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News and Important InformationAre These Problems Hurting Your Practice? Watch out for People-Related ‘Gotchas’ Attestations Teaching Physicians vs Split Shared Visits Today's healthcare provider needs to understand (or hire an expert who understands)
Find-A-Code Tools and ResourcesE/M CalculatorUse this tool to calculate an E/M (Evaluation & Management) CPT code based on components or time Patient Responsibility CalculatorPatient responsibility calculator, quickly calculate patient payment Pro Fee CalculatorVerify Medicare Reimbursement and UCR Fees for Professional Services NCCI Edits Validator NON-FacilityCheck NCCI Edits and avoid denials Guidelines and ManualsAdditional guidelines and manual resources Medicare LCDs and NCDsMedicare LCD/NCD/Article Search EventsMedical Coding & Billing Events & Webinars NewsIndustry News & Find-A-Code updates Subjects - Audits, HIPAA, PMMedical Documentation, Coding, Billing & Other Resources Additional Links and ResourcesQPro CertificationsBecome a QPro Certified Coder QPro CEUsQPro CEUs available for QPro members Free CEUs Compliant Coding AcademyFree CEUs from Compliant Coding Academy for Find-A-Code Subscribers BC Advantage 20+ CEUsBC Advantage Magazine & CEUs Billing Requirements for OPPSBilling Requirements for OPPS Providers with Multiple Service Locations ICD-10 Basics MLN ConnectsICD-10 Basics MLN Connects™ Call 06/4/14 MLN Fact SheetFor ICD-10-CM, ICD10-PCS, CPT, and HCPCS Code Sets Select the title to see a summary and a link to the full article. June 8th, 2022 Medicare Improper Payment Report — Chiropractic 2019 to 2021By Raquel Shumway | Published June 8th, 2022 How did you do? Take a look at the Improper Payments Report and see where there can be improvement in your practice. May 26th, 2022 Preventive Medicine Versus E&M Codes: The Same-Day Coding DilemmaBy Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMSCS, CMCS, ACS-CA, SCP-CA, QMGC, QMCRC | Published May 26th, 2022 Choosing a proper office visit code can become confusing unless one understands the rules separating preventive medicine and evaluation and management (E&M) coding. Problem-oriented E&M services, office, and other outpatient visit codes 99202-99215 (along with hospital, observation, and consultative encounters) are for patients who present with signs, symptoms,... February 14th, 2022 Vaccine Mandates & Your PracticeBy Wyn Staheli, Director of Research | Published February 14th, 2022 Staff vaccination requirements and who they apply to could greatly affect your organization. What does the Supreme court ruling mean for you. September 23rd, 2020 My Location and CBSA is Missing!By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 23rd, 2020
We often get questions on missing Core Based Statistical Areas, known as CBSAs. CBSAs are used for pricing and other factors according to the geographical location. If you do not see your CBSA, it is important to note they are not missing - it may not have an assignment, according to ... August 5th, 2020 Coding with PCS When There is No CodeBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 5th, 2020 ICD-10-PCS covers ALMOST everything! But not quite! What if a body system does not contain a body part for toes or fingers? What about an elbow? When it does not cover what you are looking for, where do you turn? To the guidelines, of course! There are ICD-10-PCS guidelines just as ... July 9th, 2020 Payment Adjustment Rules for Multiple Procedures and CCI EditsBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 9th, 2020 Surgical and medical services often include work that is required to be done prior to a procedure and post-procedure. When there are multiple procedures done by the same physician, group, or another qualified healthcare professional on the same day, the pre and post work is only required once. Therefore, CMS ... July 7th, 2020 New ABN Form is HereBy Wyn Staheli, Director of Content | Published July 7th, 2020 - Last Review/Update July 8th, 2020 The anticipated changes to the Advanced Beneficiary Notice of Non-coverage (ABN) Form (CMS-R-131) have arrived. This important form is issued to the patient or client by providers, physicians, practitioners, and suppliers in situations where Medicare payment is expected to be denied.
You can begin using the new ABN immediately if you so wish. However, it becomes mandatory on August 31, 2020. July 1st, 2020 Understanding UCR Inpatient Fees used on DRGsBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 1st, 2020 June 15th, 2020 Outpatient Facility PricingBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 15th, 2020 Our newest feature launch offers UCR pricing for Outpatient Facility. We recently released pricing information based on databases of insurance claims from private-sector health care providers.Usual, customary, and reasonable charges (UCR) are medical fees used when there are no contractual pricing agreements and are used by certain healthcare plans and third-party payers to generate ... May 12th, 2020 Getting Your Practice Back on TrackBy Wyn Staheli, Director of Content | Published May 12th, 2020 As we begin returning back to work, we will all face a new normal. The COVID-19 pandemic has changed the face of business. While it has certainly been a challenge to keep up with the ever-changing regulations (that’s likely to continue for a little longer), exciting new opportunities have also been created, such as the expansion of telemedicine. There’s also the maze of government funding that needs to be navigated and an increased awareness of OSHA standards to implement. April 15th, 2020 CMS Temporarily Suspends Contract-Level RADV AuditsBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published April 15th, 2020 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. April 13th, 2020 Financial Impact of CARES Act on Healthcare ProvidersBy Wyn Staheli, Director of Content | Published April 13th, 2020 The recently enacted Coronavirus Aid, Relief, and Economic Security (CARES) Act has several provisions to ease the financial burden being faced by healthcare providers who have been impacted by the effect of the coronavirus. Learn more about how the Provider Relief Fund and the Accelerated and Advance Payment Program work. March 24th, 2020 "What is the ICD-10 code for...?" - Search Smarter With Find-A-Code ToolsBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published March 24th, 2020 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: ... October 11th, 2019 Why is HIPAA So Important?By Namas | Published October 11th, 2019 - Last Review/Update October 15th, 2019 Why is HIPAA So Important?
