Select the title to see a summary and a link to the full article.
August 20th, 2019
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 ...
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 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 ...
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 ...
If you are hesitant about collecting co-pays, consider that you may be paying interest on credit cards, property mortgages, and business loans. Each dollar that you do not collect in co-pays could have been used to pay down the practice debt. Without question, if you are having difficulty finding ways ...
The authorization for the Children's Health Insurance Program (CHIP) funding expired at the end of September 2017. The aim of the program is to fund health insurance for children in families who make too much to qualify for Medicaid but cannot afford private insurance. Without reauthorization, 9 million children are ...
By Wyn Staheli, Director of Research | Published November 28th, 2017
In 2015, the CMS Innovation Center announced plans for new value-based Medicare Advantage plans in an effort to reduce healthcare costs while improving quality of care. This five year pilot program began in 2017 with seven states and is expanding to ten states for 2018. Results must have been positive because they ...
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 ...
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 Dr. Mario Fucinari, Author & Member of the Carrier Advisory Committee for Medicare | Published June 28th, 2017 - Last Review/Update February 8th, 2019
Identity theft has become a major problem in the United States. As a prevention measure, the Centers for Medicare& Medicaid Services (CMS) is readying a fraud prevention initiative that removes Social Security numbers from Medicare cards to help combat identity theft, and safeguard taxpayer dollars.
CMS Issues Proposed Rule to Increase Patients’ Health Insurance Choices for 2018
By CMS.gov | Published February 15th, 2017
The Centers for Medicare & Medicaid Services (CMS) today issued a proposed rule for 2018, which proposes new reforms that are critical to stabilizing the individual and small group health insurance markets to help protect patients.
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 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 ...
By Wyn Staheli, Director of Research | Published September 17th, 2016
Consumer Directed Healthcare Plans (CDHP) were developed as a way to shift the control of healthcare dollars from the insurance companies to the patient (consumer). The goal of these types of plans is to allow the patient to take a more active role in their own health and healthcare decisions ...
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 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.
The Medical History and Health History forms are very important documents for the initial patient visit. Most patients dislike filling out forms when they arrive and sometimes they may not bring all the necessary information with them.
By completing this form before arrival, the patient saves their time as well as ...
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 Instacode Institute | Published April 5th, 2016 - Last Review/Update January 2nd, 2019
Providers need to understand that even though there are now federal laws, state laws are often different. It is important to ascertain patient coverage before treatment begins. This article contains some federal laws which address mental health services.
Many of your physicians perform surgeries and diagnostic procedures on patients. It is easy to call and determine if precertification is required, but how many of you actually look at what is required of a patient prior to performing the procedure? In many cases outpatient procedures...
Deductible and Coinsurance Application for Laboratory Tests (Rev. 2581, 04-01-13)
By Jared Staheli | Published July 9th, 2015
Neither the annual cash deductible nor the 20 percent coinsurance apply to:
• Clinical laboratory tests performed by a physician, laboratory, or other entity paid on an assigned basis;
• Specimen collection fees; or
• Travel allowance related to laboratory tests (e.g., collecting specimen).
Codes on the physician fee schedule are generally subject to ...
Coinsurance and Deductible for the IPPE (Rev. 2159, 04-04-11)
By Jared Staheli | Published July 6th, 2015
The Medicare deductible and coinsurance apply for the IPPE provided before January 1, 2009.
The Medicare deductible is waived effective for the IPPE provided on or after January 1, 2009. Coinsurance continues to apply for the IPPE provided on or after January 1, 2009.
As a result of the Affordable Care Act, ...
Deductible and Coinsurance for Prostate Cancer Screening Tests and Procedures (Rev. 1, 10-01-03)
By Jared Staheli | Published June 29th, 2015
The screening PSA test is a lab test to which neither deductible nor coinsurance apply. Both deductible (if unmet) and coinsurance are applicable to screening rectal examinations.
...
