With impending federal changes and tightening billing and reimbursement rules, coding and health care data remained a reader hot topic this year
From using data to improve health care to fixing billing issues, coding and health care data remained a hot topic in 2021. Chiropractic and health care continued to move towards a more unified system that is less complicated for patients and less of a weight on health care providers.
The most popular coding and health care data articles on Chiropractic Economics in 2021 included a Point-Counterpoint where doctors of chiropractic shared documentation tips, coding and billing fixes, tips to avoid audits, coding changes and the new “Blocking Rule,” and more.
“Going after fraud is highly profitable,” writes coding expert Kathy “KMC” Weidner. “Fines and recoveries from big offenders can earn the U.S. federal government and other third-party payers up to a cool $1 million per audit. Most DCs aren’t deliberately and knowingly breaking the law. They make documentation errors not with the cold intent to defraud, but from sheer ignorance or being overwhelmed. But just because you may not be one of the ‘big offenders’ that auditors are looking for doesn’t mean you can breathe a big sigh of relief and ignore required elements of code documentation.”
Here are the Top 5 most popular coding and health care data articles from 2021:
By D. Rottinghaus, DC; D. Barton, DC, MCS-P, CIC; K. Weidner, MCS-P, CCPC, CCCA; T. Wakefield, DC, DACBSP, CSCS, CCST
Doctors know the treatment they give an individual patient and therefore feel justified in how they code the service — but if documentation doesn’t support the code, there is a problem. Remember, as far as a third-party payer (or auditor) is concerned, if it isn’t in writing, it didn’t happen. If, for example, you bill a chiropractic manipulative treatment (CMT) code for a certain level of service, but the documentation only justifies a lower number of regions treated, you’ve just waved another red flag.
By KATHY WEIDNER, MCS-P, CCPC, CCCA
In the absence of other state or local guidance, in my opinion, using the Medicare standards for documentation and coding is simple and thorough. Since Medicare’s documentation standards are clear and easy to follow, they make an excellent guideline for all the practice’s documentation. Often, more minimum documentation standards can be met for non-third-party patients or those on maintenance care. This is where an understanding of what your board expects is critical.
By KATHY WEIDNER, MCS-P, CCPC, CCCA
So job one is to get your documentation in impeccable shape. It takes time to put procedures in place, but once you’ve got the steps down, it’s actually far easier to just do it right the first time around than to deal with time-sucking records requests, or worse, the extensive time and stress spent preparing for and recovering from an audit … Don’t make unnecessary errors by failing to know the rules of the game you’re sitting down to play with your $200,000 chiropractic license as an ante.
By JENNIFER KIRSCHENBAUM, ESQ
The Blocking Rule effective date is approaching, and while most practitioners have systems in place for storing and transmitting their patients’ electronic medical records and health care data, those who do not have such systems are expected to fall in line. Ensuring that your practice is capable of complying with the rule is important because there will be a risk of audit and fines for non-compliance (likely to initiate from a patient complaint if at some point you cannot electronically share a patient record).
By MARTY KOTLAR, DC, CPCO, CBCS
Approximately two years ago an initiative was introduced by the Centers for Medicare & Medicaid Services (CMS) called “Patients Over Paperwork.” The purpose of this program is to reduce the administrative burden placed on health care providers and their staff members and to also allow doctors to spend more time with patients. The new 2021 evaluation and management (E/M) guidelines allow chiropractors to spend more quality time with patients for increased reimbursement.
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