Primo Practice EMR Documentation

Practice Management Blog Visit www.spinetech.us or www.primopractice.com for more information on the Primo Practice EMR Touchnote System! Chiropractic Practice Management Tips from Dr. David Bohn, DC. Pump up your practice with these hints and tips from a practicing chiropractor who has seen over 15,000 patients during the course of his career.

[quicksoap-blog]

Is Patient Education Worth the Time?

Is Patient Education Worth the Time?

by Dr. David Bohn, DC

  Chiropractors will talk about educating patients and never question that an educated patient is more likely to begin care and then stick with a recommended care plan. When many chiropractors elect to educate their patients they usually fail to do it in a creative way that attracts and holds attention, answers the questions that really need answered, yet do not nag or annoy their patient.

  People today are not like the patients of the 1980's. Attention spans are shorter, information on any topic is available with just the click of a mouse, and the competition to be noticed and heard is fierce.

  This presents a dilemma. If we all agree that if our patient is educated about their problem and the solution we are offering results in a less stressful practice for us and a better outcome for the patient why isn't this happening?

  Perhaps I can offer an example from my own life to help illustrate. 

  As an undergraduate college student I drank and apparently enjoyed low cost beer, sometimes to excess. I knew very little about how beer was brewed and really wouldn't have cared to have it explained. Beer was important to me for the same reasons it is to all 21-year-old men. In chiropractic school a friend of mine introduced me to home brewing. I read every book I could find, spoke with people in the local shop that sold home brewing supplies and eventually mastered understood the importance of understanding the importance of balling degrees and terminal gravity. As the years past my interest and understanding in beer grew to the point that I cannot bring myself to drink a can of mass produced swill that many people find so satisfying.

  Well enough about beer, here's the moral to the story. The more you learn about something, the more interested you become in it and the more of it you begin to buy. You buy more and become more loyal to it until you become a valuable lifetime customer of the product. I will admit to you, I am now a loyal lifetime Samuel Smith's Oatmeal Stout raving fan although I still enjoy experiencing fine microbrews as I travel. Applying this to chiropractic means that the better you educate your patient, the better client they will be, the more loyal they will be to your practice, the more money they will spend, and most importantly the better they will be able to explain your practice and what you do to their friends and family. This means you will get more referrals and have a better, less stressful practice.

  It all comes down to increasing the value of each patient. Not just for 18-24 visits but for the lifetime of that patient, for the referrals and the new problems they may have over their lifetime.

  Patient education;

1.   Increase the number of internal referrals your practice receives.

2.   Increases the PVA (patient visit average) of each patient because educated patients comprehend the value of chiropractic.

3.   Educated patients understand the value of maintenance.

4.   They are more likely to remain long term patients in your practice and educated patients are less concerned about fees.

  My personal favorite example of quality, creative patient education is the take home report of findings. This would include copies of the patient's x-rays with lines drawn on it demonstrating the patient's biomechanical faults. Pictures of the patient preforming each range of motion. A posture analysis showing the patient the abnormalities. A listing of their subluxated segments with the corresponding effected organs and muscles, and a financial case presentation. I also like to provide the patient a copy of their first visit note in narrative format. This take home report allows the patient to fully understand and share their problem and my solutions will everyone.

  Dr. David Bohn, DC is the founder of http://www.chiroconceptions.com and has been practicing chiropractic since 1988. For more information on software and other tools to increase your practice visit our website or call 301-777-3710 for more information.

[quicksoap-blog]

Still Using Handwritten Notes?

Still Using Handwritten Notes? I get several calls a week from doctors who are still using handwritten travel cards or antiquated computer technology because they either have very little computer knowledge or do not like to change. Well, let me be the one to break the news, computerized notes with EMR/EHR technology is here to stay. If you are one of those chiropractors who has been putting off moving into the future of documentation then QuickSOAP Notes is the program for you because at www.chiroconceptions.com we specialize in "technophobes". Moving your documentation into computerized touch screen technology will increase your compliance, decrease the time you spend doing new patient notes, and can even increase the number of referrals you get from primary care providers and attorneys. Even with these potential benefits many DC's hesitate on moving forward. When you buy QuickSOAP Notes we will "hold your hand" and help you get set up. This includes helping you get you computer set up and running and connecting your iPad if that is the way you want to go. QSN's is intuitive and help videos are available on every screen so you can learn as you go without constantly turning to a manual to find out how something works. Over the years I have discovered that doctors have a strong interest in updating their practice and their patient management with computerized documentation but have doubts about their ability to learn the software and work on a computer. We have had many self described "older" doctors update to QuickSOAP Notes and adapted to the technology very quickly. The biggest barrier to purchasing and upgrading seems to always involving expanding your headspace first, after that it is all downhill. It will take a few weeks to become completely comfortable with the program and then it will seem as if you had it made just for your practice.  All of our screens can be customized to fit your practice and you have the option of adding unlimited template screens meaning that you can finally create a documentation that is uniquely yours for less than $2000. The main thing is don't be afraid of expanding and growing. All of our staff from our graphic artist to our senior programmer will be glad to help you get the most of your software. You get 30 days of support when you buy and if you would like unlimited support and updates we will be only a phone call away, year after year, for only $295/year. We are happy to take suggestions for new screens or improvements from our support subscribers. Stop being afraid, we're here to help. Call us at 301-876-4565 if you would like to move forward and add QuickSOAP Notes to your practice today.

