Sponsored by Best Practices Academy
Within the last decade, regulatory changes in healthcare have caused providers to be slowly left uneasy about their practice.
Perhaps even leading to sleepless nights at times. But there is no better time than now to pay attention to the tea leaves in care delivery and begin to cover your bases in practice.
The MACRA law (Medicare Access and CHIP Reauthorization Act of 2015) singlehandedly will move healthcare in the U.S. into value-based care delivery.1 Doctors of chiropractic, once registered as a Medicare provider, may not opt out of being a provider, unlike other physicians.
An “opt out” refers to a physician’s ability to decide not to bill Medicare at all, thereby allowing the ability to enter into private contracts with the Medicare beneficiaries they treat.2
In addition, unless you meet the low volume threshold ($30,000 or less in allowed charges or 100 or fewer unique Medicare patients annually) or are involved in an advanced APM or have only been practicing for a year; no eligible clinician can “opt-out” of MACRA.
Central to the success of a practice in the new payment model, is the ability to report and stay complaint with the new system. And by the way, the low volume threshold will continue to lower to capture more providers over time.
HIPAA compliance and OSHA
Health Insurance Portability and Accountability Act (HIPAA) was signed into law on August 21, 1996 and became effective on April 14th, 2001. Revisions of the HIPAA rules throughout the past decade haven’t seemed to have stirred the lack of apathy towards the HIPAA privacy and security rules.3
Case in point, have you updated your practice’s HIPAA manual to comply with the 2013 HIPAA Omnibus requirements?5 Are you doing what your policy says you need to do? Do you conduct a Security Risk Analysis annually to check your computer system’s vulnerability?
In addition, with the Occupational Safety and Health Act of 1970, Congress created the Occupational Safety and Health Administration (OSHA) to assure safe and healthful working conditions for working men and women by setting and enforcing standards and to provide training, outreach, education, and assistance.7
The chiropractic practice is not immune to these standards. Staff training in the safeguards of patient care are pertinent because as in 2010, the healthcare and social assistance industry reported more injury and illness cases than any other private industry sector.
Medicare was enacted in 1965 out of an expressed interest to create affordable access to the elderly who have fixed incomes and who have a greater need for care.6 Doctors of chiropractic were included as providers in 1972.7
Although the doctor of chiropractic is defined as a physician under Medicare, it is within a limited scope of diagnosis and services that coverage applies for Medicare beneficiaries. The Centers for Medicare and Medicaid Services (CMS) has largely been responsible for rolling out quality initiatives and electronic health record (EHR) technology integration and transformation over the last decade.
In addition, based upon the direction of the Office of Inspector General (OIG), CMS has cracked down on more stringent documentation standards for chiropractic physicians in an effort to determine medically necessary treatment for Medicare beneficiaries. So, doctors of chiropractic have coding and documentation requirements to perform moving forward.
The MACRA, HIPAA, OSHA, and CMS documentation requirements for chiropractic physicians have reached the level of priority and urgency for every DC. The depth of complexity and volatility of the rules updates and enforcement clarifications has left the chiropractic physician vulnerable in practice.
You can’t afford to go without the team of experts needed to stay compliant in today’s healthcare and business world. A clinic management system can bring you into compliance — and keep you there for years to come.
Scott Munsterman, DC, FICC, is founder and CEO of Best Practices Academy (BPA) and is an expert on the transforming model of healthcare delivery with a commitment to the promotion and advancement of the chiropractic profession. BPA assists chiropractic physicians to focus on growth, risk management, technology, and quality improvement. Munsterman can be contacted through bestpracticesacademy.com.
About Best Practices Academy
Providing leadership in practice growth, risk management, quality performance, and certified EHR systems since 2006. Best Practices Academy (BPA) will be sure your practice is ready to migrate from fee-for-service-based to a value-based system, and help you grow the practice of your dreams. BPA studies your practice’s statistics such as CPT codes being utilized, most common ICD-10 code selections, random review of documentation, capacity analysis, and financial account reports to determine if your practice is healthy or sick.
Best Practices Academy prides itself in having some of the best people in the industry to evaluate practices. A team approach is taken to find out what areas of concern are. This is usually an eye opener for many DCs. BPA’s Clinic Management System can bring you into compliance in this ever-changing healthcare market.
- Congressional Budget Office. “Medicare Access and CHIP Reauthorization Act of 2015.” cbo.gov/publication/50053 Published March 2015. Accessed July 19, 2016.
- Centers for Medicare and Medicaid Services. “The Medicare Learning Network.” MLN/MLNProducts/downloads/Chiropractors_fact_sheet.pdf . Accessed Sept. 2016.
- S. Department of Health and Human Services. “The HIPAA Privacy Rule.” hhs.gov/hipaa/for-professionals/privacy. Accessed on Sept. 9, 2016.
- S. Department of Health and Human Services. “The Security Rule.” hhs.gov/hipaa/for-professionals/security/index.html. Accessed on Sept. 9, 2016.
- S. Department of Health and Human Services “Summary of the HIPAA Privacy Rule,” www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/combined-regulation-text/omnibus-hipaa-rulemaking. Accessed on Sept. 9, 2016.
- Centers for Medicare and Medicaid Services. “Medicare General Information, Eligbilty and Entitlement.” cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/ge101c05.pdf. Accessed on Sept. 6, 2016.
- United States Department of Labor. “About OSHA.” Osha.gov/about. Accessed Sept. 9, 2016.