Chiropractic Billing, Coding, Documentation Blog

The Final Word on Chiropractic EHR Stimulus Dollars (For Now)

by Tom Necela on July 27th, 2010 in Business, Documentation, EHR / EMR, chiropractic EHR, chiropractic EMR, chiropractic documentation, compliance

Reading time: 3 – 4 minutes

The recent release (July 16, 2010) of the “Final Rule” regarding Meaningful Use criteria and EHR (Electronic Health Records) Financial Incentives has certainly prompted lots of questions from many chiropractors about how to obtain stimulus dollars for their EHR / EMR systems and what they need to do to qualify.

Below is a summary of some key points regarding EHR eligibility for those of you who don’t care to read the original documents or fact sheets on Meaningful Use and EHR Financial Incentives in their entirety:

Meaningful Use Criteria which establish eligibility for financial incentives are for EHR Certified programs only. Translation: if your EHR is not certified, you may not receive any financial stimulus. Many EHR companies are advertising that they are “eligible” for certification, although this is not the same as being certified. Buyer beware!

You know only need to complete 20 of the 25 Meaningful Use Objectives/Measures as defined in the Final Rule issued by CMS. Even though you may “defer” 5 of these requirements, this is still an ambitious list for most practitioners in order to qualify for the funds. (See my previous blog post “The 25 Meaningful Use Criteria for Chiropractic EMR Systems” for a full list of criteria)

The completion of these Objectives/Measures fulfills Stage 1 requirements only (which make you eligible for the financial incentive portion). Stage 2 and Stage 3 objectives exist, but the exact requirements and penalties are not as well defined.

Chiropractors are Eligible Professionals that may qualify for the EHR financial incentives

Chiropractors may be eligible for EHR financial incentive payments as early as 2011; payments can proceed for up to 5 years.

The total financial payments that chiropractors are eligible to receive is a maximum of $44,000 over a 5 year period or equal to 75% of Medicare allowable charges for covered professional services furnished by the chiropractor in an eligible year. This is perhaps the biggest criteria EHR companies fail to mention. In other words, in one given year, you can receive up to $18,000 IF (and only if) you provide at least $24,000 worth of covered services (based on allowable charges) to Medicare patients. On the other hand, if you have a small Medicare practice, your eligible financial incentives will be reduced accordingly and capped at 75% of the allowable charges for your covered services (which, in chiropractic, is CMT only). Do the math to see if your practice qualifies for anywhere near the $44K amount.

The Bottom Line

My final opinion is not changed by the “final rule” criteria. I would highly recommend that most offices switch to some form of electronic health records. However, this advice is NOT based on the presumption that you are doing so to capture any potential financial stimulus incentives. Rather, migrate to EHR because of its potential to improve your documentation, level of care and overall recordkeeping.

Random Thoughts Episode #136: Chiropractic Audits, Business Building & Success

by Tom Necela on July 20th, 2010 in Audits, Billing, Business, Chiropractic Audits, Coding, Collections, Documentation, Medicare, chiropractic billing, chiropractic business, chiropractic coding, chiropractic collections, chiropractic documentation, compliance

Reading time: 5 – 8 minutes

I’m on the road for the next couple weeks traveling for a number of on-site consultations with clients so this blog post will be a summary of random thoughts on the most common questions that repeatedly brought to my e-mail inbox.

1) Chiropractic Audits: a few months ago I received a lovely piece of hate mail to accuse me of trying to disproportionately scare well intentioned, upstanding chiropractors in regards to the possibility of an audit. My latest “tweet” included a post to the most recent findings from Medicare reviews for the states of Nevada and Hawaii. In those two states, chiropractic documentation failed to meet requirements 60 to 70% of the time. Similar posts from other review results in the past were even higher than that and OIG reports even higher still.

I might not be the greatest mathematician, but it seems to me that the majority of chiropractors are not scared enough! If 60%+ of chiropractic documentation is substandard, that means most of you are in trouble or headed down the wrong road. It’s not a great picture for me either. There are roughly 50,000 chiropractors in the United States, so that it would be physically impossible for me to help roughly 30,000 of you get your documentation in order, teach you proper billing and coding, or come to your assistance in the case of an audit. I wish that I would live long enough to be able to help, but with those numbers, some of you are just going to have to suffer the consequences.

For those of you who think slightly more highly of me or take the potential of audits more seriously, now is the time to take action. It is obvious to all that audits are a big business for not only cash-starved government entities like Medicare, but also for insurance companies looking to expand profits by taking your money back. The audit numbers and amounts recovered in post-payment demands are so large that they are virtually beyond comprehension for the average chiropractor.

