Medicare Publishes Chiropractic Assessment Findings on the first Quarter
The other day, the Medicare service provider (Palmetto GBA) issued the company’s first Quarter findings regarding Medical Reviews they’ve recently been performing. Although Palmetto is just one of many companies that administer claims for Medicare, their results happen to be highly relevant to doctors of chiropractic as well as, in my own past experiences, reflective of tendencies throughout the chiropractic profession.
The intention of the evaluation process is to decrease payment errors as a result of finding and correcting documentation and billing errors regarding insurance policy coverage and also coding. During the assessments, Palmetto GBA discovered 10 areas of concern for the first quarter of 2010. The top areas of concern from 1-10:
1. Split/shared visits
2. Signatures
3. Labels/Diagnostic Testing
4. Hospital & Nursing Facility Discharge Services
5. Chiropractic Services
6. Therapy Services
7. Individual Psychotherapy Services
8. Evaluation & Management Services
9. Legibility
10. Teaching Physician Services.
Please be aware that this isn’t an all-inclusive list although it does indicate most documentation concerns uncovered throughout the evaluation process. On this shortlist, three things happen to be relevant to chiropractic reimbursements in the Medicare program.
Which means that we’ll go over the 3 “Frequently committed errors”:
1. Signatures. To explain, Medicare demands an “identifier” for services provided or ordered. This identifier is your signature – either in handwritten or electronic form. Signature rubber stamps as part of your documentation aren’t acceptable per Medicare Signaure Requirements (See section 3.4.1.1 B) Really, this really is so fundamental that it’s absurd that it actually makes the top 10. Evidently, in spite of its straightforwardness, most doctors apparently forget about it.
1. Chiropractic Services. Being a comparatively minuscule profession as a percentage of total Medicare claims, we should not actually make the top 10 hit list. But we did, which means that now it’s our responsibility to fix these types of issues as soon as possible as a profession. Palmetto commonly found chiropractic documentation to be inadequate with regard to Treatment Plans. They reported that chiropractors were missing treatment plans with specific objective, and measurable treatment goals. Follow thru with these specific objective treatment goals on subsequent visits was regularily omitted. Complicated? Not really. Documented? Evidently, not so often. Are you able to correct this, doctor? Absolutely!
1. Legibility. If this sounds the biggest commercial for EMR, It should! Once again, there isn’t any legitimate reason a chiropractor should get dinged for this one. Unfortunately, I’ve looked at plenty of your notes and I regrettably concur, that they’re rarely legible, oftentimes just to the highly trained eye (your own and the eyes of your longstanding office staff) – not to mention that sometimes, even you are unable to understand your personal records. To put it differently, if your current patient treatment records can’t be quickly read and understood by a third-party then it is now the time to get an EMR (Electronic Medical Record) System that you WILL USE!
There are many effective programs on the market. The truth is, ANY program that generates legible records provides great improvements over marginal handwriting. FYI, I haven’t yet experienced an EMR program which does not generate legible documentation!
As a profession, chiropractors will need to get our act together right away, not just for Medicare, but also for every third party payer. The items previously mentioned are certainly not hard to correct, yet I understand that most of you happen to be overcome by the amount of work you need to do to bring your current documentation, billing and coding up to satisfactory requirements. Other individuals could possibly be so consumed with building your practice that you honestly do not have time to take a look upwards to see the arrow crusing straight at the bullseye on your chest. And some of you are simply sick and tired of putting out the fires in all these areas because of insufficient reliable methods that equally increase your reimbursements while minimizing your audit risk.
Fortunately help can be found. Check out www.touchnotes.com or www.chiroconceptions.com for QuickSOAP Notes or call me at 301-777-3710
