professionals to learn about compliance hot topics, common Q/A, need-to-know details for compliance implementation and evaluation and much more. Also, this webinar will present to you advanced compliance training tools that will save you time, money and be easy to time manage as you navigate and implement compliance. There is so much to cover in this webinar session, doctors and CA's will not want to miss out.
DeskBook 101: Evaluation and Management Self Audit
Presented by Evan Gwilliam DC MBA BS CPC NCICS CCPC CCCPC CPC-I MCS-P CPMA
April 19, 2016
Tuesday @ 10:15 AM PST, 11:15 AM MST, 12:15 PM CST, 1:15 EST
Chapter 5.3 of the 2016 ChiroCode DeskBook is all new, with tables and examples to help you become an expert on E/M coding for chiropractic. E/M codes are a top target by auditors because many providers use them incorrectly, or trust their EHR system templates to do the work for them. In this webinar, find out how to audit your own E/M codes so you don't have to fear the auditors.
Presented by Brandy BrimhallCPCCMCOCPCOCCCPC
April 12, 2016
Tuesday @ 10:15 AM CT, 11:15 AM MT, 12:15 PM CT and 1:15 PM ET
Claim forms are revealing! Find out what payors look for when reviewing claims for payment. There are many billing practices that can put providers at risk for an audit. Learn what these things are now so you can find and fix your own mistakes before the payors do.
Presented by Chantal Bryant, Meaningful Use Expert for ChiroTouch and SmartCloud and Jennifer Hay, Meaningful Use Specialist for ChiroTouch and SmartCloud
March 22nd
Tuesday @ 10:15 AM PST, 11:15 AM MST, 12:15 PM CST, 1:15 EST
The presenters will cover need to know information on Meaningful Use and then will be taking MU related questions directly from listeners. Meaningful Use is a comprehensive and often confusing topic. These presenter spend their time "in the trenches" of Meaningful Use and attestation. They will be able to offer clarity to listeners. Attendees are invited to bring their Meaningful Use questions to this webinar to be answered directly by Meaningful Use expert.
March 1, 2016 - Let's discuss patient collections!
Presented by Brandy Brimhall CPC CMCO CPCO CCCPC Tuesday @ 10:15 AM CT, 11:15 AM MT, help evaluate and optimize your patient collections. This includes, over the counter ...
Chapter 4.5 of the 2016 DeskBook is all about creating care plans that are evidence based and logical. They allow the doctor to take care of patients based on their clinical skill, but also show medical necessity to outsiders. Bring your DeskBook to follow along as you learn how to use this chapter.
Preparing Your Practice for New Reimbursement Models
Presented by Steven Kraus DC, DIBCN, FIACN, FASA, FICC
February 18, 2016
Thursday @ 10:00 AM PT, 11:00 AM MT, 12:00 PM CT, 1:00 PM ET
Requirements for DC’s In order to participate in the new payment methods. Fee for Service is Going Away!
Presented by Noel Lloyd, DC
Tuesday @ 10:15 AM PST, 11:15 AM MST, 12:15 PM CST, 1:15 EST
Get all the new patients you need! Not enough new patients is the number one challenge that holds most chiropractic practices down. Get new patients right and you’ll succeed. Get new patients wrong and your struggle. Dr. Noel Lloyd will take you step by step through how to create your own new patient Tsunami!
ChiroCode worked hard to update and revise and enhance our ICD-10 book. It has been expanded, but also refined. In this webinar find out how to use your 2016 ICD-1
In this webinar, Dr. Gwilliam will review chapter 4.2 Common Procedure Codes. More than half the chapter is brand new for 2016 and it is crammed full of coding and documentation tips for the codes you use most. Figure out all the little tricks you need to keep your claims clean and survive an audit. Bring your copy of your DeskBook to follow along.
Crucial Changes Needed in Your Billing and Collections Process in 2016
Presented by Alan D. Bergquist, D.C., MCS-P, CCPC and Jeff Smith
Tuesday @ 10:15 AM PT, 11:15 AM MT, 12:15 PM CT, 1:15 PM ET
As more financial responsibility for healthcare is shifted from insurance to the patient themselves it is important, and even imperative that your office procedures adapt to those changes as well to ensure that your office continues to thrive financially as well as continue to improve patient satisfaction (which will begin affecting your reimbursement in 2017.)
Presented by Ron Short DC, MCS-P, CPC
Tuesday @ 10:15 AM PT, 11:15 AM MT, 12:15 PM CT, 1:15 PM ET
The Physician Quality Reporting System will affect you and your practice more than ever before. Failure to report PQRS measures this year will result in a 2% cut in your Medicare payments in 2018. It will also result in you being assigned the lowest level Value Based Modifier which could result in an additional cut.
For additional information visit ChiroCode.com. Since 1993 Chiropractors have depended on ChiroCode as a reliable source of information for the Chiropractic community. View current and recent webinars, order the ChiroCode DeskBook, (comprehensive go-to chiropractic reimbursement manual) and much more. Because of the dependability and education, ChiroCode has earned much renown.
Chiropractic Resources
Deskbook (Reimbursement Guide)
ICD-10-CM Specialty Specific Code Book
Provider Documentation Guides
ICD-10-CM Comprehensive Code Books
Cheat Sheets and Diagnostic Coding Cards
and more...
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