Some may think that what they do to protect patient information may be a bit extreme. Others in specialty medical fields and research understand its importance a little more. Most of that importance lies in the information being protected. Every patient has a unique set of ... 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 ... July 29th, 2019 The Role of Chiropractic in Value Based Payment SystemsBy Wyn Staheli, Director of Content | Published July 29th, 2019 Chiropractic care can play a valuable role in overall patient health. It is important to realize that chiropractors can effectively participate in Medicare's new value based payment systems. Read about one organization who has made this transition. July 22nd, 2019 Are These Problems Hurting Your Practice?By Wyn Staheli, Director of Content | Published July 22nd, 2019 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. June 21st, 2019 Small Breaches Can Be Subject to Large PenaltiesBy Namas | Published June 21st, 2019 - Last Review/Update June 27th, 2019 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 ... May 13th, 2019 Q/A: Two Payers Both Paid the Claim. Who Gets the Refund?By Wyn Staheli, Director of Content | Published May 13th, 2019 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 ... May 13th, 2019 Prioritize Your Patient's Financial ExperienceBy Wyn Staheli, Director of Content | Published May 13th, 2019 For many years, the ChiroCode DeskBook has emphasized the need for providers to firmly establish the patient’s financial responsibility through clear communication. We even created a “Patient Financial Responsibility Acknowledgment Form” to help providers with this process. Lately, the lack of pricing transparency has been in the news and even ... April 22nd, 2019 Auditing Chiropractic ServicesBy By Evan M. Gwilliam, DC MBA BS CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow Clinical Director, PayDC Chiropractic EHR Software President, Gwilliam Consulting LLC drgwil@gmail.com | Published April 22nd, 2019 Chiropractic is unique from other types of health care and auditors need to be aware of the nuances of this field. Chiropractic has become the focus of more and more audits as doctors seem to struggle to create records that properly support the care provided to the patient throughout the entire episode. April 15th, 2019 Watch out for People-Related ‘Gotchas’By Wyn Staheli, Director of Content | Published April 15th, 2019 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 ... March 1st, 2019 Understanding NCCI EditsBy Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | 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 ... February 22nd, 2019 Q/A: What's the Difference Between Q5 and Q6 for a Substitute Provider?By Wyn Staheli, Director of Research | Published February 22nd, 2019 - Last Review/Update March 5th, 2019 It is important to understand that modifiers Q5 and Q6 are not interchangeable. So when do you use each of them? February 5th, 2019 Clinical Staff vs. Healthcare ProfessionalBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published February 5th, 2019 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 ... February 1st, 2019 Attestations Teaching Physicians vs Split Shared VisitsBy BC Advantage | Published February 1st, 2019 - Last Review/Update February 7th, 2019 Physicians often use the term "attestation" to refer to any kind of statement they insert into a progress note for an encounter involving work by a resident, non-physician practitioner (NPP), or scribe. However, for compliance and documentation purposes, "attestation" has a specific meaning and there are distinct requirements for what ... January 10th, 2019 Are You Protecting Your Dental Practice From Fraud?By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | 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 ... November 30th, 2018 Auditing looking between the linesBy BC Advantage | Published November 30th, 2018 - Last Review/Update January 9th, 2019 When given the task of auditing a group of charts, most often the scope of the audit is well defined. For me, there are times when my natural inquisitive nature turns on and I find my noticing the "timing" of parts of documentation. These are things that you would not... November 26th, 2018 Present on Admission POA IndicatorBy | Published November 26th, 2018 - Last Review/Update November 29th, 2018 This article will focus on the Present on Admission (POA) indicator which is used as a method of reporting whether a patient’s diagnoses are present at the time they are admitted to a facility. We’ll look at a few scenarios to determine the correct reporting of POA and the impact... October 19th, 2018 We've Always Done It This Way and Other Challenges in EducationBy BC Advantage | Published October 19th, 2018 - Last Review/Update November 1st, 2018 As coders, auditors, and compliance professionals, we are the provider's advocates in closing the gap between what is medically necessary and what is required for documentation. Sometimes that places us in the role where we need to save our clinicians from themselves, and the patterns they have fallen into... October 17th, 2018 Wolters Kluwer Drug PricingBy Find-A-Code | Published October 17th, 2018 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... September 26th, 2018 HIPAA Handling Patient Requests for Medical Record RestrictionBy | Published September 26th, 2018 - Last Review/Update October 17th, 2018 Healthcare compliance professionals frequently face confusing situations about sharing of protected health information (PHI). The Health Insurance Portability and Accountability Act (HIPAA) supports the protection of privacy of medical records. However, even when a patient does not authorize sharing of his record, there are permitted uses and disclosures, such as... September 26th, 2018 The Potential Impacts of a Flat Rate EM Reimbursement on our IndustryBy BC Advantage | Published September 26th, 2018 - Last Review/Update October 17th, 2018 The proposed E&M changes by CMS would decrease provider administrative work burden by, per CMS, 51 hours a year; however, how will reducing documentation requirements truly affect the professionals of the healthcare industry? First, let’s discuss the 30,000-foot overview of the most impactful E&M changes—which is the change to the... September 24th, 2018 Q/A: Do I Have to Accept Any New Patient?By Wyn Staheli, Director of Content | Published September 24th, 2018 - Last Review/Update January 28th, 2019 Question: Is it legal for us to not allow a patient to be seen in our office if their parents have bad debt with us? September 11th, 2018 Getting the Right Eligibility Information for Payment Your Rights and Health Plans RequirementBy BC Advantage | Published September 11th, 2018 - Last Review/Update September 24th, 2018 We need timely and accurate patient information to bill health plans and receive appropriate payment. Clinical information is, of course, important. But we also need the "administrative" data - patient demographics and especially the insurance information. Physician offices create their clinical information, but usually rely on patients for information on... August 27th, 2018 Pricing for ASC’s and APC’sBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 27th, 2018 For Medicare purposes, an Ambulatory Surgical Center Resources (ASC) is a distinct entity that operates exclusively to furnish surgical services to patients who do not require hospitalization and in which the expected duration of services does not exceed 24 hours following admission. ASC payment groups determine the amount that... July 9th, 2018 Documentation: Face to Face for Home Health CertificationBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 9th, 2018 As a physician, you are responsible for providing appropriate, accurate supporting documentation of your face-to-face encounters (FTF) with your patients regarding home health care.
Analysis of the recent errors identified by the Comprehensive Error Rate Testing (CERT) Review Contractor shows a continuing increase in denials related to documentation for the FTF. The ... June 25th, 2018 How Does the Physician Compare Website Affect You?By Wyn Staheli, Director of Content | Published June 25th, 2018 The physician compare website may not be working quite the way you think it is. Not all providers will have rankings showing up for them. Physician compare lists basic information, but quality measure information was not added until this year (2018) and not all quality measures are included in the ... June 15th, 2018 The Money in MIPSBy Diana Strubler | Published June 15th, 2018 - Last Review/Update July 3rd, 2018 Seema Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS), recently announced that 91% participated in the first year of the Quality Payment Program (QPP), barely squeaking by their goal of 90%.... June 7th, 2018 Three Ways Bundled Payments Can Be a SuccessBy BC Advantage | Published June 7th, 2018 - Last Review/Update July 3rd, 2018 Bundled payment models continue to attract interest for their potential benefits over traditional fee-for-service payment models. With bundled payments, also known as episode-based payments or packaged pricing, a group of providers is reimbursed based on a contracted price to cover all of the care and services related to a particular ... May 30th, 2018 Routine Waiver of Patient Out of Pocket ExpensesBy Linda Walker | Published May 30th, 2018 - Last Review/Update June 4th, 2018 Medical billers often encounter the dilemma of a physician who wants to be the hero