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May. 24, 2012
Are insurance companies or adjusters obligated to return calls from a provider’s office?
No. They are under no contractual obligation to the provider.

May. 24, 2012
Are x-rays required to document a diagnosis for Medicare patients?
Yes, unless a PART exam is used to document the subluxation.

May. 24, 2012
Can a provider discount a non-covered service such as decompression to a Medicare patient, since Medicare won’t be paying for the treatment?
No. Federal law prohibits offering anything in value over $10.00 per time or $50.00 per year to people receiving federally funded insurance (Medicare, Medical Assistance etc). When this conflict has occurred in other States, I have been successful in discussing the issue with the Executive director of the board and gaining tacit approval that keeping the federal disclaimer on the ad will not result in an allegation of a State rule violation. FYI laws and rule conflict way more than you would think. Normally the bigger stick wins (Federal Law).

May. 24, 2012
Can chiropractors claim “write-off’s” on their taxes?
No. If the money never came into the clinic, it cannot be claimed on taxes.

Aug. 9, 2012
Can I be a participating provider at one clinic but non-participating at a separate location for medicare? For medical assistance?
As long as the different facilities are at separate locations and have separate group NPI numbers/tax ID numbers the clinic may have different credentialing statuses. Medicare and Medicaid credentialing are both done at the group level rather than individual for facilities (other than sole proprietor clinics), so separate credentialing for the different groups will allow for the clinic to apply for different network/participating statuses.

May. 24, 2012
Can providers offer prepayment plans to patients?
It is important for you to consult your attorney and/or individual state laws restricting prepayment plans prior to engaging in this practice. If your state does allow for prepayment, be sure the funds are properly deposited into a separate escrow account and all payments made to the clinic from that account are properly documented. It is also recommended that you have a reimbursement plan in place that the patient agrees to prior to care, should they elect to discontinue treatment at any point.

May. 24, 2012
Can we advertise free exams or discounted services to new patients?
You can advertise free or discounted services, provided you abide by the following:

1. Written advertisements must include disclaimer language that indicates offer not applicable to patients with federally funded insurance.
2. TV or radio ads must have the 456.062 disclaimer language.
3. You must extend the same “free” offer to a third party payer.
4. The offer of free x-rays must include the language “Free X-rays if medically necessary”

May. 24, 2012
Can we target-market potential patients?
The US supreme court has determined that direct marketing cannot be prohibited for professionals, but that in person solicitation can be limited.

Here are some laws related to limiting advertising for telemarketing to MVA patients and other advertising rules:
(5) Advertising Records and Responsibility.
(a) Each licensee who is a principal partner, or officer of a firm or entity identified in any advertisement, is jointly and severally responsible for the form and content of any advertisement. This provision shall also include any licensed professional employees acting as an agent of such firm or entity.
(b) Any and all advertisements are presumed to have been approved by the licensee named therein.
(c) A recording of every advertisement communicated by electronic media, and a copy of any other form of advertisement shall be retained by the licensee for a period of two (2) years from the last date of broadcast or publication and be made available for review upon request by the board or its designee.
(d) Severability. It is hereby declared that the sections, clauses, sentences and parts of these rules are severable, are not matters of mutual essential inducement, and any of them shall be exscinded if these rules would otherwise be unconstitutional or ineffective. If any one or more sections, clauses, sentences or parts shall for any reasons be questioned in any court, and shall be adjudged unconstitutional or invalid, such judgment shall not affect, impair or invalidate the remaining provisions thereof, but shall be confined in its operation to the specific provision or provisions so held unconstitutional or invalid, and the inapplicability or invalidity of any section, clause, sentence or part in any one or more instances shall not be taken to affect or prejudice in any way its applicability or validity in any other instance.
(6) Telemarketing.
(a) Telemarketing or telephonic solicitation by licensees, their employees, or agents to victims of accidents or disaster shall be considered unethical if carried out within thirty (30) days of the accident or disaster, and subject the licensee to disciplinary action pursuant to T.C.A. §63-4-114.
(b) Telemarketing transcripts shall be maintained for a period of two (2) years following their utilization.
(c) A log of contacts must be maintained for a period of two (2) years following the telemarketing encounter.

May. 24, 2012
Can we use patient testimonials in our office?
Have your attorney review your proposed testimonials prior to posting. Also be sure to have the patients sign a letter of approval for the testimonial. Criteria to remember when posting/using testimonials:
1. All the proper consents and releases have been properly signed by the patient.
2. That every testimonial is reviewed and the following testimonials are not published:
a.       Claims of cures that appear too fantastic
b.      Claims that are untrue or contain any misrepresentations
c.       Testimonials without proper consent
3.       Use just the patient’s first name, last initial and city
4.       Remove any testimonials upon request of the person who gave it.
5.       Remove any testimonial that has valid complaints.

May. 24, 2012
Can you extend a discount or reduce the bill for a Medicare patient whose entire claim gets denied by Medicare (citing no coverage exists) and who selects 1 on the ABN?
Financial hardship is the only legitimate reason for extending a discount to a Medicare patient.

