As is very typical with government, the implementation rollercoaster ride continues!  The FTC has decided to delay the enforcement of the Red Flags Rules until June 1, 2010.  Legislation is pending to exempt health care, accounting or legal firms with 20 or fewer employees; so they don’t want to push any policy into implementation knowing that it will probably not apply to many of those who are having to implement it.

You can read the bulletin here:  http://www.ftc.gov/os/2009/10/091030redflagsrule.pdf

As a chiropractic office, the policies that are within the Red Flags Rules should already be in place in all practices. Whether mandated or not, such policies reduce the likelihood of identify theft and insurance fraud in your office and following them is smart business.  Making sure that you are making a copy of all insurance cards and a legal id on every patient will reduce the likelihood that your practice will be affected by the growing trend of identity theft.  Previous practicalca posts cover the basics of the Red Flags Rules and you will find that most of what was to be required should already be in place in your office!

http://practicalca.wordpress.com/2009/10/27/red-flags-rules-go-into-effect-for-chiropractic-offices-november-1-2009/

Practically Yours,

the PracticalCA

Unless further action is taken before November 1st, all Doctors of Chiropractic will need to be in compliance with the regulations that encompass the “red flags rules.” At this time, there is pending legislation to exempt private physician’s offices which have fewer than 20 employees, but until this legislation is signed, all D.C.s need to be prepared to follow the approved practices.  These rules are designed to reduce the likelihood of identity theft, and the subsequent damage that it can cause.  Most offices already have in place much of the required actions needed to be in compliance.  However, all offices will need to be sure that all employees are trained in proper procedures by Nov. 1, 2009.

Here’s a link to a site which will give you all you need to know about being compliant.

http://www.ftc.gov/bcp/edu/microsites/redflagsrule/index.shtml

While the AMA failed to get healthcare providers exempted from the new FTC regs called the Red Flags Rules, the deadline implement a plan in your office has been extended.

http://www.ftc.gov/opa/2009/04/redflagsrule.shtm

Subscribe to this blog and in the coming weeks, receive a multi-part series on designing a Red Flags Rules protocal for your practice. You are probably already doing much of what you will need to do to be compliant, so long as you are up on HIPAA procedures and follow common sense practices about copying I.D.s etc. So don’t fret, just check back here and we’ll make sure you have all the information that you need.

Practically Yours,

the PracticalCA

You often hear of practice management groups who offer their *secret* strategy on how to garner M.D. referrals. They package marketing kits that really are just letters that they claim* say just the right thing,* media presentations etc. I’ve yet to see that any of these are a magic bullet. Let’s face it; there are certain medical doctors who understand the value of referring their patients (and family and friends) to a good chiropractor. However, many M.D.s are hesitant to refer if they are in a tight network of doctors. Even if they know the value of chiropractic care, many physicians groups have contractual or unspoken consequences for doctors who refer out of their group’s scope of practice. There isn’t a lot that we can do about that; however we can work to build professional relationships with doctors in our area if we are willing to follow the basic rules of medical professional communication. Notifying a patient’s PCP that you are treating his or her patient is not only suggested, it is a form of proper documentation, something that this profession needs to improve upon. But with just a few changes in your intake and patient processing procedures, you can see your practice getting M.D. referrals from a variety of sources.

Do you collect your patient’s PCP information? Are you sending a letter to their PCP when you begin treatment, and at the release of care? This is one of the best ways to build a professional network between yourself and PCPs in your area. Here are the simple steps to creating a database of local doctor contact information, and collecting the patient PCP information.

