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Straight Talk Provider Bulletin – July 2014

July 31, 2014

In This Issue:

Important Dates
Becoming Active Care Certified
Registration Now Open: Documentation and Coding Seminar
Advertising Statutes: Avoiding Fraud and Abuse Pitfalls
Coding Corner
Compliance Corner

Important Dates

activecareActive Care Certified ChiroCare Chiropractors Take Personalized Care to New Levels

The ChiroCare Active Care Certification Program is a four-part series comprised of online and classroom instruction. Active Care Certification emphasizes the current state of evidence regarding the use of active care programs in chiropractic practice.

Following program certification, providers are eligible to receive a complimentary premium account subscription to the Perfect Fit System. This online exercise delivery solution provides exercise animations and workout codes to create a unique exercise experience for each patient. Exercises can be printed, e-mailed, or sent to a smart phone.

ChiroCare has a new flyer titled Evidence-based Care for Low Back Pain: Integrating Active Care and Spinal Manipulations Improves Patient Outcomes

27076Online Registration Now Open! September 6 Documentation and Coding Seminar

If you’re looking for a great way to earn four CEU credits while gaining practice-critical knowledge, we hope you will consider attending Dr. Anthony Hamm’s Documentation and Coding seminar on September 6 from 8 a.m.-noon, at Northwestern Health Sciences University. Course topics include:

  • Correct use of Financial Disclosure Forms and Medicare ABNs
  • Case Examples of E/M Codes, Care Plans, and Documentation
  • Understanding and Implementing Medicare’s Physician Quality Reporting System (PQRS)
  • Identifying functional deficits and goals for Care Plans
  •  Request or Release of Protected Health Information
  • Informed Consent/Shared Decision Making
  •  Patient Discharge and Preventive Services
  • Outcomes Toolkit

Chiropractors in Minnesota, North Dakota, South Dakota, and Iowa will earn four CEU credits by attending one session. Unfortunately, CEUs are not available for chiropractors in Wisconsin.

Online registration is now open! 


fraudAdvertising Statutes: Avoiding Fraud and Abuse Pitfalls

In response to a number of questions from our doctors, we are providing information about the requirements of state and federal advertising laws, statutes and regulations. For example, the Office of Inspector General (OIG) states that “routine waiver of deductibles and co-payments by charge-based providers, practitioners or suppliers is unlawful because it results in:

  1. False claims;
  2. Violations of the anti-kickback statute; and
  3. Excessive utilization of items and services paid for by Medicare.”

Another potential pitfall is offering free spinal screenings at health fairs or businesses. If offerings induce patients—especially those with federally funded coverage—to come to your clinic for additional services or supplies, this is commonly considered a violation of anti-kickback provisions of the Social Security Act.

The American Chiropractic Association (ACA) offers this advice: “A good test after you check the laws is to check your motive. If you are doing screenings as a community service—the way a hospital would do blood pressure checks at a health fair—that is different from performing screenings so that you obtain patient referrals.”

Misleading, false or deceptive advertising or marketing was the fourth highest violation reported from the state licensing boards across the nation last year, according to the Federation of Chiropractic Licensing Boards (FCLB). FCLB advises that doctors of chiropractic must be careful when describing themselves and their services: “They should use language that is specifically allowed according to individual jurisdictions. Under no circumstances can the terminology be potentially misleading to the public.”

Some examples of the type of language that might be considered misleading include:

  • Claims such as “no side effects” with treatment, or that treatment is “painless.”
  • Claims of cures for certain conditions, for which there is little credible research to support the claims.
  • Advertising free products or services, such as meals where attendees are presented with information about the clinic, X-rays when there is no presence of medical necessity, or drawings for things like gym memberships, exercise equipment, or tickets to athletic or cultural events.
  • Claims of expertise for which the provider does not possess credentials.
  • Use of scare tactics to intimidate readers into seeking care, such as “a study showed…” without providing a citation.
  • Claiming a success rate that cannot be substantiated to a court of law or a board.

ACA’s Code of Ethics states, “Doctors of chiropractic should exercise utmost care that advertising is truthful and accurate in representing the doctor’s professional qualifications and degree of competence. Advertising should not exploit the vulnerability of patients, should not be misleading, and should conform to all governmental jurisdictional rules and regulations in connection with professional advertising.”

