“Nothing great is created suddenly, any more than a bunch of grapes or a fig.
If you tell me that you desire a fig, I answer you that there must be time. Let it first blossom, then bear fruit, then ripen.”
~Epictetus
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“If the path before you is clear, you’re probably on someone else’s.”
~Joseph Campbell
For a printable copy of this tent poster click the link: Campbell – Your Path
“We have healing power inside us. But we block it because we feel we need to take pills and become dependent upon outside forces…
We have an inner doctor.”
~Wim Hoff
For a printable copy of this tent poster click link: Wim Hoff
Patient education is definitely a clinical function. But… it is also good marketing.
And note that your entire office IS the marketing department and each team member has a marketing role.
To help everyone on your team better participate in patient education, use this simple and fun method:
Get a whiteboard and place it where patients can see it. Assign someone to write something on it each day so that your patients, or you, can comment on it.
For example, you could write:
“Pain is the last to show
… and the first to go.”
This will be a cue for the doctor or a team member to talk to your patients – and can also provoke your patients to talk to you.
Here are some other examples:
At your morning team meetings, or weekly meetings, go over each subject so everyone has a better idea on how to educate patients on the topic.
For active PM&A members, go here for a more complete list: PMAmembers.com
New ABN Form and Implementation Instructions
Frequently asked questions and answers for the ABN form
New ABN English 2017(PDF) – Form CMS-R-131 goes into effect June 21, 2017. You may begin using the new one now(April 2017), but on and after June 21 per CMS, you may not use your current ABN.
New ABN 2017 (DOC) Form CMS-R-131 goes into effect June 21, 2017. You may begin using the new one now(April 2017), but on and after June 21 per CMS, you may not use your current ABN.
New ABN_Spanish 2017(PDF)-Spanish Version Form CMS-R-131 goes into effect June 21, 2017. You may begin using the new one now(April 2017), but on and after June 21 per CMS, you may not use your current ABN
ABN-Use(Doc) How and when to use the Advanced Beneficiary Notice for Medicaid Services
Script-for-ABN-form(DOC)– Script for explaining the form to the patient
Final Revised ABN-2012- Advanced Beneficiary Notice for Medicare Services – expires June 21, 2017.
Ms. Lisa Barnett with Petty, Michel and Associates specializes in preventing Medicare Audits. She has helped those who have already been targeted find a fast and safe way out of trouble.
You are not alone…. Things do Happen…..
You are busy and possibly you have overlooked a certain requirement. Your computer has gone through updates and you have not kept up. Or possibly your documentation is simply inadequate in the eyes of medicare or the government.
Whether you are faced with a prepay audit or a post payment audit. I can help !
With 10 years of experience in the chiropractic industry and with documentation; and a chiropractic advocate for 30 years I care and I want to help.
Call today for your complimentary phone consultation and record review. 920-334-4561
Most of your staff are not engaged in the success of your office. Most of them JUST DON’T CARE.
At least that is according to a 2015 Gallup report that interviewed over 80,000 working adults.
The report showed that there are twice as many “actively disengaged” workers in the workplace as there are “engaged” workers who like their jobs. The percentage of U.S. workers in 2015 considered engaged in their jobs averaged 32%. The majority (51%) of employees were “not engaged,” while another 17% were “actively disengaged.” (“Actively disengaged” means that they are actively sabotaging their work.)
But let’s say your office is different, which I am sure it is. You are motivated enough to read this article and I am sure that is reflected by your team as well. But all the same, take a look with me at the level of motivation of your office.
How was your last team meeting? Were you there? Was everyone sitting on the edge of their seat and contributing new ideas and plans on how to reach new goals in the office? Or, were most everyone pretty silent?
Sure, your employees smile and look busy when you are around, and often work hard and they do care. But really, how much?
What would your office be like if the motivation, creativity, and level of pro-activity was always very high at “10,” or even ranged from 7-10? If they felt that it was “their” business, where they took responsibility for the quality and quantity of outcomes, and regularly worked to improve the business – and themselves?
I have been reviewing the subject of motivation for some time, from my own experience over the years and from what social scientists have reported.