1. Assess your intake forms to make sure that they include the following information. Patient PCP name, number and address. This should be a part of a patient’s permanent file and it should be kept up to date. When you do patient update forms, always include this information and make sure that it stays current.
2. Create a good Outlook or rolodex database with the PCP information easily accessible. Keep current fax numbers as well. When you create the entry, include the name of the person that you spoke to in the office. It always helps to address someone by name, should you need to contact them by phone at any time.
   1. Create a good general “your patient is under my care” letter template. Keep this on your desktop where it is easily accessible. When a new patient comes in, your front CA should be able to pull most of the information that is needed, from the chart. I use a simple patient update form which has all of the information for our CAs to pull from. The letter should be simple – below is a simple guide for you to use.
      Dear Dr. Jones:

      Please be advised that your patient, Susie Smith, aged 52 Caucasian female presented in my office on March 10, 2009 complaining of neck pain and stiffness, shooting pains into the right upper arm and radiating down into the fingertips. Patient stated that this pain has been off and on for the last 3 years, but was recently exacerbated by an incident where she fell asleep in a chair and slept there through the night. She is having difficulty sleeping since the exacerbation, and has missed time from work. I have examined the patient and positive test findings include: restricted range of motion in the right shoulder, positive foramina compression test, and shoulder depressor test. Additionally I found palpable muscle spasms in the right cervical spine. I have advised the patient to use ice and an estim daily as needed, and recommend specific spinal manipulative care at 3x per week for the next 4 weeks. I will perform a re-exam. on the 12^th visit and reassess the condition at that time.

      
      Please contact me should you have any questions.
      

3. Let your CA fill in the blanks of your template letter from the information on the patient’s chart, but always proof it and sign it by hand. Be careful to make sure that they have the correct test results, treatment plan etc. because this will become part of the patient’s permanent record.
4. When the patient has been released from care, whether because they are well, have progressed to MMI, you have chosen to refer the patient out, or they have been released due to non-compliance, send the PCP a follow up letter simply stating that the patient was released from care on (date) and list any lingering symptoms, or the doctor whom you referred them to and reason for the referral. If the patient was released due to non-compliance, you may state the compliance issue. Make sure that you let the doc know what symptoms you cleared up in successful cases.

These are simple steps that will help you to cultivate a professional relationship with your patient’s PCP and as your name is brought before this doctor time and again, he or she will have name recognition and may consider referring to you when another patient may need similar treatment. Of course, some docs may never refer to us. But if nothing else, you are helping to move the profession forward by following professional protocol to notify the PCP that you are treating his patient.

Practically Yours,

The PracticalCA

Are you ready for the new Medicare ABN? It becomes mandatory March 1, 2009. Does your office need training on when and how to utilize an ABN (Advance Beneficiary Notice)? Not sure whether or not you need training? Check out some of the comments below to see how well you do.

• Have you heard you no longer need to bill Medicare? NOT TRUE!
• Or that you no longer need to bill maintenance care? In some cases, that may be true – do you know when?
• Non-covered services may now be included — but only if you know how!
• On the new ABN, there are now THREE options from which the patient can choose. Do you know what you can and cannot tell the patient as they fill out their form?

  Final instructions were not released until September 2008—any information prior to that might be obsolete! Much of the training information available came out with the first wave of information (prior to September). Are you sure your information is UP-TO-DATE?

  There is so much mis-information about Medicare related issues. I always recommend that you KNOW YOUR SOURCE! Susan McClelland is a sought after lecturer on Medicare issues and I highly recommend her! You can be confident the information you get is necessary, current, and delivered in a manner which you will be able to understand and implement in your practice!

  If you need further information on the new ABN, take a moment to sign-up today and make sure that you are compliant!

  *The fee is $69.00 per office! Proceeds from the teleconference will benefit FCER, the Foundation for Chiropractic Education and Research.

  Sign-up today by clicking HERE! Or if you are unable to attend the live teleconference, you may click HERE to purchase the CD.

  Medicare is not as scary as it seems, so long as you have good information.

  Practically Yours,

  the PracticalCA

New Medicare ABN Effective March 1, 2009!

