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Chiropractic News

September 2010

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The $44,000 question: industry insider responses (Mike Norworth)

This is in reference to Melissa Heyboer’s article, “The $44,000 question,” which appeared in Issue 13, 2010. The following is Mike Norworth’s responses in their entirety.

Question 1: How will this affect the chiropractic office? i.e., do you think this program is beneficial?

A: I expect it to be beneficial in the long run. After all, the end result is a period of higher reimbursement for Medicare/Medicaid services. However, at the beginning, it’s possible that becoming recognized as an “Eligible Professional” may require patience on the part of the provider. It’s also likely that it will force providers to do things they’ve resisted for years. For instance, a chiropractor who has avoided sending claims electronically will not meet the “meaningful use” standard even after purchasing a “certified EHR.”

Question 2: What do chiropractor’s need to take advantage of this incentive? How much will it cost, as far as time and money, to implement?

A: For starters, all you need are Medicare and/or Medicaid patients and a computer system. And since the money for this program was pre-allocated, beware of sales tactics from companies that declare that “money is about to run out, so you’d better grab it now!” Reimbursement will be for rendered services starting next year. Keep in mind that reimbursement is based on actual services in 2011 and beyond. Most important, no company can guarantee that you will meet the “meaningful use” requirements -- even if they can provide a certified EHR (which at the time you read this is impossible because no company is certified to do certifications). How much will it cost, as far as time and money, to implement? Unless there’s a cost for individual certification as an Eligible Provider, the answer for most computerized practices should be “Nothing!” However, you must meet criteria – such as submitting the requisite percentage of claims electronically. Many of these declarations from the interim rule have actually been relaxed in the final rule. So… percentages for criteria such as electronic claim submission are lower – making it easier to qualify.

Question 3: Will all chiropractic offices qualify? Can cash-based practices benefit?

A: If you don’t have a computer… no. But

though the “Final Rule” has been released, we’re still waiting for the companies that will provide accreditation to get approved. Then, they must define “Stage I” based on the CMS 864 page “Final Rule.” Stage I criteria include such capabilities as automatic BMI calculation, patient’s ethnicity, whether you can electronically (e.g. automatically via email) provide the patient with his/her info… including medications, allergies, problem list, etc., what percentage of your claims are submitted electronically and other items. Note that starting on page 60, the CMS Final Rule specifically allows for the fact that chiropractors don’t prescribe medications.  When, Can cash-based practices benefit? By law, “cash” practices must still submit Medicare claims for patients with Medicare (to ensure those patients are reimbursed). Thus, with regard to this program, there’s little difference between a practice that bills payers and one that bills patients. According to page 451 of the Final Rule, Eligible Provider payments will be made on an annual basis, so there’s no need to be concerned that disbursements will accidentally go to the patients.

Question 4: When can chiropractors expect to receive payments?

A: Qualified Eligible Providers can expect reimbursement increases starting in 2011. For starters, look at example 1 on page 194 of the interim proposal. In 2011 (the first year of the program), if you bill Medicare (not private insurance) at least $24,000 (that’s Medicare’s allowed charges – not your fees), you’ll be eligible to receive as much as $18,000 (75%) in incentive payments on or before February 29, 2012.

Question 5: What questions should chiropractors ask their providers (insurance and software) to ensure they are being compliant?

A: Since accreditation bodies don’t exist yet, it’s too early to ask specific questions. However, the interim rule was released on 12/31/2009. Your should ask vendors what steps they’ve taken to ensure Stage I compliance since that date. Also, it’s how you use the EHR that counts. For instance, it’s not enough to have a certified EHR, you must separately meet criteria that include submitting an appropriate percentage of electronic claims. Thus, having the technology doesn’t guarantee that you’ve fulfilled “meaningful use” objectives.

Question 6: What new products or services do you think will come out of this incentive?

A: Eventually, patients will have better online access to their data as more programs better communicate with one another.














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