Is there or isn’t there a 12 visit cap for Chiropractic Services? Do you know for sure?

Obviously from the title we’re calling this one out as a myth, and here’s the straight scoop right from the Centers for Medicare & Medicaid Services (CMS). If you treat Medicare patients you really have to have this information “exactly” right.

There are no caps/limits in Medicare for covered chiropractic care rendered by chiropractors who meet Medicare’s licensure and other requirements as specified in the Medicare Benefit Policy Manual, Chapter 15, Section 30.5. (This manual is available at http://www.cms.hhs.gov/manuals/IOM/list.asp on the CMS website.) There may be review screens (numbers of visits at which the Medicare Carrier or A/B MAC may require a review of documentation), but caps/limits are not allowed.

 There you have it, 6 more myths to go!

Medicare Myth Busters- Myth #1 of 7: The 12 Visit Cap for Chiropractic is a post from: ACOM Health Blog

By: Jeff Brown, DC, CPC, CCPC

The liveliest debate among chiropractors regarding the EHR Incentive “Stimulus” Program revolves around drugs, naturally!  With rare exception, medication prescription does not fall within chiropractic’s scope of practice.  Why then, must a chiropractor use an EHR with all the drug bells and whistles or maintain an active medication list on his or her patients to be eligible for stimulus money? 

NOTE: This article has the most up-to-date information at the time of this writing; however, the government program is continually evolving, so please join me for the latest news update at my regularly scheduled educational webinars at www.acomhealth.com/EHRwebinar.

Let’s start at the top, the Final Rule

On July 28, 2010, after much debate and public comment, CMS released 42 CFR Parts 412, 413, 422 et al. Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Final Rule.  Essentially, this 276 page document is the EHR Incentive Program’s Bible.  It says, an EP (Eligible Professional), that’s you, must utilize a single “complete” certified EHR, or multiple “modular” certified EHRs when combined cover 100% of the required Meaningful Use (MU) measures.  The government’s intent is to ensure the decision of whether or not any particular MU measure is used, or not used, remains in the hands of the provider, not the vendor.  As a result, software vendors who chose to attain “complete” certification status – so doctors would only need to purchase a single EHR – had to incorporate all drug related MU measures into their product, including those related to drugs, even though their end users may never ePrescribe or make medication recommendations.

Side note: A glimmer of sunshine was written into the Final Rule allowing EHR vendors to “turn off” the ePrescribe functionality as long as it could be activated at a provider’s request.  This language was extremely important from the chiropractic perspective because it meant chiropractors, other than those few who prescribe drugs, wouldn’t have to pay for software functionality which doesn’t apply to them and is actually illegal to use. 

What You Must do to Qualify for Incentive Payments

Now let’s look beyond vendor requirements and into what the provider must do to qualify for incentive payments.  If you read my previous article, Meaningful Use – In A Nutshell, you’ll know there are 25 MU measures.  Of these, seven are drug related, but only three really matter: Drug Interaction Checks (Core #2); Active Medication List (Core #5); and Medication Allergy List (Core #6).  Why?  Because there is “no exclusion” for these measures!  Therefore, all providers wishing to meet MU must complete all three to successfully attest. 

No need to panic.  Drug Interaction Checks must simply be “enabled,” or turned ON.  Drug Interactions run automatically in the background of your software and alert you when two drugs on a patient’s medication list have known severe incidence of adverse effects (huge opportunity to educate patients here).  Simple enough!  Next, Medication and Medication Allergy Lists are both straightforward activities which you are “not required to update…at every contact with the patient” and you may use your “clinical judgment to decide when additional probing is required.”  Super simple! 

CPOE for Medication Orders (Core #1), ePrescribing (Core #4), and Drug Formulary Checks (Menu #1) are three more MU measures related to drugs, however, all three carry an exclusion for providers who write fewer than 100 prescriptions.  Think of exclusions as exemptions, or immunity.  So, unless you write more than 100 prescriptions, there’s no need to worry about these three drug measures at all, you’re excluded!

Medication Reconciliation (Menu #7) is the last of the seven MU measures related to drugs, however, it too is of little concern because it is a Menu item; meaning, you don’t need to report on it (remember, you only need to report on 5 of 10 Menu measures).  Besides, other Menu items are recommended and less problematic.  Plus, Medication Reconciliation has an exclusion you may qualify for if you are not the recipient of any “transitions of care” – a patient was referred to you by another provider. 

Recap

There are seven MU measures related to drugs, but only three carry significance to DCs because they do not have exclusions.  They are:

1. Drug Interaction Checks

2. Active Medication List

3. Medication Allergy List

Consequently, all providers, regardless of scope, must report on these three measures if they are to successfully meet MU and get a stimulus check.  The good news is this: Even though your software must do it all, you don’t; and the abovementioned measures are reasonable and easy to complete when given the right EHR technology. 

NOTE: This article has the most up-to-date information at the time of this writing; however, the government program is continually evolving, so please join me for the latest news update at my regularly scheduled educational webinars at www.acomhealth.com/EHRwebinar.

EHR Incentive Program “Drug” Requirement – Why Chiropractors? is a post from: ACOM Health Blog

ACOM Health, the company that developed the RAPID Chiropractic Software suite, will again be sponsoring a series of Impulse Adjusting System seminars held in selected cities this year. Four IAS seminars have already been held since the beginning of 2011 – in Pennsylvania, Florida, North Carolina, and Arizona – and there are 8 more seminars scheduled in the remaining months. The events will showcase advanced instruments and software systems that are designed to help doctors eliminate the need for manual chiropractic adjusting procedures so as to increase the the flow of patients as well as the efficiency and quality of each patient visit.

