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Public Message Archive / In Your Corner Newsletter, Volume 1

May 13th 2005 11:19am

In This Issue

» Medicare and Chiropractic
» Appeal Letters
» HIPAA
» Refund Demands
» United Healthcare Referal Procedure
» Tek-Collect

Welcome to Cornerstone Medical Management's newsletter, In Your Corner.

Things change rapidly in this industry. In Your Corner was started in an effort to share information that affects your practice. Information from a variety of sources bombards us daily. It can take hours to read all the insurance bulletins, e-mail updates, magazines and periodicals that arrive each week. It's difficult to know where to go and what to believe, especially on controversial and fast changing topics such as HIPAA, Medicare, and practice management to name just a few. In Your Corner will strive to provide a summary on many of the issues facing physical medicine today.

Medicare seems to present the most questions to our office, the next couple of issues will feature information regarding Medicare and Chiropractic.

As always, your input is important to us. Let us know what you think of this format and it's content.

Medicare and Chiropractic

Medicare specifically limits treatment by a chiropractic physician to Manual Manipulation of the spine. No other diagnostic or therapeutic service furnished by a chiropractor or on the order of a chiropractor will be covered.

As of January 1, 2000 x-rays are no longer required to demonstrate the presence of a subluxation. Physical examination utilizing the PART method is an acceptable method to demonstrate subluxation.

Diagnosing the Medicare patient
The presence of "pain" and/or a subluxation is not considered by Medicare to be sufficient medical necessity for treatment. Low-level diagnoses, especially "pain" type diagnoses, do not define a correctable condition and therefore are often denied completely or given very limited visits. The patient must have a neuromusculoskeletal condition that necessitates treatment. The manipulation must have a direct therapeutic relationship to the patient’s condition AND provide a reasonable expectation of recovery or improvement in function to be reimbursed.
One of the most common mistakes made by chiropractors in billing Medicare is not fully understanding the rules Medicare has established with regard to diagnosis. It is also the easiest to correct.

For each area identified as being adjusted, by use of the 9894x CPT code, two diagnoses must be present. They can be explained most simply as Where and Why; the "Where" piece of the diagnosis identifies the region of the spine where the subluxation was identified (i.e. 739.x); the "Why" identifies the "correctable condition" being treated.

Each "where" must be unique, you cannot re-use a region in your diagnosis. Two complaints in the thoracic region are still in one region. Failure to understand and correctly present your diagnoses to Medicare will result in claim denials.
Before CMM transmits your Medicare claims, each case is reviewed using our Medicare Audit report. This report identifies errors in the "where" and "why" a rule of diagnosing as well as allows our staff to make sure your primary diagnosis is your longest level of care.

Appeal Letters

CMM generates appeal letters for services denied that we believe should have been paid. Claims bundling on ice/hot packs, manual therapy techniques and massage are our most frequently bundled services. These appeals are generated and sent directly from our office.

Other appeals require the inclusion of the progress and / or examination notes. These appeal letters are sent to your office. Please review your office notes and send a copy of the note with the letter and attached EOB in the envelope provided. It is important that you review the letter and SOAP notes and send them as quickly as possible. Most plans have a limited number of days under which you can appeal.

CMM has encountered more insurance plans that just will NOT pay for heat/ice application and are considering it a bundled service.

HIPAA

There have been many rumors and much concern over those 5 letters - I’ve even seen them cause great panic! Cornerstone staff members have attended several HIPAA seminars in recent months and will be attending others as the situation warrants.

HIPAA will affect your office and you can't opt-out. It will increase or change some of your patient entrance forms. It will not cost you thousands of dollars to comply with, despite some of the estimates I've seen!

There are two upcoming milestone dates for HIPAA: October 16, 2002 and April 14, 2003.

October 16 - Your office must be using CPT, ICD-9 and HCPCS codes. All CMM clients currently adhere to this policy so no action is required.

April 14 - Your office must implement the HIPAA Privacy Policies.

CMM will be hosting a HIPAA compliance seminar in November and will have sample policies and forms. We can discuss in depth the Notice of Privacy Practice (NOPP) and other HIPAA terms and requirements.

The privacy part of HIPAA takes effect April 14, 2003.

Refund Demands

If you routinely receive and pay demands for refunds on old claims, paying them without question will only reduce your bottom line. In most cases, these payments were not paid in error! When refund requests are forwarded to CMM, we review the payment history before issuing a letter with a refusal to pay. There are several state and federal cases that can be quoted in this letter that states the insurance company is in the best position to know what should be paid and can not recover mistaken payments, but must bear the responsibility for their mistakes.

The process of dunning physicians’ current payments to recoup old claims is more prevalent in managed care plans. It has become so prevalent that some states have lobbied and won specific rules including time limits and notification at least 30 days in advance of any retroactive denial.

There are situations where refund requests are valid. A thorough review of the situation is warranted before issuing any refund.

United Healthcare Referal Procedure

When your office receives a UHC referral, please enter the referring physician, number of visits allowed, referral number and expiration date into the HMO referral section of Front Desk Manager.

Please fax a copy of the referral to one of the following UHC referral telephone numbers:
UHC Medicare Complete : 877-403-2273
UHC Non-Medicare Plans: 888-841-7093
Some of what we’ve learned:

Sign-in sheets have not been affected. You may choose to use them, however if you do please know that when records are copied, sign-in sheets should also be copied and all other names on the sheet must be blocked out or removed. That can be very time consuming and tedious. CMM recommends have a travel card or super bill that the patient signs at each visit. This will accomplish three factors; it affirms the presence of the patient in the office, assures greater privacy and decreases you labor in retrieving multiple sign-in sheets and removing other names when records are copied.

Computers should have password protection and have a screen saver that removes the display of patient information. This can be accomplished very simply in Windows and does not require any elaborate security software or procedures.

Each office must have an employee handbook that contains written privacy policies, security and privacy issues (including staff training on those issues), in addition to your other office policies.

Each office MUST have a Notice of Privacy Practice posted and/or given to each patient one time. (Don’t panic - it isn’t that bad)

Charts and other patient records should be in a controlled-access environment (can be locked)

Staff should be cognizant of conversations held regarding a patients care. What is being discussed and who can hear it?

Tek-Collect

Backed by more than 25 years of successful collection experience, Tek-Collect is one of the largest collection organizations in the country. Its clientele is ever growing and ever changing as more and more medical practices learn of the advantages of its comprehensive approach to managing receivables.

What are these advantages?
Maximum recovery ratios.
Minimal risk of patient alienation.
Virtually no write-offs.
And with Tek-Collect, these benefits come with a low fixed fee of typically less than 10%.

Tek-Collect assures service excellence and provides you with the results to maintain a healthy bottom line. Don’t just take our word for it - statistics show our recovery ratio is more than double the national average. And to further communicate our commitment to proving the best service in the industry, we offer a 100% collections guarantee on every account. If we are unable to provide you with the full recovery, we’ll work another account at no charge.

As the name implies, Tek-Collect employs the most efficient and technologically advanced approach to collections. Tek-Collect Online enables clients to access their account information all day, every day, via the Internet. You can submit an account online, and view status reports and comprehensive records of all verbal and written contacts. All of these benefits are accessible on a password-protected site for optimum convenience and your peace of mind.

America’s most astute health care providers are choosing Tek-Collect to help them maintain the cash flow necessary for continued profits and growth. An advanced collection solution that’s practical, economical, and easy to implement.

For more information please contact Susan LaFountain at 314-412-7167.

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