5 Things to Know About Chiropractic Compliance

Have you noticed that more of your peers are receiving records requests?  Are there more stories circulating about chiropractic audits? These are not rumors, unfortunately, the number of records requests has been increasing.  The increase in requests is due to the Office of the Inspector General (OIG) urging The Centers for Medicare & Medicaid Services (CMS) taking a fine-tooth comb, to look through you ratio of spine region codes, how often you are seeing patients in the course of a year, and your usage of an AT modifier code.

How to Protect Your Practice

Those are not the only things that can cause a flag for CMS. Even minor errors like missing a signature, failure to update insurance information or being off a number on a particular code can raise a red flag. If a pattern starts to emerge and you are frequently making these types of mistakes, whether intentional or not, it may incite an investigation into your documentation.

1. OIG Compliance Program

You went to school to develop the skills to heal others with your hands, not become an expert policy maker. But this could be one of the major tools in your toolbox when it comes to protecting your practice. With a properly implemented compliance program, you can catch your mistake, and if you were to ever receive a record request or an audit, you would be able to show that you do not have the intent to swindle the system.  Having a program like that in place is proof of your desire to do it right.

2. Receiving a Records Request

If you receive a records request, do not downplay the seriousness of this or what it could lead to. When you receive that request, the first step is to verify that it is accompanied by a legal authorization for release of information.  Unless it is covered as a part of a Treatment, Payment, and HealthCare Operation. If the request does not come with this release of information it could be in violation of your HIPAA policy.

3. Know What’s Covered Under Medical Necessity

When determining a treatment plan for patients, it is important to know what a carrier provides from a reimbursement perspective. This is because what you prescribe may not qualify for a reimbursement. Make sure that you are aware of the carrier’s review policy, so that you and your patient know what will be covered (and you will be reimbursed for), and what the patient will be expected to pay.

4. HIPAA Programs & Compliance

When was the last time you reviewed your HIPAA program? Are all staff members trained on the program? Having an up to date HIPAA program is critical for your practice. Make sure that your knowledge is up to date on the required HIPAA Security Compliance Evaluation, HIPAA Security Risk Analysis, a Privacy and Security Risk Management policy, and have a Breach Notification policy in place. Also, don’t forget about your Notice of Privacy Practices for your patients!

5. Shield Your Practice from Whistleblowers

By now you should be privy to the fact that the number of records requests and audits is increasing. Did you also know that you could be audited because of an unhappy employee, a competitor, or even a patient?  To make sure that you are protected in the event that one of these things leads to an audit, make sure that you have already put your practice under the microscope – from your documentation to your HIPAA Program – so that you are not feeling completely distraught in the event of an investigation.

If you are participating in chiropractic insurance billing you should make an effort to have a compliance program in place. There is no doubt that a records request or an audit that it will be a nerve racking process. However, with a plan in place to address these areas of compliance, you can have more confidence in the outcome of these types of investigations.