Chiropractic Compliance Articles and Resources
Because compliance covers so many areas of a healthcare provider practice, a more thorough explanation is found in Chapter 3-Compliance in the ChiroCode DeskBook. Generally, healthcare providers need to understand:
- How to maintain a dynamic compliance plan
- Fraud and abuse standards
- Federal requirements (see related topics below)
- How to minimize the impact of audits.
Related topics:
For additional information visit ChiroCode.com. Since 1993 Chiropractors have depended on ChiroCode as a reliable source of information for the Chiropractic community. Because of the dependability and education ChiroCode has earned much renown. View current and recent webinars, order the ChiroCode DeskBook, (comprehensive go-to chiropractic reimbursement manual) and much more.
Select the title to see a summary and a link to the full article. some articles require a subscription to view.
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
According to the OIG "MEDICARE OVERPAID MORE THAN $636 MILLION FOR NEUROSTIMULATOR IMPLANTATION SURGERIES."
So often we think if we get paid, we must be doing it right, well this is not always the case. You may get paid and then have to return the funds if billed incorrectly or a step ...
by Stephanie Allard, CPC CEMA RHIT
When x-rays are audited on the same date as an E/M encounter we have one of three decisions to make about the work that went into the radiological exam when the practice owns x-ray equipment and does their own interpretations internally. First, we must determine whether the x-ray was...
Mar 14th, 2022
Medicare Auditors Caught Double-Dipping
by Edward Roche, PhD JD
Overlapping extrapolations require providers to pay twice. Some Medicare auditors have been caught “double-dipping,” the practice of sampling and extrapolating against the same set of claims. This is like getting two traffic tickets for a single instance of running a red light. This seedy practice doubles the amount...
Mar 10th, 2022
Cybersecurity & Ransomware Warnings
by Wyn Staheli, Director of Content - innoviHealth
Although HIPAA Security protocols have been in effect for some time, as technology advances, if we are not diligent, gaps can be left available for intruders. On top of that, on February 23, 2022, the American Hospital Association issued a cybersecurity advisory. They stated, “there is concern that Russia may retaliate against the U.S. and allied nations with disruptive cyberattacks.”
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Audits are currently underway to verify the monies distributed through the CARES Act were warranted and properly used by those organizations that received them. The federal government has contracted with financial institutions such as KPMG and PricewaterhouseCoopers, among others, to perform these audits referred to as Provider Relief Fund (PRF) audit contractors, funded with monies from the very same program. There were four phases of funding disbursements with phase 1 audits beginning in September. How ready are you to be audited?
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
We always knew there would come a day when payers would look down on an "unspecified" diagnosis code and possibly even deny it or delay payment until a review of the record could be performed. ICD-10-CM was adopted by the U.S. for data analytics, which cannot be accurate if unspecified codes are reported when the documentation verifies greater specificity. Join us for a look at the many guideline changes to ICD-10-CM, a review of the newest code changes and suggestions on documentation improvement to elevate coding protocols.
Jul 29th, 2021
Medicare's ABN Booklet Revised
by Wyn Staheli, Director of Content - innoviHealth
The “Medicare Advance Written Notices of Non-coverage” booklet, published by CMS’s Medicare Learning Network, was updated. This article discusses the changes to this booklet regarding the use of the ABN.
Jun 29th, 2021
Compliance in the Small Practice
by Christine Woolstenhulme, QMC QCC CMCS CPC CMRS
If your practice does not already have a compliance program in place, you will want to get started after reading this article. We have uncovered some important findings with the Office of Inspector General (OIG) in dental practices you need to be aware of. A compliance program offers standard procedures to follow, ...
by Wyn Staheli, Director of Content - innoviHealth
Intersegmental traction therapy via the use of roller tables has been used by doctors of chiropractic for many years. Recently, questions have arisen regarding the appropriate billing of roller tables. This is largely due to the statement published in the July 2020 CPT Assistant published by the American Medical Association (AMA). Which code should you really be using?
Jan 11th, 2021
HIPAA Penalty Changes
by Wyn Staheli, Director of Content - innoviHealth
On January 5, 2021, H.R. 7898 was signed into law by President Trump. This new law modifies the HITECH Act such that when an organization experiences a breach, fines and/or penalties may be reduced if (for at least a year) they have instituted “recognized security practices” as defined within the law.
by Wyn Staheli, Director of Content - innoviHealth
To assist low-income Medicare beneficiaries, CMS created the Qualified Medicare Beneficiary (QMB) program; a Medicaid benefit which pays for Medicare deductibles, coinsurance, or copays for any Medicare-covered items and services for Medicare Part A, Part B, and Medicare Advantage (Part C). Providers/suppliers are prohibited from billing premiums and cost sharing to Medicare beneficiaries who are enrolled in QMB.
Apr 20th, 2020
Dismal OIG Report on Telemedicine
by Wyn Staheli, Director of Content - innoviHealth
Providers need to understand the rules for reporting telemedicine services. A recent OIG report shows that this is not the case. What problems are being found in documentation claims? As providers are expanding their telehealth offerings, now is the time to understand the potential pitfalls since disallowed amounts will be taken back.
Apr 15th, 2020
CMS Temporarily Suspends Contract-Level RADV Audits
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
The Centers for Medicare and Medicaid Services (CMS) is suspending contract-level RADV audits, related to the payment year 2015 and will not initiate any new ones until after the public health emergency has ended. Any documentation already submitted will be reviewed as usual.
Mar 25th, 2020
COVID-19: Cybercrime, Telehealth, and Coding
by Wyn Staheli, Director of Content - innoviHealth
Your inbox is probably like mine with all sorts of announcements about COVID-19. Here are just a few reminders of things we felt should be passed along.