Today, over 6,000 chiropractic offices around the country and around the world make use of Impulse iQ Adjusting Instruments to optimize their practice. By using these systems, doctors are able to see more patients in the same amount of time, and patients benefit from more organized and efficient care.

In each two-day seminar, groups of 30 to 40 medical professionals will receive training in the implementation of Neuromechanical Innovation’s Impulse Adjusting Technique, which combines the impulse iQ adjusting instrument with computer-assisted auto-sense technology to increase the efficiency of chiropractic adjustments.

The upcoming Impulse Adjusting System seminars will be held in:

• Costa Mesa, CA (03/12 – 03/13)
• Columbus, OH (03/19 – 03/20)
• Boston, MA (03/26 – 03/27)
• Seattle, WA (04/02 – 04/03)
• Vienna, VA (04/30 – 05/01)
• San Francisco, CA (05/14 – 05/15)
• Chicago, IL (05/21 – 05/22)
• Denver, CO (06/11 – 06/12)

ACOM Health Division

ACOM Health specializes in serving chiropractors with software and services that improve practice efficiency and increase revenue while cutting costs. ACOM’s RAPID Chiropractic Software suite consists of Clinical Documentation and Notes, Home Exercises, and Chiropractic Practice Management programs for billing, scheduling, patient management and detailed reporting. ACOM Health Division has over 700 customer installations nationwide and is partnered with multiple state health associations. Their Chiropractic Services team is dedicated to helping practices maximize their billings and collections systems while ethically streamlining their practice operations.

According Dr. Christopher J. Colloca, president and founder of Neuromechanical Innovations, ACOM’s software suites are ideal for automating the documentation of data acquired from diagnoses and treatments of patients using the Impulse iQ Technique. ACOM’s automated documenting systems are certified under the HITECH (Health Information Technology for Economic and Clinical Health) Act of 2009, which set up quality standards and reimbursements to encourage doctors to switch from paper to electronic health record systems (EHR).

ACOM’s RAPID electronic health records software has been chosen by many chiropractic practices for a variety of reasons, among them the fact that doctors who purchase ACOM Health’s software automatically qualify for a full reimbursement of their purchase, courtesy of the government’s stimulus package. Other factors that have added to the growing prestige of the RAPID Chiropractic Software Suite include:

• ACOM’s chiropractic software caters specifically to the unique aspects of Impulse treatment reports.
• The RAPID software systems automate SOAP notes and reports, cutting down on the amount of time doctors and other medical professionals spend doing paperwork and other clerical jobs, such as dictating and editing reports. This allows doctors to focus on patient care and other professional duties.
• RAPID software was designed to adhere strictly to Medicare standards, ensuring precision and consistency.
• The RAPID software suite has a user-friendly interface that’s easy to learn and customize to a practice’s specific needs.

RAPID Documentation software is designed to give chiropractors the advantage of being able to focus on their patients’ care, instead of having to spend hours scrutinizing paperwork. With the data of every patient visit carefully and precisely documented, doctors can have an easier time establishing medical necessity and maintaining efficient, well organized records systems. By automating medical practices, the RAPID Software Suite helps doctors increase collections and reduce delays, denials and audits. Features like patient self-registration and streamlined final report forms allow for greater patient flow and increased revenue. The RAPID software suite includes an advanced, user-friendly interface that guides medical professionals step by step through the set up process.

Upcoming Events in Your City: Impulse Adjusting System Seminar is a post from: ACOM Health Blog

For most chiropractors the “words” 739.1, 739.2, 739.3, 739.4, and 739.5 are regular vocabulary, however, in two years they will vanish!  Why?  Because they are ICD-9 codes, and ICD-9 is scheduled for execution on October 1st, 2013.  ICD-10, incidentally, is also scheduled for execution on October 1st, 2013, bringing a whole new diagnosis vocabulary.  Our beloved 739.x Nonallopathic lesions will become M99.01, M99.02, M99.03, M99.04, and M99.05 under ICD-10.  These new M99.0x codes are titled “Segmental and somatic dysfunction,” a bit more descriptive than “nonallopathic lesion” I’d say.

ICD-10 “Subluxation” Codes is a post from: ACOM Health Blog

Congress just passed the Red Flag Program Clarification Act of 2010 (S.3987).  The Act, which exempts physicians from needing to comply with the FTC Red Flags Rule, now goes to President Obama for final approval.  This means you don’t have to create a Theft Prevention Program within your office prior to the January 1st effective date, or anytime in the foreseeable future.  By the way, the President is expected to sign the Act.  And if he doesn’t, I’ll let you know.

“Red Flags Rule” – Not For Chiropractors! is a post from: ACOM Health Blog

Yeah! Congress passed the Medicare and Medicaid Extenders Act of 2010, reversing the 25% physician fee reduction that was scheduled for January 1st.  This means chiropractors can expect to be reimbursed by Medicare through all of 2011 at current rates.  Billing personnel rejoice!

Medicare Fees Unchanged For 2011 is a post from: ACOM Health Blog

Please be mindful of specific carrier policies when billing for foot orthotics.  Recently, the BCBS of Illinois policy (also applies to New Mexico, Texas, Oklahoma, and Federal) on billing L3020 and L3030 came to my attention, which includes very specific guidelines for these two orthotic codes used extensively by chiropractors.  The policy boiled down to this:  Foot orthotics are only medically necessary (reimbursable) when they are used directly to the area of complaint and linked to a relatively short list of approved diagnoses, none of which related to the pelvis or spine.  In short, always verify carrier policies regarding orthotics (if they exist), especially when you are using them as “pelvic stabilizers” and not for podiatric problems.

Orthotic Coding For Chiropractors – BCBS Policy is a post from: ACOM Health Blog