Since I don’t know most of you personally nor do I care to manipulate the facts to scare you, let me just share a few recent scenarios that came by my desk.

Chiropractic Audit case #1: Medicare audit, six patient, 94% error rate determined; post-payment demands made for 18 months (legal limit for that state). Total bill amounts to only a little over $2000. Big pain in the patootie is that this doc failed a previous audit and now has to submit all claims for “pre-payment review” which means that Medicare doesn’t pay him a dime until they receive and approve all notes and every treatment.

Chiropractic Audit case #2: Auto insurance carrier, handful of patients who were treated for the last 3 yrs on claim (bad state, no limitations statute). Total repayment demand is approx $56,000. Legal expenses totalled $8000 so far. Doctor may also face civil fines.

Chiropractic Audit case #3: Commercial insurance. Re-payment demands made by insurance company after extrapolation (process of configuring an error rate to apply across the board). Demand total was close to $95,000. Insurance in error on reviews in some instances and doctor’s repayment will be significantly less, but she will still have to re-pay. Doctor will likely be kicked off insurance provider list as well. Legal fees approximately $17,000.

Maybe this is all chump change to you and you have a life of leisure that can afford the time and hassle it takes to wrestle with the insurance companies, hire attorneys and formulate your audit defense. The rest of you, take note.

2) Business Building: Don’t chase your customers or patients. Find out where they are going and get yourself or your information in front of them. This simple advice (not mine but I can’t remember who I heard it from) is full of wisdom and potential applications. For example, people who are sick or hurting often go to the medical doctor. How can you get the MD to route them toward your office? Most people work. Which of your patients has a position in human resources or is the owner of a small business with a fair number of employees? Rather than try to come up with some fancy high-powered presentation that you will likely work on for the next four years until you’ve whittled it to perfection, why don’t you just approach people who already know and trust you as patients and see if they can help you make inroads into their company? People surf the Internet. First off, that means you need to have a website too. While the chances of catching random visitors that become patients are slim, but you can stack the deck and give them a reason to come to your site by writing articles, posting videos, and providing other informative content for your community.

Obviously if you are busy enough, you may not need to employ any or even all of these strategies. But for the rest of you, instead of spending time surfing the net do something tangible to improve your web presence. Rather than whining that referrals are down, take a concrete step towards leveraging your patient relationships to increase your referrals on your patience. Instead of sitting in your office hoping patients will come to you, reach out to where they are and bring them in.

3) Success. Keep in mind that your business should be there to serve you and not vice versa. I’ve run into too many chiropractors whose primary purpose seems to be providing jobs for their employees. Worse, I’ve seen too more “successful” chiropractors whose drive to succeed left their spouses, children, health and sanity by the side of the road. A few fortunate ones can come back and retrieve it. But for many once these items are lost, they are gone forever. Take a day off and go play while the weather is nice. Spend the afternoon with your children, the evening with your spouse. Your bank account may not look immediately better for it, but in the long run it is cheaper to stay married, stay healthy, stay sane and not have to pay for years of therapy for your screwed up kids!

As for me, I intend to practice what I preach both working and playing. If you have an Audit or business issue to discuss, feel free to drop me an email. That’s the beauty of the internet, it can be checked anywhere. On the other hand, if you see a bald man not acting his age on a wakeboard at a lake near you, it just might be me

Selling Chiropractic Products and Billing Insurance

by Tom Necela on July 13th, 2010 in Billing, Coding, Collections, chiropractic billing, chiropractic coding, chiropractic collections, chiropractic practice management

Reading time: 2 – 4 minutes

Many chiropractors have realized the benefits of offering products for sale to our patients. Whether it’s the convenience factor for the patient, our ability to control quality or brand use, or the fact that we want to be able to help our patient’s outcomes, products make sense.

Unfortunately, some chiropractors have a difficulty in making the sale of products make financial sense.

Worse, if you are the type of DC to stock your office with every “hot” new product that catches your fancy, only to quickly lose interest in it a few weeks later, product inventory and sales can become a financial drain on your profitability.

Furthermore, some chiropractors to fail to tap into the full potential of product sales, particularly those that fall into the category of Durable Medical Equipment (DME).

While most insurance companies do not provide coverage for patients to purchase nutritional supplies, analgesic gels and other OTC topicals, many insurance companies do reimburse DME. In other words, that cervical pillow or that lumbar back brace you just sold your patient may have been covered by their insurance benefits, if you correctly billed for this supply.