[quicksoap-blog]

Invitation to connect on LinkedIn

LinkedIn

[quicksoap-blog]

A GUIDE FOR LIVING IN 2011

A GUIDE FOR LIVING IN 2011  

Health: 1. Drink plenty of water. 2. Eat breakfast like a king, lunch like a prince and dinner like a beggar. 3. Eat more foods that grow ON trees and plants and eat less food that is manufactured IN plants.. 4. Live with the 3 E's -- Energy, Enthusiasm and Empathy. 5. Make time to pray. 6. Play more games 7. Read more books than you did in 2010 . 8. Sit in silence for at least 10 minutes each day 9. Sleep at least 7 hours. 10.Take a 10-30 minute walk daily.  And while you walk, smile.   Personality: 11. Don't compare your life to others. You have no idea what their journey is all about. 12. Don't have negative thoughts on things you cannot control. Instead invest your energy in the positive present moment. 13. Don't over do.  Keep your limits. 14. Don't take yourself so seriously.  No one else does. 15. Don't waste your precious energy on gossip. 16. Dream more while you are awake. 17. Envy is a waste of time.  You already have all you need. 18. Forget issues of the past.  Don't remind your partner of his/her mistakes in the past, that will ruin your present happiness. 19. Life is too short to waste time hating anyone.  Don't hate others. 20. Make peace with your past so it won't spoil the present. 21. No one is in charge of your happiness except you. 22. Realize that life is a school and you are here to learn.  Problems are simply part of the curriculum that appear and fade away but the lessons you learn will last a lifetime. 23. Smile and laugh more. 24. You don't have to win every argument.  Agree to disagree...   Society: 25. Call your family often. 26. Each day give something good to others. 27. Forgive everyone for everything. 28. Spend time with people over the age of 70, and under the age of 6. 29. Try to make at least three people smile each day. 30. What other people think of you is none of your business. 31. Your job won't take care of you when you are sick.  Your friends will.  Stay in touch.   Life: 32. Do the right thing! 33. Get rid of anything that isn't useful, beautiful, or joyful. 34. GOD heals everything. 35. However good or bad a situation is, it will change. 36. No matter how you feel, get up, dress up, and show up. 37. The best is yet to come... 38. When you awake alive in the morning, thank GOD for it. 39. Your Inner most is always happy. So, be happy.    Last but not the least:   40.    Consider forwarding this guide to those you care about.

[quicksoap-blog]

Here is the blue tooth mac keyboard with my iPad running quicksoap notes. Full features, no need to use a desktop touchscreen.

[quicksoap-blog]

EHR Stimulus Funds for Chiropractic Note Programs

On July 16, 2010 the “Final Rule” regarding Meaningful Use criteria and EHR (Electronic Health Records) Financial Incentives was released and has generated  lots of questions and a lot of confusion for many chiropractors about how to obtain stimulus dollars for documentation software (EHR/EMR). Several times a week a chiropractor will ask me if my program QuickSOAP Notes (www.chiroconceptions.com) meets the requirements.

Here are what I believe are the key points regarding EHR eligibility for those of you who don’t care to read the original documents or fact sheets on Meaningful Use and EHR Financial Incentives in their entirety:

Meaningful Use Criteria which establish eligibility for financial incentives are for EHR Certified programs only. Translation: if your EHR is not certified, you may not receive any financial stimulus.  Many EHR companies are advertising that they are “eligible” for certification, although this is not the same as being certified.  Buyer beware!

You know only need to complete 20 of the 25 Meaningful Use Objectives/Measures as defined in the Final Rule issued by CMS.  Even though you may “defer” 5 of these requirements, this is still an ambitious list for most practitioners in order to qualify for the funds.

The completion of these Objectives/Measures fulfills Stage 1 requirements only (which make you eligible for the financial incentive portion).  Stage 2 and Stage 3 objectives exist, but the exact requirements and penalties are not as well defined.

Chiropractors are Eligible Professionals that may qualify for the EHR financial incentives

Chiropractors may be eligible for EHR financial incentive payments as early as 2011; payments can proceed for up to 5 years.

The total financial payments that chiropractors are eligible to receive is a maximum of  $44,000 over a 5 year period or equal to 75% of Medicare allowable charges for covered professional services furnished by the chiropractor in an eligible year.  This is perhaps the biggest criteria EHR companies fail to mention.  In other words, in one given year, you can receive up to $18,000 IF (and only if) you provide at least $24,000 worth of covered services (based on allowable charges) to Medicare patients.  On the other hand, if you have a small Medicare practice, your eligible financial incentives will be reduced accordingly and capped at 75% of the allowable charges for your covered services (which, in chiropractic, is CMT only).  Do the math to see if your practice qualifies for anywhere near the $44K amount.

The Bottom Line

My feelings have not been changed by the “final rule” criteria.  I would highly recommend that most offices switch to some form of electronic health records.  However, this advice is NOT based on the presumption that you are doing so to capture any potential financial stimulus incentives.  Rather, migrate to EHR because of its potential to improve your documentation, level of care and overall record-keeping. I would add that you should search for a program that you WILL USE and not for the best deal or all in one package.

[quicksoap-blog]

Have You Recieved Your Medicare Audit Letters Yet?