The OIG views the following advertising/wording as “indications of improper waiver of deductibles and copayments:”

  • Advertisements that state: “Medicare accepted as payment in full,” “insurance accepted as payment in full,” or “no out-of-pocket expense.”
  • Advertisements promising “discounts” to Medicare beneficiaries.
  • Routine use of “financial hardship” forms, which state that the beneficiary is unable to pay the co-insurance/deductible, where there is no good-faith attempt to determine the beneficiary’s actual financial condition, where the income scale used was not derived from valid statistical data, or where such forms are not offered to all patients equally.
  • Collection of copayments and deductibles only when the beneficiary has Medicare supplemental insurance (“Medigap”) coverage (i.e., the items or services are “free” to the beneficiary).
  • Charges to Medicare beneficiaries that are higher than those made to other patients for similar services and items (the higher charges offset the waiver of co-insurance.)
  • Failure to collect copayments or deductibles for a specific group of Medicare patients for reasons unrelated to indigency (e.g., a supplier waives co-insurance or deductible for all patients from a particular hospital, in order to get referrals).
  • “Insurance programs” that cover copayments or deductibles only for items or services provided by the entity offering the insurance. The “insurance premium” paid by the beneficiary is insignificant and can be as low as $1 a month or even $1 a year. These premiums are not based upon actuarial risks, but instead are a sham used to disguise the routine waiver of co-payments and deductibles.

Federal False Claims Act
The Federal False Claims Act establishes liability under a number of circumstances, including instances in which a person or entity knowingly:

  • Presents or causes a false claim to be presented to the federal government for payment or approval.
  • Makes, uses—or causes to be made or used—a false record or statement material to a false or fraudulent claim.
  • Conceals and/or improperly avoids or decreases an obligation to pay or transmit money or property to the federal government.
  • Conspires to commit a violation of the liability sections of the act.

Penalties of the Federal False Claims Act include:

  • Civil penalties between $5,000 and $11,000 plus three total damages per times the claim.
  • Possible exclusion from Medicare and Medicaid.
  • Possible criminal prosecution.

Screen Shot 2014-06-23 at 8.08.52 PMCoding Corner

  • ChiroCode Institute: Providers can take advantage of free, weekly news alerts regarding coding and compliance by signing up for the ChiroCode Institute newsletter.
  • ICD-10 Update. Don’t let the delay in ICD-10 implementation give you a false sense of security, advises the American Chiropractic Association: “Proper clinical documentation is crucial to a successful practice, no matter what code set is being used. The delay of ICD-10 implementation is an opportunity for DCs and other health professionals to focus on documentation improvement.”

Many resources are available to help your practice prepare for ICD-10.

ehrCompliance Corner

  • Medicare Electronic Health Record (EHR) Incentive Program. If you are participating or planning to participate in Stage One of the Medicare Electronic Health Record Incentive Program this year, it’s important to be aware of milestones and changes. The official website offers all the details that will help with implementation, and offers a clear explanation of the 2014 definition for Stage One of Meaningful Use.
  • Record Keeping Tips:
    • The age limit increased for recording blood pressure in patients from age two to age three; there is no limit for height and weight.
    • For more than 50 percent of all unique patients seen by the eligible professional during the EHR reporting period, blood pressure for patients age three and over, and height and weight for all ages, should be recorded as structured data.
    • Assessments must be updated after each visit.
    • Treatments need to have a clear beginning and end date.
    • Measurable treatment goals must be clearly stated and updated:
      • Using neck and low back indexes to track improvement
      • Using Outcome Tools on ChiroCare Connect
    • The treating doctor must match the billing doctor.
  • Security Risk Assessment. The Health Insurance Portability and Accountability Act (HIPAA) Security Rule requires that covered entities conduct a risk assessment of their health care organization. A risk assessment helps your organization ensure it is compliant with HIPAA’s administrative, physical and technical safeguards. A risk assessment also helps reveal areas where your organization’s protected health information (PHI) could be at risk. Watch the Security Risk Analysis video to learn more about the assessment process and how it benefits your organization. Earlier this year, the U.S. Department of Health and Human Services (HHS) made available a new security risk assessment (SRA) tool to help guide health care providers in small to medium sized offices conduct risk assessments.
  • Compliance Hotline: ChiroCare holds its network chiropractors to the highest practice standards and ethical behavior. As part of this expectation, we have established a 24/7 compliance hotline for providers, patients, ChiroCare employees, and other individuals who are concerned about a possible compliance issue. Doctors even have a duty to report themselves if a breach occurs (e.g., a laptop with unencrypted patient data is stolen; a flash drive containing patient data disappears).

    You may call the hotline to raise concerns or report possible violations to ChiroCare pertaining to suspect actions of ChiroCare, its providers, its employees or its associates. ChiroCare’s Compliance Officer will investigate all reports and ensure that corrective action is taken in response to all confirmed compliance violations. ChiroCare does not allow any retaliation or discrimination against any individual who in good faith reports a compliance concern.