{"id":628,"date":"2015-10-07T13:48:24","date_gmt":"2015-10-07T17:48:24","guid":{"rendered":"http:\/\/www.eclipsepracticemanagementsoftware.com\/blog\/?p=628"},"modified":"2017-12-09T15:14:32","modified_gmt":"2017-12-09T19:14:32","slug":"dhhs-oig-targeting-tactics-for-chiropractic-audits","status":"publish","type":"post","link":"http:\/\/eclipsepracticemanagementsoftware.com\/blog\/2015\/10\/07\/dhhs-oig-targeting-tactics-for-chiropractic-audits\/","title":{"rendered":"DHHS OIG Targeting Tactics for Chiropractic Audits"},"content":{"rendered":"<p>While you were making last minute preparations for ICD-10, the Department of Health &amp; Human Services Office of the Inspector General published\u00a0a new report\u00a0on 9\/29\/2015. The report makes specific recommendations to CMS with regard to curbing &#8220;<em>questionable and inappropriate payments for chiropractic services<\/em>.&#8221;<\/p>\n<p><em><strong>Why should you care?<\/strong><\/em> Well, if you know what\u00a0OIG considers\u00a0<em>questionable and\u00a0inappropriate<\/em>, you can make\u00a0adjustments (no pun intended) to\u00a0your documentation, use of CPT codes &amp; modifiers, and visit frequency to avoid trouble &#8212; the kind of trouble that may eventually land you in a position of\u00a0oversight (including\u00a0pre-authorizations for services), not to mention fines and return of funds previously paid.<\/p>\n<p>You undoubtedly have a computer in your office &amp; can generate all sorts of reports that provide information about patients. DHHS has computers too.\u00a0OIG did a great deal of data analysis on chiropractic services performed in 2013. And their data mining techniques\u00a0helped them pinpoint\u00a0those of you who don&#8217;t\u00a0seem to follow the rules &#8212; and\u00a0outliers. <span style=\"color: #0000ff;\"><em>So&#8230; what are they looking for and what can you do to stay off their radar?<\/em><\/span><\/p>\n<ul>\n<li><span style=\"color: #0000ff;\">First, don&#8217;t forget to use the <strong>AT<\/strong> modifier for chiropractic services.<\/span> It&#8217;s required. CMS realizes that its use doesn&#8217;t guarantee the service was actually reasonable &amp; necessary, but the modifier is required. In 2013, 96% of all claims included this modifier.<\/li>\n<li><span style=\"color: #0000ff;\">Think twice before using CMT code <strong>98942<\/strong>\u00a0for the majority\u00a0of your Medicare patients.<\/span> 10% of paid services in 2013 included this code and OIG believes that almost half of these were upcoded. Why? OIG\u00a0computes your RVU&#8217;s (Relative Value Units).\u00a0They identified 1450 chiropractors who were being reimbursed at higher levels\u00a0than their colleagues. (Outliers.)<\/li>\n<li><span style=\"color: #0000ff;\">High average numbers of claims per beneficiary\u00a0by your practice indicates to OIG that you&#8217;re providing maintenance therapy.<\/span> OIG believes that 16% of chiropractors received questionable payments and that almost half of these were\u00a0probably for maintenance therapy. To\u00a0be specific, <em>96% of chiropractors averaged 8 services per beneficiary. In contrast, the remaining chiropractors averaged 25 services per beneficiary.<\/em> <span style=\"color: #000000;\">This is where your documentation becomes critically important<\/span>.\n<ol>\n<li>If you use an electronic kiosk system where patients enter their own subjective data and have the ability to indicate: &#8220;<em>No change. Same as last time<\/em>&#8221; regarding subjective symptoms, and\u00a0use this option regularly, you <em>will<\/em> have a problem when your documentation is reviewed.<\/li>\n<li>With CMT codes, make sure you\u00a0separately document each region you treated.