I am hearing from many of my clients and some billing and coding professionals that I know that Medicare has stepped up its audits and reviews on chiropractors.

Medicare carriers around the country are sending out these audits as part of President Obama’s Executive Order # 13520, “Reducing Improper Payments and Eliminating Waste in Federal Programs.”  The goal of this order is to eliminate payment error, waste, fraud, and abuse in Federal program and requires federal agencies to conduct semi-annual studies to identify and reduce vulnerabilities in high risk areas.

This is happening right now, it started in mid-August 2010, Medicare carriers will begin increasing their recovery efforts and sending piles of CERT (Comprehensive Error Rate Testing) letters aimed at chiropractors. Although the program is not targeting chiropractors specifically (all Medicare providers are under similar attack), they have made the chiropractic targets public knowledge.  Chiropractors who meet the following criteria will be subjected to “random” audits:

Chiropractors who have submitted multiple claims for the same Medicare beneficiary between April and June 2010

The CERT audits will focus on determining whether chiropractic services billed to Medicare were medically necessary as acute (active) chiropractic treatment.

For each claim selected, CMS will review medical records up to 12 months prior to the date of service on the claim.

Based on the “random” criteria listed above, CMS will deny claims for services that the reviews have determined to be maintenance and not active treatment.  Accordingly, the Medicare carrier will then take steps to recoup any over-payments.

From my experience with chiropractors I would guess that these CERT criteria will apply to just about every chiropractor in the country.

According to data published by Medicare in the press release for this new CERT launch, Medicare is going after $174.1 million in projected improper payments to chiropractors.   Taken across the board, that $174 million could mean every DC in the country would be forced to cough up roughly $3500.  Since a sizable chunk of DC’s on record are practicing part-time, retired, or not practicing at all, it’s possible that the 50,000 DC pool is much smaller.  In half, that would mean $7000 per DC.  Frankly, some of you don’t have anything to worry about because you see Medicare patients once every blue moon.  This conceivably can chop the available audit pool in half again, leaving all the remaining DC’s to foot a $14,000 bill.

If you are still reading and are concerned, here are a few brief recommendations to tackle this issue with a sober mind and some strategic planning:

The worst mistake is to ignore the CERT audit request. You have 30 days to comply.  Do it quickly.  If Medicare deems your documentation, billing or coding unworthy, they will ask for money back.  If they don’t even receive your documentation, they will still ask for their money back AND they can pursue the opportunity to charge you with fraud.

Medicare has stated that the primary causes of the errors were payments for maintenance therapy and missing plans of care. Two recommendations here: (1) if it walks, talks, quacks like a duck, it’s a duck.  When Mrs. Jones comes in like clockwork every first Monday of the month, with no rhyme or reason other than, it’s her scheduled appointment, it’s going to be a long hard road to prove that this visit is not maintenance.  (2)  Include a plan of care!  Some docs mistakenly think that they are flying “under the radar” by not documenting any scheduled visits.  If it’s PRN, say it’s PRN!  If you want them to come in 3x over the next 2 weeks, state that!  And remember, a treatment plan is more than a schedule of care (but that’s another topic for another day)

Seize the opportunity! Scared?  Some of you should be!  But being afraid accomplishes nothing. Face your fears and fix your shortcomings!  Get help instead of sitting there wondering if the Medicare monster is going to eat you for lunch.  No third party payer – Medicare included – expects your notes to be perfect.  Your documentation should meet standards and if you want to keep yourself out of trouble, it should look better than your peers.  Why? Because, statistically speaking, many of your peers are getting it wrong – which is why we are in this mess in the first place.

The Final Word

For those of you who are feeling a bit paranoid, persecuted or just plain peeved, take heart: Medicare is not trying to eliminate chiropractic.  What they are trying to do is to clean up errors within their own systems – for physicians of all types – and in the process, reclaim money that should not have been paid out in the first place.  It may not seem fair that they have “suddenly” raised the bar. In actuality, the rules were there the whole time; they have recently taken the opportunity to enforce them.

And yes, it’s about the money.  When a cash-strapped government entity discovers that it can recoup $900 Million in incorrectly paid claims in about three years time, it wants to repeat that “experiment” over and over again.  If you haven’t been paying attention, that’s exactly what happened starting in 2005.  And the nearly $1 billion recovered was not just from chiropractors. In fact, we are only a small piece of the pie.  Unfortunately, the coffers are so empty, the powers that be want to scrape up every penny they can get back.

We do have the ability to defend ourselves here.  First, we can make sure our chiropractic billing, coding and documentation is as bulletproof as possible.  Then, our best defense will come in the fact that Medicare (and every other third party payer) may take a few pennies back from the chiropractic community, but it will cost them a few dollars to do it!