The old Medicare ABNs will no longer be effective after February 28, 2009, and they will be replaced with the revised form “ABN” (CMS-R-131.) It may also be used to replace the “Notice of Exclusion
from Medicare Benefits” (NEMB) (CMS Form 20007.) There are several changes that will take place with the new revision, you can find out more at the following links:
http://www.cms.hhs.gov/BNI/Downloads/ABNAnnouncementFAQs.pdf
http://www.cms.hhs.gov/bni/

Additionally, I highly recommend attending the teleconference which will be held by Susan McClellan, February 24, 2009 at 1:00 Eastern Time. The ABN is one of the most misunderstood components of Medicare. It is imperative to not only use the correct form, but also use the form correctly. With an ABN, if you use the form but do not use it correctly, it renders it void. So, stay tuned and check back to this site for more information on both the ABN, as well as the teleconference.

Practically Yours,

The PracticalCA

So how do you think you did on the True – False quiz last week? Take a look at the answers below:

TRUE OR FALSE

1. Doctors of Chiropractic can “opt-out” of Medicare. That is, they can sign a form and still treat Medicare patients, but they must agree not to bill Medicare for any of the services.

   False.
   While medical doctors can in fact opt out of Medicare and still see Medicare patients, chiropractors cannot. I have heard of a few who claim to have done so, my suspicion is that they were unaware that chiropractors are not allowed to do so, and they filled out the application, and some untrained employee processed the application and gave them the opt-out status inadvertently. Who knows, it may simply be one of the chiropractic urban legends, but if you happen to have one of those letters, better store it in a safety deposit box somewhere. (And fax me a copy, I’d love to have it for my files. J )

2. It is always good to get an ABN signed at the beginning of care for any Medicare patient. This way, any time you are denied payment for services, your patient has been warned well in advance so they won’t be surprised, and you can still collect from them.
   False.
   Having an ABN signed “in case” you get denied is not proper procedure and could render all of your ABNs useless. The only time you have an ABN signed is if the care that the patient is getting is truly maintenance by Medicare standards OR, you have reached a clearly defined or demonstrable screen from your carrier.
3. If I am billing a CMT with the codes of 98940, 41 or 42 and it is active care, I should append the AT modifier on the CMT.
   This is a little bit of a trick question; the answer is that this is
   True
   so long as it is not maintenance. All active treatment care has the AT modifier appended to the 98940, 41 or 42.
4. The acronym for the Medicare accepted system for documenting subluxation is S.O.A.P.
   False.
   The acronym that Medicare seeks to define medical necessity, is P.A.R.T.. Pain and tenderness. Asymmetry/Misalignment. Range of Motion. Tissue/tone changes. You can use a S.O.A.P. note to list these findings, if you wish, so long as they answer the P.A.R.T. with at least two of the four components, and at least one is A. or R..
5. As a C.A., if I follow instructions that my doctor gave me, or I learned at a publicized Medicare seminar and bill incorrectly for a Medicare patient, I cannot be charged with any crime.
   False.
   Ignorance is no excuse for breaking a law or a rule. C.A.s could be held accountable if they bill Medicare incorrectly, even if they are following the doctor’s orders. ALL C.A.s need to know how to properly bill and to be able to recognize when they are being asked to do anything that is against federal, state or local rules and regulations.
6. Medicare is no longer covering x-rays that are ordered by a medical doctor for a patient to receive care from a chiropractor.
   False!
   Prior to this year, a chiropractor could send a patient to their medical doctor or the E.R. and have x-rays paid for by Medicare. But since Medicare no longer require x-rays as documentation method, they no longer pay for it if a chiropractor or radiologist orders them so that the patient can have chiropractic care.  You can however, send them to their PCP to get x-rays and they can be reimbursed.
7. It is necessary for me to learn my state’s own Medicare rules and regulations since surveys have shown that more than 90% of the time when a Medicare carrier is contacted with a question on a Medicare issue, there is at least one incorrect answer given.
   True!
   Surveys have shown that as much as 93% of the time false information is given when a Medicare carrier employee is consulted about a Medicare issue. SCARY. So once again C.A.s (and Doc.s!) know your stuff or know where to find the right answers!
8. If I don’t want to follow the rules of Medicare, I can choose to be non-par and then I won’t have to worry about denials, documentation etc., and I can still collect from my patients.
   False!
   Being non-par has absolutely NO bearing on whether or not you have to go by the rules! All of the documentation rules still apply to any doc who is adjusting a Medicare patient. Basically, the only thing that changes is the amount you can charge a Medicare patient.

