WOW! Kathy s. Words of Wisdom. Special Message from Kathy ICD-10 Delayed Until 2015: But Only for Medicare?? In this issue: April 2014 Theme: Coding

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1 Kathy s WOW! Words of Wisdom April 2014 Theme: Coding In this issue: Special Message from Kathy: ICD-10 Delayed Until 2015: But only for Medicare? How to Write and Speak Fluent Code KMC University s Q&As Traffic Jam Alert! Will a Physician Appeal Slowdown Affect YOU? The Compliance Corner: Got to Be There Upcoming Dates for Webinars Reimbursement Room: The Secret Code to Bulletproof Billing Product of the Month Special Message from Kathy ICD-10 Delayed Until 2015: But Only for Medicare?? On Monday, March 31st, the Senate passed H.R. 4302, the Protecting Access to Medicare Act of The House of Representatives had already passed the bill the week before and President Obama signed the bill, as expected, on April 1st. This bill includes two very significant actions. It delays the Medicare Sustainable Growth Rate (SGR) cuts for another year pushing them out until March 31st of Until that time it is expected that your Medicare Fee Schedule will stay as it is currently constructed. The SGR cuts would have reduced reimbursements by approximately 24%.This is the 17th delay of the SGR cuts over the last 11 years. The bill also delays the implementation of the ICD-10 diagnosis codes for another year. The ICD-10 implementation is set for October 1, 2015 for now. So why this last ditch effort to delay ICD-10, tucked into the SGR bill? The answer to that billion dollar question can best be answered by the congressional leaders involved in the drafting of H.R The American Health Information Management Association (AHIMA) suggested that the insertion of the ICD-10 delay section into H.R was likely done to placate physicians who are against an SGR patch. The AMA has said they are against moving to ICD-10 entirely. These changes leave many unanswered questions. For example: 1. Will the new 1500 billing form still be mandatory as of April 1, 2014? 2. Will commercial carriers begin to accept the ICD-10 codes ahead of the government s deadline of October 1, 2015? 3. Will we skip ICD-10, and go right to ICD-11? 4. Will chiropractors ignore this gift of another year to prepare? (We certainly hope not, and will help you use it to your advantage!) Watch for further announcements from KMC University as we await an official statement from the Department of Health and Human Services (HHS).

2 How to Write and Speak Fluent Code We ve said before that coding is a language, and, like any language, it s intended to communicate your message to your recipient as clearly as possible. But if you re not fluent, miscommunications are bound to happen. Those who aren t native English speakers, for example, might get tripped up by homophones like hair vs. hare blow-drying one of them is common; trying to blow dry the other might not go so well. Chiropractic code fluency has been and always will be an issue, and it s critical to use the right code to the treatment rendered. And our industry language is about to get more complicated; ICD-10 will multiply our diagnosis coding vocabulary tenfold. Using a code that s off by just one out of seven digits could mean the difference between reimbursement or, if you make the same mistake often enough, an audit. Incorrect punctuation (i.e., putting the decimal point in the wrong place) could get your claim tossed out simply because the user or system at the other end couldn t read or interpret it correctly. But what s also true is that with this larger vocabulary of code comes ample opportunity for gain. ICD-10 gives us a much larger vocabulary to learn but also much more specificity and precision. If the goal of coding is to communicate a clear story of medically necessary treatment supported by thorough documentation of the initial visit, diagnosis, course of treatment and graduation from acute care, then ICD-10 is like getting the keys to a very sparkly kingdom. Your coding will actually spell out which side of the patient s body you re treating, and exactly where you ve found disc degeneration on your patient s spine. No wiggle room. No misunderstandings. Honestly, it s a good thing. KMC University s Q&As Q: Q: I don t participate with Medicare. So I don t have to know about all this Medicare coding stuff, right? A: Wrong. Being a non-participating (non-par) health care provider doesn t mean you don t have to bill Medicare. A non-par provider is actually someone who has enrolled to be a Medicare provider but chooses to receive payment in a different method and amount than Medicare providers classified as participating. Even if your Medicare patients pay you directly, you still have to submit a bill to Medicare so that the patient can be reimbursed for the portion of the charges for which Medicare is responsible. And that, my friends, means you need to know the codes. Oh, yes, you do. When traveling in a country speaking a foreign language, you need tools: a good phrasebook, a guide, a pocket translator. In other words, you need help getting up to speed. Consider KMC University your coding tour guide. We are fluent in code, both diagnosis and procedure coding, and we know how to create systems that help you use it seamlessly and painlessly. Fluent and precise coding keeps your documentation bulletproof and error-free. So you will never, ever, feel like tearing your hare (or, if you prefer, hair) out. Traffic Jam Alert! Will a Physician Appeal Slowdown Affect YOU? Will there be a wait for CMS appeals that involve an Administrative Law Judge (ALJ)? There is news that CMS is placing the Recovery Audit Contractor program on hold for hospitals indefinitely due to a tremendous backlog of appeals. CMS has 65 Administrative Law Judges that are equipped to handle 2000 appeals per week. That breaks down to 6 cases per day, per judge. The ALJs are currently receiving approximately 15,000 cases per week. This would require each judge to handle 6 cases per hour, 5 days per week, for over 23 weeks just to keep up! They currently have a backlog of 350,000 cases, and hospitals are currently being notified that CMS will not accept any further appeals until the backlog is handled. The 65 ALJs referenced appear to deal exclusively with hospital appeals. This could affect chiropractors because CMS could pull ALJs from other areas to help deal with the backlog in hospital appeals. We feel if ALJs are pulled in from other areas, this could cause a slowdown in physician appeals. KMC University is aware of what s happening with the hospitals and what this could mean as a trickle-down effect, and we ll be watching for additional reports. Stay tuned for more information!