I have incorporated certain principles into a new system of business management that are specifically designed to unleash everyone’s innate motivation – including business owners like you!
Motivation is the foundational in a chiropractic office, or dental office, acupuncture – even with therapists and other service firms. It is a bedrock for any healthy practice and business.
Here is one very useful principle specifically about motivation and how you can use it to generate more engagement – and productivity — with your team.
3 Goals System of Business Management: Principle #5
Everyone wants their own sandbox to play in.
You do. This is one of the reasons you went to school – and why you started your business.
We all want to have something that we can call our own where we can create and demonstrate our competence. What we get in return is feedback that we can do something good, that we have power, that we can make something beneficial happen, that we can … make a positive difference. If only to ourselves, we can say: “Look what I did. I did this. This is my creation.”
You can see it in children, for example, when they bring you their colored scribbles on crumpled pieces of paper to proudly show you their great work of art. This is their sandbox.
Of course, we all work for money. But we also have deeper motivations that if tapped into and nurtured, can be very powerful. By harnessing these motivations, and then linking them with others who have a shared goal, we can create a dynamic team driven business that is very profitable.
This has been explored by social scientists who have studied what has come to be called Self-Determinism Theory. I have also seen it in action. Essentially, it states that we all have innate drives and inherent needs that motivate us to be more self-determined rather than determined, or controlled by, outside forces.
External motivation, like the fear of being fired, can only motivate us so far. Threats, criticisms, negative reinforcement may produce short term action, but in the end, they demotivate, or worse.
The level of employee motivation has a tremendous influence over the success of your business.
An unmotivated staff, one that only becomes engaged to the level of “I will perform just good enough so that I don’t get fired or criticized,” will weigh the office down.
Self-Determinism Theory (STD) has three components, all of which easily apply to your business. These are:
And by the way, while reading this, consider how this also applies to you as well!
You do not want your treatment plans second-guessed by a clerk in an insurance company. Neither does your front desk want you breathing down their necks about where all the patients or practice members are, or why they used the blue pen. You should train and educate your team, but then get out of their way and let them succeed or fail.
Think of helping a child ride a bicycle. Sure, they will need your help for a while. A push now and then. Perhaps some training wheels. But you will have to let them fall down a few times and allow them to get the courage to get back on the bike and succeed. You can continue coaching them to improve, but you must let them go.
Even if you see employees appearing idle, or having brief personal discussion with another employee, back off. Tolerate minor errors. Give your team some rein. Come back around later to coach them and train them to improve. Mostly educate them on the mission of the office and of their roles, and get them to understand what outcomes they are supposed to be producing. Once they see that the statistics measure their performance, they will be more self-directed and want to do all they can to win the game!
We all want to be free to create our own enterprises, even if we work for someone else. As long as what we do is in line with the purpose or mission of the business and our role, there should be no problem. This helps us demonstrate our competence, which is the next element of Self-Determined Theory.
Doing a good job, all by itself, is its own reward. It pushes away self-doubts and shows us, and others, how good we really are. It is positive reinforcement.
And the better we can do a good job, the better the results will be, which demonstrates to us just how awesome we truly are! Plus, as we increase our skills, we also will find that our duties are easier to perform.
Your team wants to improve their skills. Help them do so.
Sign them up for seminars, webinars, give them monthly reading assignments, and give them a coach or three of them. But this has to be done in conjunction with your supervision. You will need to guide them through the training so that they see how it applies to their roles and the business as a whole. Quiz them on what they are learning and have them give presentations to the team on what they are learning. The old maxim applies: “to teach is to learn twice.”
And where possible, make sure they earn certificates and can wear pins or insignia that testify to their competence. This goes along with Game Theory – people win at one level and then want to go to the next level. They want their “badges.”
Business owners throw staff into their jobs and expect them to produce with little or no training. Without exception, the offices I have seen that provide more training and coaching for their team — do better. Companies spend an enormous amount on employee training. $161 Billion in the U.S. last year (trainingindustry.com). And, it pays off.
One study showed a comparison between car companies and how many hours they trained their new employees: Japan spends an average of 364, Europe averages 178, and the United States – 21 (Pfeffer –The Human Connection).
