Overwhelmed by Obamacare

Dr. R. A. Foxworth, FICC, MCS-P

President Obama and his administration celebrated the 5th anniversary of the Affordable Care Act (aka Obamacare) in late March. Whether you believe it’s been a good thing or a bad thing, it remains, unless Republicans can overturn it as they continue to threaten, a current fact of our professional lives. Good or bad, one thing you can be sure of: when the government steps up its presence in healthcare, the prosperity and even survival of your practice can depend on making sure you’re following all the rules.

And oh, my goodness, there are so many, many rules! If you are like most, it’s easy to get overwhelmed when trying to keep up. You took a great step when you joined ChiroHealthUSA, because you simplified your fee schedule and created opportunities to offer your patients legal and compliant discounts. What else could and should you be doing to protect yourself and your practice?

• Medicare
  I sure hope you know by now that opting out of Medicare isn’t an option. You can, however, choose to participate (par) or not (non-par). Make sure you’ve made a conscious choice here and that you understand your status and what it entails. Medicare is related to Obamacare for the simple reason that Medicare, historically, guides all third-party payers and thus our country’s universal health care model. If you’re out of step with Medicare’s requirements, you’re likely in hot water elsewhere and may not even know it.
• Compliance
  HIPAA Omnibus hit the street just as we began seeing significant surges in the number of federal audits. And private insurers quickly followed suit. The OIG has issued various statements over the past five years putting documentation error rates at anywhere from 80% to 94%. But even if we go with the lower of the two figures, that still represents way, way too many practices who are at risk. If you don’t have OIG and HIPAA Compliance manuals installed in your practice and procedures in place to actually use them, you’re vulnerable. It doesn’t matter whether you make mistakes out of ignorance or malice. The recoupments can be devastating either way.
• ICD-10
  Although not directly related to Obamacare, your preparation, or lack of it, is another area that puts you at potential risk with the federal government and other auditors. Unlike 2014, it’s clear by now that we’re not going to get a reprieve. ICD-10 is coming, and at this point, five months out, it’s coming more or less like a freight train. It takes awareness, commitment, and effort to get your practice fully prepared, but the good news is, it’s probably not as hard as you think. This doesn’t mean, however, that you should procrastinate. At this point, you should already know which codes will be the ones you’ll most commonly use, your vendors’ changes to accommodate these longer, more specific codes, and have an ICD-10 “cheat sheet” of sorts in place with the codes you’ll use most. I have suggested to our staff doctors that we should start adding an ICD-10 sheet to our files, and start practicing picking the right codes and review them at the end of the week with each other to make sure they are spot-on. October 1st should not be the first time we’ve looked up the new codes. Just an idea for you to consider. Figure out what works best for you and starting practicing early, then on October first, do away with the 9’s and in with the 10s!

Anything above make you gulp? No worries. As a ChiroHealthUSA provider, you have access to some of the best and brightest minds in the business through our on-going webinar series. They can advise you on how to make sure your Medicare, documentation, compliance and ICD-10 prep are all up-to-date and risk-free. Be sure and join us for our on-going weekly webinar series’ to stay up to date on the latest issues facing our profession, as well ideas for a more profitable practice in 2015!