[quicksoap-blog]

Medicare Publishes Chiropractic Assessment Findings on the first Quarter

The other day, the Medicare service provider (Palmetto GBA) issued the company's first Quarter findings regarding Medical Reviews they've recently been performing.  Although Palmetto is just one of many companies that administer claims for Medicare, their results happen to be highly relevant to doctors of chiropractic as well as, in my own past experiences, reflective of tendencies throughout the chiropractic profession. The intention of the evaluation process is to decrease payment errors as a result of finding and correcting documentation and billing errors regarding insurance policy coverage and also coding. During the assessments, Palmetto GBA discovered 10 areas of concern for the first quarter of 2010. The top areas of concern from 1-10:    1. Split/shared visits    2. Signatures    3. Labels/Diagnostic Testing    4. Hospital & Nursing Facility Discharge Services    5. Chiropractic Services    6. Therapy Services    7. Individual Psychotherapy Services    8. Evaluation & Management Services    9. Legibility 10.  Teaching Physician Services. Please be aware that this isn't an all-inclusive list although it does indicate most documentation concerns uncovered throughout the evaluation process.  On this shortlist, three things happen to be relevant to chiropractic reimbursements in the Medicare program. Which means that we'll go over the 3 “Frequently committed errors”:    1. Signatures.  To explain, Medicare demands an “identifier” for services provided or ordered.  This identifier is your signature – either in handwritten or electronic form.  Signature rubber stamps as part of your documentation aren't acceptable per Medicare Signaure Requirements (See section 3.4.1.1 B) Really, this really is so fundamental that it's absurd that it actually makes the top 10. Evidently, in spite of its straightforwardness, most doctors apparently forget about it.    1. Chiropractic Services.  Being a comparatively minuscule profession as a percentage of total Medicare claims, we should not actually make the top 10 hit list.  But we did, which means that now it's our responsibility to fix these types of issues as soon as possible as a profession.  Palmetto commonly found chiropractic documentation to be inadequate with regard to Treatment Plans.  They reported that chiropractors were missing treatment plans with specific objective, and measurable treatment goals. Follow thru with these specific objective treatment goals on subsequent visits was regularily omitted.  Complicated?  Not really.  Documented?  Evidently, not so often.  Are you able to correct this, doctor?  Absolutely!    1. Legibility.  If this sounds the biggest commercial for EMR, It should!  Once again, there isn't any legitimate reason a chiropractor should get dinged for this one.  Unfortunately, I've looked at plenty of your notes and I regrettably concur, that they're rarely legible, oftentimes just to the highly trained eye (your own and the eyes of your longstanding office staff) – not to mention that sometimes, even you are unable to understand your personal records.  To put it differently, if your current patient treatment records can't be quickly read and understood by a third-party then it is now the time to get an EMR (Electronic Medical Record) System that you WILL USE!   There are many effective programs on the market.  The truth is, ANY program that generates legible records provides great improvements over marginal handwriting.  FYI,  I haven't yet experienced an EMR program which does not generate legible documentation! As a profession, chiropractors will need to get our act together right away, not just for Medicare, but also for every third party payer.  The items previously mentioned are certainly not hard to correct, yet I understand that most of you happen to be overcome by the amount of work you need to do to bring your current documentation, billing and coding up to satisfactory requirements.  Other individuals could possibly be so consumed with building your practice that you honestly do not have time to take a look upwards to see the arrow crusing straight at the bullseye on your chest.  And some of you are simply sick and tired of putting out the fires in all these areas because of insufficient reliable methods that equally increase your reimbursements while minimizing your audit risk. Fortunately help can be found. Check out www.touchnotes.com or www.chiroconceptions.com for QuickSOAP Notes or call me at 301-777-3710

[quicksoap-blog]

This is an audio from CMS on meaningful use to qualify for stimulus funds on EHR or EMR systems and documentation.

[quicksoap-blog]

Qualifying for reimbursement payments for Electronic Health Records (EHR)

Under the Medicare and Medicaid from Title XIII of the American Recovery and Reinvestment Act of 2009

Q. Briefly, what does the bill mean to the typical chiropractor?

A. If you are reading this then you likely have already heard something about receiving 44K in stimulus money. Probably some software company, a speaker at a convention, or one of your friends has told you that in order to get your 44K, you will need to buy right away, otherwise you won’t get your share of the stimulus money.

Judging from all the questions I get from chiropractors, I would be surprised if you didn’t have questions or at least be a little confused.

Most doctors want to know how to qualify or if my software is compliant. Well, at least according to the latest documentation, there are a number of things combined to allow a chiropractor to qualify for the stimulus money.

Must be seeing more than 30% Medicare patients.

Must be using a “certified system” (Certification not yet confirmed).

Must be able to demonstrate meaningful use (whatever that may mean).

Number 1 alone knocks out a large number of chiropractors. The other items might be possible, but you must consider if spending a large amount of money on software is right for your practice – with or without stimulus money.  Would that be what is best for your business?

Initially, I was excited with the President announced that stimulus funds would go towards EMR systems. I thought this would mean more sales because doctors would finially be willing to invest money they should have invested anyway. But when the 2000 page stimulus report was released and we reviewed the sections reporting on EMR we discovered it was very vague on the topic of how payment would be made to doctors. How could I answer questions when the bill itself was vague? I became confused.

I would like for other vendors who are promising stimulus refunds list how they are going to have chiropractors meet the requirements by using their software. They all have a lot of talk but they don’t have specific information. Show us all the regulations explaining which certification is needed for a product to qualify?

Where is their certification certificate? Does certification really mean anything if you’ll never qualify as a chiropractor? A recent search on the CCHIT* (most common certification at this time for large EMR products) website, indicated there are NO Chiropractic products with the certification.

*****A big point on certification: Today the certification is the same cost and has the same feature requirements whether your software is designed for a large hospital or a small specialized practice. Anyone reading this probably realizes the needs of those two software products are very different. Wouldn’t you think that the certification requirement process and cost for vendors should also be different?

