*Continue to visit this section frequently!  New Questions/Answers are posted regularly!  You can send your short questions to us via e-mail by filling out the Contact & Questions Form for ChiroNetwork.

Medicare:
Q:  How do I find my local Medicare fees?
A:  Every local Medicare carrier posts a ‘fees’ section within their website.  If you are not able to locate your fees there, you may also check the primary Medicare website which is www.cms.hhs.gov.  It is very important to know your local, current fee schedule for Medicare and of course, the fees are different for Participating and Non-Participating providers. 

Q:  Do I have to enroll with Medicare?
A:  There is currently not an ‘opt out’ option for chiropractic.  Thus, if you are treating Medicare covered patients with Medicare covered services (spinal manipulation), then yes, you must be enrolled in Medicare as either a Participating or Non-Participating provider. 

Q:  How do I find the Medicare approved diagnosis?
A:  Medicare lists their approved diagnosis for chiropractic care on each of their local Medicare Carrier websites in a section generally labeled LCD’s, which means Local Coverage Determination.  As you locate and view your local, current LCD, you will see a list of Medicare approved diagnosis.  Remember, these can be updated periodically so it is a good idea to verify this at least annually.  If you are uncertain where to find your local Medicare carrier website, please see the Resources & Links section of the ChiroNetwork as all Medicare carriers are listed there. 

Q:  How do I find information on documentation requirements for Medicare?
A:  Medicare lists many of their documentation requirements within the LCD (Local Coverage Determination).  Again, this can be found on your local Medicare carrier website.  If you are unable to find it there, you may find it also at the primary Medicare website, www.cms.hhs.gov.  If you are uncertain where to find your local Medicare carrier website, please see the Resources & Links section of the ChiroNetwork as all Medicare carriers are listed there.

Q:  Medicare is denying my claims, how do I find out what my claim form requirements are?
A:  Your local Medicare carrier is the best resource for this as you may ask them directly their specific claim form requirements.  Be sure to take thorough notes as you discuss and ask questions regarding this and confirm your information with the Medicare representative to insure you have the correct information. 
Another great resource is the current year ChiroCode Deskbook.  Claim form instructions are listed for standard insurance as well as Medicare specifics, in the ChiroCode Deskbook.  However, do not rely on older versions of the code book to provide you with accurate and current information.  It is always best to have the most current information on hand as guidelines and requirements do change periodically. 


Insurance:
Q:  Why should I verify benefits for coverage?
A:  Verification of benefits is very important for both the patient and the practice.  First, it allows the practice to more clearly and accurately inform the patients of their individual policy benefits and limitations.  As a patient yourself, wouldn’t you want to know?  Secondly, having this information allows the practice to more properly bill and maximize your collections from insurance companies.  Additionally, the practice is better able to track important things such as visit count, etc, so as to prevent unexpected denials from insurance companies. 

Q:  Sometimes claim representatives give incorrect information when I verify benefits.  What can I do?
A:  There is a liability to an insurance company for giving out inaccurate information regarding claims benefits and limitations.  However, to pursue this, can sometimes be quite costly.  If you would like more information on this specifically, please contact Total Practice Resources directly with your questions. 
Because incorrect information is indeed sometimes provided, the best we can do to protect our practices and our patients is to be clear in our explanation to patients as to what their insurance will and will not cover.  Thus, it is necessary that the patient be made aware that the verification of benefits is only an estimate of insurance coverage as actual coverage is not determined until claims are received and processed by the insurance companies.  For specific questions regarding their own policies, patients are encouraged to contact their own insurance companies for further clarification. 

Q:  How do I know what my fees should be?
A:  Your fee schedule is very important.  Each year this should be evaluated to insure that it is consistent and congruent with peers in your area.  There are many ways to determine average fees for services.  A couple of the most commonly used are as follows:
-The current year ChiroCode Deskbook provides calculations and formulas for you to use in determining your fee for each individual service.  Of course, you must have the current year ChiroCode Deskbook in order to accurately calculate this.
-Fee Schedule Analysis determined by zip code is prepared by a company that monitors statistics from providers and payers through the course of each year.  Using this tool, you are able to collect information specific to your zip code which shows you the low, mid, and high averages of fees for services.  For information on ordering this zip code analysis, contact Total Practice Resources.

Q:  Is there a way to protect myself from an insurance audit?
A:  Although there is no way to prevent an audit, there are several things that a practitioner can do in order to protect his/herself from an insurance audit.  For more information on this, please refer to the TPR Spotlight newsletters as well as webinars posted.  Specific things such as fee schedules, proper coding, proper use of modifiers, regular and organized claims submissions & having complete and correct patient information are all examples of things that are necessary and helpful in protecting a practice from a records review or audit.

Q:  Do I have to collect co-pays and co-insurances?
A:  Regardless of the network status of a practice, it is important to remember that each patient has a contract and agreement with their insurance companies due to insurance policies and coverage.  This agreement between the patient and the insurance company requires that the insurance company process insurance claims based upon the benefits and limitations of the policy that the patient has been assigned or has selected.  In addition to this, the patient also has an obligation to pay their individual deductibles, co-pays and/or co-insurances for their policies.  As practices intend to collect the appropriate payment from insurance companies for payment of services, we must also hold the patients accountable for their respective fees as well, in order to prevent the patient from being in breach of contract with their said insurance carrier.  Finally, there is liability to a practice for not fulfilling this requirement and instead, waiving fees assigned to patient responsibility.