3 The Compliance Corner: Got to Be There Many CPT codes describe physical medicine or therapies that require constant one-on-one attendance by the provider in order to bill for the service rendered. Constant attendance is usually required for a specific CPT code to ensure that the service is provided safely, as well as effectively, for the patient. One-on-one attendance is defined as maintaining visual, verbal, and/or manual contact with the patient during the provision of the service. One-on-one attendance is achieved when the provider is attending to one patient individually for each minute counted toward the required minutes in order to bill the CPT code for that particular therapy service. This sounds obvious, but during a busy day and most especially in an office with an open treatment area, it s easy to get distracted and step away to answer a phone, refill your coffee or welcome an arriving patient. So, to belabor the obvious, here s an example of one-on-one attendance: Let s say you re providing ultrasound services to a patient. You remain beside the patient, not only to provide the service manually (with equipment, such as the ultrasound wand) but also to maintain visual and verbal contact with the patient. Another example of one-on-one attendance would occur in the case of a patient performing Therapeutic Exercises, CPT code The provider is to be within arms distance of the patient, in order to give verbal and/or physical cues to the patient; thus ensuring proper form is maintained during the performance of the prescribed exercises to maximize the expected outcome of the prescribed exercises. Upcoming Dates for Webinars April Live Webinars (Visit to order, or click the links below) April 22, :00 PM EST Cracking the Code(s): Manual Muscle Therapies, 97140/ April 30, :00 PM EST April s ICD-10 Updates Released! Get both information-packed Webinars at a discounted Price! Reimbursement Room: The Secret Code to Bulletproof Billing Practices with fewer than 10 full-time employees don t have to bill Medicare electronically but here at KMC University, we strongly recommend you do so anyway. It s quite simply the most efficient and time-sensitive way to bill correctly and get paid. The advantages of electronic billing include quick cash flow, elimination of paper and effort, and swift payment. But whether you bill electronically or on paper, the following are key for a clean claim: All necessary blanks filled in Patient s ID number and group claim number in the right location Diagnosis linking between box 21 and 24e, if appropriate Secondary payer information filled in, if necessary Proper modifier usage Doctor s PIN number and NPI number in the right location Initiation of treatment date in box 14 within proper range of these dates of service The most important part of the process? Review and review again before you click send. Even one keystroke out of place can delay or take out your claim. Think you make a lot of typos now? Just wait until you re typing in seven digits instead of five!