After all, a major benefit for having “certified software” is to help with compatibility between systems (being able to import and export records between doctor’s EMR/EHR systems). Without a unique certification it may mean many of the specialty products won’t become certified and we will have incompatibility with patients’ primary doctors’ EMR/EHR systems for years to come.

Another thing to consider about this program is funding. Will there be any money left once the other programs are done getting funded today? For example the “Cash for Clunkers” program burned through 1 billion dollars already and was recently allocated an additional 2 billion. Auto dealers are predicting the additional funding may run out by the end of the year.  So 3 billion will have been paid out to consumers, recent research has shown that doctors have yet to receive any money for EMR/EHR purchases from the stimulus package.

I come from the old school mindset of “the truth, the whole truth and nothing but the truth” and that is how we operate everyday. Until we receive more information on which regulations/certification is selected, and if there are other certification rules for non-MD software, we are in a holding pattern.

Here is my current advice on the subject:

Do your homework and keep up with the latest news about this topic.

Keep in mind upon review of new software, on the most basic level a sales person’s job is to sell you. Find a record keeping product that works for your practice.

Don’t get stuck with one that may be compliant or certified but won’t really contribute to the flow of your practice.

Best patient care (meaning more time with the patient talking about their needs) should remain your goal.

And finally, great software doesn’t have to be expensive.

[quicksoap-blog]

[quicksoap-blog]

Documentation of Chiropractic Medical Necessity.

by David Bohn, DC  www.chiroconceptions.com and www.quicksoapnotes.om If you take time to follow some basics documenting your daily office visits should not be difficult. Perhaps to make it simple let's look at what we shouldn't do.. You cannot create some magic formula to stamp out documents to meet medical necessity guidelines. I get asked all them time if my note program (www.quicksoapnotes.com) will produce a note that will make sure care meets a payers medical necessity requirements. My answer is always the same. Assuming that a chiropractor could meet all the initial criteria with some super advanced note generating software, eventually problems would develop as the plan of care progressed.  What doctors most often neglect is that the patients’ symptoms should and do change during care. Follow up exams are not performed or documented and consequently the initial objective findings never change or improve. I look at notes from doctors who have the same, goals of care from visit 1 to visit 50! They never change and the doctor wonders why payers refuse to pay the claim because of lack of medical necessity. Remember, as the case progresses and the patient improves you must document the changes and update your goals of care. What this means is that using the same note over and over will be discovered at some point by the carrier and you will be flagged for audit or continued requests for notes until you both change your pattern and document properly or you are dropped from the panel of providers. I was talking to a doctor in Pennsylvania last week and he told me that he only saw personal injury patients so he did not do any of his notes until the end of care and then he used a template "that told a story" and all he did was change the names and dates of treatment. This is a perfect example of why chiropractors have documentation problems! It is also important to keep in mind the Medical Necessity requirements are not the same for each and every insurance carrier.  Medical Necessity definitions will vary from carrier to carrier and will also be different on a case by case basis. If you get out, and finally read, the contracts you signed when you applied and accepted being a provider for all the insurances you accept you will notice differences in the documentation requirements. You will also likely have state requirements on documentation. I practice chiropractic in Maryland and the requirements for documentation are clearly posted on the MD Board of Chiropractic's Web Page at http://www.mdchiro.org/Regulations%20.%202007.htm - COMAR code 10.43.15 Recordkeeping. Contrary to what many believe or have been told, documenting Medical Necessity isn't related to how good you can write or the quality or your software's random text generation capability. Writing pages of information each visit is not necessary, good documentation doesn't have to be lengthy, but it certainly must cover all the mandated requirements. Dr Bohn practices as a chiropractor and he can be reached at [email protected] and his web page can be found at www.accentonhealth.org

[quicksoap-blog]

