The results of the annual Health Insurance Report Card are in and, as usual, the AMA’s yearly check-up on health insurance companies and their claims processing trends is not pretty.
Although the data generated from these Report Cards is derived from MD practices, the big picture perspective is one that is still relevant for us to view as chiropractors. Here are a few interesting tidbits from this year’s Report Cards: Read More
Three important details emerge as the bottom line from the recently passed legislation:
Obviously, this creates some logistical mess in the present and to anticipate in the future regarding exactly what fees one should anticipate being paid. To access your fee schedule directly, you should go to your Medicare carrier’s website because that is who will ultimately be responsible for processing your claims. The American Chiropractic Association also has a helpful page with some Q&A’s and additional Resources on this subject matter. Read More
In case you were really hankering for some bad news from Medicare, here’s a couple gems that hit directly at the chiropractic profession.
Perhaps you have been following the trail of the Medicare fee increase or maybe you have better things to do in between adjustments than watch a complete demonstration of Medicare insanity. Either way, you will be pleased to know that:
“in anticipation of the vote to increase Medicare fees in 2010 by 2.2% and in 2011 by 1% which was in response to the previous defeat of the bill to decrease Medicare fee schedule by 21%, Medicare has reported that they will continue to hold claims through Thursday June 17th. If Congress has not taken final action by Friday June 18th, claims will be paid with the 21% fee decrease applied.”
And if you can read that quote, you probably either have a law degree or spend too much time reading plot-twisting Tom Clancy novels not actually written by Tom Clancy!
To summarize: Medicare may not quite know what it’s doing with the fee schedule fiasco yet and they plan to hold your claims until June 17, 2010 — in other words, not pay you anything. After that point, they may pay based on the 21% fee decrease, IF no further action is taken….
Not surprisingly, I have received many emails full of confusion and conflict over this issue from chiropractors around the country. I have been repeatedly informed of carriers who have already been processing claims with a small fee decrease since January 1 – not the proposed 21% decrease, nor the 0% “interim” fee increase from the 2009 fee schedule that is supposed to be in effect until Medicare gets its act together and a resolution has been obtained. Others have written in to state that Medicare has been paying exactly as expected. Still other more valiant chiropractic efforts have been reported by offices who have attempted to call their Medicare carrier and ask for an explanation of why, when and how they are to be paid. The responses have ranged from ridiculous to right on the money.
(Interesting side note: I even have a couple Medicare carriers following ME on my Twitter page. Isn’t that supposed to be the other way around?! Perhaps just everyone is desperate for info on the subject matter, even Mr. Medicare himself.)
Obviously, there is still a lot of confusion over the details of the proposed Medicare fee schedules (from both the payers and the providers) and a lot of anger. Witness the recent move by the MD’s represented by the AMA who turned in their lab coats as a sign of protest over Medicare’s move.
One thing emerges as a clear action step: DC’s really need to watch reimbursements to determine exactly how you are being paid. Then compare that to how you should be paid. Hopefully they match. If not, my suspicion is that Medicare will be getting more calls and appeals than usual this year.
More Medicare Mess
In other news, Medicare carrier Palmetto GBA released its Medical Review findings for the 2nd Quarter (yes, I know for most of the world, the 2nd quarter hasn’t finished yet – see they’re not behind on EVERYTHING!).
While these findings are specific to this carrier, I believe that they are indicative of challenges the chiropractic profession faces at large, so I will report them here. Of the 12 items listed that reflect “the majority of documentation issues discovered during the review process” there are four that affect chiropractic in general, and one is specific to chiropractic services exclusively.
Here are the common errors (with my comments in italics below) that were found so that you can be sure to avoid them in your own practice, as I am certain your carrier is finding similar problems:
Signatures: Documentation missing signature authentication by the author of the electronic medical record or contains an illegible signature.
(This is an easy mistake to fix and too simple to get nailed on. See Medicare signature requirements so you don’t kick yourself for getting claim denials over your signature.)
Evaluation and Management Services: Services do not meet the minimum documentation requirements.
? Specific concerns:
(While Medicare doesn’t pay DC’s for E/M codes, other insurance companies do. From my experience looking at chiropractor’s documentation, many of the errors above are routinely made on many regular insurance claims.)
Legibility: We accept transcribed notes in addition to copies of originals.
(In other words, if you are not on EMR and your handwriting is pitiful enough that it cannot be read by the average person with no special eyesight abilities, use a transcription service to type up your chicken scratch so at least someone can read them.)
No response to request for medical records: Often times this is because a provider failed to update his/her address/phone number; therefore we are unable to locate the provider. Please keep in mind it is the provider’s responsibility to notify Palmetto GBA within 90 days of any changes that occur. Please follow all instructions provided on any letter requesting documentation.
(These instructions are for Palmetto, but most – if not all – carriers have a similar policy. From experience, I can tell you that nearly every DC that has ever moved a practice incurs a lag time before Medicare catches up. In the past, this was just inconvenient. Presently, if you happen to receive a negative determination or payment demand and fail to respond – due to the fact that you moved or for ANY reason – you need to respond PROMPTLY or you will pay the price…literally.)
Chiropractic Services: Missing treatment plan with specific objective, measurable treatment goals. Follow thru with these specific objective treatment goals on subsequent visits is often omitted. The initial visit and subsequent visit often was missing key elements/requirements outlined in the Internet-Only Manual Medicare Claims Processing Manual 100-04, Chapter 12, section 220. Reminder: Subluxation may be established by either an x-ray or hands-on examination (P.A.R.T.)
(In other determination and reviews I have seen, the terminology “missing” is actually different than “incomplete.” While that may sound obvious to you, consider what this carrier is saying: DC’s are not including ANY treatment plan as a part of their notes. It’s not inadequate, incomplete or subpar – it’s just not there!! Obviously, if there is no treatment plan, there will be no measurable treatment goals. Heck no goals at all!)
