Avoiding the “Technique Trap” Audit

There’s a potential Achilles heel in chiropractic documentation that I’ve pointed out over the years in my seminars and webinars. Though this oversight is a huge one, it’s been a “theoretical” crack in the pavement…until recently. The trouble is your chiropractic technique and it’s ability to get you in a whole lot of hot water. To be specific, I’m not …

Mastering Chiropractic Medical Necessity in 2015 (Part 2)

  In Part One of this article, we looked at a few medical necessity “traps” that are plaguing chiropractors.  In other words, things NOT to do when attempting to document or meet criteria for medically necessary care. We also discussed that one of the challenges with mastering the maze of medical necessity is that the definitions may vary from payer …

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 …

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.

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 …

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 …