25 Criteria For Meaningful Chiropractic EMR Systems

Adopting an electronic medical records (EMR) system could net you up to $44,000 in government incentive money. Or it could be a complete waste of your hard earned dollars. Anytime I am out and about speaking to doctors of chiropractic or simply addressing problems on the telephone I am very often questioned if my QuickSOAP Notes (www.chiroconceptions.com <http://www.chiroconceptions.com>) EMR system could be approved to get stimulus fund reimbursement that can potentially go along with EMR implementation. We must first of all look at the problem. Every one of the stimulus incentives hinged on practices adopting “meaningful use” of the EMR systems in question. Then again, this is without a doubt the catch. Up until December 2009, “meaningful use” had been left undefined! In other words, you could never receive the money unless you ended up using EMR with respect to certain set requirements but no one went on record to establish exactly exactly what all those criteria were! Unfortunately, the fog turned out to be not really exactly lifted this past December because the suggested rules regarding “Meaningful Use” happen to be 556 pages long! Worse still, business specialists really do not believe the final regulation to end up being significantly different which means that knowing the proposed rule is very important to achieving meaningful use and being paid. And so, consequently, exactly how can one break the mystery code and determine meaningful use? Lost inside all those 556 pages are a total of 25 standards your practice must satisfy in order to attain meaningful use. Do not worry, I should be able to save you the trouble of analyzing the electronic equivalent of War and Peace (which is much more difficult to comprehend and considerably less enjoyable) and summarize the 25 points in this post. Before I get in front of myself permit me to start with this. Just for those of you who have recently bought an EMR system as well as those who happen to be considering a purchase, don’t count upon obtaining those stimulus dollars just yet. For those of you that are still thinking of getting an EMR program, allow me to go on record and state that I feel that is a terrific plan for virtually all practices. However…don’t order one simply because you think the stimulus dollars are going to be rolling in later. Buy one with the intention connected with having a system strengthen your clinical documentation, practice management and all round effectiveness. Many will do that, provided you purchase the ideal system to meet your requirements. Can’t make a decision on which program to purchase? With the understanding that you should take stimulus dollars out of the picture, there are certainly some other aspects to think about in picking out the best program for you. Frustrated with your current System? It’s not too late to start fresh and think logically on just what would be a better fit for you and your practice. I see far too many chiropractors who have high-priced EMR systems collecting dust for the reason that they abandoned them out of frustration and went back to paper. Generally there had been a good reason you decided to get EMR, you need to acquire a system that you will definitely benefit from - they are actually available. For those of you still reading, these are the 25 “Meaningful Use” Criteria for eligible providers. (These criteria were taken from the proposed rule: Medicare and Medicaid Programs; Electronic Health Record Incentive Program.) 1- Objective: Use computer physician order entry (CPOE) Measure: CPOE is used for at least 80 percent of all orders 2 -Objective: Implement drug-drug, drug-allergy, drug- formulary checks Measure: The EP has enabled this functionality 3 - Objective: Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM or SNOMED CT® Measure: At least 80 percent of all unique patients seen by the EP have at least one entry or an indication of none recorded as structured data 4 - Objective: Generate and transmit permissible prescriptions electronically (eRx) Measure: At least 75 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology 5- Objective: Maintain active medication list Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient is not currently prescribed any medication) recorded as structured data 6- Objective: Maintain active medication allergy list Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient has no medication allergies) recorded as structured data 7 - Objective: Record demographics. Measure: At least 80 percent of all unique patients seen by the EP or admitted to the eligible hospital have demographics recorded as structured data 8 - Objective: Record and chart changes in vital signs Measure: For at least 80 percent of all unique patients age 2 and over seen by the EP, record blood pressure and BMI; additionally, plot growth chart for children age 2 to 20 9 - Objective: Record smoking status for patients 13-years-old or older Measure: At least 80 percent of all unique patients 13-years-old or older seen by the EP “smoking status” recorded 10 - Objective: Incorporate clinical lab-test results into EHR as structured data Measure: At least 50 percent of all clinical lab tests results ordered by the EP or by an authorized provider of the eligible hospital during the EHR reporting period whose results are in either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data 11 - Objective: Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach Measure: Generate at least one report listing patients of the EP with a specific condition 12 - Objective: Report ambulatory quality measures to CMS or the States. Measure: For 2011, an EP would provide the aggregate numerator and denominator through attestation as discussed in section II.A.3 of this proposed rule. For 2012, an EP would electronically submit the measures are discussed in section II.A.3. of this proposed rule. 13 - Objective: Send reminders to patients per patient preference for preventive/ follow-up care Measure: Reminder sent to at least 50 percent of all unique patients seen by the EP that are 50 and over 14 - Objective: Implement five clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic test ordering, along with the ability to track compliance with those rules Measure: Implement five clinical decision support rules relevant to the clinical quality metrics the EP is responsible for as described further in section II.A.3 15 - Objective: Check insurance eligibility electronically from public and private payers Measure: Insurance eligibility checked electronically for at least 80 percent of all unique patients seen by the EP 16 - Objective: Submit claims electronically to public and private payers. Measure: At least 80 percent of all claims filed electronically by the EP 17 - Objective: Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, and allergies) upon request Measure: At least 80 percent of all patients who request an electronic copy of their health information are provided it within 48 hours 18 - Objective: Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies) Measure: At least 10 percent of all unique patients seen by the EP are provided timely electronic access to their health information 19 - Objective: Provide clinical summaries to patients for each office visit Measure: Clinical summaries provided to patients for at least 80 percent of all office visits 20 - Objective: Capability to exchange key clinical information (for example, problem list, medication list, allergies, and diagnostic test results), among providers of care and patient authorized entities electronically Measure: Performed at least one test of certified EHR technology’s capacity to electronically exchange key clinical information 21 - Objective: Perform medication reconciliation at relevant encounters and each transition of care Measure: Perform medication reconciliation for at least 80 percent of relevant encounters and transitions of care 22 - Objective: Provide summary care record for each transition of care and referral Measure: Provide summary of care record for at least 80 percent of transitions of care and referrals 23 - Objective: Capability to submit electronic data to immunization registries and actual submission where required and accepted Measure: Performed at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries 24 - Objective: Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice Measure: Performed at least one test of certified EHR technology’s capacity to provide electronic syndromic surveillance data to public health agencies (unless none of the public health agencies to which an EP or eligible hospital submits such information have the capacity to receive the information electronically) 25 - Objective: Protect electronic health information maintained using certified EHR technology through the implementation of appropriate technical capabilities Measure: Conduct or review a security risk analysis in accordance with the requirements under 45 CFR 164.308 (a)(1) and implement security updates as necessary The Way I See It After 22 years of clinical practice I just don't find the majority of these 25 criteria relevant to chiropractic. Besides that, I have yet found an EMR supplier define these criteria in such a manner that they can promise stimulus dollars for the practicing chiropractor. And so for what it's worth here is what I suggest. In case you currently are employing EMR, approach your supplier by using this checklist and find out how their system will be able to complete the measures to attain each objective so that you at the very least have got a chance at receiving a little bit of stimulus money. If you do not yet have an EMR system, make use of these criteria as part of your questions to each product that you are thinking about for purchase, particularly if they are claiming to get you some stimulus money. If you still have questions, call me or visit my web page at www.chiroconceptions.com <http://www.chiroconceptions.com> for more information. My Touch screen SOAP note program will make your documentation solid, get your notes finished fast, but won't put stimulus funds in your pocket. But I really don't see how any of them will.

