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Chiropractic Auditing Information Articles
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Q/A: I’m Being Audited? Is There a Documentation Template I can use?
April 29th, 2019
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 ...
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...
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 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.
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 ...
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.
Employee Exclusions Screenings Must be High Priority
February 24th, 2016
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.
Chiropractic Listed as Focal Point in 2015 OIG Work Plan
August 19th, 2015
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 ...
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 ...
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 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
November 17th, 2014
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 ...
Chiropractic is Listed as a Priority in the 2014 OIG Work Plan...Find Out Why
October 16th, 2014
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 ...
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 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
Click the webinar title to view a summary and link to the webinar video.
Conducting a Self-Audit
September 20th, 2017
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, 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.
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.
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.
DeskBook 101: Evaluation and Management Self Audit
March 11th, 2016
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.
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