Surprise! The Office of the Inspector General (OIG), made recent headlines by jumping up and down and warning that chiropractic documentation is so poor they’re recommending CMS turn up the heat. That means more intense scrutiny, more records requests, more audits, and perhaps by 2017, proposed prior authorization review for doctors with high documentation error rates.
If this feels like same old-same old, don’t be lulled into a false sense of security. The OIG has been saying all of this for years, but they’ve also been following through. Records requests and audits are up- way, way up. It’s no longer a question of if you’ll get audited, but when.
What puts you most at risk? The OIG says:
- Coding patterns of any kind, but especially a predominance of high-paying five-spinal-region codes. Full-spine adjusters may feel this is warranted, but we can promise you that CMS doesn’t agree.
- Too many visits comprising one episode of care. CMS wants to see a clear beginning, middle, and end of care, and they want that care to wind up in fewer than 12 visits in many cases. Some doctors spread this over as many as 25 visits, red-flagging both computer monitors and auditors.
- Maintenance or wellness care masquerading as active treatment. Slapping the AT modifier on a code doesn’t automatically mean you’ve documented medical necessity. If your patient doesn’t have an acute or chronic condition that can be improved by chiropractic treatment and proven by increased functionality, you’re in muddy waters.
- Sloppy documentation: incomplete notes, no initial treatment date, no signature from the doctor, etc.
With all of these compliance concerns to worry about, there is a great way to avoid the scrutiny that comes with improperly discounting your patient care. Its bad enough to trigger an audit, but you don’t want that audit to turn into a bigger problem by them noticing you’ve been waiving deductibles or copays, or giving away free services, such as therapy or rehab. ChiroHealthUSA is a Network that works in conjunction with a Discount Medical Plan Organization (DMPO). Doctors who become ChiroHealthUSA providers can offer legal discounts to uninsured, under-insured, and partially insured patients, making it easy for Medicare patients to afford clinically appropriate, if medically unnecessary, care, and cleaning up your documentation fudging. There is no cost to chiropractic practices to join with an affordable $49 fee per family per year, which is easily recovered in the first patient visit. We have a collection of several short videos that will help you learn more about both remaining compliant AND growing your practice using ChiroHealthUSA.
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