to his or her patients and waive their out-of-pocket expenses. Out-of-pocket expenses include a patient's co-payment, coinsurance, deductibles, charges above U&C (Usual and Customary), and even services a plan may not cover in some situations.... May 16th, 2018 Key Performance Indicators RevisitedBy Glenn Krauss | Published May 16th, 2018 - Last Review/Update May 24th, 2018 DI's present-day Key Performance Indicators centered upon reimbursement do not truly reflect a meaningful account of performance in impacting the quality, completeness and effectiveness of medical record documentation. Common KPIs include number of physician queries left, number of queries responded to by the physician, number of queries responded to... May 4th, 2018 The Devil is in the Data DetailsBy J. Paul Spencer, CPC, COC | Published May 4th, 2018 - Last Review/Update May 24th, 2018 As an auditor who has reviewed thousands and thousands of encounter documents for level of service, a predictable pattern has merged when it comes to the Medical Decision Making (MDM) component that has attracted my attention. May 3rd, 2018 Saving Time and Money with Automated Insurance Eligibility VerificationBy BC Advantage | Published May 3rd, 2018 - Last Review/Update May 24th, 2018 The healthcare revenue cycle contains multiple potential pinch points for the parties involved: patients don’t enjoy dealing with insurance companies and have trouble understanding their benefits, and they especially hate being responsible for surprise medical costs that aren’t covered by their insurance plan. Healthcare providers compete in a challenging... April 24th, 2018 FHIR RevisitedBy Dugan MadduxDugan Maddux, MD, FACP & Dr. Ahmad SharifAhmad Sharif, MD, MPH | Published April 24th, 2018 - Last Review/Update May 2nd, 2018 Like a moth to a flame, we periodically have to take a close look at FHIR. As mentioned in the March 26 blog post, interoperability was the hot topic at HIMSS, and FHIR is at the blazing edge of interoperability... April 19th, 2018 Proper Record Keeping and DocumentationBy | Published April 19th, 2018 Proper record keeping and documentation is not only essential for today’s dental practitioner, but is also required by law. Moreover, correct, current and accurate records directly enhance patient care by enabling the dentist to plan treatments, monitor progress, and provide essential notations. Clear and concise treatment plans, medical alerts, and ... April 12th, 2018 Dentists Submitting Claims to MedicareBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 12th, 2018 When a Dental provider is treating a Medicare Beneficiary, it is important to get a copy of the Medicare card to verify the patient's medical benefits, provider eligibility and claims address/submission prior to submitting a claim. CMS is in the process of changing Medicare Policy Numbers, so you may see ... April 12th, 2018 Use it or Lose it - How We Can Help!By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published April 12th, 2018 If you don’t use the correct information or document the proper information and submit a medical claim you will lose! You will lose reimbursement, could be excluded from participating in Federal Health Care programs, you could possibly lose your license and family time. The government has every tool they need, you ... April 4th, 2018 What Do Patients Expect in 2018?By BC Advantage | Published April 4th, 2018 - Last Review/Update April 12th, 2018 Evolutions in technology continue to merge with a trend toward consumerism in healthcare. As a result, patients are expecting a different kind of experience in managing their healthcare.... March 9th, 2018 The Comprehensive Error Rate Testing ProgramBy Frank Cohen, MBA, MPA | Published March 9th, 2018 - Last Review/Update April 12th, 2018 With nearly a million physicians in this country, how do auditing organizations determine whom to audit? March 6th, 2018 Increase Revenue by Outsourcing Medical BillingBy iSALUS Healthcare's | Published March 6th, 2018 - Last Review/Update April 12th, 2018 Many practices are starting to weigh the benefits outsourcing medical billing compared to keeping it in-house.... February 27th, 2018 Health Information Exchange and Trusted Exchange FrameworksBy Dugan Maddux, MD, FACP | Published February 27th, 2018 - Last Review/Update April 12th, 2018 Despite progress in health IT, Health Information Exchange (HIE) remains squarely in toll booth mode, with gated stops and slowdowns that may or may not permit information to move forward. ... February 23rd, 2018 The Comprehensive Error Rate Testing ProgramBy Frank Cohen, MBA, MPA | Published February 23rd, 2018 - Last Review/Update February 26th, 2018 With nearly a million physicians in this country, how do auditing organizations determine whom to audit? February 1st, 2018 Using a 2015 Certified EHR in MIPS Year 2By Diana Strubler | Published February 1st, 2018 The following information is from BC Advantage. As of Dec 31, 2017, Acumen EHR v8.0 achieved Office of the National Coordinator for Health Information Technology (ONC-Health IT) 2015 edition certification! What's a 2015 CEHRT?A CEHRT (Certified EHR Technology) is defined by CMS specifically for their incentive payment programs such as... February 1st, 2018 Don’t Be Hesitant About Collecting Co-PaysBy | Published February 1st, 2018 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 ... January 31st, 2018 Adjusting Your Collection Strategies to HDHPsBy Ashley Choate | Published January 31st, 2018 - Last Review/Update March 29th, 2018 High Deductible Health Plans (HDHPs) are recent and growing trend in healthcare that is probably here to stay, regardless of the future changes to the national healthcare system or federal regulations..... January 31st, 2018 Mobile Health: Growing Engagement and New ResponsibilitiesBy Dugan Maddux, MD, FACP | Published January 31st, 2018 - Last Review/Update March 29th, 2018 This week I'm blogging about an M-word. Not MACRA or MIPS, but Mobile Health or mHealth.... January 31st, 2018 Developing Coding Policies for ComplianceBy Marge McQuade, CMSCS, CHCI, CPOM | Published January 31st, 2018 Every physician practice depends upon correct coding and billing for their financial success. Coding drives reimbursement. All of the resources available for coding information and guidance are meaningless without the practice manager translating it into provider-specific coding policies and compliance plan. As a practice manager, you need to develop a ... January 29th, 2018 Dental and Medical- Controlled Substance AwarenessBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 29th, 2018 As an effort to cut down on opioid abuse and related crimes, in August of 2017 the Attorney General Sessions established a new Department of Justice (DOJ) section called “Opioid Fraud and Abuse Detection Unit”. Due to the serious public health issue and drug overdose deaths, this unit was established and ... January 29th, 2018 Referring and Ordering Physician - CMS-1500 Box 17By Christine Woolstenhulme, QCC, CMCS, CPC, CMRS | Published January 29th, 2018 Enter the name of the referring or ordering physician if the service or item was ordered or referred by a physician. All physicians who order services or refer Medicare beneficiaries must report this data. Similarly, if Medicare policy requires you to report a supervising physician, enter this information in Item ... January 25th, 2018 Prescription Drug Discount ProgramBy Wyn Staheli, Director of Content | Published January 25th, 2018 Prescription drugs can be quite costly for those who are uninsured or underinsured. Prohibitive costs have been shown to lead to poor patient outcomes because medications are not taken as prescribed. Medicare has taken steps to address this problem with their Medicare Advantage value based plans (see referenced "Medicare Expands Value ... January 25th, 2018 UCR Pricing, What is it?By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published January 25th, 2018 UCR (Usual, Customary, and Reasonable) pricing is a method of generating healthcare pricing based on the average pricing in a particular geographic location. Gathering information on pricing based on what other providers in that area is charging is commonly used for a fee or payment reference, as it gives a basis ... January 24th, 2018 Better Office Communication Leads to Stronger RCMBy Ashley Choate | Published January 24th, 2018 - Last Review/Update March 29th, 2018 According to a recent Physicians Practice study, one of the top five reasons for denied medical claims is a lack of adequate documentation. While this might seem like an electronic records issue, the problem may be bigger than that. ... January 11th, 2018 Advance Beneficiary Notice of Noncoverage (ABN) Modifier GuidelinesBy Find-A-Code | Published January 11th, 2018 The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131 may be used for services which are likely to be non-covered, whether for medical necessity or for other reasons. Refer to CMS Publication 100-04, Medicare Claims Processing Manual, Chapter 30, for complete instructions.Effective from April 1, 2010, non-covered services should be billed with modifier GA, GX, GY, or GZ, as ... January 4th, 2018 Diagnosis Coding with Diagnostic TestingBy Marge McQuade, CMSCS, CHCI, CPOM | Published January 4th, 2018 Adequate documentation is an essential part of selecting a correct code in any setting. When providers order a test, the information that they document regarding the test results determines the primary and secondary diagnosis codes a coder assigns.