And you can guess which country has cars with the best frequency of repair record.
Children want to be super heroes and wear their capes.
Don’t we all!
This is the feeling of being connected – and there are two aspects to this.
Family. First, “relatedness” is the feeling of not being left out of the “loop” and of being included. Staff meetings help with this as does the general work environment. This is the sense that we are in this venture, job, and profession together. That we are part of a family.
Keep your team involved with your decision making. Give them some of the issues you are dealing with and encourage their input. They are stakeholders – it is their office too!
Greater Purpose. The other aspect of relatedness is that people generally want to be associated with a greater purpose. The more that each member can connect to the greater purpose of the group and make it their own, the more motivated they will be. Taking it a step further, if employees have higher goals of their own that coincide with the organization’s and they are allowed to pursue them within the organization, there would be no reason for employees to work anywhere else.
Train your team, let them own and creatively improve their own areas – and help to do the same for the entire office. Nurture camaraderie and a spirit of family – and always remind them – and yourself — why we are doing what we are doing.
Do this, and not only will your business be more successful, but you too will be more motivated and have more fun in the bargain.
# # #
“To bring about change, you must not be afraid to take the first step. We will fail when we fail to try.”
~Rosa Parks
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An elder Cherokee Native American was teaching his grandchildren about life. He said to them…
“A fight is going on inside me… it is a terrible fight and it is between two wolves. One wolf represents fear, anger, envy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority and ego.
The other stands for joy, peace, love, hope, sharing, serenity, humility, kindness, benevolence, friendship, empathy, generosity, truth, compassion and faith.
This same fight is going on inside you and every other person, too.”
They thought about this for a minute, and then one child asked his grandfather… “Which wolf will win?”
The old Cherokee simply replied… “The one you feed.”
For a printable copy of this tent poster click: 2017-02-Two Wolves-3
If you are having challenges with your “marketing,” or you just want to generate more new patients, you need to consider something.
There are many good and great marketing activities you can do. (You can go to our website under “Free Resources” and find buckets of marketing. And, for those of you who are active members, there are mountains of even more marketing programs for you on our Member’s site.)
There are many paid programs you can purchase that explain different methods of generating more new patients. You have seen them, perhaps purchased them: DVD’s on dinner talks, workshops on how to present to businesses, Facebook and print advertising programs, and automated newsletters and Facebook posts.
These all can be useful in generating new patients, but the results often fall short from what the few successful doctors who promote the programs claim. This is usually because there were two major components missing in the marketing.
When doctors return from marketing programs, I like to ask them what they thought of the material.
“Yes, I liked it. It was good info. Learned a lot.”
“Great.” I say. “So, who is going do it?”
“Well, Susan can do it.”
“Oh really, when? She has a backlog in insurance and is working overtime trying to work with your sketchy notes as it is.”
“Hmm, well, we’ll hire someone.”
“Great. Who is going to train them? You?”
Not trying to be a jerk, but part of any good consultant’s job is to provoke analysis!
Besides the marketing event or procedure, there are two other critical elements to practice marketing that have to be included for the promotion to work. These are not always taken into account.
This was the basis of the Marketing Manager System I wrote and published some 17 years ago.
Most companies, as Simon Sinek talks about in his TED talk*, boast about what they do, or how they do it. It is all about them. Look at us!
But the better companies talk about WHY they do what they do, and they do it for YOU. They do it for your kids, grand kids, community, and the betterment of the world.
This is practice marketing. It is personal. You tell people why the heck you do what you do — and you say all this with genuine care and confidence – in your own VOICE. You do this in your newsletter, in your talks and in your ads. The best marketers do this – often naturally.
Complete practice marketing then, has three major components:
Increase the WHY, increase the CAPACITY, then yes, please — lots of marketing activities.
Let the party begin!!
Ed Petty
Spring Marketing Planner- (DOC) Sample Marketing Planner for Spring
*TED Talk link: www.pmaworks.com/observations/2011/02/10/leadership-in-chiropractic-the-golden-circle/
“The illiterate of the 21st century will not be those who cannot read and write, but those who cannot learn, unlearn, and relearn.”
