Why Medicare Thinks 79.5% of Chiropractic Treatment Plans are Bad

  According to the results of a dismal third quarter report by Railroad Medicare (administered by Palmetto GBA), chiropractors will continue to be audited through the 4th Quarter of 2014 due to a high error rate.  Palmetto’s latest audit investigation revealed that 79.5% of chiropractic claims were submitted incorrectly and therefore, did not merit any payment. Although Palmetto’s findings were spread …

adminWhy Medicare Thinks 79.5% of Chiropractic Treatment Plans are Bad

Payers Posing as Patients (& Other Audit Tricks) Still Threatening Chiropractors

  Last year, I wrote several posts about the rise in several specific audit threats to your chiropractic business and bottom line. (see also “Chiropractic Compliance Bombs You Don’t Want to Explode”) Unfortunately,  from the number of concerned emails and whispers I get at seminars, payers haven’t given up on using these dangerous tactics.  If anything, they have seemingly increased. What exactly …

adminPayers Posing as Patients (& Other Audit Tricks) Still Threatening Chiropractors

Medicare Reveals Exactly How to Get Audited in Latest Chiropractic Review

  CMS carrier Palmetto GBA Railroad Medicare (who administers claims for Railroad Medicare beneficiaries nationwide) recently conducted a “widespread review” of chiropractic services submitted between October and December 2013. Specifically, Railroad Medicare reviewed 21,109 services that were submitted by chiropractors for CPT codes 98940 and 98941.  As you can see below, the results were eye-opening.

adminMedicare Reveals Exactly How to Get Audited in Latest Chiropractic Review

Medicare Auditor’s Reveal 2 Biggest EHR Weaknesses That May Lead to “Fraud”

  Buried amidst a flurry of OIG recommendations, targets and auditing hoopla are two gems that can help us as chiropractors reduce the possibility of EHR-induced documentation problems.  The news is riddled with stories about the cost of health care “fraud” (current guestimates put this between $75 billion and $250 billion) and are starting to spook even the most jaded …

adminMedicare Auditor’s Reveal 2 Biggest EHR Weaknesses That May Lead to “Fraud”

Assessing Your Chiropractic Compliance Risks

The September 23, 2013 deadline for HIPAA Compliance via the Omnibus Rule is past.  Covered entities (every chiropractic office) are now “eligible” for audits from the Office of Civil Rights (HIPAA abuse violations) and the Department of Justice (criminal fraud investigations) for compliance related violations. Essentially, you have one of three choices: 1)      Hope your practice and procedures are compliant …

adminAssessing Your Chiropractic Compliance Risks

Simple Strategies to Avoid Trouble with Chiropractic Tx Goals, PRN & Maintenance Care

Many chiropractors dangerously dance right into the grey area with respect to treatment goals between medically necessary care, maintenance care and PRN care. Unfortunately, every payer requires a treatment plan and without one, your claims could be deemed maintenance. Worse, depending on your office procedures, your fee policies on “cash” or “time of service” patients who may be receiving maintenance or PRN …

adminSimple Strategies to Avoid Trouble with Chiropractic Tx Goals, PRN & Maintenance Care

The Chiropractic Audit, Compliance & Staff Bomb You Don’t Want to Explode (Part 2)

In Part 1 of this article series, I introduced the “triple threat” that is looming around your practice attempting to take your money, your license and your good reputation down with it.  We discussed the fact that the most likely attacker would be a “secret shopper” calling on behalf of an insurance payer to determine if your office has a …

adminThe Chiropractic Audit, Compliance & Staff Bomb You Don’t Want to Explode (Part 2)

The Chiropractic Audit, Compliance & Staff Bomb You Don’t Want to Explode (Part 1)

Over the past couple years, a “triple threat” has been slowly, subversively gaining steam and, in the process, formulating an explosive bomb that could easily destroy your practice.  Unfortunately, too many chiropractors have contacted me after facing even one arm of this threat and very unfortunately, there is little ability to protect your practice once this thing detonates. Worse still, …

adminThe Chiropractic Audit, Compliance & Staff Bomb You Don’t Want to Explode (Part 1)

Chiropractic Compliance, Statistics and Keeping Your Money

As third party payers around the country, Medicare and even the Office of Inspector General (OIG) put together a collective assault on healthcare fraud, my email keeps pinging and my phone keeps ringing from chiropractors around the country who are getting increasingly nervous about this present state of affairs. Not that I blame them.  At no point in healthcare history …

adminChiropractic Compliance, Statistics and Keeping Your Money

A Landmark Court Case For Chiropractors Fighting For Their Rights?

If you do PI work, you may want to forward this on to attorneys that you work with as it could prove helpful to future MVA cases. A recent case in the New Jersey Supreme Court ruled that Expert witnesses who testify in medical liability lawsuits must be in the same specialty as the defendant physician. In Nicholas v. Mynster, …

adminA Landmark Court Case For Chiropractors Fighting For Their Rights?