About Your Data Security & Liability
What Software Companies Don’t Want You To Know About Your Data Security & Liability 8 secrets they keep and the truth you need to know For Your Data Security: What are the two types of systems? Do you still own your data if it is stored in the cloud? Will you be able to access the data if you switch chiropractic software companies? Can a cloud based company hold your data hostage if you leave? Where is my data safest? Where is the easiest place for a hacker to get data? Is there any liability if your data is stolen? Will the government ever really enforce these laws?
Genesis Chiropractic Software Webinar Teaches Three Key Practice Compliance Skills
Industry leaders unveil tested strategies in chiropractic practice management software to increase office compliance and save practice owners time and money in this short new webinar. Genesis Chiropractic’s new short webinar reveals three most effective methods to increase compliance in the office, thus saving chiropractors time and money. The webinar is available online, and can be watched or listened to on a computer here at any time. “Ninety healthcare providers were charged with compliance violations reaching $260 million in billing in May 2014. A growing number of practices are subjected to audits and penalties,” says Reuven Lirov, Chief Practice Growth Officer at Vericle. “Chiropractic practice owners too struggle to maintain compliant practices against a tangled web of regulations from insurance companies, the government, Medicare, and Medicaid.” Each of those unbilled visits would be marked as a “fail” in the audit, with a resulting penalty of $10,000 per line item. According to Lirov, mistakes and oversights in the office are a regular occurrence in most healthcare practices. “Chiropractic office practice managers face difficult problems posed by compliance issues such as the increased risk of audit failure, growing compliance complexity, and lack of time to learn and implement new procedures based upon new rules,” says Lirov. Lack of compliance is a serious issue that can lead to substantial loss of revenue and fines. For example, a chiropractic office might see 100 patients a day, or approximately 25,000 patients a year. Suppose just 0.4% of those visits (100 visits) are undocumented. Each of those unbilled visits would be marked as a “fail” in the audit, with a resulting penalty of $10,000 per line item — or $1 million in audit penalties. “Better compliance liberates chiropractic practice owners from worrying about fines and audits, and lets them get back to treating patients,” says Lirov. “Chiropractic practice management software helps practice owners stay compliant and grow. Our average clients have seen substantial growth in their practices including an average revenue growth of 186% and patient growth of 141%.” [vc_video title=”Dr. Greg Loman D.C. talks about compliance.” link=”https://youtu.be/i0slFN2U1GA”] “We’re in a compliance era in which we must really become compliant,” says Dr. Greg Loman D.C., an accomplished physician, a high volume practice owner, and a co-founder of Maximized Living. “In my opinion it is just necessary that you use Genesis Chiropractic Software by Billing Precision not just a for compliance but for just how amazing their product is.” Continuously increasing compliance requirements and lack of time do not excuse chiropractic practice owner during a practice audit. This short thirty minute webinar teaches the three most important practice management skills to save a chiropractic office and avoid audit failure penalties. The webinar includes a demonstration of Genesis chiropractic practice management software. It contains automated features to discover the most frequent documentation errors that lead to compliance issues, such as undocumented visits, unsigned notes, and late billing. The software is also browser-based, so it can be changed as the law changes without inconveniencing the practice owner. Click here to sign up for the free webinar and find out more information. About Genesis Chiropractic Software and Billing Precision, LLC Genesis Chiropractic Software by Billing Precision, LLC was designed by chiropractic business owners with both patient relationship management and practice profitability in mind. Genesis software provides a complete chiropractic practice management system that supports every role in a busy chiropractic practice, from the owner and practitioners to the front desk and back office. It automates the vast majority of standard tasks, including patient relationship management, revenue cycle management, compliance and office management. Its exclusive workflow functionality continuously improves productivity, control and predictability, fostering teamwork and time savings, which leads to greater profitability and practice growth. Visit https://genesischiropracticsoftware.com for more information.
