Compliance Articles and Resources

News and Important Information

Date of Service Reporting for Radiology Services

Q/A: I’m Being Audited? Is There a Documentation Template I can use?

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Billing Requirements for OPPS

Billing Requirements for OPPS Providers with Multiple Service Locations

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Dismal OIG Report on Telemedicine

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Providers need to understand the rules for reporting telemedicine services. A recent OIG report shows that this is not the case. What problems are being found in documentation claims? As providers are expanding their telehealth offerings, now is the time to understand the potential pitfalls since disallowed amounts will be taken back.

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CMS Temporarily Suspends Contract-Level RADV Audits

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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.

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COVID-19: Cybercrime, Telehealth, and Coding

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Your inbox is probably like mine with all sorts of announcements about COVID-19. Here are just a few reminders of things we felt should be passed along. We have heard of several cases of cybercrime related to this outbreak. For example, there was a coronavirus map which loads malware onto your ...

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"What is the ICD-10 code for...?" - Search Smarter With Find-A-Code Tools

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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: ...

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2020 Official ICD-10-CM Coding Guideline Changes Are Here!

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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 ...

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Are You Aware of Medicare Advantage Plans Timely Filing Rules?

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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 ...

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The OIG Work Plan: What Is It and Why Should I Care?

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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 ...

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Are These Problems Hurting Your Practice?

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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.

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Denial Management is Key to Profitability

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Q/A: Can I Put the DC’s NPI in Item Number 24J for Massage Services?

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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 ...

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Rules for Rendering Unproven, Investigational or Experimental Procedures

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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 ...

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Q/A: Can I Refuse to File a Patient's Medical Insurance for an Auto Accident?

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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 ...

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Small Breaches Can Be Subject to Large Penalties

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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 ...

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What Medical Necessity Tools Does Find-A-Code Offer?

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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 ...

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Q/A: Two Payers Both Paid the Claim. Who Gets the Refund?

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Question  We have a personal injury situation where we submitted a claim was sent to the patient's auto policy carrier who refused payment. We then submitted it to her other insurance. Eventually, both companies paid her claims. Her auto paid at full value, and her secondary paid at a reduced rate ...

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Q/A: I’m Being Audited? Is There a Documentation Template I can use?

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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 ...

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OIG Announces New Review For Medicare Part B Payments for Podiatry and Ancillary Services

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Due to prior OIG work identifying inappropriate payments for podiatrists and ancillary services, the OIG announced in Feb 2019 they will begin a new review starting in 2020.  The OIG stated they will review Medicare Part B payments to determine if medical necessity is supported in accordance with Medicare requirements.   Part of the ...

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Let's Talk High Risk E/M Services

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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 ...

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Watch out for People-Related ‘Gotchas’

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In Chapter 3 — Compliance of the ChiroCode DeskBook, we warn about the dangers of disgruntled people (pages 172-173). Even if we think that we are a wonderful healthcare provider and office, there are those individuals who can and will create problems. As frustrating as it may be, there are ...

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Prepayment Review Battle Plan

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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. ...

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Clearing Up Some Medicare Participation Misunderstandings

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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 ...

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Q/A: How do we Know Which Codes a Payer Will Allow?

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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 ...

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Date of Service Reporting for Radiology Services

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Providers need to ensure that they are reporting radiology dates of service the way the payer has requested. Unlike other many other professional services which only have one date of service (DOS), radiology services can span multiple dates. Medicare requirements may differ from professional organization recommendations.

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Understanding NCCI Edits

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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 ...

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Proposed Rule: Expanded Telemedicine Benefits for Medicare Advantage Beneficiaries

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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 ...

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Charging Missed Appointment Fees for Medicare Patients

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Some providers mistakenly think that they cannot bill a missed appointment fee for Medicare beneficiaries. You can, but Medicare has specific rules that must be followed. These rules are outlined in the Medicare Claims Policy Manual, Chapter 1, Section 30.3.13. You must have an official “Missed Appointment Policy” which is ...

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Medicare Reviews

Medicare continues to increase their efforts to review doctors and recover “overpayments”. This increases the likelihood that your notes will be reviewed and that you will be required to pay money back to Medicare. In this webinar Dr. Short will show you:  Why you should appeal every adverse decision.  How to appeal adverse decisions.  What information you need in your documentation for an effective appeal.  How to structure your appeals to be most effective.

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How to Create a Medicare Compliance Plan

In this webinar, Dr. Marty Kotlar (certified coding and compliance expert) will discuss how to create an OIG/Medicare compliance plan. He will explain how to create policies, how to perform a "self-test" on your SOAP notes, search the Medicare exclusions list, Stark, anti-kickback and how to handle compliance concerns.

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Medicare Reviews

Medicare reviews claims for a variety of reasons. Some are routine and are not a problem for the doctor or the practice. Some are investigatory in nature and indicate a serious potential threat for both the doctor and the practice. Dr. Ron Short will go over the types of reviews and which are routine and which should cause you to lose sleep. In this webinar you will learn: -What routine reviews are and why they are conducted -What reviews are a potential risk -What triggers reviews -When to get help and what kind of help to get

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Healthcare Compliance- Fraud/Waste/Abuse…Avoiding the Pitfalls

Presented by Howard Levinson, DC  June 12, 2018 Tuesday @ 10:15 AM PT, 11:15 AM MT, 12:15 PM CT, 1:15 PM ET Dr. Levinson will discuss what constitutes healthcare fraud, waste and abuse and some of the strategies the insurance industry uses to identify outlier providers. Examples of healthcare providers who ...

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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.

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Strategy to Assess & Strengthen Cervical Posture

Join the posture expert, Dr. Steven Weiniger, to learn how observing posture engages people for StrongPosture® habits… such as getting adjusted! Posture literally sets the baseline for all locomotor function, and current research confirms the importance of improving vertical alignment to functionally improve pain as well as longevity. DCs across the globe use the free PostureZone app and StrongPosture® rehab protocols to literally help people stand taller. Learn the framework to communicate bio-mechanics to patients, the public and other professionals. First for patient compliance, then results, and then for retention and referrals!

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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

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Complete & Easy HIPAA Compliance

A simple and practical guide to implementing HIPAA, HITECH, and Omnibus Final Rule components. Includes the forms and policies and information you need to meet compliance requirements. Plus over 50 customizable forms!



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