If this is old news to you, that’s a good thing! If not, you should begin checking out your patient’s DME benefits when verifying their coverage to see if their insurance covers such items. A quick glance through ChiroCode or other coding resources will give you some common HCPCS codes used for such supplies. Note: the bed of nails is not a recommended supply or product and does not have a HCPCS code

Finally, some of you who have been doing this a while may have noticed an “extra” hoop lately that insurance companies are requiring before processing payment. In other words, your claims may be rejected or delayed due to missing modifiers in connecting with your billed HCPCS code.

If this happens to you, the three basic modifiers most insurance companies are looking for are as follows:

RR Rental
NU Purchase of new equipment
UE Purchase of used equipment

In most cases, chiropractors will sell their patients a new product, in which the appropriate modifier attached to that product’s HCPCS code would be –NU. But, if you rent or sell used equipment, you should report the –RR or –UE modifiers, respectively.

From the email inquiries I have been getting about how to get paid for DME, this should clear up the basic problems I see many chiropractors facing. If you want the “advanced” course, you will have to check out one of my seminars this fall – the new schedule and full details are coming soon!

Still Free? The Word on Co-pays, Coupons & Discounts

by Tom Necela on July 6th, 2010 in Audits, Billing, Business, Chiropractic Audits, Collections, Medicare, chiropractic billing, chiropractic business, chiropractic collections, compliance

Reading time: 1 – 2 minutes

Last year, I posted an article on co-pays, coupons, and discounts – essentially what to do and what not to do.

This subject remains one of the most popular questions I still get asked.

As we recently have celebrated the freedom of the USA with Independence Day, I thought it fitting to re-visit the “freedoms” (or lack thereof) that we are challenged with inside our chiropractic practices.

Unfortunately, when freedoms are abused, trouble sets in. Keep your nose clean and re-visit the post

Chiropractic Co-Pays, Coupons and Discounts – When Free Isn’t

(click the link above to see the post)

2010 Health Insurance Report Cards

by Tom Necela on June 29th, 2010 in Billing, Business, chiropractic billing, chiropractic business

Reading time: 4 – 6 minutes

The results of the annual Health Insurance Report Card are in and, as usual, the AMA’s yearly check-up on health insurance companies and their claims processing trends is not pretty.

Although the data generated from these Report Cards is derived from MD practices, the big picture perspective is one that is still relevant for us to view as chiropractors. Here are a few interesting tidbits from this year’s Report Cards:

1 out of 5 claims are processed incorrectly by health insurance companies
More than $777 million in unnecessary administrative costs could be saved if health insurers could improve claims processing accuracy by just 1%
Increasing claims processing accuracy to 100% would save US healthcare costs up to $15.5 billion annually
Physicians spend as much as 14% of their revenue to ensure they receive proper payments from insurers

What to Do Next

While the size and magnitude of these numbers are startling, I have yet to speak where seminar attendees were surprised by such revelations. However, what I do commonly see is a sort of “analysis paralysis” where DC’s feel there is nothing they can do about such things.

While the parallel to the Biblical account of David and Goliath may be an accurate representation of the battle scenario, the end result is also possible: David won and so can the rest of us “little guys.” Apart from getting on your knees in prayer and appealing to the man upstairs (not a bad idea given the current sad state of the healthcare marketplace), here are three quick tangible actions to take in light of the recent report card results:

1. Pay Attention! If 1 in 5 claims are processed incorrectly, odds are that yours will be among them sooner or later. In the absence of a unified effort against a particular insurance company, you need to track your reimbursements to ensure that you are being correctly paid. This involves a working knowledge of fee schedules, accurate balance posting, and an eye for detail on the part of whoever is doing your billing. Without this, you will allow insurance companies to slowly extract the profits from your pockets to theirs.

2. Do the Math on ROI Externally: Let’s face it. Not all insurance companies are worth the time or effort give the number of hoops they require you to jump through and/or their pitiful fee schedules. Sometimes, you just have to do the hard math and give them the boot. But do it by the numbers and not by emotions. If you haven’t read my article on “The Annual Payor Survey or How to Drop an Insurance Company” – read the report cards and then consider it for any big “offenders” who are stealing the life and profits from your practice.