-Alvin Toffler
For a printable copy of the tent poster email us.
Oklahaven, a non-profit children’s chiropractic center has been dedicated to making sick children well using natural, drug-free chiropractic care for over 55 years. To help fund their efforts the Annual Have A Heart Campaign is held in conjunction with Valentine’s Day each year.
If you’d like to participate, a complete marketing kit is available directly through Oklahaven simplifying the event preparation for your marketing coordinator.
Click here for a pamphlet with more details or visit the Oklahaven “Have A Heart” web-page.
We recommend offering a special promotion to patients who have not been active for 6 months or more.
The links below will take you to a couple of articles describing procedures that can be used to encourage less active patients to come in to see you.
The Reactivation Program has a number of sample letters and a sample postcard and the Reactivation Card is a sample post card that can also be customized for your email newsletter.
Sample Reactivation Postcard – Sample postcard layout and instructions on how to customize your postcard. Information can also be used for email notification.
Reactivation Program An article on the importance of regular reactivation program.
Best Wishes for your New Year!
Phyllis has been on the Parker Seminar speaker circuit since before starting with PMA. She presents a powerful presentation to motivate and inspire doctors and staff alike.
Coming to you from Las Vegas Nevada, February 23-25, 2017, Phyllis will be joining other colleagues in the chiropractic profession to bring a well rounded presentation of new patient procedures, billing and coding, obtaining referrals, handling objections, creating great patient experiences, and much more specifically designed for your Chiropractic Assistants.
Don’t miss out on this amazing lineup of CA Speakers:
For more information or to register visit parkerseminars.com
or download the flier here: Parker Seminar Flier
New Info on Medicare!
Happy Holidays Chiropractic Friends!
First snowfall always seems to bring renewed energies and hope – my wish is you experience this, too.
Are you ready for January 2017? Ready or not, here it comes. Today I want to introduce and give you some of the latest and greatest on what’s happening with the new Medicare reimbursement model also beginning our new year.
To start with, six new acronyms to introduce to you: MACRA, MIPS, CHIP, APM, SGR, CPIA
Here’s a bit of background for you regarding the initiative. In April 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act 2015 (MACRA). This is an act to transition Title XVIII of the Social Security Act to the Medicare sustainable growth rate and strengthen Medicare access. How? By improving physician payments and making other improvements, like the Children’s Health Insurance Program. We could say MACRA is the umbrella to the program.
What is the purpose of the change in reimbursement model? The purposes include simplifying reporting for the convenience and ease of the providers participating; decreasing the current costs of healthcare, allowing patients the best quality of care; and to make patient information sharing safe and easy. The blueprint for pay for performance is the Merit-Based Incentive Payment System, and the goal is to create an acceptable payment system for physicians and the program.
Who are the stakeholders in the broader MACRA program? They include beneficiaries (your patients), businesses, payers, providers, and state partners.
Are you eligible to participate?
Both participating and non-participating providers are eligible to participate if you meet both of the following criteria: 1) Have seen 100 or more unique patients in a year, and 2) Have billed for covered services at $30,000 or more a year. You are exempt from participating in 2017 if 2017 is your first year as a Medicare provider. You are also exempt if you do not meet one of the two criteria above.
How will it work?
CMS has indicated through various webinars that they will notify via written communication if you are or are not eligible to participate. Once you learn of your eligibility, the program will require participating providers to report on three categories for the Merit-Based Incentive Payment System:
Additionally, if you are eligible to participate and choose not to, there will be a negative adjustment of 4% to your Medicare reimbursement. If you are eligible and do choose to participate, you may receive a positive adjustment of 4 to 9% depending on your level of reporting involvement, as well as a minimum 0.5% bonus for exceptional performance if your final reporting score meets or exceeds a certain point value.
You will have two reporting options: You may report for the entire 2017 calendar year, or you may report for the partial year, one quarter, and may begin no later than October 2, 2017.
PM&A will continue to monitor any changes to the above information.
In addition, I will be conducting onsite MACRA readiness assessments at chiropractic offices and am available to visit yours. Please contact me if you are interested in learning more!