Chiropractic Software Patient Education Increases Compliance
Personal Growth Could patient education help reduce Dr. Ben’s exasperation with compliance? Ben pulled a weed viciously. His wife looked at him with raised eyebrows. “What did that dandelion ever do to you?” “I guess I’m just exasperated,” Ben said, tossing the weed into a wheelbarrow and starting in on another. “You can take out all your exasperation on these weeds,” Carmen laughed. “But tell me what you’re upset about.” “Another no-show this afternoon!” Ben said, pulling more weeds with more force than was absolutely necessary. “I’m just getting sick of it.” “I thought you had worked out –” “Oh, we have a good system in place now, as far as the practice is concerned. But I still hate it. This particular patient skips half her regular adjustments, and then comes in with pain and emergencies that she probably wouldn’t have if she just followed her treatment plan. It’s frustrating to know that I can’t do my best for her because she won’t cooperate and be in compliance.” Carmen nodded sympathetically, digging out a stubborn root. “I sometimes think,” Ben went on, sitting back on his heels, “that they don’t really get what we’re doing.” “Maybe they don’t,” Carmen suggested. She reached across to help their son with a tough weed he was trying to pull. “They act like what you do is magic. They don’t know why it works, they just feel happy that it does.” “But you see, that attitude means that they don’t follow through with my recommendations.” “You explain things clearly, I know,” Carmen assured him. “I’ve heard you do it.” “Better sometimes than at other times,” Ben admitted. “It depends how busy I am, and which room I’m in — some have better visual aids than others.” Carmen laughed again. “I hadn’t thought of that, but it’s true. Plus, you’re not always the one giving the explanation. It’s not really systematic, is it?” “I guess it’s not,” Ben agreed. “We all just answer questions and give explanations as needed — office staff, too. And of course we work together on patient cases, or with other health care professionals. There can be a lot of people involved in a single medical decision, and we don’t all end up sharing the same information.” “I don’t do a lot of education in my business,” Carmen said, “but I know that anything that doesn’t use a good system ends up taking more work, more time, and more trouble than it needs to.” “Hmm.” Ben stood up, brushing dirt from his knees, and hoisted the wheelbarrow. “It sounds like non-compliant patients are my fault.” “That’s not how I meant it,” objected Carmen. Jonathan scrambled up into the wheelbarrow, shouting that he wanted a ride. “I’m just going with what you said — they don’t always get what you’re doing. Then they might not realize the importance of doing their part.” “I’m doing my part,” Jonathan announced. His parents assured him that he was, and Carmen lifted him down from the wheelbarrow so Ben could tip the weeds onto the compost pile. “A little patient education might do wonders,” Ben said. “I hadn’t really thought about it, but I’m sure the patients would be more cooperative if they understood the value of follow through.” Could patient education help reduce Dr. Ben’s exasperation? Disclaimer: For HIPAA compliance, all characters appearing in this post are fictitious. Any resemblance to actual persons or actual events is purely coincidental.
Shedding Light on the Issue
How will Ben and his practice cope with more changes? Worried about Meaningful Use? Ben was staring at his computer screen, lost in thought, when Carmen arrived. She had sailed past the reception desk with a wave as the staff was closing up for lunch, so she hadn’t been announced. It was only a moment or two before Ben felt her presence and looked up, but it was long enough for her to register the stress Ben was feeling. “Hey, honey,” he greeted her. “Hey,” she said softly. “Is it that ONC HER thing?” “ONC-certified EHR, actually, but yes, that’s what’s on my mind.” “I thought you might be able to have lunch with me. We could talk about it over a sandwich or something,” Carmen suggested. “Why not?” Ben agreed. They left through the back door, heading to the tree-lined parking lot. “I’m not so concerned about our software, but the meaningful use requirement might bite us. We have to look not just at what our systems can do but at what our people actually are doing.” Carmen nodded. “I know just what you mean. At the pizzeria, we know that we have everything the health regulations require set up and in place, but follow-through is something else. People get into a hurry, or get set in their ways, or just don’t see the importance of following the rules, and first thing you know we have a scoop in the ice bin or something.” “The stakes are high enough here that everyone ought to be on board,” Ben said. “Hey, we could just walk over to the sandwich shop.” “Works for me,” Carmen agreed. “High stakes matter a lot as long as you’re thinking about them. But, speaking from my own experience with scoops in the ice bin, I’d say that during a normal day we don’t spend a lot of time thinking about those things. Plus, sometimes the consequences are more immediate for the people in charge than for the rank and file. If the restaurant has health code issues, it will affect everybody eventually if nothing is done, but usually it just means that I have