www.njchiropractors.com I 3 TM Insurance Update MEDICARE Q&A L ANJC Leadership Executive Director’s UPDATE rs UPDATE Le Protecting your practice by getting your notes in order With ANJC fighting for you, your practice and patients and common thread continues to come to the surface when dealing with the insurance carriers: chiropractic treatment notes. The recent Medicare OIG report speaks of the volume of claims that they feel were paid inappropriately and were not medically necessary when submitted by the chiropractic profession throughout the United States. Medicare estimates between $257-$304 million dollars is overpaid annually for chiropractic services, and Medicare is looking for ways to either curtail paying or get whatever monies they can back. The following is directly from CMS: “According to the contractors we interviewed, claims for chiropractic services were typically denied because the services were medically unnecessary, billed with an incorrect procedure code, not documented, or insufficiently documented.” We have heard that auto carriers now may be abusing the Pre-Service/Post-Service Appeal process by partially denying requests for services providers request for pre-certification and routinely use the doctor’s own notes ( many times not sufficient) against them to deny. Pick virtually any health carrier that requests notes, and if your notes are not covering all the bases, the carrier will deny them. I have seen malpractice cases where the chiropractic physician has a short scribble of a note, barely possible to read or even interpret. How can your carrier or anyone defend minimal notes, barely legible writing, or notes that are not even compliant with the minimal standard? We are not the only ones, but the only ones I care about! With regard to the medical profession and Medicare, the government in 2014 stated the following: “In total, Medicare inappropriately paid $6.7 billion for claims for E/M services in 2010 that were incorrectly coded and/or lacking documentation, representing 21 percent of Medicare payments for E/M services that year. We found that 42 percent of claims for E/M services in 2010 were incorrectly coded, which included both upcoding and downcoding (i.e., billing at levels higher and lower than warranted, respectively), and 19 percent were lacking docu- mentation. Additionally, we found that claims from high-coding physicians were more likely to be incorrectly coded or insufficiently documented than claims from other physicians”. Let’s take pre-emptive actions and measures when any carrier requests records. Start talking to colleagues regarding what they use for their notes, whether paper or elec- tronic. No one mandates that you have to have electronic notes, yet many have found them useful and helpful with hitting all the important points for documentation. Others find them cumbersome and too time-consuming. ANJC has a number of vendors to investigate when considering going electronic with your notes. There are others out there that have note-taking systems you might consider as well. If you are using paper records, put yourself in the position of a reviewer and ask yourself if your notes would meet the minimal standard of information to tell the story: what the patient’s problem is, what you found, what you treated and what your future plan of action is. Make forms that will cover all the bases for you. If you are billing for example 99213 (re-evaluation code), look up what the code requires to be utilized, make a form that covers all those aspects, and when requested, you have what is needed. You might find that a hybrid system works best for you, where you have a computer HER system and also use some paper note-taking. There is no right or wrong… just get better at it! The bottom line is that carriers are looking for ways to cut your care up front as well as grab your money back on the backside. Let’s not give them any ammunition when they come calling. By Dr. Steve Clarke ANJC President What’s Inside: ANJC Spring Summit Page 4 Scholarship Details Page 5 Our New Members Page 5 Featured Articles: ANJC Leadership Page 4 Executive Director’s Update Page 5 Legal Ease Page 6 Legal Q&A Page 7 Legislative Update Page 8-9 Seat Belt Injuries Page 10 Nutrition Council Page 11,12 Insurance Update Page 14-16 Medicare Q&A Page 17 Rehab Council Page 18-19 Technique Council Page 20-22 Our Sponsors Page 24-27 Chiro Assist Page 28-33