[quicksoap-blog]

Correcting, Amending, or Altering Chiropractic Treatment Records (SOAP Notes)

For More Information: www.quicksoapnotes.com or www.chiroconceptions.com

What must you do if you find an omission? Suppose you review a person's previous SOAP note and learn that you forgot to record that you made an scheduled appointment to get a new patient x-ray? Or suppose you talked about the x-rays and in the process of documenting the findings, accidentally left a key finding from your record? Many times, omissions may possibly not have medical relevance but are needed for clarity. For example what do you do after you discover that a straightforward typing mistake makes your 36 year old patient 63 years old? In situations such as these, including a SOAP note could very well demonstrate the truth that you are a conscientious chiropractor by just demonstrating that you are careful enough to go through your chart and additionally interested enough to add the missing information. In order to correctly amend SOAP notes, it is advisable to: ==>Put a notation within the margin next to the original entry: “see my note below.” ==>Enter an additional note at the time you discover the error. Write in all the extra details. Initial and date it. ==>Put a single line through the wrong entry. Make sure that the original entry is still legible. ==>Describe the modification. If possible, describe exactly why the earlier note was wrong, the reason for the error, and the reason the error was discovered. However, removing, making use of correction tape or fluid, or obliterating any documentation in the actual documentation is without a doubt unacceptable not to mention would certainly be considered a big no-no that could land your butt in hot water.

[quicksoap-blog]

Tips for Properly Billing Chiropractic Codes

When doing your billing consider these tips:

1. All E/M chiropractic codes should have a -25 modifier (i.e 99201-25, 99211-25) when billed with other services 2. All 98943 (extremity adjustments) should have a different diagnosis linked to it than the 98940-2 (spinal adjustment codes). For example, 98941---- 739.1, 739.2; 98943------ 739.7 3. 97140 and 97112 must have a '59' modifier. 4. 97140 must have a different diagnosis than the diagnosis for the adjustment code (98940-3). The diagnosis must be on different areas (regions) of the body. 5. Sequence Billing 1st service ----E/M or OV (99201-99205; 99211-99215) 2nd service ---------Diagnostic (x-rays) (7000 codes) 3rd service----Spinal Adjustment (98940, 98941, 98942) 4th service---------------Extremity Adjustment (98943) 5th service--PT service by dollar amount (97000 Codes) 6. Diagnosis Pointing - When billing out insurance claims, you will usually have more than one diagnosis on the form. When you have more than one CPT (procedure) code, and more than one ICD-9 (diagnosis) code, you need to match them correctly. On the HCFA box 21, there are 4 places to put your ICD-9 codes. In box 24E, there is a place to 'point your diagnosis'. Be specific and only put the code(s) from box 21 the diagnosis that apply to that particular service you provided. You may use all four of the codes for a particular service; however that may not be the case each time. 7. Medicare - All '98' codes must have 'AT' modifier, unless service is considered maintenance. In which case, Medicare does not allow payment for maintenance care. All other services must have the 'GY' modifier to indicate this is a nonpayable service. The 'GP' modifier is used on all physical therapy codes. The 'GA' modifier is used to indicate that you have a completed and signed ABN (Advanced Beneficiary Notice) on file.

[quicksoap-blog]

Are You Giving Your Services Away?

Most chiropractors are performing a great deal of services that they are not billing for. You should bill and get paid for the services that you perform. You may be able to increase your reimbursement by $100-$200 per visit and you are giving the service away by not properly billing. You can do this by simply using the appropriate Chiropractic codes. Here are some examples: Examples of services with high RVU (Relative Value Units) *97110 - Therapeutic exercises to develop strength, endurance, range of motion and flexibility (i.e. stair stepper, stationary bike, exercise ball)

*97112 Neuromuscular Re-education of movement, balance, kinesthetic sense, posture (i.e. wobble board, balance board, wobble chair, exercise ball)

*97140 Manual Therapy as defined by CPT, manipulations, manual lymphatic drainage. Manual therapy applied to the soft tissue to increase joint range of motion, restore joint integrity and improve overall performance

*97535 Self Care Home Management Training These codes are billed per units. One unit is equivalent to 15 minutes. Be sure that you have documented the time spent on each service. You must use the -59 modifier to CPT code 97140 when billing this service in addition to the adjustment code. Now add any of the above mentioned services to your adjustment code and you will see how much you have been giving away. Be sure that your fee schedule is appropriate for your geographical region. Having an outdated or inappropriate fee schedule is costly. Chiropractic vs. Physical Therapy. If you are performing physical therapy services and the patient has reached the maximum benefits allowed for chiropractic services, you may be able to receive payment for the physical therapy services that you are performing. When verifying insurances, be sure to ask if these services (Chiropractic and Physical Therapy) will be reimbursed separately. Whether or not the DC is able to perform PT services may vary from state to state. Be sure to check with your Chiropractic Board to be certain.