Neither the Part B deductible nor coinsurance apply for services paid under the laboratory fee schedule. The Part B deductible for screening Pap smear and services paid for under the physician fee schedule is waived effective January 1, 1998. Coinsurance applies.
A. Carrier Action for Submitting Claim to CWF and CWF ...
Waiver of Cost Sharing Requirements of Coinsurance, Copayment and Deductible for Furnished Preventive Services Available in Medicare (Rev. 2233, 06-28-11)
By Jared Staheli | Published June 25th, 2015
Section 4104(b)(4) of the ACA, amends section 1833(a)(1) of the Act, by requiring 100 percent payment for the IPPE, AWV and for those preventive services recommended by the United States Preventive Services Task Force (USPSTF) with a grade of A or B for any indication or population and that are ...
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 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 ...
By Christine Taxin | Published October 9th, 2014 - Last Review/Update January 27th, 2017
Who has dental benefits?
At year-end 2012, approximately 187 million Americans (2013 NADP/DDPA Joint Dental Benefits Report on Enrollment), or 60 percent of the population, had dental benefits. About 99 percent of dental benefits are provided through an employer or other group programs like AARP. Group coverage also includes public programs like Medicaid, the federal ...
By Wyn Staheli, Director of Research | Published August 4th, 2014 - Last Review/Update March 5th, 2019
The following frequently asked questions (FAQs) are adapted from the American Pyschiatric Association (APA). It is relevant to all types of providers with questions about managed care.
Q: I am having a problem getting in the network of managed care company X. They have a contract with a major employer in the ...
By | Published February 12th, 2014 - Last Review/Update January 27th, 2017
When discussing the changes to health insurance plans due to the Patient Protection and Affordable Care Act (PPACA) of 2010, the subject of "grandfathered plans" has been in the news lately. Plans that do not undergo "substantial changes" are not required to meet the requirements of the PPACA. So the question that arises is, what is a substantial change and what is a non substantial change?
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October 5th, 2018
New Patient Processing & How to Maximize Reimbursement -November 13th, 2018
In this webinar, Dr. Marty Kotlar (certified coding and compliance expert) will discuss new patient essentials as it relates to the initial paperwork, cash plans, deductibles and wellness care. You’ll also learn how to eliminate insurance and the in-network vs. out-of-network pros and cons.
Skyrocket Cash Collections, Even When Patients Have High Deductibles and Copays
Are you seeing $5,000, $7,500, and even $10,000 deductibles? We're hearing doctors from every state tell us they can't believe how high patients' insurance deductibles are getting. Some are even reporting patient copays of $50 - $60. (That's more than most docs charge for their adjustment!) When accepting insurance, do you know that you CAN'T discount services that apply to these large deductibles? And you can't treat them as "cash" patients. There is a way to overcome this problem of rising deductibles & copays and collect more cash - all while still accepting insurance. This one strategy alone will help you increase your case acceptance, even when patients have $10,000 deductibles. Join Dr. Miles Bodzin for this information-packed presentation. If you're going to be able to serve your communities and sleep well at night, you need this information.
How to Handle High Deductibles, Cash Plans and Pre-Pays
In this webinar, Dr. Marty Kotlar (certified coding and compliance expert) will discuss how to handle high deductibles, pre-pays, discounts, hardships and in-network vs. out-of- network care plans. Learn what the OIG is looking for when it comes to discounts and offering free services.
Outsourcing Your Insurance Verifications to Increase Profits, Save Time & Decrease Overhead
Join Dr. Tom Necela of The Strategic Chiropractor to learn why outsourcing insurance verifications can be an ideal solution to fix one of the biggest insurance headaches that plagues chiropractors and their staff. Virtually every chiropractor agrees that insurance verifications are both a necessary evil and a huge waste of staff time. In this webinar, Dr. Necela will discuss how to increase your profits, save time and decrease overhead by utilizing a simple outsourcing strategy that any chiropractic office can employ!
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.
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!
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.
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.
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 ...
Find-A-Code's 2020 specialty specific Reimbursement Guides give you the coding, billing, and documentation support you need to get paid properly and keep it.
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