If a physician confirms a diagnosis based on the results of a diagnostic ... December 29th, 2017 Patient With Complex NeedsBy Kelly Ogle, BSDH, MIOP, CMPM, CHOP | Published December 29th, 2017 - Last Review/Update January 31st, 2018 In each practice, there are patients who present with a multitude of problems. These problems can range from the smallest of symptoms to the more complex illnesses..... December 15th, 2017 Is Your Practice in Need of a Wellness Visit?By Valora Gurganious, MBA, CHBC | Published December 15th, 2017 - Last Review/Update January 31st, 2018 Is your practice busier than ever, but net practice income continues to drop? November 27th, 2017 Does an Informed Consent Really Matter?By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published November 27th, 2017 November 17th, 2017 Fear Factor: "The Unethical Business of Medicine"By Sean Weiss, CHC, CEMA, CMCO, CPMA, CPC-P, CMPE, CPC | Published November 17th, 2017 - Last Review/Update January 31st, 2018 I want this story that I am about to share with you to fit with the majority of clients that I represent and work with because I have represented clients with refund demands as small as $1,000 and clients who had demands greater than $30 million. This year has been ... November 16th, 2017 Can an Unlicensed Person Perform Physical Therapy Services Such as 97110?By Wyn Staheli, Director of Research | Published November 16th, 2017 - Last Review/Update January 30th, 2019 Can an unlicensed person perform code a 97110 service as long as they're under doctor supervision? I use only PT, ATC, or DC's to perform these codes and I've been told that I don't need such highly qualified therapists to perform therapy. October 18th, 2017 Avoid Deactivation of your Medicare Billing PrivilegesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published October 18th, 2017 According to the Affordable Care Act all Medicare providers are required to re-validate their enrollment information every three or five years. To determine if you are due for re-validation the list below will display a re-validation due date. If you have a due date of “TBD”, this means there has not ... September 29th, 2017 Big Data & Facility Audit Complex ReviewsBy Shannon Cameron, MBA, MHIIM, CPC | Published September 29th, 2017 - Last Review/Update January 31st, 2018 Big data and its use in the healthcare spectrum has proven to be an incredible source of the knowledge and has rapidly abetted progress in seemingly all areas of healthcare...... September 15th, 2017 Copy and Paste: The Real Rules PrevailBy Shannon DeConda, CPC, CPC-I, CEMC, CMSCS, CPMA, CEMA | Published September 15th, 2017 - Last Review/Update January 31st, 2018 Have you looked for published guidance on cloning/copying and pasting from the Centers for Medicare & Medicaid Services (CMS)? There is one published resource that provides rudimentary guidance..... September 1st, 2017 2017 Physical Therapy Evaluation & Management CodesBy Kathy Price, RHIT, CPC, CCS-P, CPMA | Published September 1st, 2017 - Last Review/Update January 31st, 2018 As you know, 2017 brought us new evaluation and management codes for physical and occupational therapy.... August 16th, 2017 The Importance of Time, Timelines, and Timing with Your Commercial Lease – For Medical Professional TenantsBy Jeff Grandfield and Dale Willerton – The Lease Coach | Published August 16th, 2017 Readers of our new book, Negotiating Commercial Leases & Renewals FOR DUMMIES, will learn (in part) that the leasing process can take differing amounts of time, depending on whether you’re opening your first or fifth location. You can discover a lot during your first few lease deals that you can ... August 15th, 2017 Transparency and FeesBy Christine Taxin | Published August 15th, 2017 More than any other industry, healthcare is almost notorious for its lack of price transparency. While patients generally know how much their copay will be and certainly how much their final bill turns out to be, few hospitals and practices publish the actual costs of their services prior to those ... August 11th, 2017 Collect More Cash from PatientsBy Christine Taxin | Published August 11th, 2017 One of the easiest things a practice can do to increase collections makes it easier for patients to pay by whatever method they have available at the time of the visit, says Christine Taxin Adjunct Professor at NYU Dental School and Owner of Links2Success.biz. June 16th, 2017 Got Drugs? Got Pricing?By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published June 16th, 2017 June 15th, 2017 Negotiating Free Rent – For Medical Professional TenantsBy Jeff Grandfield and Dale Willerton – The Lease Coach | Published June 15th, 2017 Free rent is just one negotiable factor in a commercial lease. To be clear, free rent is a period of time where you are not paying the Base or Minimum Rent (but are, typically, paying your Operating Costs) and you are open for business. Many medical professional tenants confuse this ... March 29th, 2017 National Association of Chiropractic Attorneys (NACA) DirectoryBy | Published March 29th, 2017 National Association of Chiropractic Attorneys (NACA) Directory
Listed by state March 15th, 2017 Real Estate: The Second-Highest Expense in Your PracticeBy Carr Healthcare Realty | Published March 15th, 2017 - Last Review/Update February 8th, 2019 When it comes to managing expenses in your practice, there are dozens of categories to evaluate: equipment, technology, loan costs and interest rates, sundries, marketing, and on and on they go. Many practice owners are quick to shop-out what they believe are the most obvious expenses, but few understand the impact of one of the largest expenses and how it can be dramatically reduced to increase profitability. February 16th, 2017 Have You Evaluated Your Fees Recently?By ChiroCode | Published February 16th, 2017 - Last Review/Update March 5th, 2019 Many providers are unsure of where their fee schedule actually came from or when it was last reviewed. As a component of compliance and for other preventive purposes, fee schedules should be evaluated once per year. Read more to help evaluate your fee schedules.
January 13th, 2017 Q/A: Is my Software Vendor a Business Associate to my Practice?By Brandy Brimhall, CPC CPCO CMCO CPMA QCC | Published January 13th, 2017 - Last Review/Update February 8th, 2019 Q: Is my software vendor a business associate to my practice? January 13th, 2017 Whiplash DamagesBy 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. December 15th, 2016 How do I Determine who is a Business Associate to Our Practice?By Melissa Hall | Published December 15th, 2016 - Last Review/Update March 5th, 2019 How do I determine who is a Business Associate? November 30th, 2016 When can I Bill for a Consult E/M Code?By | Published November 30th, 2016 - Last Review/Update March 5th, 2019 Physician referrals -- When can we bill a consult code? If we do not have the referral on our referral pad can we bill the consult code? November 29th, 2016 Medical Billing and Coders Professional LiabilityBy | Published November 29th, 2016 Companies who regularly handle such sensitive information as patient medical records have a particular responsibility to maintain the confidentiality of the data. Failure to exercise the appropriate degree of care – whether intentional or not – can have a significant adverse financial impact on your firm.
The Federal Health Insurance Portability ... November 29th, 2016 E/M 101By BC Advantage | Published November 29th, 2016 - Last Review/Update December 8th, 2016 E/M stands for "evaluation and management". E/M coding is the process by which provider-patient encounters are translated into five digit CPT codes to facilitate billing. CPT stands for "current procedural terminology." These are the numeric codes which are submitted to insurers for payment. Most billable procedures have their own CPT ... November 18th, 2016 It's Time to Evaluate Your Fees!By Melissa Hall | Published November 18th, 2016 - Last Review/Update March 5th, 2019 Why might it be necessary to evaluate your fees? October 25th, 2016 Another OIG Report on ChiropracticBy Melissa Hall | Published October 25th, 2016 - Last Review/Update March 5th, 2019 On October 19 the Office of Inspector General for Health and Human Services (OIG) released another report on chiropractic. Oddly enough the Wall Street Journal had an article on that report published the day it was released (I wonder how that happened). Read hear to see the results. October 14th, 2016 Q/A: Are You Liable When a Business Associate Has a Data Breach?By ChiroCode | Published October 14th, 2016 - Last Review/Update March 5th, 2019 We have a Business Associate who has recently had a data breach, are we liable? September 17th, 2016 Consumer Directed Health Plans (CDHP)By Wyn Staheli, Director of Content | 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 ... August 16th, 2016 Happy Patients Means a Happy Chiropractic PracticeBy ChiroCode | Published August 16th, 2016 - Last Review/Update March 4th, 2019 Did you know that the key to a successful and beneficial practice lies within the satisfaction of your patients? July 29th, 2016 What's My Benefit For Implementing Compliance SolutionsBy ChiroCode | Published July 29th, 2016 - Last Review/Update March 4th, 2019 Lots of Chiropractic practices want to know why compliance is necessary and how implementing compliance can help the practice. July 5th, 2016 Q&A: We just learned that for Meaningful Use attestation, we have to complete a Security Risk Assessment. What is that and how do we do it?By ChiroCode | Published July 5th, 2016 - Last Review/Update March 4th, 2019 Q&A:
We just learned that for Meaningful Use attestation, we have to complete a Security Risk Assessment. What is that and how do we do it? June 23rd, 2016 Commercial Lease Assignments for Chiropractic TenantsBy Jeff Grandfield and Dale Willerton | Published June 23rd, 2016 When The Lease Coach speaks at chiropractic conventions (such as Parker Seminars in Las Vegas), we are magnets for commercial leasing-related questions. Among the most common are concerns relating to assigning or transferring a Lease Agreement. As we explain in our new book, Negotiating Commercial Leases & Renewals For Dummies, ... June 16th, 2016 Q&A: Will Using Lower Level Codes Reduce Our Chances of Being Audited?By ChiroCode | Published June 16th, 2016 - Last Review/Update March 5th, 2019 Q&A: If we use low level codes on each visit (such as 98940, 99212, 99202), will our chances of being audited be less than if we billed higher level codes? June 15th, 2016 Mastering Medicare: When Opting Out is not an OptionBy Dr. Ray Foxworth, Certified Medical Compliance Specialist and President of ChiroHealthUSA | Published June 15th, 2016 - Last Review/Update March 5th, 2019 Unlike MDs and DOs, chiropractors may not opt out of Medicare.
