Kristi Hudson, Director of Special Projects
It won’t be long now. You’ll have a shiny new license that lets the world know that you are a Doctor of Chiropractic. Whether you plan to go into practice on your own or join an already-existing practice as an associate, there will be a multitude of complex state and federal regulatory guidelines that you’ll be expected to follow. SO, what should you be doing now to educate yourself on these guidelines to protect your license and your livelihood?
Compliance
The HIPAA Omnibus Rule hit the street just as we began to see significant surges in the number of federal audits. Private insurers quickly followed suit. The OIG has issued various statements over the past seven years putting documentation error rates ranging from 80 to 94%. Even if we go with the lower of the two figures, that still represents way too many practices who are at risk. You should begin working on your OIG and HIPAA Compliance manuals as soon as you start in practice. Before accepting a position at an existing practice, verify that they have taken the appropriate steps to adopt and maintain HIPAA and OIG compliance. Begin attending webinars and seminars now to familiarize yourself with the guidelines for HIPAA and OIG compliance.
Medicare
Did you know that opting out of Medicare is NOT 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. If you get out of step with Medicare’s requirements, you’re likely to be in hot water elsewhere and may not even know it. Getting started with Medicare is also an arduous task. Be sure to engage the help of a professional that has experience in processing and submitting Medicare applications for new providers. It will save you time and your sanity.
MIPS
In 2015, the Medicare Access and CHIP Reauthorization ACT (MACRA) was passed. This change encourages and incentivizes providers to provide high-quality care rather than more care. It also helped by consolidating three quality-based programs into one: Meaningful Use (MU), Physician Quality Reporting System (PQRS), and the Value-Based Modifier (VBM). The great news is that reporting these measures is significantly less cumbersome than MU and PQRS. MIPS is comprised of four categories that make up an overall performance score that is viewable online. As a new provider, you are exempt from participating in MIPS your first year in practice. This gives you additional time to learn as much as you can before you begin participating.
There are so many things to think about as you get closer to graduation. Remember that you will never have more time than you do right now to build your knowledge base to help you meet the rules and regulations of healthcare. If you would like a few more insights to the decisions you need to make and the pitfalls to avoid, download a copy of the article “5 Things Every Recent Graduate Should Know Before Joining or Starting a Practice.”
Kristi Hudson is the Director of Special Projects and Administrator of the ChiroHealthUSA Foxworth Family Scholarship. Since 2010, she has worked with state associations, COCSA, F4CP, and the CCGPP to provide educational awareness on changes within the profession. As of December 2016, ChiroHealthUSA has donated over $958,000 to support the chiropractic profession. To apply for the scholarship, go to chusascholar.com.
Why is the Discount Challenge prize amount $11,181? Because that is the average “per-occurrence” fine for Medicare inducements. That’s not $11,181 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.