Best,
Lisa Barnett, Consultant
Petty, Michel & Associates
Call: nine two zero.334.4561
Email: Lisa@pmaworks dot com
A natural health lending library is a very practical marketing tool – if used.
A lending library is a collection of books, DVD’s, and other information that you can loan your patients. It is part of an ongoing patient education program. The better your patients understand what you do and why you do it, the more likely they will be to stick to a long-term care program and to refer their family and friends for services. Patient education, compared to other marketing activities, is not that expensive. It has a good ROI!
Download a list of suggestions here for your chiropractic or natural health care library. [Ideas for your Lending Library] Please give us your suggestions as well.
This all is logical, right? We all know this.
So…why is it rarely done? Most of the offices that I have seen with lending libraries have them on the bottom shelf in some corner of their office filled with books from a garage sale and old VHS video cassettes.
Everyone knows patient education is important. Like the Spinal Care Class, or new patient education class, everyone knows this is good for the patient and helps the office grow. Right?
Funny story… I attended a small get-together of chiropractors one evening here in Southeast Wisconsin. The presentation was given by the lead doctor of a multiple doctor office. Great doctor, nice practice. He had been in practice for years and looked weathered and ready for retirement. The talk was how to give an effective Spinal Care Class for new patients. The presentation was full of practical content. The only thing… the doctor wasn’t that cheerful about his presentation.
After he finished, and as he left the front of the room looking down at the floor, he muttered, as if passing on a confidential apology to another spy… “But we don’t do the classes anymore.”
So, no need to fool ourselves here. It might be just easier to buy some nice posters and be done with it.
Ah, but there is a trick to making your lending library work… and patient education in general work!
The lending library is primarily for YOU — and each member of your professional team.
We have been looking at it all wrong. The lending library is a reflection of YOU!
If YOU study, and if your support team studies and learns, you all will be so enthusiastic about the information that you will insist that your patients learn this information as well.
Be curious and ask yourself some questions. For example:
Read a book, watch a video, question authority, ask questions — seek the truth. Get excited about learning new things about your profession.
DON’T GET BORED. If you are bored, quit and go home!
Otherwise, be grateful for the opportunities we all have to learn and expand our knowledge and understanding of the services we provide and the world in which we provide them.
Be curious.
Ultimately, you sell yourself before you sell your services. How can you sell a care class or an extended treatment plan if you are not truly excited about them?
Learning new aspects of chiropractic, health care, wellness, sickness, the sickness industry, how your patients are being manipulated and exploited… all this should agitate you one way or another.
For example, I watch Vaxxed – the movie — and then listened to Dr. Andrew Wakefield and Brandy Vaughn (former Merck employee) talk on YouTube about the movie and how they are now being covertly and overtly intimidated to shut up. If this pharmaceutical company is trying to help members of your community get healthier, why are they now attempting to squash dissent and in such a sinister and yet powerful way? I can’t help but wonder: just how powerful are they at manipulating public opinion? How are they influencing my community and my family?
If you look further into the effects of pharmaceuticals, from Vioxx to statins to MMR and vaccines, and explore some of these questions, you can’t help but feel compelled to educate your patients on how to keep their children healthy and free from a toxic environment.
Some of the most successful offices I have seen have spent untold sums on going to seminars (and on coaches!). The verysuccessful can be reckless with book buying and webinar watching and seminar attending.
Continuing education isn’t just for re-licensing seminars. How dull!
If you are not impatiently curious about different aspects of your profession – its science, its philosophy, what it is up against in the market place, you are becoming part of the problem.
Stay curious. Question authority. Study.
Do this:
Assignment #1. You. Order a book – or video- from Barnes and Noble, your local books store, or Amazon. Read most of it on a weekend or weeknight evening rather than watching TV. Present what you learned at the next staff meeting and put the book in your Library.
Assignment #2. Your Team. Have your staff read a few chapters from a book, or watch a video from your lending library and then give a presentation about it at a staff meeting. Everyone learns and the staff member learns twice! Give bonuses for outside study.
Just like we work on our patients, just like we work on our business, we must work ON our roles as professionals and we do this by studying.