When it comes to Medicare, providers and patients alike feel like beating their heads against the wall. Signing up to be a provider or a patient is confusing, understanding what is covered is confusing and just about the time you think you have it figured out, you receive a notice that suggests you don’t.
The hassles of Medicare certainly validate any sane person questioning whether they should see a Medicare patient, but with the rising number of Medicare patients in the US do you really want to limit your patient base? June 9th, 2016 Understanding and Using Taxonomy Codes to Maximize ReimbursementBy | Published June 9th, 2016 Taxonomy codes are used by insurers as indicators of legal scope of practice. Scope of practice is key to getting reimbursed under the Affordable Care Act or ObamaCare. However, Most providers will only choose one taxonomy code to describe their training. This limits their scope of practice. To maximize scope ... June 7th, 2016 Q/A: Do you Have any Recommendations for Audit Prevention?By Melissa Hall | Published June 7th, 2016 - Last Review/Update March 5th, 2019 Q: Do you have any recommendations for audit prevention? May 26th, 2016 Groupon: Is it worth the risk?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. May 25th, 2016 EOB ProblemsBy | Published May 25th, 2016 Have you had to send money back to a dental insurance company? You may have received a letter informing you that a patient received benefits but then turned out to be ineligible and now the insurance company wants their money back. Hopefully, you sent them a check for the amount ... May 3rd, 2016 Certified Community Behavioral Health Clinics (CCBHC) Moving ForwardBy Wyn Staheli, Director of Content | Published May 3rd, 2016 Certified Community Behavioral Health Clinics (CCBHCs) were created in an effort to improve access and outcomes behavioral healthcare by providing community-based mental and substance use disorder treatment through an integrative approach to care. May 3rd, 2016 Provider/Patient Dynamic Changes as Result of High Deductible PlansBy Wyn Staheli, Director of Content | 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. April 28th, 2016 Q&A: What is a Program for a Systematic Approach to Becoming Compliant?By Melissa Hall | Published April 28th, 2016 - Last Review/Update March 5th, 2019 What is a comprehensive program for a systematic approach to becoming a compliant office? April 28th, 2016 An Important Rule that You're Probably Not FollowingBy ChiroCode | Published April 28th, 2016 - Last Review/Update March 5th, 2019 The HIPAA Security Rule requires that covered entities (your practice) conduct a Security Risk Assessment (SRA) for your organization, at a minimum of once per year. It is critical that practices perform the Security Risk Assessment for multiple of reasons. Not only is it important to comply with rules and regulations, but also, for what you may consider to be a more motivational reason, to protect your practice (and bank account) from what could become disabling fines and penalties. April 13th, 2016 Jumping on the Telehealth BandwagonBy Wyn Staheli, Director of Content | Published April 13th, 2016 Telehealth's rapid expansion needs to be carefully considered by healthcare practices wanting to maintain profitability. April 6th, 2016 HIPAA Violations - The Process Is The AnswerBy Instacode Institute | Published April 6th, 2016 It's not just the names and addresses that matter -- It's the compliance. If you can demonstrate that you are hleping yourself to maintain HIPAA compliance by careful documentation and proper procedures, you can go a long way toward avoiding being fined by the HIPAA squads.
Complete & Easy HIPAA Compliance is a clear, simple “Just help me do what I have to do!” workbook that contains all the things the designated security officer must do to instantiate a robust HIPAA compliance program. It comes complete with over 45 forms and letters which can be used to state the office policies, spell out procedures, and ensure that each patient will be protected in their rights under HIPAA policy. It also can help demonstrate that a compliance program is in progress. April 5th, 2016 Voluntary Disclosure - Look Before You LeapBy Melissa Hall | Published April 5th, 2016 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. March 16th, 2016 Protected Health Information De-Identification StandardsBy Instacode Institute | Published March 16th, 2016 - Last Review/Update January 27th, 2017 This article contains detailed information on the OCR guidance regarding the de-identification of Protected Health Information (PHI). Avoid HIPAA violations and learn specifically what de-identification is. March 14th, 2016 Q/A: What is the Best Way to Handle Denials?By Melissa Hall | Published March 14th, 2016 - Last Review/Update March 5th, 2019 What is the best way to handle denials? March 7th, 2016 ABN's, Third Party Payers, and Cash PayBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published March 7th, 2016 Medicare no longer wants providers to use ABN's for anyone other than CMS. Therefore, if contracted under commercial payers and 3rd party payers, you may need to contact the payer for a pre-service organization determination regarding coverage. This must be done before the provider can perform the service and bill the beneficiary ... March 4th, 2016 Choosing the Right Software for Your PracticeBy | Published March 4th, 2016 It's difficult to know where to start when selecting the best software for your practice. With dozens of selections to choose from, making the right choice can be a daunting task. For new or established practices looking to implement or upgrade software into their practices, there are some general need-to-know ... February 11th, 2016 What are the Rules for Safeguarding Patient Records?By ChiroCode | Published February 11th, 2016 - Last Review/Update March 5th, 2019 Secure medical records is a broad topic that should be addressed in detail by all practices. There are multiple items to consider when meeting standards to best safeguard protected health information (PHI). February 1st, 2016 Will Incident-To in Your Organization Pass a Compliance Audit?By Aimee Wilcox, CPMA, CCS-P, CST, MA, MT | Published February 1st, 2016 Practices that bill incident to services need to periodically audit compliance with Medicare and private payor guidelines to avoid potential denials or third-party audits. December 3rd, 2015 Keeping Track of Your SurgeriesBy | Published December 3rd, 2015 When working my AR, I work my surgeries separately since that is my big money or bulk money. I want to make sure I get that money in as quickly as possible. For me, I created an excel spreadsheet. The columns are: DOS - PATIENT NAME/MRN... August 10th, 2015 Chiropractic Tenants – Choosing the Location Where Your Practice will ThriveBy By Jeff Grandfield & Dale Willerton – The Lease Coach | Published August 10th, 2015 As we explain in our new book, Negotiating Commercial Leases & Renewals For Dummies (Wiley, 2013) and when we recently spoke at Parker Seminars in Las Vegas, finding the right location or property for your practice is one of the most important decisions you can make. It’s not always easy, ... August 10th, 2015 Alphabet Soup for Waste and Fraud InspectorsBy Melissa Hall | 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 ... August 3rd, 2015 Chiropractors - Negotiate a Mid-term Rent Reduction for Your Commercial LeaseBy Jeff Grandfield and Dale Willerton - The Lease Coach | Published August 3rd, 2015 When The Lease Coach spoke at Parker Seminars in Las Vegas, we met a number of struggling chiropractors leasing commercial space. These chiropractic tenants desperately need a rent reduction ... right now. July 20th, 2015 Top 8 Tips to Achieve Patient Billing SuccessBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published July 20th, 2015 It's no secret that healthcare costs are on the rise. But what's worrisome is that patients' out-of-pocket costs are skyrocketing too.