Aug. 6, 2012
Can you verify whether my current lease agreement with a fellow Chiropractor is compliant? The term of the lease is one year. The rent is "fair market" for the space and services which they are receiving. Also, in this scenario with lessor/lessee, is 1099 OK or would W-2 be better in terms of withholding and reporting? What about commission for supplements? The typical split is 80/20 clinic/practitioner on sales. Is that allowed?
Almost perfect. The rent must be for fair market value that does not get impacted by quantity of services or income received for those services. No paying rent based on a percent of collections for services. As for the 1099, just report rent as income for you and expense for the lesee in your books.
The split you reference for the supplements is unfortunately not allowed.

May. 24, 2012 by Mike
Does a Medicare patient with a true secondary insurance need to sign an ABN form?
Yes. I recommend having one master ABN with all potential non-covered services.

Jan. 26, 2014
Hello Todd. My practice located in New Jersey, mostly consists of personal injury clients with a few major medical and cash patients. I wanted to know if I advertised with Groupon, would it affect any of the personal injury aspect of my practice. Thank you for your time.
Be careful with doing contracts with social network groups for chiropractic and massage services. Often their contracts put you in a position of violating fee splitting laws. I am currently working with Groupon's attorney to craft a compliant contract. Be sure to have a healthcare attorney review a social network contract before signing it.
In addition, your state has chiropractic advertising rules that could provide for additional restrictions on what you can say in the ad. Review those before doing any advertising.

Dec. 23, 2013
How can I set up compliant coupons for my patients under the new healthcare act?
Under the new exceptions established in the Patient Protection and Affordable Care Act (PPACA), chiropractors are now able to offer discounts and deals under the following circumstances:

Transfer of coupons or rebates from a retailer - Providers are able to offer services or items of value at less than FMV if the item or service consists of a coupon, rebate or other reward from a retailer, the deal is offered on equal terms to the general public regardless of health insurance status, the offer is not connected to other items or services reimbursable by federally funded insurance.
Extension of financial hardship allowances - In addition to the previous allowances under this category, providers are able to offer free or below FMV services if the services aren't advertised or solicited, the services are not reimbursable by federally funded insurance, and the service is connected reasonably to the patient's medical care.
Although the door has been widened for Chiropractors to offer discounts to their patients, it has also become easier to prosecute potential violators. It is no longer necessary to prove that a doctor violated the anti-kickback statute knowingly and with intent. For this reason, it is recommended that you have your healthcare attorney review and approve all discounts/coupons before you offer them to the public.

May. 24, 2012
How long do I need to keep my patient sign-in sheets and treatment notes?
As long as the longest record requirement by the various networks and the med mal statute, plus 1 year. General rule of thumb is ten years.

Jul. 12, 2012 by THage
How often should I do a Medicare ABN?
I recommend having all of your current Medicare patients complete an ABN at least once a year. All new Medicare patients should complete the ABN at the time they start treating with you.

Jul. 30, 2012
I am considering different forms of advertising like Radio, TV, and Print. If I am not offering free services do I have to include the 456.062 disclaimer? Also, in a multidisciplinary setting with MD's, PT's, Physician Assistants, Nurse Practicioners, Acupuncturists, and Chiropractors together do any (or all) of the names of the practitioners have to be listed in the ad (assuming again no free services offered)?
You are still recommended to use the disclaimer in all advertisements. In integrated or multidisciplinary settings, you do not need to list all of the pratitioners in your ad.

Jan. 20, 2014 by Jennifer
I am in a 1-provider office. We just started using Office Ally for EDI billing. I have no training in billing, was just handed over the billing, and don't really know what I am doing. We get a lot of denial for claims, mainly from Medicare. I just found out we should be using G-codes. I need direction in where to go to get info for billing, compliance, etc... Can you help with this?
There are a lot of resources out there to assist you in understanding proper coding and denials, but codes do change periodically so you will need to ensure your information is timely and accurate.

The WPC website is a good starting point. It offers definitions for denials that you are likely already receiving.

Coding books can be purchased as well. Private insurers like BlueCross often have their own coding guidelines that you will want to review periodically if you are billing to these entitles, too. You may also want to review some of our coding blogs found on this site.

Arming yourself with knowledge on coding and denials is only part of ensuring optimum collections. We do recommend consulting with a practice management individual or company, like Clinic Doctor, Inc (www.clinicdr.com) to offer you specific feedback on your current processes and procedures for billing. The initial financial investment may seem high but when you factor in an increased collection percentage, it often pays for itself.

May. 24, 2012
I am looking to rent a room in my office to a massage therapist. Can we do an hourly rate for the room as an independent contractor?
It is recommended that you consult your attorney before entering into any sort of contract. To be considered in the contract are Stark laws, anti-kickback, fee splitting and taxes.

Jan. 10, 2014
I am trying to switch billing software companies and wanting to get out of their contract. How can I get my patient data base legally? Who owns it and can they keep it if i still owe them money? And can they charge me for it to send it to me?
The contract you signed with the billing service will dictate to a large extent how you terminate your business relationship with them, so we can only offer you a general response. You are legally obligated to reimburse said business for the services they provided to you. Failure to do so could result in legal action or collections. Assuming you still have access to your records, many companies have a wind-down period in which they will allow you time to extract your patient files and convert them onto a new system. However, they are not obligated to do this for you, so it would be your responsibility to initiate the process. They are able to legally charge you a service fee for downloading or converting your files, at your request. Depending on the terms of your contract, they don't have to allow you access to your system if you owe them money. The patient legally owns the contents of their medical records, but not the software/system.

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