3. Demand ROI Internally: Knowing that the average doc spends 14% of revenues trying to bring in the money, as a business owner you should be acutely aware of where your billing service/department stands as a revenue generator. In other words, don’t assume they are doing a good job, but track their performance and hold them accountable so that you can mitigate losses the insurance companies are trying to force feed you. For more specific details on the how, when and whys, see How to Oversee Your Chiropractic Billing Service or Staff.

Those of you who can’t quite figure out the mess you are in, suspect you are leaving too much money on the table, or know that some directed effort in this area would produce tangible returns in your practice may wish to complete a no-obligation Practice Analysis Questionnaire and get an objective opinion on what’s going on in your business. There’s no obligation and no cost, but great potential to gain from realizing potential strategies for improvement.

Chiropractic Medicare Mess Sort of Fixed (For Now)

by Tom Necela on June 22nd, 2010 in Billing, Medicare, chiropractic billing

Reading time: 3 – 4 minutes

Three important details emerge as the bottom line from the recently passed legislation:

The 21% Proposed Fee Cuts are Delayed Until November 2010
Medicare Claims will begin processing with a 2.2% fee increase from June 1 to November 30, 2010
The House will vote on the finalization of this increase on 6/22/2010

Obviously, this creates some logistical mess in the present and to anticipate in the future regarding exactly what fees one should anticipate being paid. To access your fee schedule directly, you should go to your Medicare carrier’s website because that is who will ultimately be responsible for processing your claims. The American Chiropractic Association also has a helpful page with some Q&A’s and additional Resources on this subject matter.

Personally, I am sure I am not alone in saying that I can’t wait for all this mess to be over and done with. The volume of email confusion hitting my inbox is astounding and, although I certainly can see the importance of dedicating space and time in this blog to the subject matter, I’d love to move on!

With that, I am going to encourage all my readers to sign up with Twitter and “follow me” so that I may continue to keep you informed of news related and important items such as this. And so we can use the blog for a format of discussing other topics of your interest apart from the latest rules and regulations thrust upon us by Medicare or other entities.

If you are not familiar with Twitter, you are obviously one of the few citizens who are not following the every move of Ashton Kutcher or Brittany Spears (and this is a good thing).

Twitter is a online “micro-blogging” site that allows users to contribute short (limited to 140 characters) messages to each other. It’s great for exchanging newsworthy items, reminders and has a host of potential business related applications. It’s also famous for being used (mis-used?) as a sort of online diary by which a person can literally blog about one’s every move, meal or madness.

For our purposes, I use Twitter exclusively to keep chiropractors updated on the latest newsworthy occurrences, regulatory changes and other pertinent info that you need to know. I typically give links to the stories or sources where you can find the needed info. And the best part is, it’s FREE and if you aren’t interested in the days topic, there’s nothing to do or delete. Since it doesn’t get emailed to your inbox, you are not overwhelmed with…um.. stuff you don’t need. Just check your Twitter account on your own time and it doesn’t cost you a dime!

So, sign up and “follow me” today so we can keep you informed of these items and so we can continue to use blog space to dedicate towards the other topics of your interest!

The Medicare Mess Continues to Affect Chiropractic

by Tom Necela on June 15th, 2010 in Business, Medicare, chiropractic business

Reading time: 6 – 9 minutes

In case you were really hankering for some bad news from Medicare, here’s a couple gems that hit directly at the chiropractic profession.

Perhaps you have been following the trail of the Medicare fee increase or maybe you have better things to do in between adjustments than watch a complete demonstration of Medicare insanity. Either way, you will be pleased to know that:

“in anticipation of the vote to increase Medicare fees in 2010 by 2.2% and in 2011 by 1% which was in response to the previous defeat of the bill to decrease Medicare fee schedule by 21%, Medicare has reported that they will continue to hold claims through Thursday June 17th. If Congress has not taken final action by Friday June 18th, claims will be paid with the 21% fee decrease applied.”

And if you can read that quote, you probably either have a law degree or spend too much time reading plot-twisting Tom Clancy novels not actually written by Tom Clancy!

To summarize: Medicare may not quite know what it’s doing with the fee schedule fiasco yet and they plan to hold your claims until June 17, 2010 — in other words, not pay you anything. After that point, they may pay based on the 21% fee decrease, IF no further action is taken….

Not surprisingly, I have received many emails full of confusion and conflict over this issue from chiropractors around the country. I have been repeatedly informed of carriers who have already been processing claims with a small fee decrease since January 1 – not the proposed 21% decrease, nor the 0% “interim” fee increase from the 2009 fee schedule that is supposed to be in effect until Medicare gets its act together and a resolution has been obtained. Others have written in to state that Medicare has been paying exactly as expected. Still other more valiant chiropractic efforts have been reported by offices who have attempted to call their Medicare carrier and ask for an explanation of why, when and how they are to be paid. The responses have ranged from ridiculous to right on the money.