The average patient's deductible has jumped 49 percent since 2009. This is not only burdensome to patients, but to medical practices as well because outstanding patient balances now make up ... June 25th, 2015 Reporting Requirements and Specifications for Indian Health Services (Rev. 1040, 09-11-06)By Jared Staheli | Published June 25th, 2015 In order to facilitate report generation and data collection regarding IHS physicians, practitioners and services, the designated carrier shall assign PINs to each IHS physician and practitioner in a manner that will allow the designated carrier to ascertain which facilities are IHS, Indian tribe or tribal organization. For example, the ... June 18th, 2015 Reporting the Ordering/Referring NPI on Claims for DMEPOS Items Dispensed Without a Physician’s Order (Rev. 1368, 04-07-08)By Jared Staheli | Published June 18th, 2015 Chapter 5, section 5.2.1 of the Medicare Program Integrity Manual (PIM) states that, in order for Medicare to make payment for an item of Durable Medical Equipment Prosthetic, and Orthotic Supplies (DMEPOS), the DMEPOS supplier must obtain a prescription from the
For Coordination of Benefit purposes, DMEPOS suppliers shall use the ... June 10th, 2015 Buying vs. Leasing Commercial Practice Space: Pros and Cons for Chiropractic TenantsBy By: Jeff Grandfield and Dale Willerton – The Lease Coach | Published June 10th, 2015 As we explain in our new book, Negotiating Commercial Leases & Renewals For Dummies, the most common reason tenants lease space instead of buying a location is because 95 percent of all commercial and office space is for lease and not for sale.
If you are in an enviable position ... April 24th, 2015 Have you been excluded from Medicare?By Dr. Chris Andersn | Published April 24th, 2015 - Last Review/Update June 9th, 2016 Compliance is an issue that you should look at as an expedition rather than an endpoint. Board complaints can be a terrifying ordeal, especially if you don’t keep up on compliance in your clinic. Board complaints are something that you have to expect to happen but you can turn that ... February 3rd, 2015 PPACA Provider Non-Discrimination FAQBy | Published February 3rd, 2015 - Last Review/Update June 9th, 2016 The following information (emphasis added) is from: http://www.cms.gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs15.html
Provider Non-Discrimination PHS Act section 2706(a), as added by the Affordable Care Act, states that a “group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against ... January 9th, 2015 What NOT to Ask Candidates in a Job InterviewBy | Published January 9th, 2015 - Last Review/Update January 30th, 2017 Conducting a job interview for potential new employees is a common occurrence, yet is often done in a manner of disorganization. Employers are frequently asking questions that shouldn't be asked and neglecting to ask those questions that may be more essential for conducting a proper interview. Federal and state laws ... January 9th, 2015 How Important is Your Fee Schedule?By | Published January 9th, 2015 - Last Review/Update June 13th, 2016 Did you know that inconsistent and un-reviewed fee schedules can lead to some of the following occurrences:
• Prompt an audit or some level of claims review
• Cause claims delays
• Increase provider liability in case of an audit or investigation
• Potentially lead to being paid less than the actual value of ... November 19th, 2014 Understanding ZPICBy | Published November 19th, 2014 - Last Review/Update January 30th, 2017 The following chart identifies each of the 7 zones for ZPIC and the states/regions within each zone. Links are provided for each zone which contain information about each zone as well as activity and updates in those regions. November 17th, 2014 Social Media and Healthcare: Unprofessional Conduct and What It Can CostBy | Published November 17th, 2014 - Last Review/Update January 30th, 2017 In this electronic age, Social Media has quickly become a very successful tool used for advertising/marketing, communication of various topics and reaching readers and networks beyond our wildest dreams. These networks are often leading to various opportunities or other positive occurrences that we may not have otherwise experienced. Social Media ... October 29th, 2014 Getting Ready for 2015By | Published October 29th, 2014 - Last Review/Update January 30th, 2017 Each new year brings a bundle of surprises in terms of changes and updates that practices must learn and implement. In effort to aid in the preparation of this year, here are some common helpful tips that you might follow in order to best manage your workload ahead.
-Evaluate fees: Fee schedules ... October 24th, 2014 Q & A: Is it a HIPAA Violation to Email Patients?By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published October 24th, 2014 - Last Review/Update January 30th, 2017 Straight from the Office of Civil Rights:
Q: Does the HIPAA Privacy Rule permit health care providers to use e-mail to discuss health issues and treatment with their patients?
A: Yes. The Privacy Rule allows covered health care providers to communicate electronically, such as through e-mail, with their patients, provided they apply ... October 20th, 2014 PPO PlansBy | Published October 20th, 2014 - Last Review/Update January 27th, 2017 Are PPOs are affecting the value of your practice?
Did you know that taking a 20% PPO write-off on a $200 procedure with a 60% overhead cuts practice profits in half?
By participating in PPO plans, you agree to take a certain discount on fees; however, your fixed overhead costs remain the same ... October 16th, 2014 Is Compliance a Dirty Word?By Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published October 16th, 2014 - Last Review/Update January 23rd, 2017 In October of 2000 in the Federal Register the Office of the Inspector General (who investigates fraud against the federal government on behalf of the Department of Health and Human Services) offered general guidelines for health care facilities to set up a “Compliance Program”. This advice has long been pushed ... October 6th, 2014 OSHA - Hazard Communication Standard Final Rule (Globally Harmonized System)By | Published October 6th, 2014 - Last Review/Update January 30th, 2017 The Hazard Communication Standard in 1983 gave workers the "right to know," but the new Globally Harmonized System gives workers the "right to understand."
What you need to do and when:
Chemical users: Continue to update safety data sheets when new ones become available, provide training on the new label elements and ... September 26th, 2014 Patient Electronic Access Tipsheet - Measure ComplianceBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 26th, 2014 - Last Review/Update January 30th, 2017 MEASURE COMPLIANCE - Meeting the Patient Electronic Access Objective
Starting in 2014, CMS requires that providers participating in both Stage 1 and Stage 2 of the EHR Incentive Programs must meet the Patient Electronic Access objective, which gives patients access to their health information in a timely manner. Providers participating in ... September 25th, 2014 Virtual Credit Cards -A new trend in trying to keep up with E-HealthBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 25th, 2014 - Last Review/Update January 30th, 2017 Beware of the changes sneaking in as “money streams” in the name of EFT standards. Virtual Credit Cards are being used in provider’s offices as payments from payers; clearinghouses are starting to offer this service as well.
Effective January 1, 2014, health plans were required to offer electronic funds transfer (EFT). ... September 11th, 2014 According to HIPAA, who are my Business Associates?By Brandy Brimhall, CPC, CMCO, CCCPC, CPCO, CPMA | Published September 11th, 2014 - Last Review/Update January 30th, 2017 Providers work with many different groups and many of them have some interaction with Protected Health Information (PHI). In an effort to help us understand who qualifies as Business Associates the Department of Health & Human Services has provided some resources.
But first … what is PHI or individually identifiable health information? ... September 9th, 2014 Cyber Insurance? What kind of Insurance Policy it that?By Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published September 9th, 2014 - Last Review/Update January 30th, 2017 Due to the increase of medical transactions stored online and in the cloud, cyber intrusions will only increase.
