Because compliance covers so many areas of a healthcare provider practice, a more thorough explanation is found in Chapter 3-Compliance in the ChiroCode DeskBook. Generally, healthcare providers need to understand:
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.
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August 13th, 2019
Will Medicare Change Their Rules Regarding Coverage of Services Provided by a Chiropractor?
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.
August 9th, 2019
The OIG Work Plan: What Is It and Why Should I Care?
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 ...
July 8th, 2019
Q/A: Can I Put the DC’s NPI in Item Number 24J for Massage Services?
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 ...
July 1st, 2019
Rules for Rendering Unproven, Investigational or Experimental Procedures
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 ...
July 1st, 2019
Q/A: Do I Really Need to Have an Interpreter?
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 ...
June 25th, 2019
Q/A: Can I Refuse to File a Patient's Medical Insurance for an Auto Accident?
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 ...
April 29th, 2019
Q/A: I’m Being Audited? Is There a Documentation Template I can use?
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 ...
November 28th, 2018
No Good Deed Goes Unpunished
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.
October 22nd, 2018
Q/A: Does My LMT need an NPI? How do I Bill Her Services?
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, ...
June 18th, 2018
Q/A: Can a PT Assistant Perform Physical Therapy Modalities?
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.
April 30th, 2018
Q/A: Should I be Using Modifier 96 on PT Claims?
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?
January 16th, 2018
Patient Relationship Codes
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 ...
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April 18th, 2018
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.
May 11th, 2017
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
June 5th, 2017
Figuring Out Your Fees
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.
Are You a Covered Entity? - by CMSAvoiding Medicare and Medicaid Fraud and Abuse; A Roadmap for PhysiciansCivil Monetary Penalties Law - by OIGCMS Complying with Medicare Signature Requirements Fact SheetCMS Medicare Fee for Service Recovery Audit ProgramCompliance Guidance - by the OIGCR 5550 Clarification - Signature Requirements by CMSDetailed Information on the New Safety Data Sheets (SDS)Disposal of Protected Health InformationFact Sheet for Chiropractic Services - by the VAFederal Exclusions Database for Healthcare WorkersFederal Sentencing Guidelines ManualHealth Care Fraud and Abuse Control Program Reports by OIGHHS Compliance LinksHHS Notifications: Online FormHIPAA Notice of Privacy Practice Pamphlet for PatientsHIPAA regulations and sign-in sheets - by HHSHIPAA: Health Insurance Portability and Accountability Act by AMAInappropriate Medicare Payments for Chiropractic Services Report - by the OIGMarketing to Medicare Beneficiaries - by MedicareMedicare Recovery Audit by HHS Office of the Inspector GeneralMSDS Forms; Safety Data SheetsOfficial HIPAA Guidelines for Media SanitationOIG Compliance Program for Individual and Small Group Physician Practices - Federal RegisterOIG Issues Renewed Focus on Chiropractic ServicesOIG Self-Disclosure Protocol - by HHSOSHA Small Business Resources - includes trainingOSHA's Computer Workstations eToolPrompt Pay Discounts - OIG Advisory Opinion 08-03PSAVE Pilot ProgramSecurity Risk Assessment by HealthIT.govSliding Fee Schedule information - by the Health Resources and Services Administration (HRSA)Special Advisory Opinion 12-21 , Offering Gifts and Other Inducements (2013)- by the Office of the Inspector General (OIG)Temporary Worker Injury and Illness Recordkeeping Requirements by OSHAUnited States Department of Labor; Occupational Safety and Health Administration
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