by Ray Foxworth, D.C., FICC •
President & Founder, ChiroHealthUSA •
Audits are an unpleasant fact of practice life, even for the most diligent chiropractic teams. A simple error or oversight can lead to heavy fines and penalties which could seriously impact your business. In addition, any claims your practice submits are subject to intense prepayment review or post-payment audit.
Guarding yourself involves ensuring best practices and seeing things from the opposite point of view. Here are some tips that can make a big difference.
Know How Auditors Operate.
The Office of Inspector General (OIG) published a handy portfolio on why and how past chiropractic audits were carried out and clarified the definition of fraud, waste, and abuse in chiropractic clinics. As a result, they claim billions in unnecessary Medicare payments have been made over the years, with insufficient or absent documentation being of prime concern to the OIG.
Using this document is your way of seeing inside the audit process and knowing which practice areas are scrutinized. You’ll then be better equipped to ensure that your documentation makes the grade. You can also review the Medicare Program Integrity Manual for more insight into how auditors work.
Review Key Qualifiers.
Every claim should clear internal quality checks before submission. Be sure the service you provided to the patient:
- was medically necessary.
- was meticulously dated at every visit- from initial treatment onwards.
- has accurate patient identifier information.
- was coded correctly in terms of diagnosis, evaluation, and management, and modifiers did not violate any regulations or statutes.
- met all coverage rules.
- was correctly and accurately billed for the service provided.
Use Chiropractic Software.
The right computer program can catch errors that are the result of human error. In addition, there is a plethora of available software that practices can use to streamline their documentation and reduce audit risks across the board.
Many of these solutions are cloud-based, which is a great advantage. It means you’re always running the most up-to-date software to help keep your compliance current and that your valuable documentation data is being continuously backed up off-site.
ChiroHealthUSA Has Your Back Against Auditors.
ChiroHealthUSA is proud to offer CHUSAdefense and ChiroArmor, both of which are designed to help you keep your practice compliant and handle the fallout from mistakes.
CHUSAdefense provides up to $1 million in coverage as protection against defense costs, fines, and penalties, while all three options of services from ChiroArmor offer practices a documentation audit package. This means teams of all sizes and budgets can reduce their risk.
You can also access our free, on-demand webinar archive to hear more audit advice. In addition, you’ll gain insider tips on how to avoid being one of the 37 – 50% of chiropractors who still run their offices with non-compliant documentation.
We’re here to protect your interests, so you can continue to provide compassionate, compliant care. If you want to learn more about Medicare documentation made easy, request your free copy of the Medicare Playbook here!
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Why is the Discount Challenge prize amount $15,024? Because that is the average “per-occurrence” fine for Medicare inducements. That’s not $15,024 per patient, that’s not per provider, that’s PER VISIT. Stinks, doesn’t it? To us, the prize amount is worth the investment if we can help our profession better understand proper discounting.