Cyber insurance also known as privacy and network security insurance can help cover the costs incurred if your computer system is compromised, or after a data breach which can include a HIPAA ... August 26th, 2014 Un-Timely Filing - ZERO ReimbursementBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 26th, 2014 - Last Review/Update January 25th, 2017 Be sure you have office procedures in place to keep an eye on the time frame of your claims: Claims denied by Medicare for “untimely submission” are not eligible for appeal. In fact most carriers do not afford you an appeal if timely filing is an issue; there are only ... August 7th, 2014 Durable Medical Equipment, Prosthetics, Orthotics and SuppliesBy Christine Woolstenhulme, QCC, QMCS, CPC, CMRS | Published August 7th, 2014 - Last Review/Update January 25th, 2017 Reimbursement for most Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) is established by fee schedules. Payment is limited to the lower of the actual charge or the fee schedule amount.  We have given you some basic information to get you started including modifiers and how CMS views DMEPOS, please ... August 4th, 2014 Managed Care FAQsBy Wyn Staheli, Director of Content | 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 ... July 31st, 2014 Fill In Doctor: Locum TenensBy Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | Published July 31st, 2014 - Last Review/Update January 25th, 2017 It is a common practice for a solo doctor to find someone to cover for them while they are away from the office for a temporary or extended period of time, such as medical leave, or vacation. Some offices fail to code properly for the services rendered by the “fill-in” ... July 16th, 2014 The Impact of ICD-10 Coding System on Medical BillingBy David Berky | Published July 16th, 2014 - Last Review/Update January 25th, 2017 Learn how the introduction of ICD-10 will impact the coding and billing of medical diagnosis and procedure. July 15th, 2014 How the Internet is Reshaping Medical Coding and BillingBy David Berky | Published July 15th, 2014 - Last Review/Update January 25th, 2017 Since the Internet is affecting (usually for better) every industry, why should it come as a surprise that medical coding and billing is now heavily dependent on the Internet? Actually, a number of important challenges and changes in the healthcare industry, and in technology as a whole, are pushing medical ... March 18th, 2014 How can I make sure new hires have not been in trouble with Medicare?By Christopher Anderson, DC MCS-P | Published March 18th, 2014 - Last Review/Update January 25th, 2017 To avoid liability, it is recommended to routinely check (every 3 months) the LEIE to ensure that new hires and current employees are not on the excluded list.
One of the many parts of the compliance program is to see if your current staff (including yourself, regular staff and associate doctors) have been placed on the OIG (Office of the Inspector General) List of Excluded Individuals and Entities (LEIE).
OIG has the authority to exclude individuals and entities from Federally funded health care programs and maintains a list (List of Excluded Individuals and Entities or LEIE)of all currently excluded individuals and entities. Anyone who hires an individual or entity on the LEIE may be subject to monetary penalties.
It’s as simple as 1…2…3..
Read More
February 19th, 2014 Are Text Messages HIPAA Compliant?By | Published February 19th, 2014 - Last Review/Update January 27th, 2017 As more and more people are using mobile and wireless devices, a new buzzword has emerged: mHealth. According to a National Institute of Health consensus group, mHealth is "the use of mobile and wireless devices to improve health outcomes, healthcare services and health research." Historically, the biggest gaps and HIPAA violations ... September 30th, 2013 Are You Compliant with the New HIPAA Regulations?By | Published September 30th, 2013 - Last Review/Update January 27th, 2017 September 23rd, 2013 was the deadline for HIPAA Omnibus Final Rule compliance. It seems to have just snuck up on everybody. ChiroCode has spoken with some clincis who say that they don't need to worry about it because ”they are just a small practice.” Please, do not wait any longer to ... December 31st, 2001 Commonly Asked Chiropractic Coding QuestionsBy ChiroCode | Published December 31st, 2001 - Last Review/Update August 19th, 2015 Commonly Asked Questions:
1. Retention of Records
2. 97140 Denials
3. Exercise Equipment
4. Coding for BioFreeze
5. 97014 or G0283
6. Billing for additional insurance forms
7. Report of Findings
8. Laser therapy
9. Spinal Decompression
10. Diagnosis Coding – 4th and 5th digit
11. Re-Reading X-rays
12. Outcomes Assessment Questionnaires
13. Accounts Receivable
14. 15-Minute Units
15. E/M and CMT December 31st, 1969 National Association of Insurance Commissioners (NAIC) DirectoryBy | Published December 31st, 1969 - Last Review/Update August 10th, 2015 National Association of Insurance Commissioners (NAIC) Directory
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Select the webinar title to view a summary and link to the webinar video. April 14th, 2022 April 14 2022 : Reporting Telemedicine Services by Aimee WilcoxSeptember 11th, 2019 Inappropriate Payments Made to Chiropractors – An OIG ReviewIn this webinar, Dr. Gwilliam will take you on a fun filled journey through all of the reports created by the Office of the Inspector General based on their reviews of chiropractors. If you can understand what they see, and what advice they give Medicare when dealing with chiropractors, then you will be better prepared to not become their next target. This webinar may feel a little frightening with hundreds of thousands of dollars paid back to CMS, but, by the end, you will know exactly what to do and what not to do. November 27th, 2018 What the Amazon Effect and Other Changes in the Business World Mean to Your Practice - November 27th, 2018In this webinar, Jeff Smith, President of Cohesion Chiropractic Resource Group, will discuss the continuous transformations taking place in business and society and how your chiropractic practice needs to address and adapt to the changes. November 13th, 2018 New Patient Processing & How to Maximize Reimbursement -November 13th, 2018In 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.
October 30th, 2018 Skyrocket Cash Collections, Even When Patients Have High Deductibles and CopaysAre 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. October 2nd, 2018 X-Ray and the Evidenced Based Practice: How DC’s Can Demonstrate the Need for X-RaysLearn:
Improve Patient Outcomes and Satisfaction with X-Rays
Increase Practice Profits Using Research Studies
Incorporate Biomechanical Measurements in Your Patient Communications September 11th, 2018 Chiropractic Practice For Sale - When, Where, Why & How Much?Dr. Tom Necela of The Strategic Chiropractor will share tips & tactics to help you with some of the biggest decisions every doc faces towards the end of their career: when to sell, where to find buyers, why sell (and what other options are available) and of course, how much is your chiropractic practice worth. If you are considering a chiropractic practice sale or transition within the next few years, this is a webinar you won't want to miss! September 4th, 2018 Mandatory Chart Reviews - What You Need to KnowIn this webinar, we are going to discuss what a Chart Review is, why it's mandatory, YOUR benefits to conducting our outsourcing a Chart Review along with the general steps for preparing, performing and properly documenting a Chart Review and its findings. Also, learn what to do post Chart Review - what your next steps should be and how to prioritize. August 28th, 2018 Posture Rehab and Motor Control ExerciseJoin the Posture Expert, Dr. Steven Weiniger, and find out why the American College of Physicians recommends motor control exercise (MCE) for low back pain over drugs and surgery. Learn how StrongPosture® MCE protocols synergizes with chiropractic by correlating the individual’s unique perceptions with objective benchmarks to systematically correct sensorimotor errors and functionally strengthen posture. August 21st, 2018 Conducting Your Own Chart Audit: Part 2 of 2In Part 1, Dr. Gwilliam shared with you where auditors and claim reviewers get their information from. Now it is your turn. Dr. Gwilliam will guide you through some of the criteria and systems he uses when reviewing charts for attorneys and doctors. Bring your 2018 DeskBook along because Appendix D will be your friend as you figure out how to keep mistakes out of your practice. August 7th, 2018 Medicare ReviewsMedicare 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 February 27th, 2018 The Law of Fair ExchangeAs we move into 2018, a higher percentage of your clinic’s cash flow is going to come from the patient, not insurance carriers. If you don’t change your office systems to ensure that you are collecting this money at the time the patient values your care the most, the revenue cycle in your clinic is going to begin to slow significantly.