(Interesting side note: I even have a couple Medicare carriers following ME on my Twitter page. Isn’t that supposed to be the other way around?! Perhaps just everyone is desperate for info on the subject matter, even Mr. Medicare himself.)

Obviously, there is still a lot of confusion over the details of the proposed Medicare fee schedules (from both the payers and the providers) and a lot of anger. Witness the recent move by the MD’s represented by the AMA who turned in their lab coats as a sign of protest over Medicare’s move.

One thing emerges as a clear action step: DC’s really need to watch reimbursements to determine exactly how you are being paid. Then compare that to how you should be paid. Hopefully they match. If not, my suspicion is that Medicare will be getting more calls and appeals than usual this year.

More Medicare Mess

In other news, Medicare carrier Palmetto GBA released its Medical Review findings for the 2^nd Quarter (yes, I know for most of the world, the 2^nd quarter hasn’t finished yet – see they’re not behind on EVERYTHING!).

While these findings are specific to this carrier, I believe that they are indicative of challenges the chiropractic profession faces at large, so I will report them here. Of the 12 items listed that reflect “the majority of documentation issues discovered during the review process” there are four that affect chiropractic in general, and one is specific to chiropractic services exclusively.

Here are the common errors (with my comments in italics below) that were found so that you can be sure to avoid them in your own practice, as I am certain your carrier is finding similar problems:

Signatures: Documentation missing signature authentication by the author of the electronic medical record or contains an illegible signature.

(This is an easy mistake to fix and too simple to get nailed on. See Medicare signature requirements so you don’t kick yourself for getting claim denials over your signature.)

Evaluation and Management Services: Services do not meet the minimum documentation requirements.

? Specific concerns:

Use of ‘noncontributory’
Documenting ‘labs reviewed’ without further information
Referred to documentation that was not included with medical review request
Ancillary staff or scribe documentation requirements were not met, and
Counseling/coordination of care missing time and/or documentation to support service

(While Medicare doesn’t pay DC’s for E/M codes, other insurance companies do. From my experience looking at chiropractor’s documentation, many of the errors above are routinely made on many regular insurance claims.)

Legibility: We accept transcribed notes in addition to copies of originals.

(In other words, if you are not on EMR and your handwriting is pitiful enough that it cannot be read by the average person with no special eyesight abilities, use a transcription service to type up your chicken scratch so at least someone can read them.)

No response to request for medical records: Often times this is because a provider failed to update his/her address/phone number; therefore we are unable to locate the provider. Please keep in mind it is the provider’s responsibility to notify Palmetto GBA within 90 days of any changes that occur. Please follow all instructions provided on any letter requesting documentation.

(These instructions are for Palmetto, but most – if not all – carriers have a similar policy. From experience, I can tell you that nearly every DC that has ever moved a practice incurs a lag time before Medicare catches up. In the past, this was just inconvenient. Presently, if you happen to receive a negative determination or payment demand and fail to respond – due to the fact that you moved or for ANY reason – you need to respond PROMPTLY or you will pay the price…literally.)

Chiropractic Services: Missing treatment plan with specific objective, measurable treatment goals. Follow thru with these specific objective treatment goals on subsequent visits is often omitted. The initial visit and subsequent visit often was missing key elements/requirements outlined in the Internet-Only Manual Medicare Claims Processing Manual 100-04, Chapter 12, section 220. Reminder: Subluxation may be established by either an x-ray or hands-on examination (P.A.R.T.)

(In other determination and reviews I have seen, the terminology “missing” is actually different than “incomplete.” While that may sound obvious to you, consider what this carrier is saying: DC’s are not including ANY treatment plan as a part of their notes. It’s not inadequate, incomplete or subpar – it’s just not there!! Obviously, if there is no treatment plan, there will be no measurable treatment goals. Heck no goals at all!)

See you next week – where hopefully there won’t be more bad Medicare news to report!

Tom Necela, DC, CPC, CPMA

3 Quick Tips for Slow Times in Chiropractic

by Tom Necela on June 7th, 2010 in Billing, Business, Collections, chiropractic billing, chiropractic business, chiropractic collections, chiropractic practice management

Reading time: 4 – 7 minutes

knock out

(Reading Time = 5 mins)

Today’s blog post will give you three quick strategies to fix slow times…fast!!