So how did you do? Any surprises? Medicare is one of the more confusing things that we have to deal with in a chiropractic office. Let’s face it, the government rules and regulations…need I say more.

Stay tuned for more to come on the navigating Medicare. If you have a question that you would like answered, please send it to practicalca@practicalpracticing.com and check back for the answer in a future edition.

Practically Yours,

the PracticalCA

I have heard from many doctors and their C.A.s that Medicare is one of the most frustrating aspects of running a chiropractic practice. I’ve heard doctors say that this is why they don’t “get involved with Medicare.” Or “I’m going to be non-par next year!” But the truth of the matter is that Medicare is crucial for all D.C.s and their C.A.s to learn and to understand. I will devote considerable time in the upcoming posts to helping to navigate the Medicare “mess.”

First of all, “why should I care?” The reason that all D.C.s need to learn how to be compliant in all aspects of the Medicare program is that many private insurers use Medicare as a model for their policy. If you learn to document in a manner that will fit the Medicare “medical necessity box” then you will be well on your way to having a compliant practice that will pass the test for just about any insurer, your state board, the courts, or if you have the unfortunate experience of being contacted for an audit.

So I will begin by asking some questions and will post the answers in an upcoming post. Please realize that at least SOME of the following statements are not true, so please make sure that you wait for the answers before you take any of this as “Medicare Doctrine.”

TRUE OR FALSE

1. Doctors of Chiropractic can “opt-out” of Medicare. That is, they can sign a form and still treat Medicare patients, but they must agree not to bill Medicare for any of the services.
2. It is always good to get an ABN signed at the beginning of care for any Medicare patient. This way, any time you are denied payment for services, your patient has been warned well in advance so they won’t be surprised, and you can still collect from them.
3. If I am billing a CMT with the codes of 98940, 41 or 42 and it is active care, I should append the AT modifier on the CMT.
4. The acronym for the Medicare accepted system for documenting a subluxation is S.O.A.P.
5. As a C.A., if I follow instructions that my doctor gave me, or I learned at a publicized Medicare seminar and bill incorrectly for a Medicare patient, I cannot be charged with any crime.
6. Medicare is no longer covering x-rays that are ordered by a medical doctor for a patient to receive care from a chiropractor.
7. It is necessary for me to learn my state’s own Medicare rules and regulations since surveys have shown that more than 90% of the time when a Medicare carrier is contacted with a question on a Medicare issue, incorrect answers are given.
8. If I don’t want to follow the rules of Medicare, I can choose to be non-par and then I won’t have to worry about denials, and I can still collect from my patients.

So take a minute and see how you do. We’ll cover these questions as well as many others, in the weeks to come right here at the PracticalCA blog.

If you have a Medicare question, please feel free to submit it to practicalca@practicalpracticing.com and we may just feature it here. J

Practically Yours,

The PracticalCA

I recently received a letter from the ACA (American Chiropractic Association) telling me that my membership will be revoked after August 31, 2008 unless I “associate” with a doctor who is a member. To be honest this was quite a shock. The ACA is a great resource for profession related news, publications and seminars etc. In all fairness to them, I was simply a “chiropractic assistant” member. I didn’t pay $600.00 per year, as do doctors or vendors who wish to join. However, since I am a chiropractic assistant, I joined as a chiropractic assistant. Someone within the organization realized that I was able to use the same resources that the doctors who pay $600.00 per year use, thought this wasn’t *fair* and brought it up with the membership VP and they decided to revoke my membership and that of any other chiropractic assistant who has a similar membership. They are now eliminating the chiropractic assistant fee, and plan to offer a “complimentary” membership to those C.A.s who wish to use their doctor’s memberships. This is frustrating to me, and I have begun a dialogue with other chiropractic assistants and even doctors and find that many feel as I do.  The ACA had just recently enlarged their chiropractic assistant’s resource area.