Then, no doubt, you and your team will be dragging your patients over to the lending library to check out the latest editions to your collection.
And your patients will know that they came to the right place. They may think you are all a little nerdy, maybe even fanatical about better health, but they will know that you sincerely care about them and their wellbeing, not just in collecting some money for some fast or rushed service.
Assignment #3. Stay curious and learn – and provoke others to do the same.
Sincerely,
Ed
See our attached list of sample books and videos for your Lending Library Ideas for Your Lending Library
Please give us your suggestions for informative books or videos!
*Questions taken from Dan Murphy’s web site.www.danmurphydc.com
“Dreams are free.
Goals have a cost. Time, effort, sacrifice, and sweat.
How will you pay for your goals?”
~Usain Bolt
For a printable copy of this tent poster click here email us.
Lisa J. Barnett
Download a PDF of this article
Hello Friends in Chiropractic!
Hope you had an awesome summer and took several opportunities to soak in some UV and Vitamin D.
This month I’d like to both expand on my July Medicare Documentation article and coach you on self-auditing evaluation and management (E/M) coding for reimbursement. Are you consistently under-coding your E/M services? It is not benefiting you to do this because more than likely you’re meeting required elements and not getting the best reimbursement available.
So, what exactly does an auditor, be it Medicare or a Commercial Payer look for in determining reimbursement for your evaluation and management services? It is pretty simple and based on both quality and as it turns out, more importantly, quantity of certain elements. Let’s look in depth how you can self-audit your E/M services*:
First, a coding history and review. In 1992, the current E/M codes were introduced as a result of a ten-year study by CMS(Centers for Medicare and Medicaid Services) and the AMA(American Medical Association). Then in 1995 and 1997, CMS and the AMA developed documentation guidelines (DG) for use of these E/M codes.
Without re-inventing the wheel, let’s lay out how you determine which code to use for your patient evaluations and management of care. To review,
Charting out information from CMS and ACA’s ChiroCode book, here is what we have as quantifiable elements to determine which code to bill for. Keep in mind that Necessity of Care drives our discussion below.
History, Exam, Complexity of decision-making are the three main elements in the evaluation and management note.
Let’s now diagram out for you each code and corresponding description of each element, using both New Patient and Established Patient criteria. What differences do you see? Which descriptions share commonality?
NEW PATIENT
| CODE | HISTORY | EXAM |
COMPLEXITY OF DECISION-MAKING |
| 99201 | Focused/Minor severity | Focused | Straightforward |
| 99202 | Expanded/Low-to-moderate severity | Expanded | Straightforward |
| 99203 | Detailed/Moderate Severity | Detailed | Low |
| 99204 | Comprehensive/Moderate to high severity | Comprehensive | Moderate |
| 99205 | Comprehensive | Comprehensive | High |
ESTABLISHED PATIENT
| CODE | HISTORY | EXAM |
COMPLEXITY OF DECISION-MAKING IN MANAGEMENT OF CARE |
| 99211 | No key component(s) required | No key component(s) required | No Key component |
| 99212 | Expanded/Low-to-moderate severity | Expanded | Straightforward |
| 99213 | Detailed/Moderate severity | Detailed | Low |
| 99214 | Comprehensive/Moderate to high severity | Comprehensive | Moderate |
| 99215 | Comprehensive | Comprehensive | High |
Building on that, here are the quantified components indicating the minimum number of each component’s required presence in the note to code appropriately and at the maximum level:
NEW PATIENT
| HISTORY | EXAM |
COMPLEXITY OF DECISION-MAKING |
||||||
| Code | Chief Complaint | HX of Present Illness | Review of Systems | Past Family/ Social HX | Exam (1997 DG) | Diagnoses | Data to be reviewed; # of Complaints | Risk Factors |
| 99201 | 1 | 1 | N/A | N/A | 1 in affected body area | 1 | 1 | Minimum |
| 99202 | 1 | 1-3 | 1 | N/A | 1-5 | 1 | 1 | Minimum |