We Can’t Help You

Recently a chiropractor contacted me to ask for help with getting his practice to be more profitable. He loved my tagline “work smarter, not harder” and wished to move his business in that direction. Without being able to point a finger on a particular problem, he stated that he felt he was working harder than ever and seeing less in the way of financial rewards and personal satisfaction.

The chiropractor submitted a Practice Analysis Questionnaire and took me up on my offer to conduct a FREE, no obligation review of his practice.

I called the doctor at our scheduled time in the morning and was immediately put on hold, during which another call came in that the receptionist needed to take. (It wasn’t a “Would you mind holding for just a minute?” either – it was a “HOLD!” and then nothing!) After several long minutes on hold, our call was disconnected.

I called again a few minutes later and was put on hold…again…for nearly 10 minutes before I hung up in frustration. Out of curiosity, I dialed the doctor again later in the day and got a recorded message saying they were out to lunch.

In addition to a myriad of billing blunders, coding issues and a sizable A/R that could sink a small town, guess what this office also listed as one of their chief challenges? Getting new patients! Sure – there are hundreds of ways to get potential new patients to call your office. And none of them will work if no one is answering the phone properly. Often the first step to working smarter is to make sure what you are doing is working at all!

What if…
Let’s go the other route and throw out a question…

What if you woke up tomorrow morning and there were absolutely NO NEW PATIENTS available anywhere in the world for chiropractors. That’s right, no matter what you did, you could NEVER get another new patient into your chiropractic practice. So the deal would be… for the life of your practice, you only had your existing patients. What would you do differently?

This question is not only a great topic for a team meeting, it may also provide you with some interesting thoughts and observations towards developing variable income streams for your practice. There’s no “right” answer here – but a lot of potentially good ones!

The Collections Knock Out

Many of you have heard me rant about the futility of sending an endless round of statements to your patients in an attempt to collect past due balances. While the alternative of sending everyone to a collections agency is not exactly a viable solution either, we’ve been “beta-testing” a solution for the past several years that has proven to be a winner. It is a “statement of delinquency” form that was developed to get slow paying patients to pay. I will admit that I was initially suspicious of its simplicity. But thousands of “beta-testing” trials later have proven one fact: simple works! In fact, several chiropractic clients using them has found that they work particularly well even in stalled economies such as the one we are in now.

The Delinquency Statements are very simple and inexpensive to produce. Here’s the
“recipe” if you’d like to make your own: include a big fat heading reading “Statement of Delinquency” that catches anyone’s attention. Then include the name of the responsible party, services rendered and, of course, the amount due. Finally, be sure to add a couple lines that mention what you will do if the balance is not paid and how the delinquency will be cancelled if payment is received in 10 days.

(For those of you who may not wish to “re-invent the wheel” you can purchase the exact template and instructions for printing and use as part of the Collections Knock Out package – and once you have purchased the template, you can reproduce as many as you like…forever!)

While this represents a definite direct hit to your escalating A/R, coupling the Delinquency Statements with an Auto-Debit Strategy in which you offer patients the ability to pay their balance over time helps you increase your ability to capture an enviable percentage of your delinquent accounts.

In fact, several clients utilizing our Collections Knock Out strategy have remarked that this one-two punch has resulted in better collections performance than their collection calls and collections agencies combined. And the best part – you can do it yourself at a fraction of the price!!

To Your Success — and may it be quick!!

Tom Necela, DC, CPC, CPMA

National Legislative Changes (or Non-Changes) Affecting Chiropractors

by Tom Necela on June 1st, 2010 in Business, Collections, Medicare, chiropractic business, compliance

Reading time: 2 – 4 minutes

Changes_next_exit

In case you haven’t heard, two recent legislative changes have been passed that will affect you as a chiropractor:

Because these changes (or non-changes) happen quickly, I typically alert chiropractors of these via my Twitter page. But for a change of pace and because I know 14, 238 of you reading this are NOT following me on Twitter I thought it might be useful here as well.

(BTW: If you are on Twitter, no worries. I won’t send you tweets about what a great lunch I am eating or give you my reaction to the latest celebrity gossip in 140 characters or less. If you are not on Twitter, it’s a quick way to stay updated on changes in chiropractic that you need to know. Plus, as a special bonus, you can re-tweet them (sort of like an email forward without the bad jokes) to friends and impress them with you ability to stay in the know on current events!)

