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The Graduate &

In this week's newsletter I'm going to discuss a relatively new phenomenon in the field of physical healing: The Medicare Audit.

If you accept Medicare patients, or if you are considering taking on Medicare patients, you've likely heard a horror story or two of doctors being "Audited" by Medicare.

This newsletter will cover the different types of Medicare Audits, and how to go through an Audit and come out the other end relatively unscathed. The key, of course, is preventive medicine on your part. The more you know about this area and the governmental requirements involved, the less susceptible you will be to any adverse effects of a Medicare Audit.
 

Trained by the IRS?

There are primarily two main types of Audits: The Pre-Payment Audit and the Post-Payment Audit.

The potentially most costly Audit is the Post-Payment Audit. This is where Medicare requests complete and thorough documentation covering a specific period of time.

If your documentation does not adequately demonstrate the need for treatment (in the eyes of Medicare, that is), they could "request" that you pay them back what they have already paid you.

This, in effect, could conceivably be much worse than the dreaded IRS Audit. And if you do need to "pay them back," they can extract it from other money they owe you, sort of like money you owe the IRS being garnished from your wages, whether you like it or not.

The Office of Inspector General

So, what are the reasons Medicare Audits are on the increase? Well, most of the reasons are delineated in a study that the Office of the Inspector General, which is a part of the Department of Health and Human Resources, published in June of 2005. This study had the stated objective: "To determine the underlying causes of, and potential ways to reduce, vulnerabilities associated with Medicare payments for chiropractic services."

First of all, keep in mind this is a government report. When it speaks of "vulnerabilities associated with Medicare payments for chiropractic services.", it is referring to their perceived weaknesses in their own system, resulting in what they consider too much money being paid out for chiropractic services.

In 1972, Congress passed a law amending another law which defined chiropractors as "physicians who are eligible for Medicare reimbursement, but only for manual manipulation of the spine to correct a subluxation, or malfunction of the spine."

Another Federal regulation further limited Medicare payment to "treatment of subluxations that result in a neuromusculoskeletal condition for which manual manipulation is appropriate treatment."

The law also requires that "all services billed to Medicare, including chiropractic manipulations, be medically necessary and supported by documentation."
 

Documenting a Subluxation

One of the findings of the above government study was that: "34 percent of chiropractic services were not supported by an evaluation that met the Manual’s (Medicare Carriers Manual) specific requirements for documenting a subluxation.

This lack of proper documentation partially explains the increased scrutiny. But, insufficient or incorrect documentation does not necessarily mean that the doctors involved did not perform a correct evaluation, it just means that they didn’t document it well enough.

How bad can a post-payment audit be? One report shows a doctor who had to pay back $38,000. We also know plenty of doctors who have not had to pay back one red cent. In the latter case, their letters from Medicare state to the effect, "I am pleased to inform you that all the services that you submitted were allowed, as the documentation supported the services billed."

Bottom line: A post-payment audit is a risk that is totally manageable. Document your daily visits correctly and you will not have to worry.

And that's where Report Master comes in. The quality of the reports, and their comprehensiveness both being vital in this type of campaign, the next question is how long should it take to produce such reports?
 

Knowing the Medicare Rules
The above study can be found online:
CHIROPRACTIC SERVICES IN THE MEDICARE PROGRAM: PAYMENT VULNERABILITY ANALYSIS

 
If you commit to sending high-quality, professional reports to Medicare, chances are very good that you will never have a problem, stemming from documentation.

Report Master takes the work out of the Narrative and SOAP Note writing process, so you'll have more time to do the things you would rather be doing, and still maintain the necessary quality in your reports that Medicare and other providers demand.
 

Also, if you'd like to get a free demonstration of the Report Master System, click on the Demo Request Button to the left, and one of our Representatives will contact you to set up a time for you to get together. You'll be able to see his or her computer screen, as if they were in your office showing you the software.

Click here to learn more
 
Best,
Jim Miller - CEO - EP Managment, Inc.

www.expandingpractice.com