There are many chiropractic assistants who choose to be “career” C.A.s; that is, they may move from doctor to doctor at times, but stay within the profession.  There are others who feel that regardless of whom they work for, they want to have control over their professional memberships.  Is it right to have to rely on someone else for such an important resource? This could appear a bit discriminatory in nature as most C.A.s are female, while the majority of doctors are male. But I am sure that this was not the intent. There are C.A.s who work remotely often with more than one doctor, and so which doctor should provide her a membership? As I began to investigate I realized that there are many state chiropractic associations that have a similar structure. They, like the ACA, have great resources available for the C.A.s within their jurisdiction, but they limit the membership to doctors but allow their chiropractic assistants to use the benefits as an attached member. The disturbing part of this is that chiropractic assistants need to have the ability to obtain these resources on their own. Each C.A. needs to understand the rules and regulations of the profession independent of any doctor for whom they work. I am urging you all to do this. This is why I started this blog. Know your state’s rules and regulations so that you are compliant. Urge your doctor to be compliant with the rules and regulations of course, but most importantly, you do it! How can we be compliant if we are denied access to the resources? What if we are associated with a doctor whose dues lapse, or they decide they don’t want to join *that* association, or for some other reason are not a member. Simply put, we need to be able to have our own membership if they offer C.A. resources for anyone.

I have written a letter to the ACA, and have collected letters and signatures of support. My suggestion is to offer a standalone membership within any national or state organization that has chiropractic assistant benefits available. I proposed that the standalone membership fee be reasonable, but fair. We will not get referrals or have voting rights, but we will have the ability to use the resources, attend seminars and buy products at a reduced rate. I proposed something along the lines of a fee approximately ¼ of the doctor’s fees since our average salaries run at approximately ¼ that of the average doctor’s salaries.
I am still waiting to hear back from the ACA, and I have every confidence that they will in fact allow some form of standalone membership if they realize that we are serious about this. I am in the process of forming a committee of chiropractic assistants who are willing to work to see that chiropractic assistants get the benefits that we truly need with any organization that has C.A. resources available, at a fair price without the need to associate with a doctor. If you would like to help, whether to simply sign a letter of support, or in some other capacity, please contact me at practicalca@practicalpracticing.com and stay tuned to this site for more on this story.

And I will go one step further and urge all C.A.s to join and support your state and national associations where you have the opportunity. Stop by http://practicalpracticing.com/default_files/CAresources.htm as I will post an organization list that offers national benefits for chiropractic assistants. You can help by contacting your state’s association to verify the types of memberships that they offer, and I will add them to the list.

Thanks for all of the support! Please feel free to share your comments and thoughts on this story in the comments section.

Practically Yours,

the PracticalCA

“Can the doctor see me at 1:15 tomorrow?” “Sure!” So you have a patient scheduled in during the time that you are usually taking lunch. Why? “We scheduled her then because that was when she wanted to come in.” This is the answer that I usually get when I ask why they scheduled a patient during non-patient time. My next question is always: “who is in charge?” Learning to take control of your appointment book is the first step in managing the all important patient flow. Often when a practice is new, or in need of growing, the doctor is willing to see the patients when they are available, and there is little method to the scheduling procedures. This is not a practical way to run your practice.

Look at your appointment book; do you have staff meetings scheduled? What about marketing time? Do you have SCHEDULED paperwork time for both your staff and doctors? When a patient calls and asks “what are your hours” what do you answer? These are some critical points to consider when setting up your front office procedures. The practical way to handle your appointment book is to first establish the difference between office hours and patient hours, within your practice. While a practice may be open or “manned” from say, 8:00 a.m. to 6:00 p.m., this does not mean that you could or should see patients during any and all of those hours. For a practice to run effectively and for staff and doctor to properly handle all of the supportive tasks that come from running a practice properly you need to have clearly defined patient time, as well as time for all of the responsibilities that must be done. Scheduling is one of the most important systems in a chiropractic office! If you would like a step-by-step module for setting up your practice schedule, then click here: http://practicalpracticing.com/default_files/coursecatalog.htm