January 23rd, 2018 How to PREVENT and HEAL Dental Problems so You Can Enjoy a Healthy Body and LifeIn this webinar Dr. Jorgensen will share with you the REAL causes of dental disease and techniques for prevention and healing. You will also learn about dental problems that may be making you or your patients SICK, how to identify them, and what can be done to help them get better. Finally, she will tell you about cutting edge dental and health practices you need to know about to improve your patient's health, and how to find a dentist that can provide this care. Don't miss this life-changing webinar! December 5th, 2017 Risk Areas in Your Practice that You May Be Overlooking!Let's take a look at the most current OIG work plan to evaluate what investigative and enforcement entities are looking at and what they're finding. Believe it or not, systems and steps you take within your practice are extremely revealing and can put you and your practice at great risk. Great risk for audits and enforcement, great risk for loss of cash flow, great risk for loss of use-able time due to inefficient time management, and much more. Let's also take some time to discuss some easy ways to implement systems in your practice to minimize your risk and enhance your cash flow and productivity. November 14th, 2017 The Phased Transition: How to Slow Down Without Killing Your Profits or Potential Chiropractic Practice SaleMany retirement age chiropractors whose numbers are decreasing feel the need to retire before their practice slips even more. Others enjoy chiropractic and want (or need) to keep working but would like to a more relaxed pace. In either case, the timing and logistics of your transition are critical to your success -- if you want to retain the value of your practice .In this webinar, Dr. Tom Necela of The Strategic Chiropractor will share strategies how you can slow down, plan for your future and maximize the value of your practice and avoid costly mistakes too many chiropractors make in their practice sale or transition. October 31st, 2017 Confessions of an IME DoctorIn this webinar, Dr. Friedman will explain why more and chiropractic cases will be cut off from treatment after only 4 weeks and why you'll be seeing 6 visit maximums in the near future. He'll explain what you need to do get past this and how to determine when more treatment is justified with confidence. October 3rd, 2017 Checklist Manifesto for Your OfficeSo much to do and keep track of for all the departments and requirements for your practice. ChiroCode has developed checklists to help you keep organized and on track. Learn the value of a checklist as well as get a free ChiroCode checklist by joining this helpful webinar. September 19th, 2017 Better Financial Planning and ManagementJoin Dr. Brent Kesler for a special ONE HOUR SPECIAL webinar presentation on Tuesday September 19th at 11:00 Mountain Time. In this hour presentation, Dr. Kesler will share financial tips and strategies that have been used by the wealthy, generation after generation.
This educational segment is full of information that can change or improve your financial outlook for 2017 and beyond, no matter what it looks like now! Rest assured, this is not an investing or sales related webinar. It is pure facts, strategies, tips, and real life examples that you can take note of and begin to implement right away. To learn more about this webinar presentation and to register, visit the webinars tab at https://chirocode.com/webinars. September 5th, 2017 The Benefits and Use of Hemp OilLearn the benefits and use of full spectrum, phytocannabinoid rich, hemp oil and taking advantage of the ground breaking information that is coming out on the medical benefits of hemp oil. There are new reports each and everyday and health practitioners all over are adopting the use of hemp oil and suggesting its use to their clients. Meet a practicing Chiropractor that is using the full spectrum, phytocannabinoid rich hemp oil in their practice and recommending it to their clients. August 29th, 2017 In-Network or Out-of-Network....Which is Best for You?Join this webinar to learn the facts and fiction of In and Out-of-Network status for your providers and practices. Gather information to make the best decision for you and your practice. Learn some of the contract "tricks" that payors like to include which can be costly to you if you aren't sure what to look for or what questions to ask. Making the decision to be In-Network or Out-of-Network isn't the same for every practice. Find out also your risk of audits as it pertains to network status.
Finally, learn about payor guidelines that you must be aware of in order to minimize your risk of audit, review, denial, recoupment and other penalties. August 15th, 2017 How to Launch Your Associate Into Instant Success and ProfitWin-Win Associate Development: Get the help you need, the freedom you desire and the extra income you deserve. Most associateships don’t work out and end badly. But it doesn’t have to be that way. Dr. Lloyd has discovered strategies, systems, processes and techniques for hiring and developing successful motivated associates who produce their own new patients, make more money than they cost, and are great to work with in long-term relationships. July 25th, 2017 Keys to a Successful Chiropractic Practice Sale or TransitionIn this webinar, Dr. Tom Necela will discuss how to maximize the value of your practice so you can sell on top or transition well to meet your goals - as well as how to avoid the costly mistakes chiropractors make in selling, pricing their practice, finding their prospect, or in the financing of their business sale or transition. June 29th, 2017 How to Convert Your Medicare Patients to Cash to Avoid the Penalties of MACRAThe #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 13th, 2017 Improving Your Over the Counter CollectionsPractices find that too much of their revenues are slipping through the cracks! This is too costly to practices and must be addressed! Though there are many reasons and areas in your practice that can have an impact on your cash flow, your Over-the-Counter Collections is one of them! Let's take a closer look at your OTC Collections, identify trouble areas, implement more seamless systems, and all around look at ways you can improve your collections over-the-counter. May 30th, 2017 Better Financial Planning and ManagementJoin Dr. Brent Kesler for a special one hour webinar presentation on May 30, 2017 at 11:15 Mountain Time. In this one hour session, Dr. Kesler will share financial tips and strategies that have been used by the wealthy, generation after generation.
This educational segment is full of information that can change or improve your financial outlook for 2017 and beyond, no matter what it looks like now! Rest assured, this is not an investing or sales related webinar. It is pure facts, strategies, tips, and real life examples that you can take note of and begin to implement right away. To learn more about this webinar presentation and to register, visit the webinars tab at https://chirocode.com/webinars. April 11th, 2017 Audit Your Evaluation VisitsIn 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. February 2nd, 2017 Mighty MACRA!Mighty MACRA! September 13th, 2016 Building your Practice during Spinal Health MonthSpine Month (October) is your chance to amplify the value of chiropractic! It’s easy to engage people with simple tools you have on hand that show why getting adjusted and spinal health are crucial to overall health and wellbeing.
Whether your focus is people with back, neck and NMS pain, or you focus primarily on keeping people healthy, active and pain free, Spinal Health month is a golden opportunity to draw interest to your practice. Register today to learn how to assess and demonstrate spinal function with a posture picture and get the essential concepts and protocols for ongoing care of spinal health.
~ Build your practice during Spinal Health Month
~ Concepts that lead to referrals and new patients
~ Demos to improve compliance and referrals May 3rd, 2016 Non-Traditional Exit Strategies: How to Leave Chiropractic WITHOUT Giving Your Business AwayPresented by Tom Necela DC, CPC, CPMA, CCP-P
Dr. Tom Necela of The Strategic Chiropractor will discuss how to avoid the mistakes that most chiropractors are making when transitioning out of their practice and reveal "non-traditional" strategies to help you maximize the value of your exit strategy and chiropractic practice sale or transition. April 26th, 2016 Alert!! THOUSAND$ at Risk for Chiropractors in 2016Join this group of compliance professionals to learn about compliance hot topics, common Q/A, need-to-know details for compliance implementation and evaluation and much more. Also, this webinar will present to you advanced compliance training tools that will save you time, money and be easy to time manage as you navigate and implement compliance. There is so much to cover in this webinar session, doctors and CA's will not want to miss out. February 9th, 2016 New Patient Tsunami!Presented by Noel Lloyd, DC
Tuesday @ 10:15 AM PST, 11:15 AM MST, 12:15 PM CST, 1:15 EST
Get all the new patients you need! Not enough new patients is the number one challenge that holds most chiropractic practices down. Get new patients right and you’ll succeed. Get new patients wrong and your struggle. Dr. Noel Lloyd will take you step by step through how to create your own new patient Tsunami! There are more webinars. View all webinars... View webinars for the current subject by subtopic: ABN- Medicare Advance Written Notices of Noncoverage (October 2018)AMA-Preventive services coding guidesDiscount Plan or Health Insurance? by FTCDisposal of Protected Health InformationHIPAA: Health Insurance Portability and Accountability Act by AMAMedicare OverpaymentsMedicare: To Participate or Not to Participate?MLN: Medicare Vision Services Fact SheetOfficial HIPAA Guidelines for Media SanitationOIG Compliance Program for Individual and Small Group Physician Practices - Federal RegisterOSHA's Computer Workstations eToolSkilled Nursing Facility Best Practice GuidelinesState Health Insurance Mandates & the ACA Essential Benefits Provisions - by the National Conference of State Legislataures
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