Chiropractic Auditing Articles & Resources
CLICK HERE to learn more about our do-it-yourself chart audit tool.
HIPAA compliance information can be found here.
Medicare compliance information can be found here.
Click here for information on OIG Compliance Program.
For additional information visit ChiroCode.com. Since 1993 Chiropractors have depended on ChiroCode as a reliable source of information for the Chiropractic community. Because of the dependability and education, ChiroCode has earned much renown. View current and recent webinars, order the ChiroCode DeskBook, (comprehensive go-to chiropractic reimbursement manual) and much more.
Select the title to see a summary and a link to the full article. some articles require a subscription to view.
by Stephanie Allard, CPC CEMA RHIT
When x-rays are audited on the same date as an E/M encounter we have one of three decisions to make about the work that went into the radiological exam when the practice owns x-ray equipment and does their own interpretations internally. First, we must determine whether the x-ray was...
Mar 14th, 2022
Medicare Auditors Caught Double-Dipping
by Edward Roche, PhD JD
Overlapping extrapolations require providers to pay twice. Some Medicare auditors have been caught “double-dipping,” the practice of sampling and extrapolating against the same set of claims. This is like getting two traffic tickets for a single instance of running a red light. This seedy practice doubles the amount...
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Audits are currently underway to verify the monies distributed through the CARES Act were warranted and properly used by those organizations that received them. The federal government has contracted with financial institutions such as KPMG and PricewaterhouseCoopers, among others, to perform these audits referred to as Provider Relief Fund (PRF) audit contractors, funded with monies from the very same program. There were four phases of funding disbursements with phase 1 audits beginning in September. How ready are you to be audited?
Jul 14th, 2020
Are NCCI Edits and Modifiers Just for Medicare?
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
The National Correct Coding Initiative (NCCI) edits were developed by CMS to help promote proper coding and control improper coding that leads to incorrect payments with part B claims. It is important to understand that NCCI edits do not include every possible code combination or every type of un-bundling combination. With that ...
Apr 15th, 2020
CMS Temporarily Suspends Contract-Level RADV Audits
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
The Centers for Medicare and Medicaid Services (CMS) is suspending contract-level RADV audits, related to the payment year 2015 and will not initiate any new ones until after the public health emergency has ended. Any documentation already submitted will be reviewed as usual.
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
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: ...
Jan 7th, 2020
Denials due to MUE Usage - This May be Why!
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
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 ...
by NAMAS
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 ...
Jun 14th, 2019
A United Approach
by NAMAS
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 ...
Jun 13th, 2019
What Medical Necessity Tools Does Find-A-Code Offer?
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
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 Wyn Staheli, Director of Content - innoviHealth
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 ...
Apr 23rd, 2019
Let's Talk High Risk E/M Services
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
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 ...
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
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 ...
Apr 8th, 2019
Prepayment Review Battle Plan
by Wyn Staheli, Director of Content - innoviHealth
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. ...
Mar 21st, 2019
The Impact of Medical Necessity on High Level E/M Services
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
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. ...
Mar 1st, 2019
Understanding NCCI Edits
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
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 ...
Feb 12th, 2019
Coding Medicare Initial Preventive Physical Exams (IPPE)
by Aubrie Rowley
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 ...
Feb 5th, 2019
Clinical Staff vs. Healthcare Professional
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
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 ...
Jan 23rd, 2019
How to Report Co-Surgeons Using Modifier 62
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
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 ...
Oct 17th, 2018
Wolters Kluwer Drug Pricing
by Find-A-Code™
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...
Select the title to see a summary and a link to the full webinar information. some webinars require a subscription to view.
Feb 8th, 2022
Medicare Audit, Do-it-yourself
by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
Apr 12th, 2018
Evaluation and Management Coding and Auditing
by Find-A-Code™
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).Feb 2nd, 2017
How to Check NCCI Edits Using FindACode
by Find-A-Code™
How to Check NCCI Edits Using FindACodeOct 4th, 2016
ICD-10-CM Updates for the Auditor, a NAMAS webinar
by Find-A-Code™
ICD-10-CM Updates for the Auditor, a NAMAS webinarLinks and resources by topic.
Appeals
Auditing
Compliance
Denial Management
E+M Documentation and Coding
Fraud
HIPAA
Medicaid
Medicare
Procedure Coding
Reimbursement
Security
Technology
suggest a resource
If you know of a resource that should be included here (links, data, etc.) please contact us.
Thank you for choosing Find-A-Code, please Sign In to remove ads.
Quick, Current, Complete - www.findacode.com