The Medicare Audit

In my last Article, I discussed the two types of Medicare Audits, and a bit about the study published by the Office of the Inspector General, which is a part of the Department of Health and Human Resources.

To reiterate, the key thing to remember when dealing with Medicare, or any government agency, for that matter, is knowing the rules of the game. Later in this Article you'll find some links to help you get more familiar with the Medicare Rules, as they exist right now, at least.

The study published by the Office of the Inspector General can be found by clicking on the link in the Resources Section of this article:

CHIROPRACTIC SERVICES IN THE MEDICARE PROGRAM: PAYMENT VULNERABILITY ANALYSIS

What's the Real Problem with Medicare?

In the last Article I also talked about what Medicare can do if you don't correctly document the treatment of your patients. Remember, it doesn't matter that you did everything ?by the book? if you didn't also document it ?by the book.? And what is the ?book?? The Carriers Manual.

This is what the people who pay the claims use to determine whether or not what they paid you is justified.

First of all, I think we can all agree that the "IRS Rules and Regulations type" manuals used to determine if something you do for your patients is justified is pretty ludicrous when you consider that a medical doctor can get away with spending five minutes with an elderly patient, prescribing 10 different drugs ranging from blood thinners to anti-depressants, and get paid for it, no questions asked.

But, if you see a patient more than 24 times, you're committing health fraud, and that two-thirds of the time when you see a patient more than 12 times, you're a criminal.

And even worse, how in the world do psychiatrists document and get paid by insurance carriers for the goofy 5 minute interviews and drugging of more than 8 million kids in the US alone, because they fidget in class. How can that possibly be considered a medically necessary service?

We definitely live in a topsy turvy world right now, but unfortunately until we change it, you'll need to know the Rules, particularly if you want to play the Medicare Game.

I'm not going to pretend to be an expert in Medicare, as far as what you can and cannot do. My expertise is in the reporting side of the equation, and in the fact that you may be following the Rules to the letter, and still get nailed, if you don't properly document what you did do and why.

What is Covered by Medicare?

Having said that, we can still go over some of the simpler aspects of what is covered by Medicare.

First of all, they only cover ?treatment by means of manual manipulation, i.e., by use of hands. Additionally, manual devices (i.e., those that are hand-held with the thrust of the force of the device being controlled manually) may be used by chiropractors in performing manual manipulation of the spine'No other diagnostic or therapeutic service furnished by a chiropractor or under his or her order is covered.?

Sorry, no extremity work. And they won't pay for you to take X-rays (even though they will pay an MD). However, for ??dates of service on or after 1/1/2000, an x-ray is not needed to document the subluxation.?

They define a subluxation as ??a motion segment, in which alignment, movement integrity, and/or physiological function of the spine are altered although contact between joint surfaces remains intact.? How do you demonstrate it? By x-ray or physical examination.

Demonstrating the Existence of a Subluxation

Physical examination to demonstrate a subluxation involves what you may have heard referred to as PART. The P stands for ?Pain/tenderness evaluated in terms of location, quality, and intensity;? The A stands for ?Asymmetry/misalignment identified on a sectional or segmental level;? The R stands for Range of motion abnormality (changes in active, passive, and accessory joint movements resulting in an increase or a decrease of sectional or segmental mobility);? The T stands for ?Tissue, tone changes in the characteristics of contiguous, or associated soft tissues, including skin, fascia, muscle, and ligament.?

According to the manual, ?To demonstrate a subluxation based on physical examination, two of the four criteria mentioned under ?physical examination? are required, one of which must be asymmetry/misalignment or range of motion abnormality.? So, at a minimum, you need 1) pain and either asymmetry or range of motion, 2) tone and either asymmetry or range of motion, or 3) asymmetry and range of motion. Obviously, you should report as many of these as you find.

As far as how exactly you document these findings, including the acceptable words and phrases, and exactly what needs to be documented initially and during treatment, I will get into that in our next newsletter. However, if you are trying to document all of this by hand, you are probably finding that there aren't enough hours in the day. And if you are trying to remember what you needed to document after the fact, you could be asking for trouble.

If you would like an easy, fast way to have complete, compliant documentation, call 877-742-9215 and speak to one of my consultants.

Summary

If you commit to sending high-quality, professional reports to Medicare, chances are very good that you will never have a problem stemming from documentation.

If you don't own Report Master yet, check out some of the Testimonials on our web site, to see what others are saying about the Report Master Software.

Report Master takes the work out of the Narrative and SOAP Note writing process, so you'll have more time to do the things you would rather be doing, and still maintain the necessary quality in your reports that Medicare and other providers demand.

In closing, if there is anything about narratives or SOAP Notes you would like me to talk about in future Articles, or if you have any questions about the Report Master Chiropractic Report Writing System, write to me directly.

Also, if you'd like to take the complete working copy of the Report Master System for a Free Test Drive, fill in the Request a Report Master Free Trial Form and Download the Software by clicking on the link in the Resource Box at the end of this Article. One of our Representatives will contact you to set up a time for you to get together, to help you get up and running quickly.

And, of course, you can also simply call us toll-free at 877-742-9215, to set up a demonstration.

Until next time,

Ron Savelo

President

Report Master, Inc.