Cracking the Code: Simplifying Chiropractic Billing
In the ever-evolving landscape of chiropractic care, one element often overlooked is the intricate world of credentialing. It’s not the glamorous side of running a practice, yet, it is undeniably crucial. Enter Target Coding, a game-changer in the chiropractic sphere, now teaming up with the esteemed Dr. Marty Kotlar to decode the complexities of chiropractic billing and coding. A Unique Approach to Credentialing “This is one of the things that makes us unique,” remarks Dr. Kotlar. It’s not your typical practice-building seminar, not about acquiring new patients but uplifting chiropractors into the world of credentialing. The partnership with Target Coding promises to be a beacon of support, particularly in the areas of Medicare, major medical insurance, CA QH, durable medical equipment (DME), and NPIs. Navigating the Credentialing Maze For those who’ve threaded the path of credentialing, Dr. Kotlar acknowledges the headaches and frustrations that often accompany the process. “Credentialing is not a fun process,” he admits. Chiropractors didn’t attend chiropractic school to fill out credentialing applications, but as Dr. Kotlar emphasizes, it’s an essential part of running a successful chiropractic business. Medicare Credentialing Unveiled Delving into Medicare credentialing, Dr. Kotlar sheds light on the importance of having an active Medicare P-TAN number. The red, white, and blue card patients, the Medicare beneficiaries, are a significant part of chiropractic practice. Without the proper enrollment, chiropractors may find themselves unable to serve this demographic. Dr. Kotlar’s analogy comparing the process to assembling a barbecue humorously underlines the complexities involved. DME Certification: A Lucrative Venture The discussion expands to DME certification, a lucrative avenue for chiropractors. Dr. Kotlar clarifies that chiropractors can become certified DME providers through Medicare, allowing them to get reimbursed for items such as back braces and knee braces. The financial gains are substantial, making DME distribution a potentially profitable revenue stream for chiropractors. Target Coding’s Comprehensive Services The blog wraps up with an acknowledgment of Target Coding’s comprehensive services. Dr. Kotlar highlights their capability to handle various aspects of credentialing, including reassignment of benefits and revalidation. For chiropractors expanding their practices or hiring additional chiropractors, these services become invaluable, streamlining the often tedious process. In conclusion, Target Coding, under the guidance of Dr. Marty Kotlar, is transforming the narrative around chiropractic billing and coding. From Medicare credentialing to DME certification, their partnership is set to empower chiropractors to navigate the credentialing maze efficiently, ensuring financial success and sustainability in their practices. Stay tuned for more updates and insights from Genesis Nation as they continue Decoding Complexities in Chiropractic Billing and Coding. See the full episode by accessing it via https://bit.ly/3O4nh2A
The Significance of Certified EHR in Modern Chiropractic Practice with Genesis Software
A New Era in Patient Data Management The journey of patient data management has been a long and evolving one. From the days of relying on sheer memory and manual record-keeping to the advent of digital solutions, the healthcare industry has witnessed a significant transformation. In this digital age, the introduction of Electronic Health Records (EHR) has revolutionized how patient information is handled, particularly in specialized fields like chiropractic care. Revolutionizing Chiropractic Care with Certified EHR The introduction of certified EHR technology marks a pivotal moment in healthcare, especially in chiropractic practices. Genesis Chiropractic Software incorporates this technology, focusing on enhancing the accuracy of patient data, streamlining communication among healthcare professionals, and ensuring the secure storage of patient information. Why Certified EHR Matters in Chiropractic Care Certified EHR goes beyond mere digitization of patient records. It represents a commitment to elevating patient outcomes through a structured and regulated technological approach. For chiropractors, adopting a system like Genesis Chiropractic Software ensures compliance with stringent standards like HIPAA and Meaningful Use, as established by CMS and the ONC. Moreover, it opens doors to federal incentives, aiding in the cost-effective implementation of EHR systems. Setting the Standards: Who Regulates Certified EHR? The standards for certified EHR systems are set by federal authorities, including the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC). These bodies are responsible for ensuring that systems like Genesis Chiropractic Software adhere to the highest standards of quality and security. Understanding Meaningful Use in Chiropractic EHR For a chiropractic practice to comply with Medicare and Medicaid and to be eligible for incentive programs, an EHR system must meet specific criteria. These are divided into three stages: Data Management and Exchange: This initial stage is about effectively capturing and managing key performance indicators in a chiropractic setting, enhancing communication within the practice and with patients. Enhancing Clinical Processes: This stage focuses on improving electronic processes, including electronic prescriptions, access to online lab reports, and the digitalization of patient care summaries, along with an emphasis on Health Information Exchange (HIE). Optimizing Patient Outcomes: The final stage aims at showcasing improved health outcomes, facilitating better decision-making, and ensuring robust patient portal access for enhanced communication and information sharing. Transforming the Chiropractic Industry The push for certified EHR adoption, driven by Medicare and Medicaid incentive programs, has significantly influenced the chiropractic industry, nudging it towards a more universal adoption of digital health records. Genesis Chiropractic Software: Elevating Chiropractic Practices Genesis Chiropractic Software stands at the forefront of this technological revolution in chiropractic care. Our commitment is to assist chiropractic practices in navigating the complexities of Meaningful Use, HIPAA compliance, and other regulatory requirements. Whether you are in the market for a new EHR system or just considering an upgrade, Genesis Chiropractic Software offers a comprehensive solution that caters to the unique needs of your practice and patients. Explore how our software can redefine efficiency and care in your chiropractic practice.