4 2 1SOLID POWERFUL EVENTS... PRACTICE! Let us prepare you and your team for the quantum shift in healthcare changes for 2014 Join us for ONE OR BOTH Hands-On events Reimbursement and/or Compliance that is EASY TO DIGEST AND IMPLEMENT. Live DEMOS, WORKSHOPS AND PRACTICUM-STYLE training sessions. KMCU flash drive, loaded with DOCUMENTS, SAMPLE POLICIES, AND MATERIALS INCLUDED. BRING YOUR LAPTOP for real-time, guided customization. KMCU Specialist-led BREAKOUT SESSIONS and workshop groups throughout the weekend for FOCUSED, HANDS-ON LEARNING. REHAB YOUR REIMBURSEMENT DENVER, COLORADO MAY 16-17, 2014 ICD-10 TRAINING AT BOTH EVENTS CLEAN UP YOUR COMPLIANCE ST. LOUIS, MISSOURI AUGUST 15-16, 2014 LEARN the patient financial policies that turn lost patients into MAINTENANCE patients. CLARIFY CODING DILEMMAS that have been haunting you and your team. PAYMENT PLAN training that will ensure patients say YES to care. LEARN about CASH PROFIT CENTERS and BACK-END MARKETING. TRAINING and SCRIPTING that will raise the roof on collections immediately! MASTER procedures to implement Monday that WILL increase EFFICIENCY! BONUS! 4 hours of ON-DEMAND Medicare training materials and forms just for attending! STARTING AT $997 PER PRACTICE* *UP TO THREE PEOPLE I m so excited to go back to my office and begin implementing the techniques I ve learned. It will definitely make our practice stronger and be able to focus on what s important- our patients. Dr. T. L. - St. Louis, MO Though I know I have a lot of work to do, I end the weekend with certainty that I can create systems to handle management of my practice! Dr. J. K. - Atlanta, GA TRAINING to bulletproof your DOCUMENTATION, allowing for LESS FEAR, MORE CERTAINTY. UNDERSTAND your COMPLIANCE requirements, including OIG and HIPAA. Receive Compliance POLICIES AND PROCEDURES to customize onsite. Participate in a LIVE AUDIT to understand how YOU look to an AUDITOR. Find out how to IMPLEMENT Medicare s DOCUMENTATION AND COMPLIANCE requirements. BONUS! Take home ON- DEMAND OIG and HIPAA Compliance Manuals, materials, and training, ready to further customize and execute. For more information, including hotel info and detailed course breakdown, call us or visit our website TEAM KMC Helping Chiropractors make and keep more money.

5 READY TO REGISTER? Use the registration form on this page. HAVE QUESTIONS? Call us at TEAM KMC Ext. 105 NEED MORE INFORMATION TO REVIEW? Visit HANDS-ON LAB REGISTRATION FORM $997 Registered by April 18, 2014 $1,197 Registered after April 18, 2014 Registration fee includes up to three people from your office. Community College Members enjoy a 20% discount! CALL FOR MORE INFO! Name Name Name Name (Additional Attendee) Name (Additional Attendee) ATTENDANCE FEE CALCULATION: Registration fee + Additional $99 each = Total Attendance Fee Payment Information Method of Payment Name (As appears on Credit Card) Last Four Digits of Credit Card Number (We ll call you within 48 hrs. to get full number) VISA MASTERCARD AMEX Office Name Billing Address Expiration Date Credit Card Validation (CCV) City State ZIP I authorize Kathy Mills Chang, Inc. to charge my credit card the amount indicated in the TOTAL ATTENDANCE FEE field above. Phone Number Address Signature Yes, add me to the KMCU mailing list! PLEASE VISIT OUR WEBSITE FOR HOTEL INFORMATION! BOOK EARLY FOR ROOM BLOCK RATES!

6 Product of the Month Cracking the Code: Coding Like a Chiropractic Rock Star! $100 OFF!!! NOW JUST $49! USE CODE WOW414 AT CHECKOUT Have you been just kind of getting by with your CPT coding? Do you and your team understand enough to get some of your claims reimbursed, but always feel like there is more in-depth knowledge that you are missing? Do you worry if you are too habitual in your coding, or picking codes out of thin air that SEEM right? Many providers down-code just to be sure they aren t going to get a slap on the wrist from insurance companies. When you code like a chiropractic rock star, you fully understand not only the claims you are sending in but the REASON behind the codes that are being billed and how each are related to the work that is being performed for your patients. Watch and discover how codes are defined, what the expected percentage of use for your CMT codes are, and learn the elusive timed coding rules needed to properly be reimbursed for services rendered. Learn how down-coding really raises red flags more often than it protects you. You could be needlessly losing hundreds or thousands of dollars if you are using codes in a habitual or clumsy way. Possessing the confidence AND understanding behind the codes you use allows you to be properly reimbursed and gives you the necessary clarity in your billing should a records request be received. Spend an hour with us and leave with more knowledge, clarity, and awareness of your chiropractic coding. This webinar is packed full of the necessary information needed by chiropractors and CAs alike. As always, we ll supply you with helpful tools so you can hit the ground running and immediately begin MAKING and KEEPING more money!! Get the Product of the Month here: Helping Chiropractors make and keep more money.