So, here’s the news:

Medicare Fee Decrease

The long-anticipated (dreaded?) 21% Medicare fee decrease is scheduled to go into effect June 1, 2010. While hopes have been high for a delay, no final Congressional action has yet been taken.

Medicare recently released a notice indicating that they would hold claims for the first ten business days of June to provide Congress with additional time to consider this issue.

Chiropractors should be aware that this hold will only affect claims with dates of service June 1, 2010, and forward.

Claims paid prior to June 1 should still be paid at the zero percent (0%) fee increase proposed by other recent legislative activity. Translation: claims paid with dates of service Jan 1 through May 31 will be paid at the same fee schedule as your 2009 rates.

Red Flag Rules Delayed

Again, the Federal Trade Commission (FTC) has delayed implementation of the Red Flags Rule. The next date is set for January 1, 2011. Although it has been a subject of much debate whether this ruling even applies to chiropractors, no worries – you still have time. Meanwhile, Congress intends to determine the scope of entities who are covered by the rule. We will just have to wait and see how that turns out.

Hope you had a great holiday weekend!

I will be back next week with my usual fare of musings on all things related to the business of chiropractic.

Tom

Chiropractic Nightmares: Going Rogue, Low Tech Hacks & Employee Stupidity

by Tom Necela on May 25th, 2010 in Business, HIPAA, chiropractic business, compliance

Reading time: 9 – 14 minutes

think_ahead

Apparently, last week’s blog post on security struck a sore spot with many readers who have experienced security problems, challenges and employee issues within their office.

Interestingly enough, the comments and questions I received were not focused on firewall breaches, corporate bank data comprises or any “high level” security threats that created a cascade of financial and stress-related nightmares for chiropractic offices. Instead, most of your comments could be summarized with two warnings:

1) Beware the low-tech hacks

2) Employees can be incredible liabilities if not managed properly

While most would probably agree that any security issue should be approached with sufficient planning and preventative measures, the stories of just how much trouble these two items caused for your fellow chiropractors was both surprising and seemed to warrant additional attention on the matter.

Let’s deal with the first topic:

Beware Employee Stupidity and Low Tech Hacks

While the thought of some financial terrorist attempting a transfer from an entire bank’s portfolio of accounts to a mysterious bank in Liberia or the possibility of a band of Bulgarian mobsters launching a viral shutdown of your town’s financial institutions is certainly upsetting, apparently it’s the not-so-flashy stuff on which we should focus our preventative measures. Similarly, while some of you may lose sleep at night for fear of violating the umpteen HIPAA regulations you didn’t know about, it’s the stuff that just makes plain common sense that you can easily prevent.

An apparently, these common, everyday issues are thwarting your fellow DC’s.

For example:

Last year about this time, big trouble broke out in Tennessee when thousands of medical records – including patient photos, files and social security numbers – were found in a Chattanooga recycling center bin. You need not be an expert in all matters HIPAA to determine that dumping your records (old, new or even patients that you do not like) into a recycling bin is not the proper way to dispose of medical files. Yet, it happened and the news was all over the story. And I am sure the fines weren’t pretty.

What’s worse is that the guy caught dumpster diving for those files (who likely thought he hit the mother lode of his career) took those files to make 1000 fake ID’s in which he ripped off other people, stores and banks. And he committed similar crimes throughout California.

I am sure you can also see several problems here:

This fella was not just looking to be the most popular guy in his high school and make fake ID’s for all his friends to get into the local bars. He is stealing your patient’s data as the starting point for his criminal sprees.
Apparently, banks have poor protective mechanisms for detecting fake id’s
Unlike banks, YOU as the chiropractor are dealing with Personal Health Information which means when someone like this steals your patient’s info, YOU are now required to report the breach
The process of reporting to Mrs. Melba Johnson that one of your employees (I am assuming it wasn’t you who dumped the files) used poor judgment and put her file in a recycling bin and some thief came and stole her social security number and other personal information and by now, has applied for an Abercrombie credit card, a home mortgage and was approved for a $1500 credit line to purchase some new wheels for their new/used Mazda (also purchased via the kind donation of Mrs. Johnson) – this is a conversation that will not go smoothly.
This conversation will need to be repeated with all of your patients whose records were breached

Silence is Golden

Sometimes privacy or security takes the simple form of silence. Unfortunately, according to my mail bag (actually e-mail inbox, but I always thought it would be fun to open a bag full of fan mail) silence is not so simple. Employees routinely assist you in violating HIPAA privacy policies by openly discussing patient information with…well, anyone!