See you next week – where hopefully there won’t be more bad Medicare news to report!
Tom Necela, DC, CPC, CPMA
(Reading Time = 5 mins)
Today’s blog post will give you three quick strategies to fix slow times…fast!!
We Can’t Help You
Recently a chiropractor contacted me to ask for help with getting his practice to be more profitable. He loved my tagline “work smarter, not harder” and wished to move his business in that direction. Without being able to point a finger on a particular problem, he stated that he felt he was working harder than ever and seeing less in the way of financial rewards and personal satisfaction.
The chiropractor submitted a Practice Analysis Questionnaire and took me up on my offer to conduct a FREE, no obligation review of his practice.
I called the doctor at our scheduled time in the morning and was immediately put on hold, during which another call came in that the receptionist needed to take. (It wasn’t a “Would you mind holding for just a minute?” either – it was a “HOLD!” and then nothing!) After several long minutes on hold, our call was disconnected.
I called again a few minutes later and was put on hold…again…for nearly 10 minutes before I hung up in frustration. Out of curiosity, I dialed the doctor again later in the day and got a recorded message saying they were out to lunch.
In addition to a myriad of billing blunders, coding issues and a sizable A/R that could sink a small town, guess what this office also listed as one of their chief challenges? Getting new patients! Sure – there are hundreds of ways to get potential new patients to call your office. And none of them will work if no one is answering the phone properly. Often the first step to working smarter is to make sure what you are doing is working at all!
What if…
Let’s go the other route and throw out a question…
What if you woke up tomorrow morning and there were absolutely NO NEW PATIENTS available anywhere in the world for chiropractors. That’s right, no matter what you did, you could NEVER get another new patient into your chiropractic practice. So the deal would be… for the life of your practice, you only had your existing patients. What would you do differently?
This question is not only a great topic for a team meeting, it may also provide you with some interesting thoughts and observations towards developing variable income streams for your practice. There’s no “right” answer here – but a lot of potentially good ones!
The Collections Knock Out
Many of you have heard me rant about the futility of sending an endless round of statements to your patients in an attempt to collect past due balances. While the alternative of sending everyone to a collections agency is not exactly a viable solution either, we’ve been “beta-testing” a solution for the past several years that has proven to be a winner. It is a “statement of delinquency” form that was developed to get slow paying patients to pay. I will admit that I was initially suspicious of its simplicity. But thousands of “beta-testing” trials later have proven one fact: simple works! In fact, several chiropractic clients using them has found that they work particularly well even in stalled economies such as the one we are in now.
The Delinquency Statements are very simple and inexpensive to produce. Here’s the
“recipe” if you’d like to make your own: include a big fat heading reading “Statement of Delinquency” that catches anyone’s attention. Then include the name of the responsible party, services rendered and, of course, the amount due. Finally, be sure to add a couple lines that mention what you will do if the balance is not paid and how the delinquency will be cancelled if payment is received in 10 days.
(For those of you who may not wish to “re-invent the wheel” you can purchase the exact template and instructions for printing and use as part of the Collections Knock Out package – and once you have purchased the template, you can reproduce as many as you like…forever!)
While this represents a definite direct hit to your escalating A/R, coupling the Delinquency Statements with an Auto-Debit Strategy in which you offer patients the ability to pay their balance over time helps you increase your ability to capture an enviable percentage of your delinquent accounts.
In fact, several clients utilizing our Collections Knock Out strategy have remarked that this one-two punch has resulted in better collections performance than their collection calls and collections agencies combined. And the best part – you can do it yourself at a fraction of the price!!
To Your Success — and may it be quick!!
Tom Necela, DC, CPC, CPMA
In case you haven’t heard, two recent legislative changes have been passed that will affect you as a chiropractor:
Because these changes (or non-changes) happen quickly, I typically alert chiropractors of these via my Twitter page. But for a change of pace and because I know 14, 238 of you reading this are NOT following me on Twitter I thought it might be useful here as well.
(BTW: If you are on Twitter, no worries. I won’t send you tweets about what a great lunch I am eating or give you my reaction to the latest celebrity gossip in 140 characters or less. If you are not on Twitter, it’s a quick way to stay updated on changes in chiropractic that you need to know. Plus, as a special bonus, you can re-tweet them (sort of like an email forward without the bad jokes) to friends and impress them with you ability to stay in the know on current events!)
So, here’s the news:
Medicare Fee Decrease
The long-anticipated (dreaded?) 21% Medicare fee decrease is scheduled to go into effect June 1, 2010. While hopes have been high for a delay, no final Congressional action has yet been taken.
Medicare recently released a notice indicating that they would hold claims for the first ten business days of June to provide Congress with additional time to consider this issue.
Chiropractors should be aware that this hold will only affect claims with dates of service June 1, 2010, and forward.
Claims paid prior to June 1 should still be paid at the zero percent (0%) fee increase proposed by other recent legislative activity. Translation: claims paid with dates of service Jan 1 through May 31 will be paid at the same fee schedule as your 2009 rates.
Red Flag Rules Delayed
Again, the Federal Trade Commission (FTC) has delayed implementation of the Red Flags Rule. The next date is set for January 1, 2011. Although it has been a subject of much debate whether this ruling even applies to chiropractors, no worries – you still have time. Meanwhile, Congress intends to determine the scope of entities who are covered by the rule. We will just have to wait and see how that turns out.
Hope you had a great holiday weekend!
I will be back next week with my usual fare of musings on all things related to the business of chiropractic.
Tom
Copyright © 2012 The Strategic Chiropractor. All rights reserved.