to deal with it. Compared with the immediate convenience of leaving the scoop in the ice bin, that doesn’t seem like much to a kid who’s getting slammed with the lunchtime service.” Ben agreed. “The possible future consequence to the group never seems as pressing as the immediate comfort of the individual.” “Or even,” said Carmen as she added a cookie to her plate, “the possible future consequence to the individual, like what that cookie might do to my energy levels this afternoon, compared with how yummy it looks right now.” “The issue for us is that Medicare will cut payments if we haven’t demonstrated meaningful use by October 1st.” “So the partners with more Medicare patients might feel more motivated than those with more private insurance patients?” “Actually,” Ben said, negotiating his way through the tables with their tray, “Medicare pretty much sets the standards for all insurers and state boards. Where Medicare goes, the rest will follow.” “Is there really a big gap between where you are now and where you should be?” Carmen asked. “We’ll have to figure that out. But I think it’s like your ice scoop example. We’re looking at people’s behavior and choices, not just the systems.” Ben took a bite of his sandwich. “I guess that’s what’s worrying me. People don’t like change. When we switched the light bulbs in the office it bothered people. Changes in the documentation systems bothered people. Now we’re talking about more changes.” How will Ben and his practice cope with more changes? Disclaimer: For HIPAA compliance, all characters appearing in this post are fictitious. Any resemblance to actual persons or actual events is purely coincidental.
ICD-10 Redux | Questions & Answers
As your practice is preparing for the impending ICD-10 changes, you might have many questions concerning billing procedures and software requirements. To help you get the answers you need, we have compiled some common questions and answers. Feel free to add any new questions in the comment section below. Q: I have a question about the top 50 ICD-9 codes we use, and doing the crosswalk to ICD-10. Where is the best resource for being able to do that? A: CMS GEMS would be one website that you can use; that’s CMS’s GEMS System, which is the General Equivalent System that they use — the General Equivalent Mapping System that they use to translate ICD-9 to ICD-10. Another good site for you is AAPC.com. Click on their ICD-10 link and they have a feature where you type in our ICD-9 and it returns the equivalent ICD-10 code. GEMS prompts you to choose the lateralities and origins, whereas AAPC is more one-to-one, but GEMS is really what most systems are basing their crosswalk from, and GEMS is built and maintained by CMS, the CDC, and AMA. Q: I’ve done all my conversions from ICD-9 to ICD-10 and I’ve done the left and right conversions. We’ve changed some of our documentation so it’s more specific about mechanism of injury — the when, where, the why and the how. What else is there really to do? A: You really want to make sure that how the practice is supposed to document the guidelines for documentation are clearly outlined in your policies and procedures manual. And that means adding in specificity and laterality. The manual should also have references as to where you seek the information; your reference point would be to CMS. Q: If I want to take a coding course to get certified, do I need to be certified on ICD-9 and ICD-10? A: Right now, you have to certify for both, but after October 1, 2015, you only have to certify for ICD-10. Q: Are you able to come out and help us train our staff? A: We can give you the tools that you need in order to train your practice. They can also take external classes — specifically from the AAPC, because their classes on physician documentation are extraordinary. In terms of crosswalking, we will work with you. Q: Where can I find CMS guidelines in written form? A: On CMS.gov, click on the Medicare link and you will find a link for both local and national coverage determinations. Q: When can I start finding ICD-10 codes within your software and submitting them? A: Our software already has all of the ICD-10 codes listed; we are building the crosswalk now. We recently completed ICD-10 testing with Medicare, and were successful with our front-end edits. We are looking to have this available to practices by June, to really start testing and crosswalking. At this point, payers are not accepting claims in ICD-10; they are not coming over until October 1, 2015, but we are testing with payers and clearinghouses directly. Q: Will you install products well before the October 1, 2015, deadline, so I can begin testing them now? A: We began crosswalking for ICD-10 in February 2014 and completed the process in April. Speak with your coach about testing for the new coding system. Q: When will you update my current products and applications for ICD-10? A: Our products are continuously update in accordance with new regulations and policies, so the ICD-10 changeover will be virtually seamless. Q: Will there be a charge for these updates? A: We do not charge for updates. Q: Will I need new hardware to accommodate ICD-10-related software changes? A: No. Our software, being cloud-based, will continue to run on your current hardware. Q: What are the costs associated with maintaining new products? A: There are no additional costs.
