|MCA In Touch: October 2016|
In this issue:
By Barbara Dolezal, DC
It’s happened to all of us at one time or another — at a family gathering, at a party, waiting at the airport, anywhere — we’ve struck up a conversation which led to someone asking how chiropractic can help them. I don’t know about you, but at that moment I become filled with a great sense of opportunity that I can help someone who’s hurting and, within the time allowed, describe to them how chiropractic care can help, hoping to inspire them to seek the care of a Doctor of Chiropractic, which I know from the experience of 31 years in practice will change their health and their life. Sometimes, there’s a moment to do a quick Google search on the spot where I can provide them with a short list of doctors that are located near them, or jot down a doctor’s name or two to help them get started on the road to health.
Having told many, many people yourself dozens (hundreds?) of times that chiropractic is the cornerstone to health, I’m sure that you can describe the various responses that people have to the question “How Can Chiropractic Help Me?” Sometimes there’s an instant connection when they know they’ve found the answer to their health problems, sometimes there’s hesitation because they need more information, and sometimes...deer in the headlights. All of the responses are good because a seed has been planted, the possibility of better health and a better life have just become possible because you took a moment to listen, to tell them about chiropractic and to refer them to a doctor they can trust. Now, the decision is theirs.
The MCA is like that. The MCA is here, working hard to protect and improve our practice health and our lives. As with potential chiropractic patients, when a doctor asks “How Can the MCA Help Me?”, I become filled with a great sense of hope that I can help someone who’s practice is hurting and, within the time allowed, describe to them how the MCA can help, hoping to inspire them to become part of a strong association of colleagues who are working to strengthen patient access and provide a level playing field for reimbursement in Minnesota.
As with talking to potential patients about how chiropractic can help them, the responses to the question “How Can the MCA Help Me?” vary. Sometimes there’s an instant connection because they know becoming an MCA member will ultimately improve their practice and their lives, sometimes there’s hesitation because they need more information, and sometimes...deer in the headlights. All of the responses are good because a seed has been planted, they now know that it takes a strong state association to support an improved practice environment and a better life. Now, the decision is theirs.
“How Can the MCA Help Me?” The MCA has the unique role of protecting our chiropractic scope of practice in Minnesota, defending chiropractic legislative issues and responding to immediate and ongoing pressures from many interest groups. No other group does that for us. Having a strong state association is the cornerstone to building a healthy practice and a healthy life. The MCA works to maintain that strong foundation. Membership is your decision. Please join or renew your MCA membership today at the MCA website: mnchiro.com or call the MCA at 651-288-3428 for assistance.
Health and Higher Ground,
Barbara Dolezal, DC
by Lyle Coleman DC
Disclaimer: This article is about Medicare law and rules. Facts presented are not the author’s, not MCA’s, not ACA’s, but rather Medicare Federal Law and Rules.
Negotiating the maze that is Medicare requires doing many small steps in a routine manner.
The Present Situation
Audited 2014 chiropractic claims to Medicare had an error rate of 54% because the documentation did not support the service billed, the highest error rate in all of Medicare. The two biggest reasons that care was denied by audit? 1. The DC did not respond to requests for records and 2. the signature was missing or illegible.
The persistence of this high error rate year after year has put our future with Medicare at risk.
Who Pays? Medicare or the Patient?
The first crucial decision you as a DC will make when a Medicare eligible patient presents with a spinal complaint (Medicare covers spine only, no extremities) is to determine the appropriate billing path.
Three elements are required to start an episode of active care. One, there must be history capable of producing symptoms that the patient is capable of recovering from (what happened?). Two, there must be a decrease in the usual functioning capacity of the patient (having trouble doing any of your usual activities?). Three, there must be findings by exam or X-ray that correlates with history and complaints. All three elements must be there. The absence of any of the elements means that the threshold for active care is not met.
Only if the three elements are established can you use the AT modifier when you submit the claim to Medicare for payment. If any element is absent, the threshold is not met, the visit is maintenance, and the patient is responsible for the charges.
Using the three-element screen at the beginning of the visit quickly establishes who should be responsible for paying for your care for that visit.
It takes consistent and persistent patient education so that patients learn and accept this part of the Medicare law. In addition, indispensible patient education includes: Medicare does not pay for the required exams; an episode of active care requires scheduled follow ups; and maintenance care does not require an exam or scheduled follow ups.
Documenting an Active Care Episode
There are many ways to document care. There is no one right way. No matter how you document, someone can always find fault with it. And the whole subject of documentation is too big for the scope of this article.
Medicare requires the use of an outcome measure to identify and quantify functional loss. There are many; use what works best for you. Remember, Medicare only cares about function, not pain. Sequential outcome measures document improvement, can establish the need for further treatment, or show failure to respond, and finally shows the return to that patient’s full functionality so they can be discharged from that episode of care.
Medicare requires the use of treatment plans that are each 30 days in length.
The specific functions and the numbers that go with them from the outcome assessment serve as the basis for establishing the baseline and setting the specific treatment goals for that time period. It is a place to establish the treatment schedule and to list co-morbidities and complications that may affect treatment response.
The initial visit for an episode includes the daily note, exam findings (if not included in daily note), outcome assessment, and treatment plan. Subsequent visits in the treatment plan must be tied to the initial note, exam, outcome assessment and treatment plan. The requirements for the daily notes are just like the requirements for record keeping in our practice act. It is vital for the DC to sign each note legibly.
Here are links to documentation examples and resources to help you comply with Medicare documentation requirements.
Saturday, October 22 will mark the First Running HOME for Jacob 5K. It will be a day of community, hope and prevention. In addition to a children’s race and a 5K run/walk, there will be many activities for children and families to participate in. HOME: Hope for Our Missing and Exploited extends to all those missing and exploited. The goal is to raise awareness to the issues of safety, prevention and a unified purpose to create a world where kids can grow up safe!
Event Details and Schedule
For more information or to register, please visit tinyurl.com/Running-for-Jacob.
October is National Chiropractic Health Month. Join the MCA in sharing why your patients choose #Chiroractic1st. If you do not have a social media account, we encourage you to share patient testimonials with the MCA by sending them to Katie Wilkerson at firstname.lastname@example.org.
Be sure to hashtag #Chiropractic1st and #MNChiro. Let’s work together to bring public awareness to the numerous benefits of choosing chiropractic!
This year’s Northwest District Pheasant Hunt at McCollum’s Hunting Preserve proved to be a huge success! Thanks to all who joined in on the always entertaining annual event.
The fall Student Series Panel at NWHSU took place on September 29. Topics included: animal chiropractic, associateship, office sharing, starting a practice from scratch, and practicing within a multidisciplinary center. Thanks to all of our panelists (left to right): Dr. Getzmier, Dr. Thurmer, Dr. Graper, Dr. Metz, Dr. Norton, and Dr. Amstutz.