-
- April 2001
Should We Call It Medicare or No-Care
by Lindsay Anglen, DC
- Graduated
from Cleveland Chiropractic KC
- Undergraduate
B.S. in Nutrition from Park University
- Has
been in practice since 1989. Practiced in Phoenix until 1991, then
owned a practice in Mt. Vernon, Missouri until 1998. Bought a
practice which was largely Medicare in July of 2000, after a 2-1/2
year hiatus.
- Have
had over 50 articles published in Dynamic Chiropractic, Chiropractic
Economics, The Internist Ñ the publication of the ACA Council on
Family practice, and others.
- Wishes he had bought a PI clinic in the poor part of
Phoenix instead.
Recently, I had to talk to Noridian (Medicare) about an
audit of a patient's file in which they requested my notes. After
receiving the notes, they said that the notes did not substantiate
medical necessity and so payment would be denied. I called Noridian to
ask how I might appeal
their decision, and I requested a telephone audit. I
wanted a telephone audit because I wished someone to point out what was
wrong with my notes such that they don't substantiate necessity. I just
purchased this office 6 months ago. It has been here 13 years and it has
about 2/3 Medicare patients.
When Medicare in my area was run by Aetna, I felt things were
fair. With Noridian, I believe that we are in for a medicolegal
blood-bath. My notes are typed by me personally, are not computer
generated. Just glancing at the notes, the second visit notes are fairly
extensive Ñ 2 paragraphs, 15 sentences. I cover how the patient felt
and how their symptoms had changed since the last visit. Also, I list
some positive orthopedic findings and in addition, I list the
subluxations by specific level including the findings of restriction and
palpatory tenderness. I list recommendations made for the patient and
what objective criteria we will use to measure progress. I then list
what treatment was given and the date of the next visit on their
treatment program. I felt this met all of the criteria listed by
Medicare in their Special Bulletin January 1998. In fact, I do know that
this meets each of the points : I) History, II) Physical exam, III)
Assessment including how the condition has changed since last visit, and
IV) treatment given.
I asked what was weak in my notes and how I might request an
appeal. She told me, “I am sorry there is really nothing you can
do.” “You can request a hearing and come to Fargo, North
Dakota and meet with a panel to argue your point.” The
fact that it is not feasible to travel to ND over $84.08 did not seem to
reach her. I did find out one weakness in my notes (according to
Noridian), which is that I did not document “how the patient responded
to the adjustment.” Okay, this might be nice information to have
(“The patient exclaimed ÔI can hear again, I can hear again,
etc.”). However, this is not required by Medicare (at least according
to the aforementioned special bulletin Jan 1998 “Medicare Policy
regarding chiropractic service”). They do not say we have to list how
the patient responded. I was told it does not matter, but it is one
thing that Noridian is looking for.
I called back about an hour later. I talked to Lisa (I did not
get the name of the first person I talked to). This conversation was
actually chilling, whereas the first attempt was only frustrating. I
called and asked to talk to Sharon Joelson (the NURSE who reviews
CHIROPRACTIC files to determine necessity). I was told I could not talk
to her. I mentioned my earlier futile attempt, and that if I am going to
understand how I might do better in the future I need to know what I did
wrong and how my notes are weak. I was told earlier that in regards to
an appeal “I am sorry there is really nothing you can do about it.”
This lady told me I could appeal and instructed me how. Here is where I
felt chilled Ñ I told her I was really worried about Medicare. I said
that I had heard it down the pipeline that Noridian had targeted DC's in
6 states and were out to really sink their boats and would really enjoy
doing so. I had heard about the 18 Chiropractors in Iowa who were all
post audited and had to refund every penny over the last 2 years. When I
mentioned this, she laughed/chuckled audibly and said “Oh yeah,
Iowa.” I then said, based on her laughter over that, I can assume that
what I fear is true. She said nothing Ñ neither affirmation or denial,
just silence.
I also mentioned a letter that I received this morning from
another DC friend who still accepts Medicare. This letter was from
Sharon Joelson and listed the fines and penalties Medicare can levy for
misbilled claims. I said I felt this was very unfair that someone could
make a clerical error and be fined $10,000. At the beginning of this
year, when Noridian took over, they messed up the first $6,000 (roughly)
of Medicare claims “accidentally” deleted in the turnover of my
office. I had to resubmit, pushing payment back another 4 weeks. When
THEY make a clerical error its just shrugged off, but when WE do they
fine us $10,000. She said that I could outline my concerns and told me
where to send the letter. I asked her if doing this would make me more
of a target. She said, “Voicing such a concern shouldn't make you more
of a target” to which I replied, “I know it SHOULDN'T, but the
president also shouldn't have sex with his interns. I still fear it
might.” To my comment, she replied with another laugh/ chuckle,
“Well, I have to admit you are right.” I felt it was made evident to
me from what was said, and the demeanor of Lisa, that the entire staff
at Medicare/Noridian do consider chiropractors fairly easy targets. Also
I felt that they plan to make sure anyone involved with Medicare is not
only denied payment, but also most likely face the fate of those in Iowa
with refunds being demanded along with penalties.
Luckily, I have the opportunity to become a part of a new group
of DC's banding together out here to make a big penetration into the
personal injury market. My goal is to eliminate all Medicare patients
within 4 months (hopefully sooner) and deny them all access to my clinic
other than for personal injury. For those of you smart enough to not be
involved with Medicare, this should help you feel good about your
decision. For those of us mom and pop operations who still
might accept even a single Medicare patient from Noridian,
keep in mind one single innocently but poorly filed claim could put a
pretty big dent in your career and lifestyle as you know it. Some in
Iowa are not recovering from this round of dents.
Back to CBP® OnLine
CONTENTS
1. Another CBP® Research Porject Accepted At Clinical Biomechanics
2. Cleveland Chiropractic College Kansas City Teaches CBP®
3. Holder / Harrison Settlement
5. Chiropractic Ethnic Cleansing Alive and Well in Saskachewan
6. Has CA Board overstepped Its Bounds?
7. Neuromechanical Research To Understand Chiropractic Adjustments
11. Chiropractic Tx of Calcific Tendonitis
12. Our 30th and 31st papers at JMPT accepted
13. Should we call it Medicare or No-Care?
14. Practice Building: Qauility Experience in the Quality of Care.
15. Correction of Lordotic/Kyphotic S-Curves Without Extension Traction
16. Subluxation and the Stock Market