Miscellaneous:
Q:  How do I better educate my patients?
A:  Patient education is the key to patient retention, patient compliance, generating patient referrals and much more.  Like us, patients must continue to be educated and it is our responsibility to insure that patients understand their benefit and need for our services.  The doctor is generally the primary educator for patients; however, it is important to recognize the valuable role that staff plays in this as well.  Staff is a doctor’s support team and it is their responsibility to aid in maintaining consistent and thorough patient education.  There are many avenues that can be employed to increase and improve patient education.  The priority to these avenues, of course, is to insure that the staff is properly educated so they may fully support the doctor and the patients.

Q:  Should I copy a patient’s Drivers License, and why?
A:  As we continue to learn more about patient privacy and Medical Identity Theft, it is becoming more necessary to verify a patient or potential patient’s identity prior to treating them.  Copies of Drivers License are a commonly used method for this and will one day be a requirement.  In effort to protect your practice and your patients, copying Drivers Licenses would be a wise implementation.  You can learn more about Medical Identity Theft and tips for protecting your practice and your patients from various resources.  Pre-Paid Legal Services, specializing in Medical Identity theft networks with Total Practice Resources.  Due to this, the TPR Spotlight periodically posts information that is very helpful and up to date.

Q:  Should I upgrade my software or invest in a paperless system?
A:  Prior to making a decision as to whether or not to upgrade your software, you must first determine what your purpose is for upgrading and what other needs should be met with any new software.  A new software system is a new implementation into your practice and must be treated accordingly.  For more information and step by step instructions to learn how to determine the best software for you and implement it accordingly, please review previous editions of the TPR Spotlight for this detail.

Q:  I am considering adding a new service into my practice but am unsure how to properly and effectively do this?
A:  Any new implementation into a practice is a big decision and must be handled accordingly.  There are specific steps necessary in which to take in order to insure proper implementation so you are able to achieve your desired outcome as quickly as possible.  For specific detail on this, please see previous editions of the TPR Spotlight as well as view webinars available on this topic.

Non-Insurance:
Q:  I want to offer pre-payment packages, are there any rules or guidelines?
A:  Yes, there generally are rules or guidelines to follow when creating and offering pre-payment packages to patients.  These rules are defined individually by each state and there is provider liability for not following these guidelines.  It is recommended that you contact your local state organizations to get this specific information so that you may be certain you are compliant with those set standards.  For contact information for your local state organizations, please see the Resources & Links section with the ChiroNetwork, as this is listed individually for each state.  Additionally, it is recommended that you confirm these guidelines each year to insure continued compliance.

Q:  Do I need to document as thoroughly for my non-insurance patients as I do for other patients?
A:  Absolutely.  Your exam and treatment notes are legal documents and regardless of your patient case type, must all be compliant with documentation guidelines.  Remember, your records may be request for review by other providers, attorneys and even insurance companies.  There are no patient records that are exempt from a records request or a review.  Additionally, there is liability for incomplete documentation, regardless of the insurance or non-insurance status of a patient.

Q:  What is Time-Of-Service (TOS) and are there any guidelines?
A:  Time-Of-Service (TOS) is a pay at time of service, ‘discount’ offered to patients where insurance submissions, etc, are not involved.  TOS is not a specific fee schedule; it is merely a discount from standard fees for self-pay patients.  There are specific guidelines to TOS, so before implementing these fees into your practice, you would be well advised to contact your local state organization to clarify any rules or guidelines that may be in place.  Of course, it is always best to get these guidelines in writing and this should be followed up with and verified each year. 

Q:  Do I have to offer discounts at Time-Of-Service?
A:  Of course not.  This is purely a decision that should be made by the doctor(s) or business owners.  Prior to making this determination of course, it would be best to have all of the information in order to make an educated decision as to what to offer or how to offer.  Again, this information can be made available to you by your local state organization.


Coding:
Q:  I am not confident in the codes that I use.  How do I find out if they are correct?
A:  Being certain that you are coding properly is extremely vital.  You should never guess or assume when coding.  Each year and even throughout the year, there are coding changes or updates.  There are multiple resources to obtain this current information.  Specific to Chiropractic, the ChiroCode Institute is an excellent resource to keep up to date on the changes and requirements for this profession.  The ChiroCode Institute is in the ChiroNetwork links section for your reference.  Common codes that you are using are listed not only in numeric order but also in alphabetical order for your easy reference and review.  It is highly recommended that you update each year to get the current ChiroCode Deskbook to further insure your correct use for codes. 

Q:  The insurance claim form only allows for four diagnoses.  Do I need more and where do I put them?
A:  Of course, the first place all applicable diagnosis for a patient should be in your treatment notes and documentation.  Many insurance payers (Medicare, etc), specify the order of priority diagnosis, so you may contact those payers to confirm their guidelines.  Additionally, box number 19 of the 1500 claim form allows for additional diagnosis if needed (although you can’t do this with Medicare).  There is also a technique called ‘claims cutting’ in which you would generate two separate claim forms, splitting your services and diagnosis accordingly and appropriately between the two.  (For more specific instructions for this, please contact Total Practice Resources).

Q:  How can diagnosis impact my claims payment?
A:  Diagnosis codes are very important for documentation and to receive proper payment for services.  For each of the service codes you are submitting for payment, you must have proper diagnosis to support the service.  Service codes say ‘What’ you are doing; diagnosis codes say ‘why’ you are doing it.  You must always support your services with diagnosis when expecting payment for services. 

Q:  How often do coding guidelines change and how does that affect me?
A:  The major changes to coding guidelines generally occur once per year at the start of each New Year.  However, throughout the year, there are often updates and changes to coding that are important to stay abreast of.  By not knowing your coding guidelines and the definitions and other requirements of codes you are using, you are putting your office at risk for denials of claims, records reviews and even audits.  Not knowing the guidelines is not an acceptable explanation for inaccurate coding and billing.  One of the best ways to begin to protect the practice, doctor(s) and patients, is to know the coding guidelines and requirements.