<\/li>\n<li>Active\/corrective manipulative treatment is\u00a0expected to be an improvement in, or arrest of progression, of the patient&#8217;s condition. <em>When further clinical improvement cannot reasonably be expected from continuous ongoing care, and the chiropractic treatment becomes supportive rather than corrective in nature, the treatment is then considered maintenance therapy<\/em>.\u00a0Your documentation must chronologically reflect the <em>active<\/em> nature of the care you are providing. If\u00a0you&#8217;re unable to document changes in\u00a0a patient&#8217;s subjective complaints &amp; objective findings\u00a0over time, a\u00a0CERT\u00a0audit won&#8217;t help you.<\/li>\n<li>Document exact bones (e.g. C5, C6) and\/or area (e.g. lumbo-sacral). Documentation must support the symptoms and have a direct relationship to the subluxation. You must have a treatment plan that includes: recommended level of care (duration and frequency of visits), specific treatment goals, and objective measures to evaluate treatment effectiveness.<\/li>\n<li>Be familiar with your Medicare carrier&#8217;s LCD (Local Coverage Determination) and use the tables.<\/li>\n<li>You can attest to signatures &amp; plan of care when you get audited,\u00a0but ideally your documentation should be electronically signed \/ locked, and your care plans should be reflected in your locked notes.<\/li>\n<\/ol>\n<\/li>\n<li><span style=\"color: #0000ff;\">Getting back to those RVU&#8217;s, OIG also looked at chiropractors whose paid services indicated the possibility that they were working 16 hour days, which OIG labeled an &#8220;<em>unlikely # of services per day<\/em>.&#8221;<\/span> As you apply CPT codes, you must consider them within the context of other codes you used that day. Make sure you have a sign-in sheet that can back up the fact that those patients were in your office.<\/li>\n<\/ul>\n<p>Finally, let&#8217;s distinguish behavior characteristics considered <em>questionable<\/em> vs. <em>average<\/em> by OIG in 2013:<\/p>\n<ul>\n<li>Average\u00a0amount paid per chiropractor: <strong>$45,313<\/strong> vs. <strong>$10,303<\/strong>.<\/li>\n<li>Average # of paid claims per chiropractor: <strong>1,604<\/strong> vs. <strong>407<\/strong>.<\/li>\n<li>Average # of beneficiaries per chiropractor with paid services: <strong>101<\/strong> vs.<strong>47<\/strong>.<\/li>\n<\/ul>\n<p><em>Where do you fit in?<\/em><\/p>\n<p>Fortunately, if you&#8217;re using the ECLIPSE Encounter to document your Medicare visits, you have everything you need to help you\u00a0establish\u00a0each patient&#8217;s\u00a0progression of care.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>While you were making last minute preparations for ICD-10, the Department of Health &amp; Human Services Office of the Inspector General published\u00a0a new report\u00a0on 9\/29\/2015. The report makes specific recommendations to CMS with regard to curbing &#8220;questionable and inappropriate payments &hellip; <a href=\"http:\/\/eclipsepracticemanagementsoftware.com\/blog\/2015\/10\/07\/dhhs-oig-targeting-tactics-for-chiropractic-audits\/\">Continue reading <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"jetpack_post_was_ever_published":false,"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":true,"jetpack_social_options":{"image_generator_settings":{"template":"highway","default_image_id":0,"font":"","enabled":false},"version":2}},"categories":[7,8],"tags":[15,16,31],"class_list":["post-628","post","type-post","status-publish","format-standard","hentry","category-audit","category-encounter-soap","tag-chiropractic-ehr-audit","tag-chiropractic-ehr-software","tag-chiropractic-practice-management"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Medicare Chiropractic Audits<\/title>\n<meta name=\"description\" content=\"If you know what\u00a0DHHS OIG considers\u00a0questionable and\u00a0inappropriate, you can make\u00a0adjustments to\u00a0your documentation, CPT codes &amp; 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