Decoding the Complexities of Chiropractic Billing and Coding
With over 16 years of chiropractic practice, Dr. Marty Kotlar from Target Coding brings a unique blend of real-life experience and coding expertise, holding certifications as a Professional Compliance Officer and Billing and Coding Specialist. In this conversation with Genesis, Dr. Kotlar shares his insights and sheds light on the top three mistakes chiropractors commonly make in billing, coding, and compliance. Insurance Practices Dr. Kotlar kicks off our discussion by emphasizing the importance of meticulous tracking in insurance-based practices. He introduces the concept of an insurance tracking spreadsheet, stressing the need to record every payment accurately to avoid potential discrepancies. He also touches on common issues such as copay discrepancies and claim processing errors, urging practitioners to ensure they receive rightful reimbursement. Moving on, Dr. Kotlar delves into the world of codes. He discusses the nuances of time-based codes and non-time-based codes, providing valuable insights into maximizing reimbursement through proper coding. Exploring the intricacies of time-based codes like therapeutic exercises (97110), he unveils the critical factors providers should consider for accurate coding. In the final segment of insurance practices, Dr. Kotlar addresses the challenge of maximizing reimbursement. He shares pearls of wisdom, including the often-overlooked activities of daily living (ADLs) code (97535) and the significance of extremity adjustments. By unraveling the complexity of re-exams and other reimbursable services, Dr. Kotlar provides actionable strategies for practitioners aiming to optimize their revenue in insurance-based practices. Personal Injury (PII) Shifting the focus to personal injury (PII) practices, Dr. Kotlar enlightens us on the crucial role SOAP notes play in building strong cases for attorneys. He emphasizes the importance of documenting “duties under duress” and “loss of enjoyment of life,” elements that can significantly impact the patient’s life post-accident. Dr. Kotlar discusses the potential pitfalls associated with overprescribing in PII cases, cautioning against unnecessary procedures or devices. He sheds light on compliance challenges related to devices like back braces, TENS machines, and home traction units. Additionally, he underscores the necessity of thorough follow-ups to prove the clinical necessity of prescribed items. In this segment, Dr. Kotlar unveils the complexities of fee schedules, dual fee schedules, and the state-specific regulations chiropractors must navigate in the PII landscape. By addressing these challenges, he equips practitioners with the knowledge needed to build strong PII practices while ensuring compliance with legal and ethical standards. Cash Practices Dr. Kotlar concludes our conversation by exploring the nuances of cash practices. He starts by cautioning against misleading advertising practices, emphasizing the need for compliance even in cash-based settings. The discussion then pivots to the intricacies of prepaid plans, highlighting the potential risks associated with mishandling prepaid funds and the necessity of putting money in escrow. The conversation takes an insightful turn as Dr. Kotlar delves into the complex realm of discounts in cash practices. He demystifies the restrictions and allowances surrounding discounts, providing practitioners with a clearer understanding of how to navigate this aspect successfully. The final focus of our discussion centers on distinguishing between medically necessary care and maintenance or wellness care in cash practices. Dr. Kotlar outlines the importance of accurately coding services based on the nature of the patient’s visit, offering practical guidance for maintaining compliance and avoiding pitfalls. Conclusion: As our enlightening conversation with Dr. Marty Kotlar concludes, chiropractors and practitioners in allied fields gain a wealth of knowledge to enhance their billing and coding practices. Dr. Kotlar’s expertise and insights serve as a compass, guiding practitioners through the intricate landscape of compliance, reimbursement optimization, and ethical considerations. In the ever-evolving field of chiropractic care, staying informed and proactive is key, and Dr. Kotlar’s wisdom provides a valuable roadmap for success. Stay tuned for Part 2 of this conversation to be released next week! Experience the entire episode by viewing it through: https://bit.ly/3U5sACL
The Network Effect
People handle adversity differently; some break down sooner than others. When a team focused on a common goal faces adverse conditions, dissent among some team members precludes them from reaching a shared goal. Under extreme conditions, a mutiny isn’t just mission-critical—it can leave everybody dead. The famous explorer Ernest Shackleton, best remembered for his Antarctic expedition of 1914–1916 in the ship Endurance, managed such risks by assigning the whiny, complaining crew members to sleep in his own tent and share the chores with him. Clustering the “complainers” with him minimized their negative influence on others, and this helped his team survive and accomplish their goals. Medicare Vs. Private Payers It’s essential to acknowledge the contrasting dynamics between Medicare and private payers. Medicare, as a government-backed program, follows distinct regulations and reimbursement structures, while private payers operate in a competitive market with more flexible terms. The negotiation strategies and considerations may differ significantly when dealing with these two payer types. Payment negotiations Actively