What will auditors find if your claims or documentation were to be audited? What would be the results be if you were investigated?
Blue Cross, Aetna and Medicare have increased audits. Recovery Audit Contractors are paid 24% commission to search through your records and recover funds for Medicare. What will you do when they audit you?
The OIG has continually listed over the years that the auditing of chiropractic field as a major priority in its Work Plan. This due to the high rate of errors in required documentation, billing for medical unnecessary services, incorrect coding as well as other errors. Chiropractors are not # 1 for fraud but are # 1 for errors.
Having an ongoing effective compliance program is one of the only factors that can help you and your practice if you are ever investigated. As part of the Federal Sentencing Guidelines, an effective compliance program can help to lower your culpability score.
Proper documentation and an effective compliance program will be even more critical in the years to come. Beginning in January of 2017, a new physician fee schedule will be released under the MACRA Act (Medicare Access and CHIP Reauthorization Act.) Under MACRA, doctors and practices will be reward with higher Medicare payments and bonuses whereas those whose practices are not compliant will have their payments reduced.
The Office of the Inspector General (OIG), listed in their work plan to focus on conducting audits in the chiropractic field as one of their main objectives.
A Compliance Program should be designed to meet the needs of each individual clinical site based on the OIG guidelines. The OIG has advised that there are three areas that must be specifically addressed in a Compliance Program: Development, Implementation, and Monitoring.
Some may know compliance, but they know little about the chiropractic office. Some know chiropractic procedures, but really don't know about compliance. Dr. Diane Barton is a Certified Insurance Consultant and a Certified Medical Compliance Specialist. James Minx is a Certified Medical Specialist and insurance consultant.
Bring our "Compliance Assistance (or Compliance Assistance Team)" to your office for personalized documentation, coding and compliance consulting.
Look around our website and if you have any comments or questions, please feel free to contact us at (708) 922-3911.