Dr. R. A. Foxworth, FICC, MCS-P
February means Valentine’s Day, a time when a doctors’ thoughts turn to . . . documentation?
“I just love documentation,” said no chiropractor ever. Because that’s not why we went to chiropractic college, is it? Doctors are passionate about taking care of their patients, not pushing paperwork. And yet, at the end of the day, there’s likely a small mountain of it, physically or digitally, on your desk. It’s an unavoidable necessity of practicing in today’s healthcare environment. If we want to get paid, we have to submit paperwork; lots and lots of paperwork.
This disparity is even in our language. Most DCs describe what they own as a practice with the emphasis on what they do to help patients, not a business. And yet, it’s both. Doctors who don’t understand the business side of their practices can find themselves overwhelmed, overworked, and, at worst, in hot water with the federal government or private third-party insurers for not following all the many, many rules and regulations around documentation and how we bill and code our services.
As a ChiroHealthUSA provider, you’ve already minimized some of your risks by having a compliant financial policy using the Discount Medical Plan Model. But the Office of the Inspector General (OIG) has been clear and unwavering in its view of chiropractic documentation as generally poor, and it has charged the Centers for Medicare and Medicaid Services (CMS) with stepping up audits to ferret out the worst offenders. And with audits for documentation, there is also increased scrutiny of billing practices and you should be in good shape with this area. Just make sure your documentation is up to par as well.
One of the biggest pitfalls for chiropractors is that their documentation doesn’t support medical necessity. In fact, the OIG found that almost 50% of paid chiropractic claims, have, historically been for maintenance therapy (not covered by Medicare) masquerading as active via misuse of the AT modifier.
Here’s another place where being a ChiroHealthUSA provider puts you at a tremendous advantage. Thanks to your forethought, your Medicare patients can afford the maintenance and preventative care this age group truly needs and deserves without your having to miscode and twist your documentation into knots trying to figure out how to get Medicare to pay for it instead.
Where your ChiroHealthUSA provider status can’t protect you is from yourself. That means that if you even unknowingly engage in “red flag behavior” like overuse of the five-spine code 98942 (incidentally, the highest-paying code), records that appear to be “cloned,” up-coding, down-coding, or standing out in any way, you’re at a higher risk of audit. In fact, you may already be seeing increased records requests.
If you’re getting records requests, we urge you to reach out and get some support. If you don’t know who to call, we’ll be happy to make a referral. Our experts stand at the ready to help you mitigate documentation risk, address records requests, and even respond to an audit, should it come down to that.
Through our on-going webinar series, ChiroHealthUSA provides guidance in all areas of your practice, including marketing advice and support, regulatory and industry updates, staff training and scripting, documentation risks, compliance, and so much more. And be sure to check out our information-packed short videos on a variety of subjects critical to the health of your practice at chirohealthusa.com/know and chirohealthusa.com/grow.
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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.