negotiating with payers is crucial for independent medical practices. However, many providers lack experience or haven’t been successful in past negotiations due to inadequate preparation. To ensure a fruitful negotiation, it’s vital to: Know Your Data: Understand your practice-specific data, including patient volume, charges, reimbursement history, and more. Know the Terms of Each Contract: Familiarize yourself with your current payer-specific contract terms, especially the reimbursement schedule and the claims filing data. (Babcock, 2021) According to a KFF analysis, as seen in the image below, private insurers often pay nearly double the Medicare rates for hospital services. Specifically, for outpatient hospital services, private insurance rates were found to be significantly higher than Medicare rates, averaging 264% of the latter. This difference underscores the varying dynamics and market powers between Medicare and private insurers. Policymakers and analysts continue to debate the necessity of high payments from private payers to compensate for the lower Medicare payments. (How Much More Than Medicare Do Private Insurers Pay? A Review of the Literature | KFF, 2020) Classification of Payment Models Payment models dictate how healthcare providers, including physicians and hospitals, are remunerated for their services. Each model inherently carries incentives and disincentives that can influence the balance between cost reduction and improving care quality. These two objectives often stand at odds. This report delves into the implications of Alternative Payment Models (APMs) in either mitigating or intensifying health disparities. However, before exploring these implications, it’s essential to understand the incentives and disincentives embedded within the prevailing payment models. These incentives play a pivotal role in fostering cost-efficient, high-quality care. The primary distinction among these payment methods lies in the unit of payment. This determines how financial risk is distributed between the payer and the provider. The nature of this risk can significantly influence the behavior of healthcare providers and the overall efficiency and effectiveness of the healthcare system (Quinn, 2015). Factors affecting payment negotiations According to AMA, it’s not just about the rates but also about the terms and conditions that can impact payment. For instance, some contracts might have clauses that allow payers to change rates without notice, or they might have stringent requirements for prior authorizations. Providers should be wary of “most favored nation” clauses, which can restrict them from offering better rates to other payers. It’s also crucial to be aware of the dispute resolution process outlined in the contract, should any disagreements arise. By being well-prepared and understanding the intricacies of payer contracts, providers can position themselves for more favorable negotiations and better financial outcomes. (American Medical Association & American Medical Association, 2022) Payer-provider conflict In the payer-provider conflict, the providers who accept lower reimbursement and who don’t challenge underpayments or delayed payments make it easier for the payers to maintain their market control (oligopsony). Recent research supports this notion, indicating that payers with larger market shares have more negotiating power in contract negotiations (HealthPayer Intelligence). ClinicMind’s network helps providers maintain their payment schedules and motivation by establishing a shared discipline for clients and billers alike in terms of both thought and action. Payers with Larger Market Share and Their Negotiating Power Payers that have a dominant presence in the local market have a distinct advantage when it comes to negotiating lower prices for physician office visits. A study conducted by researchers from Harvard Medical School found that health insurance companies with a market share of 15% or more negotiated visit prices that were 21% lower than those set by payers with a market share of 5% or less. For instance, payers with less than 5% of the market negotiated prices of $88 per office visit. In contrast, those with 5 to 15% of the market share settled for a price of $72, and those with more than 15% of the market share negotiated even lower at $70 per visit. The graph below shows this analysis. From Policy Changes to Physician Consolidation In 2010, President Barack Obama signed the Affordable Care Act (ACA) into law, a move that expanded Medicare’s reach by adding millions to its coverage. This expansion meant that more physicians had to accept Medicare rates, which have been systematically reduced over time. The ACA not only aimed to extend healthcare access to uninsured Americans but also set in motion a wave of consolidation in healthcare services. As Medicare adjusted its rates, private insurance companies followed suit. While they still paid above Medicare rates, they too began to reduce their payouts. This trend forced physicians to grapple with a challenging reality: working more hours for less pay. The Power of the Network Effect In response to these financial pressures, physicians began to see the value in consolidating their practices. By joining larger organizations, they could harness the network effect, gaining more significant negotiating leverage with insurance companies. This consolidation is not just about survival; it’s about strength in numbers. Large groups, especially those with revenues exceeding $1 million annually, have more room to negotiate than smaller entities. The Rise of Management Service Organizations (MSO) Amidst these challenges,