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Practice Management Topics Page

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Are These Problems Hurting Your Practice?

Watch out for People-Related ‘Gotchas’

Attestations Teaching Physicians vs Split Shared Visits

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Select the title to see a summary and a link to the full article.

Why is HIPAA So Important?

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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 ...

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Are You Aware of Medicare Advantage Plans Timely Filing Rules?

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The Medicare Fee for Service (FFS) program (Traditional or Original Medicare) has a timely filing requirement; a clean claim for services rendered must be received within one year of the date of service or risk payment denial. As any company who has billed Medicare services can attest, the one-year timely filing ...

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The Role of Chiropractic in Value Based Payment Systems

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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.

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Are These Problems Hurting Your Practice?

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There are many things that can be missed when trying to run an effective and profitable practice. This article covers some important tasks that are often overlooked such as not reviewing your payer contracts or failing to check eligibility.

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Q/A: Do I Really Need to Have an Interpreter?

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Question: I heard that I need to have an interpreter if someone who only speaks Spanish comes into my office. Is this really true? Answer:  Yes! There are both state and federal laws that need to be considered. The applicable federal laws are: Title VI of the Civil Rights Act of 1964,  Americans with Disabilities ...

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Small Breaches Can Be Subject to Large Penalties

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Small Breaches Can Be Subject to Large Penalties    We may have heard about the large fines issued by the Office for Civil Rights (OCR) against big organizations like Anthem or the University of Texas MD Anderson Cancer Center. These organizations have been in the news due to privacy breaches that constituted violations ...

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

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

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Prioritize Your Patient's Financial Experience

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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 ...

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Auditing Chiropractic Services

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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.

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Watch out for People-Related ‘Gotchas’

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

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Understanding NCCI Edits

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Medicare creates and maintains the National Correct Coding Initiative (NCCI) edits and NCCI Policy Manual, which identify code pair edits. When performed on the same patient, on the same day, and by the same provider, the secondary code is considered an integral part of the primary code, and payment for ...

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Q/A: What's the Difference Between Q5 and Q6 for a Substitute Provider?

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It is important to understand that modifiers Q5 and Q6 are not interchangeable. So when do you use each of them?

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Attestations Teaching Physicians vs Split Shared Visits

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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 ...

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Are You Protecting Your Dental Practice From Fraud?

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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 ...

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Auditing looking between the lines

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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...

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Present on Admission POA Indicator

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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...

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We've Always Done It This Way and Other Challenges in Education

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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...

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Wolters Kluwer Drug Pricing

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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...

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HIPAA Handling Patient Requests for Medical Record Restriction

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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...

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The Potential Impacts of a Flat Rate EM Reimbursement on our Industry

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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...

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Q/A: Do I Have to Accept Any New Patient?

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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?

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Getting the Right Eligibility Information for Payment Your Rights and Health Plans Requirement

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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...

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Pricing for ASC’s and APC’s

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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...

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Documentation: Face to Face for Home Health Certification

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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 ...

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How Does the Physician Compare Website Affect You?

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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 ...

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The Money in MIPS

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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%....

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Three Ways Bundled Payments Can Be a Success

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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 ...

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Routine Waiver of Patient Out of Pocket Expenses

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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....

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Key Performance Indicators Revisited

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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...

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The Devil is in the Data Details

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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.

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Saving Time and Money with Automated Insurance Eligibility Verification

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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...

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FHIR Revisited

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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...

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Proper Record Keeping and Documentation

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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 ...

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Dentists Submitting Claims to Medicare

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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 ...

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Use it or Lose it - How We Can Help!

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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 ...

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What Do Patients Expect in 2018?

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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....

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The Comprehensive Error Rate Testing Program

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With nearly a million physicians in this country, how do auditing organizations determine whom to audit?

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Increase Revenue by Outsourcing Medical Billing

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Many practices are starting to weigh the benefits outsourcing medical billing compared to keeping it in-house....

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Health Information Exchange and Trusted Exchange Frameworks

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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. ...

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The Comprehensive Error Rate Testing Program

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With nearly a million physicians in this country, how do auditing organizations determine whom to audit?

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Using a 2015 Certified EHR in MIPS Year 2

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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...

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Don’t Be Hesitant About Collecting Co-Pays

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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 ...

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Adjusting Your Collection Strategies to HDHPs

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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.....

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Mobile Health: Growing Engagement and New Responsibilities

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This week I'm blogging about an M-word. Not MACRA or MIPS, but Mobile Health or mHealth....

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Developing Coding Policies for Compliance

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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 ...

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Dental and Medical- Controlled Substance Awareness

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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 ...

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Referring and Ordering Physician - CMS-1500 Box 17

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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 ...

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Prescription Drug Discount Program

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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 ...

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UCR Pricing, What is it?

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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 ...

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Better Office Communication Leads to Stronger RCM

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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. ...

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Advance Beneficiary Notice of Noncoverage (ABN) Modifier Guidelines

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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 ...

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Diagnosis Coding with Diagnostic Testing

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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 ...

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Select the webinar title to view a summary and link to the webinar video.

September 10, 2019 — Inappropriate Payments Made to Chiropractors – An OIG Review

In 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.