ICD-10 Strikes Back
Believe it or not, there is a method to the madness of ICD-10. The system was developed by the World Health Organization (WHO) as a means of standardizing the categorization of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. Officially known as the International Statistical Classification of Diseases and Related Health Problems, ICD is the standard international diagnostic tool for epidemiology, health management and clinical purposes. This system is designed to map health conditions to corresponding generic categories together with specific variations, assigning for these a designated code, up to six characters long. Thus, major categories are designed to include a set of similar diseases. ICD-6, adopted in 1949, was the first version of ICD that was deemed suitable for morbidity reporting. The combined code section for injuries and their associated accidents was split into two: a chapter for injuries, and a chapter for their external causes. With use for morbidity there was a need for coding mental conditions, and for the first time a section on mental disorders was added. Work on ICD-10 — the tenth revision of the system — began in 1983. It was officially copyrighted by WHO in 1990, though it wasn’t actually completed until 1992. It was then adopted relatively quickly by many countries of the world, starting with Australia in 1998. Today, ICD-10 is the most widely used statistical classification system for diseases in the world. For numerous reasons, but particularly due to the special interest groups that affect policy, the United States wasn’t able to get on board until August 2008. At that time, the Department of Health and Human Services proposed that ICD-10 be adopted in America — a move that was formalized in January 2009, establishing ICD-10 as the new national coding standard, with an implementation date of October 1, 2013. And if the prospect of changing over to ICD-10 wasn’t imposing enough, ICD-11 is “scheduled” to become the new standard in 2017 — though with the numerous delays in getting ICD-10 onto the books, it’s likely that ICD-11 will be pushed back for at least a few years.
PQRS | How These Four Letters Affect Your Practice | Webinar Q&A
Unless you are billing the right set of PQRS codes on 50 percent of your qualifying visits, then you will lose 2 percent of your allowed reimbursement in 2016 and forward. As a result, you may have concerns about the changes that this reporting system brings to your chiropractic clinic. To help you get the answers you need, we have compiled all questions that were asked during our recent webinar “PQRS | How These Four Letters Affect Your Practice,’ along with the presenter’s responses. Feel free to add any new questions in the comment section below. Q: Is Genesis powered by Vericle an eligible registry? A: Right now, the only way to submit a PQRS code to CMS is claim-based. Vericle is working on becoming a registry. It’s a very long process. Right now, we are working on Stage Two Meaningful Use. This is another way for users to avoid the 2016 penalty. Q: Does pain and medication measure have to be reported on every visit? A: Whatever measurements you choose to report, the documentation has to be in your chart. Q: What is Genesis powered by Vericle doing to maintain compliance with Medicare? A: In terms of compliance with Medicare, Vericle does keep up on the rules. In some cases, if you need a different secondary diagnosis when you’re submitting your claims to Medicare, Vericle is C-CHIT. Vericle completed EHR Meaningful Use Stage One and is preparing for Stage Two, which is Medicare compliant. PQRS codes have been available in the Vericle system.