And while this too may seem like common sense, again, see above. It’s not usually the stuff out of The Matrix that is going to foil you. But when your employee casually mentions in the grocery store that she has seen Mr. Weasly in your office, not knowing that Mrs. Weasly has been trying to chase him down for 7 months worth of alimony, suddenly you are amidst a family squabble AND your employee’s loose lips have sunk your HIPAA ship. Mr. Weasley may be forced to pony up on his alimony but you will be footing the bill once he turns you in for violating his privacy.

Similarly, it may seem like you can safely assume that the 16 year-old your tech is about to x-ray is not-pregnant, has their parents permission or even has parents that are paying, none of this is safe. And when your staff member e-mails the x-ray results to her parents, questions abound that you do not want to answer.

Silence is golden, if you can get it.

Some Employees are Smart, Lazy and Vindictive

Judging from the responses I received in regards to employee security threats, not all employees are dumb enough to dump data in dumpsters. In fact, some employees are too smart for their own (or our) good.

They play endless rounds of computer solitaire while claiming they don’t have enough time to do their job. They surf the internet on your time and your dime. Literally – you pay them and some of them shop for personal items using your credit card. Others make money by selling your patient list to direct mail marketing companies. And when they leave or you fire them (associates or other independent contractors), they attempt to take your patients (and sometimes your records too) with you. Then, they try and sit on unemployment for a year and half (despite the fact they only worked for you for a week and a half!).

Learn from the multitude of chiropractors who wrote in asking how to prevent these exact situations that occurred at the hands of wasteful or rogue employees. Protect yourself from unanticipated emergencies (let’s face it, no one’s smart enough to predict this type of behavior predictably).

Here are Three Protective Agreements I think can prevent a multitude of the problems many of you are facing or have faced in the past:

1) Establish an Employee Confidentiality Agreement: While might seem basic to have your employees sign something that states they can’t blab info or dump data, but if it occurs, you have at least protected your end from needless additional punishments or penalties via HIPAA or the consumers. Also, you need to demonstrate ongoing training in these matters, so having employees sign such an agreement (along with actual training) provides a paper trail of your compliance in this regard.

2) Utilize a Non-Compete Clause for All Associate Doctors: Sure, it may work out. You may even be partially at fault if it doesn’t work well. But protect your practice and livelihood if it does not. Some states limit the usage of these agreements, but in general, something is better than nothing. And I have witnessed the successful enforcement of non-competes which served their legally binding purpose along with stiff financial consequences for their violation.

3) Establish Appropriate Technology Policies: I use the word “technology” because really you have to have written guidelines for proper usage of the internet, of computers (and passwords), of cell phones, voice mail, email, downloads, instant messaging, etc. The least of your troubles (but the most common) is employees wasting time while surfing or emailing for personal reasons. As above, it can get a whole lot uglier than that, so to prevent this, put a policy in place!

Hindsight is 20/20 Wisdom

According to every chiropractor who e-vented (vented via email) their security and/or employee problems, you will undoubtedly and repeatedly kick yourself for future fiascos in this department – especially after reading this blog and being warned! Skip e-mailing me about how ridiculous it is that we have to do this and how deplorable society has become. I agree and the entities that make these rules don’t care. You just need to protect your asset numero uno.

Here are your options:

Have your attorney draft the Three Protective Agreements for you and sleep soundly knowing you’ve done your part.

Search the internet for these agreements – make sure they are up-to-date! Most technology agreements, for example, that I have seen online are outdated either have no reference to what we do as chiropractors (translated HIPAA!) or do not contain clauses for relatively new “social media” provisions, online downloads policies or even instant messaging.

For those who’d like to save time and searching, you can obtain a copy of my Three Protective Agreements that I use with my clients, updated and ready-to-go. Simply, open the Word Document, change the names and any relevant info to your clinic and you are on your way! For those who would like to have an attorney review your document, this will save you time and money from having them draft one from scratch.

Anyway you slice it, be sure to act on this promptly. While both crime and stupidity are unpredictable, the price of planning is not nearly as painful as the headaches and hassles that will occur as a result of your neglect on this!

To Your Success!

Tom Necela, DC, CPC, CPMA

Legal Disclaimer: Every reasonable effort has been made to ensure the accuracy of the information and recommendations provided in respect to these Three Protective Agreements. However, due to the nature of changing payer requirements and state regulations, you may wish to seek advice from a local health care attorney to ensure that the use of these agreements are legally valid and compliant with your state laws.

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