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What the Amazon Effect and Other Changes in the Business World Mean to Your Practice - November 27th, 2018

In 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.

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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.

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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.

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X-Ray and the Evidenced Based Practice: How DC’s Can Demonstrate the Need for X-Rays

Learn: Improve Patient Outcomes and Satisfaction with X-Rays Increase Practice Profits Using Research Studies Incorporate Biomechanical Measurements in Your Patient Communications

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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!

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Mandatory Chart Reviews - What You Need to Know

In 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.

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Posture Rehab and Motor Control Exercise

Join 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.

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Conducting Your Own Chart Audit: Part 2 of 2

In 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.

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Medicare Reviews

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

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The Law of Fair Exchange

As 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.

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How to PREVENT and HEAL Dental Problems so You Can Enjoy a Healthy Body and Life

In 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!

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ACA PolicyAnnual and Lifetime Limits; PPACA UpdatesAnswers to new practitioners’ questions about running a business - by the American Chiropractic Association (ACA)Behavioral Health Provider TypesBreach Notification Rule by HHSBusiness Insurance Resources - by SBACertified Chiropractic Clinical Assistant Certification ProgramCivil Monetary Penalties Law - by OIGCMS 1500 Claim FormsCMS Complying with Medicare Signature Requirements Fact SheetCMS Medicare Fee for Service Recovery Audit ProgramCMS Physician Fee Schedule Look-UpCR 5550 Clarification - Signature Requirements by CMSCyber Claims StudyDetails about EHR Incentive ProgramDiscount Plan or Health Insurance? by FTCDisposal of Protected Health InformationDurable Medical Equipment (DME) Medicare Administrative Contractor (MAC) JurisdictionsExcellence In Mental Health Act information by the National Council for Behavioral HealthFact Sheet for Chiropractic Services - by the VAFECA - Additional Info & Enrollment CenterFederal Employee Program - by the ACAFederal Employees Compensation (DFEC)Federal Employees Health Benefits (FEHB) ProgramFederal Exclusions Database for Healthcare WorkersFederation of Chiropractic Licensing Boards - State Specific RegulationsFurther Details on the Revalidation of Provider Enrollment Information by CMSHealth Savings Accounts (HSAs) in the newsHHS Notifications: Online FormHIPAA Notice of Privacy Practice Pamphlet for PatientsHIPAA regulations and sign-in sheets - by HHSHIPAA Risk Analysis and Risk Management Tip Sheet by OCRHIPAA: Health Insurance Portability and Accountability Act by AMAIndependent Contractor vs. Employee - by the Internal Revenue service (IRS)Injury and Illness Recordkeeping RequirementsInteractive Directory of VA OfficesIs Chiropractic Covered for TRICARE?Is your Office Listed on the PECOS Listing?Kaiser Employer Heatlh Benefits SurveyLink to CMS Form - Request for Review of Administrative Law Judge (ALJ) Medicare Decision/DismissalLink to CMS Form - Transfer of Appeal RightsMarketing to Medicare Beneficiaries - by MedicareMedicare Advantage Plans: Cost Sharing LimitsMEDICARE ENROLLMENT APPLICATION Institutional Providers CMS-855AMedicare Medical Savings Account (MSA) Plans - by CMSMedicare Provider-Supplier Enrollment - by CMSMedicare Reconsideration RequestMedicare Secondary Payer fact sheet by CMSMedicare: To Participate or Not to Participate?Misinformation about Chiropractic Services - by Medicare Learning NetworkMLN: Medicare Vision Services Fact SheetMultiple Employer Welfare Arrangements (MEWA)National Board of Chiropractic ExaminersNew Doctor Toolkit - by the American Chiropractic AssociationNew OSHA Online Reporting PageNPI ApplicationNPI RegistryOfficial HIPAA Guidelines for Media SanitationOIG Compliance Program for Individual and Small Group Physician Practices - Federal RegisterOpting out of Medicare and/or Electing to Order and Refer Services - MedLearn articleOSHA's Computer Workstations eToolPolicies for Social Media - by HHSPractice ManagementPrompt Pay Discounts - OIG Advisory Opinion 08-03Self-Funded Plans and the PPACA: Is this the new normal?Skilled Nursing Facility Best Practice GuidelinesSkilled Nursing Facility ChecklistSliding Fee Schedule information - by the Health Resources and Services Administration (HRSA)Small Business Resources - by OSHASpecial Advisory Bulletin, Offering Gifts and Other Inducements (2002) - by the Office of the Inspector General (OIG)Special Advisory Opinion 12-21 , Offering Gifts and Other Inducements (2013)- by the Office of the Inspector General (OIG)State Health Insurance Mandates & the ACA Essential Benefits Provisions - by the National Conference of State LegislatauresSteps to Starting a Business - by the Small Business AdministrationTriWest to Administer VA Patient-Centered community Care ProgramVA Patient-Centered Community Care (PC3) FAQ SheetWhat is Covered Under a Cyber Liability insurance PolicyWhat is Integrated Care - by the Substance Abuse and Mental Health Services Administration (SAMSA)Workers Compensation Laws - State by State ComparisonYour Guide to Who Pays First - by CMS


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