Something for the Pain
By Kathleen Casbarro Simplifying coding issues can relieve practice tension How can software make a difference in the ICD-10 changeover? “Doctor!” The box on Ben’s desk squawked. Pam always sounded professional, but Ben knew her well enough to hear the tension in her voice. Ben hesitated for just a moment over the stack of paperwork he’d been plowing through, but decided he should respond to Pam’s obvious stress. As he neared the front desk, he heard raised voices. “You’ve already been to the doctor!” a young woman shouted at an older man whose face was set in pain… or perhaps in stubbornness. “He’s already been to the doctor!” she repeated in Pam’s direction. “Maybe I can help,” Ben offered. “I was in a car accident–” the older man began. “My dad has been to the doctor and to the hospital,” the young woman said firmly, “and they told him it was back pain and it would get better in time. They gave him pain medication to take and he won’t take it. Now he’s insisting on coming here, and I don’t think his insurance will pay. I just want to take him home.” Family altercations weren’t as common in Ben’s chiropractic clinic as they were in hospitals, but he recognized the situation. The daughter was worried that her dad wouldn’t be able to pay, the old man was still in pain, and their worries were showing up as anger. “Let me take these good people back and have a little chat,” he said calmly to Pam. Getting the shouting out of his waiting room was the first priority. He’d get them calmed down, explain the situation, and then bring them back to Pam for intake, and the paperwork — well, it looked like he’d be working late again. It was hours later when Ben had a chance to discuss the event with Pam. “I’ve been thinking about the man who’d had a car accident,” she said. “We’re always careful to avoid using the ICD-9 code 724.5 for back pain because it tends not to get paid. We make sure to use the most specific code we can so the patient’s insurance will be able to pay.” Ben nodded. “I realized that I don’t have that knowledge about the new ICD-10 codes,” Pam continued. “We’re always focused on the people we treat, but the paperwork is what allows us to keep the doors open and take care of those people. I’m worrying that the new insurance reporting codes will get in the way.” “I think we may have a solution,” Ben said. “I’ve been talking with the people at Genesis — the new practice management software. They had a really sensible approach to it. Three things: assessment, documentation, and implementation. That’s better than focusing on the 70,000 new codes, right?” “It might be,” Pam said uncertainly, “If I knew just what that meant.” Ben laughed. “Fair enough,” he said. “What I get is that the software will cluster the codes into groups so we can drill down to the right one, instead of trying to memorize everything. We’ll be able to see the relevant ICD-9 and ICD-10 codes on the billing screen, along with which payers are using each set, and we’ll have a crosswalk that will let us learn and train before the deadline.” “All on the billing screen?” Pam sounded excited. “That sounds workable.” “Workable,” Ben repeated. “That’s it exactly. It’s like when we get a patient having a meltdown in the front office — we may feel a little stress, but we have workable systems in place to handle it, and it turns out well.” How can software make a difference in the ICD-10 changeover?
Trouble Brewing
By Kathleen Casbarro ICD-10 spells a major adjustment What will Ben’s chiropractic office face with the changes in insurance reporting? Carmen sat on the sofa next to her husband and pulled her feet up under her. “Ben,” she said, taking his hands, “I want to know what’s going on. You picked at my homemade manicotti, you provided no challenge at Wii Bowling, and you didn’t even do the voices for Jonathan’s bedtime story.” Ben smiled ruefully. “You’re right. I’ve got something on my mind,” he admitted. “Remember I told you about the new codes for insurance reporting?”“ICD-10 codes?” Carmen thought back to the previous week, when Ben had told her some government changes would affect his chiropractic clinic. “I remember you didn’t seem to know just how they would affect you.” “Ignorance might have been bliss! I just found out that the effects are going to be significant. The AMA estimates that complying with the changes will cost a practice like mine in the neighborhood of $83,000.” “That’s not a neighborhood we’d feel comfortable in,” Carmen protested. “Things have been rough with the practice already–” “I know,” Ben agreed. “It’s already so stressful dealing with uneven cash flow, I don’t know where I’m supposed to come up with the funds to cover this kind of investment, but it’s not optional. We have to complete these changes by October 1, 2014, or we won’t get paid at all.” Carmen frowned. “Are you sure it has to cost that much? I’m pretty good at pinching pennies.” “I know you are, but this isn’t like negotiating with your suppliers at the pizzeria. I can’t negotiate with the government, and the the new ICD book has 1,107 pages of non-negotiable changes. We’ll need software upgrades, changes in billing practices, training for all the staff… that’s all going to cost.”Carmen and Ben both stared glumly ahead. “Even if you figured out some way to do everything yourself, you’ll have some opportunity costs,” Carmen said. “You’d have to cut down on the patients you see or the other work your team is doing. I’m at your place a lot and I never see people sitting around doing nothing. You’re already running efficiently, so extra time is the same as extra money.” “Exactly. Plus, any change increases the risk that we’ll be audited or that the insurance companies won’t pay claims. We don’t yet know what will be considered medically necessary under the new system, but we’ve heard that there’ll be opportunities for cherry picking. That means that our choice of words in the notes we write up could affect whether or not we get paid.” Carmen shook her head. “You’re already dealing with non-payment of claims, aren’t you?” Ben nodded. “I just don’t see how we’re going to get through this.” “Things are good at the restaurant. And, as I said, I’m good at pinching pennies.” Ben forced a smile. He was lucky to have Carmen, and he knew she’d do what she could, but the stress was getting to him. This was definitely not what he had dreamed of when he had set up his practice. What will Ben’s chiropractic office face with the changes in insurance reporting? Visit our ICD-10 page to see everything we’ve published about ICD-10 diagnosis codes.