We have heard of several cases of cybercrime related to this outbreak. For example, there was a coronavirus map which loads malware onto your ...
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Do you still find yourself searching the internet for an ICD10 code? Medical coders often type into their search engine, what is the ICD10 code for ... and a specific diagnosis code, to avoid repeatedly dragging out the incredibly large ICD10 codebook. Ironically, some of the most commonly searched ICD10 diagnoses include: ...
by Wyn Staheli, Director of Content - innoviHealth
Exclusion screenings require far more than just checking a name on a federal database at the time you are hiring someone. Far too many providers don’t realize that in order to meet compliance requirements, there is MUCH more involved. There are actually over 40 exclusion screening databases/lists that need to be checked.
by Wyn Staheli, Director of Content - innoviHealth
It’s that time of year for offices to get ready for the ICD-10-CM code revisions. As part of that process, it’s also good to know what is going on with the ICD-10-CM Official Guidelines for Coding and Reporting. In the examples listed below, strikeout text is deleted and highlighted text ...
by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
The Medicare Fee for Service (FFS) program (Traditional or Original Medicare) has a timely filing requirement; a clean claim for services rendered must be received within one year of the date of service or risk payment denial. As any company who has billed Medicare services can attest, the one-year timely filing ...
by Wyn Staheli, Director of Content - innoviHealth
Two separate pieces of legislation introduced in the House of Representatives (H.R. 2883 and H.R. 3654) have the potential to change some of Medicare’s policies regarding doctors of chiropractic. Find out what these two bills are all about and how they could affect Medicare policies.
Aug 9th, 2019
The OIG Work Plan: What Is It and Why Should I Care?
by NAMAS
The Department of Health and Human Services (HHS) founded its Office of Inspector General (OIG) in 1976 and tasked it with the responsibility to combat waste, fraud, and abuse within Medicare, Medicaid, and the other HHS programs. With approximately 1,600 employees, HHS OIG is the largest inspector general's office within ...
There are 13 related documentation, coding and billing tips.
Select the title to see a summary and a link to the full webinar information. some webinars require a subscription to view.
Sep 5th, 2023
Modalities Used in Your Chiropractic Office
by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
Electrical stimulation, ultrasound, and mechanical traction are modalities commonly used in chiropractic offices. And they are commonly documented incorrectly or billed improperly. Learn the right (and wrong) ways to get paid for these kinds of services. Join Dr. Evan Gwilliam, certified coder, and all-around nice guy, as he answers your most burning questions about the CPT codes 97012, 97014/G0283, 97032, and 97035.Jan 25th, 2023
Medical Necessity: it’s far easier to prove than you think, and far more important than you realize.
by Tom Grant DC, Med-Legal Consultant, Pragma Intel Director of Education
Besides coding errors, it’s the 2nd most common tool used by health insurers and 3rd party payers to deny care and deny liability. How do you decide what to use as a tool to prove your care is viable and needed? Expensive equipment and elaborate testing procedures are not what you need. It’s as simple to prove as opening a can of beans, unless you don’t have a can opener. I’ll share with you my insider tips and experience as a medical expert on over 3000 successful PI case settlements and give the can opener that you and your patients need you to use to prove medical necessity, and why you’ll need it in treating what I feel is the next great opportunity for Chiropractic: V_______ care.Aug 16th, 2022
Medicare and the ABN for Chiropractic
by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
Medicare can be intimidating, but fortunately, the rules can be made simple and actually reduce anxiety when applied properly. All you need to know about ABNs and Medicare modifiers will all be covered in this presentation so that you can feel confident you know you are doing things right.by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
Anyone who sees patients who have services that are not covered by insurance needs to know about the No Surprises Act. In this quick webinar, Dr. Gwilliam will show you how to properly notify patients of their options and create a Good Faith Estimate, as required by this law. Expect this…Feb 8th, 2022
Medicare Audit, Do-it-yourself
by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
Don't wait for Medicare to look over your records and try to find deficiencies. Dr. Gwilliam, a Certified Professional Medical Auditor, will show you how to find your own deficiencies, and fix them before they become a compliance or financial concern. This isn't just for Medicare either. If you can…Jan 11th, 2022
Chiropractic Documentation: The Subjective Element
by Ron Short, DC MCS-P CPC
The Subjective element of S.O.A.P. is where we document what the patient tells us. But what is the best way to gather this information? In this webinar Dr. Ron Short will review the guidelines for the subjective element and explain the best way to gather information from the patient.&…by Ron Short, DC MCS-P CPC
We have all heard of the S.O.A.P. format for our documentation. But what does each element mean and what additional information do we need in our documentation? In this webinar Dr. Ron Short will review the S.O.A.P. documentation format and discuss what additional information you need document. In…by Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow
The most commonly used procedure in chiropractic is the chiropractic adjustment, also known as chiropractic manipulative treatment or CMT. There are nuances to the CPT and ICD-10 codes and Medicare guidelines that must be mastered by any chiropractor hoping to find success when creating their…Jul 8th, 2021
Chiropractic Treatment Paradigm 2021
by Ron Short, DC MCS-P CPC
Chiropractic care is different from medical care. We know that but how do we explain it. Reviewers deny claims that are medically necessary because they don’t know what they are looking at when they review our claims. Dr. Ron Short will explain how to approach these reviewers in this…by Tom Grant DC, Med-Legal Consultant, Pragma Intel Director of Education
This is the easiest of therapies to initiate and it adds great medical value. Most DC's do not prescribe/proscribe self-care instructions. Self-care Rx's have defined timelines for implementation and updates. Done incorrectly, self-care Rx's damage medical value and decrease reimbursements.Nov 7th, 2013
HIPAA Has New Requirements (New as of 2013-11-07)
by Wyn Staheli, Director of Content - innoviHealth
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