| 99203 | 1 | 4+ | 2-9 | 1 | 6-11 | 2 | 2 | Low |
| 99204 | 1 | 4+ | 10+ | 2-3 | 12+ | 3 | 3 | Moderate |
| 99205 | 1 | 4+ | 10+ | 2-3 | All components | 4 | 4 | High |
All 3 elements are required in the new patient note to consider reimbursement: History, Exam, Complexity
ESTABLISHED PATIENT
| HISTORY | EXAM |
COMPLEXITY OF DECISION-MAKING |
||||||
| Code | Chief Complaint | HX of Present Illness | Review of Systems | Past Family/ Social HX | Exam (1997 DG) | Diagnoses | Data to be reviewed; # of Complaints | Risk Factors |
| 99201 | 1 | N/A | N/A | N/A | N/A | N/A | N/A | N/A |
| 99202 | 1 | 1-3 | N/A | N/A | 1-5 | 1 | 1 | Minimum |
| 99203 | 1 | 1-3 | 1 | 1 | 6-11 | 2 | 2 | Low |
| 99204 | 1 | 4+ | 2-9 | 2+ | 12+ | 3 | 3 | Moderate |
| 99205 | 1 | 4+ | 10+ | 2+ | All components | 4 | 4 | High |
Two (2) out of the 3 elements are required in the established patient note to consider reimbursement: History, Exam, Complexity
As you may deduce from the above established patient table, 99211’s are rarely used in chiropractic offices. Can you see why?
Additionally, give your current score an extra two points for management of care, i.e., reviewing old records and summarizing in the note stability/worsening of condition, or, two points for obtaining history from someone other than the patient. Add one point for diagnostics performed and reviewed, (i.e., x rays).
Finally, make sure to attached your -25 modifier on all E/M codes if you are giving a CMT on the same DOS.
Have a specific patient in mind and you’d like to find out if you coded and billed at the most appropriate and highest level? Contact me on how you can qualify for a complimentary audit! Call 920.334.4561 or email lisa@pmaworks.com
Sincerely in Chiropractic,
Lisa Barnett,
PM&A Coach and Consultant
Where Managing by Numbers and Progress Says It All.
My purpose is to be the Best Chiropractic Advocate in the World
*EHR systems may already have built-in features to automate the components for you via their macros/templates.References:
List of Components:
History of Present Illness – Elements:
Location (example: left leg); Quality (example: aching, burning, radiating pain); Severity (example: 90 on a scale of 1 to 100); Duration (example: started 3 days ago); Timing (example: constant or comes and goes); Context (example: lifted large object at work); Modifying factors (example: better when ice/heat is applied); and Associated signs and symptoms (example: numbness in toes)
Review of Systems:
Constitutional Symptoms (for example, fever, weight loss); Eyes; Ears, Nose, Mouth, Throat; Cardiovascular; Respiratory; Gastrointestinal; Genitourinary; Musculoskeletal; Integumentary (skin and/or breast); Neurological; Psychiatric; Endocrine; Hematologic/Lymphatic; and Allergic/Immunologic
Past Family/Social History:
Past history includes experiences with illnesses, surgeries, injuries, and treatments/medications. Family history includes a review of medical events, diseases, and conditions that may place the patient at risk. Social history includes an age-appropriate review of past and current lifestyle activities.
To download the article in it’s entirety click the here [LINK]
“Train people well enough so they can leave… treat them well enough so they don’t want to.”
-Sir Richard Branson business magnate, investor and philanthropist.
For a printable copy of this tent poster click: [LINK]
We know all too well how keeping abreast of all the changes in the insurance world can sometimes be overwhelming for your practice so we wanted to simply help you out by sharing some recent information regarding ICD-10 codes.
ChiroCode Institute recently published the changes to ICD-10 Codes that are going into effect October 1st. While there are thousands of code changes, we have listed below the codes most relevant to chiropractors. To download a printable copy of this list click here [ICD-10-Changes-Oct-2016]
ICD-10 Reference:
Gwilliam, Evan M, DC MBA BS CPC CCPC NCICS CPC-I CCCPC MCS-P CPMA, ChiroCode Institute
If you have any questions regarding these changes Petty, Michel and Associates would be glad to help guide you in the right direction. Please email to services@pmaworks.com or call us at 414-332-4511. We are here to help!