[quicksoap-blog]

Medicare Chiropractic Codes

Billing Medicare can be confusing for a new chiropractor and sometimes for an established chiropractor.

Coverage of chiropractic services is specifically limited to treatment by means of manual manipulation (i.e., by use of hands) of the spine for the purpose of correcting a subluxation. For the purpose of Medicare Chiropractic codes, a subluxation is defined as a motion segment in which alignment, movement integrity, and/or physiological function of the spine are altered, although contact between the joint surfaces remain intact. The patient must have a subluxation of the spine as demonstrated by x-ray or physical examination. Keep in mind that x-rays are considered noncovered when billed by the chiropractor. No other diagnostic or therapeutic services furnished by a chiropractor or under his or her order is covered. This means if a chiropractor orders, takes or interprets x-rays or any other diagnostic test, the x-ray or diagnostic test can be used for claims processing purposes, but Medicare coverage and payment are not available for these services. ICD-9-CM Codes that Support Medical Necessity The CPT/HCPCS codes included in this policy will be subjected to "procedure to diagnosis" editing. The following lists include only those diagnoses for which the identified CPT/HCPCS procedures are covered. If a covered diagnosis is not on the claim, the edit will automatically deny the service as "not medically necessary." Medicare is establishing the following limited coverage for CPT/HCPCS codes 98940, 98941 and 98942: Primary Diagnosis Codes Covered for: 739.0-739.5 Non-allopathic lesions, not elsewhere classified Secondary Diagnosis Codes Group A Diagnoses Covered for: 307.81 Tension headache 719.48 Pain in joint, other specified sites Note: When using this code, you must specify spine. 723.1 Cervicalgia 724.1-724.2 Other and unspecified disorders of back 724.5 Backache, unspecified 724.8 Other symptoms referable to back 728.85 Spasm of muscle 784.0 Headache Group B Diagnoses Covered for: 720.1 Spinal enthesopathy 721.0 - 721.2 Spondylosis and allied disorders (arthritis, osteoarthritis, spondyloarthritis) 724.79 Disorders of coccyx, coccygodynia 729.1 Myalgia and myositis, unspecified 729.4 Fasciitis, unspecified 846.0 Sprains and strains of sacroiliac region, lumbosacral (joint)(ligament) 846.1 - 846.3 Sprains and strains of sacroiliac region 846.8 Sprains and strains of sacroiliac region, other specified sites of sacroiliac region 847.0 - 847.4 Sprains and strains of other and unspecified parts of back Group C Diagnoses Covered for: 353.0-353.4 Nerve root and plexus disorders 353.8 Other nerve root and plexus disorders 722.91-722.93 Other and unspecified disc disorder 723.0 Spinal stenosis in cervical region 723.2-723.5 Other disorders of cervical region Group D Diagnoses Covered for: 721.3 Lumbosacral spondylosis without myelopathy 721.41 - 721.42 Lumbosacral spondylosis with myelopathy 721.7 Traumatic spondylopathy 722.0 Displacement of cervical intervertebral disc without myelopathy 722.10-722.11 Displacement of thoracic or lumbar intervertebral disc without myelopathy 722.4 Degeneration of cervical intervertebral disc 722.51-722.52 Degeneration of thoracic or lumbar intervertebral disc 722.81-722.83 Postlaminectomy syndrome 724.01-724.02 Spinal stenosis, other than cervical 724.3 Sciatica 724.4 Thoracic or lumbosacral neuritis or radiculitis, unspecified 724.6 Disorders of sacrum, ankylosis 738.4 Acquired spondylolisthesis 756.11 - 756.12 Anomalies of spine 839.01 - 839.08 Other, multiple and ill-defined dislocations, cervical vertebra, 839.20 - 839.21 Other, multiple and ill-defined dislocations, thoracic and lumbar vertebra, closed 839.41 - 839.42 Other, multiple and ill-defined dislocations, other vertebra, closed 953.0 - 953.4 Injury to nerve roots and spinal plexus Note: Providers should continue to submit ICD-9-CM diagnosis codes without decimals on their claim forms and electronic claims. Documentation Requirements Documentation supporting the medical necessity of the service should be legible, maintained in the patient's medical record, and must be made available to Medicare upon request. Please see Medicare Benefit Manual sections referenced above for national documentation requirements for Medicare payment of chiropractic services. Utilization Guidelines Medicare does not expect that substantially more than the following numbers of treatments will usually be required: 12 chiropractic manipulation treatments for Group A diagnoses. 18 chiropractic manipulation treatments for Group B diagnoses. 24 chiropractic manipulation treatments for Group C diagnoses. 30 chiropractic manipulation treatments for Group D diagnoses. Claims for chiropractic services that exceed the numbers above may be subjected to complex manual medical review either prior to payment or as part of a post-pay Medicare audit. The AT modifier must be used when a patient is being treated for an acute treatment. If you do not use the AT modifier, the services will be considered maintenance and will therefore be denied.

QuickSOAPnotes from www.chiroconceptions.com makes documenting a Medicare visit easy and fast.