Why Audit Charts?

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BCBS Medically Unnecessary Services

Effective July 14, 2014 BCBS IL has a change in policy for services deemed to be medically unnecessary or medically unproven (experimental and/or investigational). These services will no longer be considered patient responsibility upon denial.  These services will be denied with a message specifying that the patient is not financially responsible for the charges.

What items are considered medically unproven?  Interferential current stimulation, pneumatic traction and spinal uploading devices in any setting, many types of allergy testing, traction devices for use in the home, kinesiology, spray and stretch technique for myofascial pain, intermittent motorized traction, intersegmental traction, methods of mechanical massage, craniosacral therapy, hydrotherapy beds, kinesio taping, and low level laser are among the many elements that are not covered by BCBS. 

In order to charge the patient for these non-covered services, the patient must sign and date an authorization form that states the member has been informed prior to the services being rendered, that the services are no covered.  It must include the total cost of the services and a confirmation that the member accepts all financial responsibility.  

PQRS 2014

The Patient Protection and Affordable Care Act made participation in Medicare’s Physician Quality Reporting System (PQRS) mandatory beginning in 2015. Failure to successfully participate in PQRS in 2014 will result in a 2% payment decrease in 2016. 

 

This friendly reminder is about the “new for 2014” PQRS code for chiropractic.  

  

Mesaure 317: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up documented.  This code must be reported one time per patient during the calendar year. 

 

A link to the details of this measure can be found here.