Code of Conduct
By Kathleen Casbarro New coding regulations: A major adjustment for chiropractors What will the new ICD-10 codes mean for Ben’s practice? “I’m a lucky man,” said Ben. His wife Carmen had brought an envelope full of family photos to his chiropractic office. The two of them had taken their son Jonathan for a photo shoot in a community park, but the pictures looked as though they had been taken in a pristine forest. “That photographer has skills.” “True, but she also had some great material to work with,” Carmen teased him. “We are a photogenic family,” Ben admitted with a wink. “I want the one with Jonathan on my shoulder for the office. We look so happy!” “That’s because we are happy,” Carmen pointed out. “But you didn’t actually look very happy when I came in. I thought things were going well with the practice.” “They are,” Ben assured her. “But now that I’m getting control over things in the practice and feeling happier at work, I’ve had time to notice an upcoming change in reporting requirements that feels a lot like… hmm… maybe a giant wave coming at me.” Carmen took Ben’s hand. “A trouble shared is a trouble halved. Tell me about it.” “Well, you know we use codes when we file insurance claims. By October 1, 2014, we have to change them all.” “Sounds like some extra work for your staff, but not exactly like a huge wave about to crash over your head.” “It’s kind of hard to know… We don’t know right now which codes for chiropractic will be identified as ‘medically necessary,’ for example, and we know that it won’t just be a question of renaming. We can’t just find all the 724.3 codes and change them to the single new code that will cover it. There are a lot more ICD-10 codes than ICD-9 codes, and there won’t be a one-to-one correspondence. We might need to make some judgement calls about what’s the best new code for a given procedure. If we make the wrong choice, we might not get reimbursed. And that’s just one thing. I don’t really know how many more things there are like that.” “Okay, I can see that you’ll need to be involved in the change. But is it mostly just about learning the new codes?” “I know that the new ICD-10 codes have seven digits instead of five, like the current ICD-9 codes. That could mean all new forms.” Ben frowned. “I guess I just don’t know what’s involved, to tell you the truth. But the government notices have said that it’ll affect scheduling as well as billing, and the way doctors make notes, and — well, pretty much everything we do.” Carmen started putting the photos back into the envelope, leaving out the one Ben had chosen for his office. “It sounds like you don’t have enough information right now,” she said. “I’m not saying don’t worry — it does sound like something to worry about. But it doesn’t sound as though you know the size and shape of the problem yet. It’s like at the pizzeria–” Ben laughed. “Everything reminds you of pizza!” “Okay, that might be true. But when we know we have big parties coming in, that’s very different from just feeling like it’s going to be a busy night. When it comes to this reporting change, you basically don’t know how much pepperoni you need to have on hand.” “Pepperoni sounds good. Let’s grab some lunch and I’ll worry about this stuff later.” “Just don’t leave it too late — October will be here before you know it.” What will the new ICD-10 codes mean for Ben’s practice?
