Shared to us .. www.peick-usa.com A POTPOURRI OF NEW YEAR LEGAL RESOLUTIONS Peick & Associates, P.S. Healthcare Provider E-Letter December 2000 What's In This Newsletter Getting your Estate Planning House in Order Surviving an Audit Questions about Mobile Labs Corporate Housecleaning Problems with Personal Injury A/R Supporting the WSCA 1. I WILL GET MY HOUSE IN ORDER. What happens to your practice, and your family well-being, if you step in front of a Metro bus tomorrow and the bus wins. Worse, what happens if you are disabled by injury or illness and can no longer practice? Do you have a succession plan? Is there another doctor you trust that will cover your practice for the time necessary to find another buyer? Does your spouse know enough about the practice to find all the requisite documents in order to properly value the practice? Have you spoken to a practice broker about what may need to be done in the event of a serious illness or death? (Dr. Jeff Dieter or Dr. Jack Flynn are both excellent choices in the latter regard) Have you acquired life insurance to tide your family over and cover debts? Have you secured a disability policy? Do you have a will that adequately covers your desires in the event of your death? If you have been successful, have you done the requisite tax planning in the event of death? Death and disability are not comfortable topics, but unfortunately, we all face it sooner or later. We may not be able to escape death, but we can mitigate its impact on our families. For more information, contact one of my colleagues, Steve Waltar, J.D., Bellevue, Washington, 425-455-9787 or email waltar@nwlink.com. 2. I WILL SURVIVE ANY AUDIT A. Utilization Management. With the Patient Bill of Rights (Sec. 8) carriers are now required to provide chiropractic doctors with their documentation and standards for UM upon request. Write to every carrier with whom you deal and request their UM. Make sure that you (1) comply with the UM standards, or (2) extensively document your patient file to support treatment. The key to successfully appealing UM decisions is to have ample documentation of patient subjective and objective conditions with a clear treatment plan. B. Keep good records. The author's experience is that most carriers, Medicare and L&I audits invariably focus on inadequate documentation and big numbers are often sought in reimbursement because record- keeping was poor, illegible, incomprehensible or simply non-existent. When questioned after the fact regarding symptoms, objective conditions, treatment and patient outcomes, it is common in the author's experience that providers do not remember and cannot reliably interpret their notes or their notes are inadequate. Read your provider contracts and manuals re the requirements of carriers and government payers regarding documentation. Medicare Tip: DCs went through a period where Medicare/Aetna was requiring certain information be placed on the HCFA 1500 form. Some doctors did so but did not put the same information into their chart notes. You cannot go back and retroactively add information, but you can keep copies of the HCFA billings in your patient file as additional documentation for an audit. If you use modifiers, you must document the need for the additional time component or complexity of evaluation. C. Pay Attention to CPT/CMT Definitions. The four CMT codes in CPT for chiropractic doctors allows upcoding when additional "regions" are adjusted, but it is not based on the number of adjustments. Accordingly, three adjustments in the cervical region does not qualify for coding as 98941 because that code requires three to four "regions." Double-check to make sure your front office or billing staff understand the requirements, and review any forms you use for billing to insure compliance. If you have coding concerns, contact the WSCA for a referral to a competent coding consultant. D. Pay Attention to Credentialing Requirements. Most carriers require licensed personnel to be separately credentialed before they will pay billings. Just because they do pay for non-credentialled personnel should not be considered an endorsement. They can return during an audit and ask for all those fees to be reimbursed. Carefully read the credentialing requirements of carrier re licensed personnel. Get any "group" credentialing understandings reduced to writing. 3. I WILL AVOID QUESTIONABLE ALLIANCES. Paying third parties for referrals of patients is verboten. Being paid for such referrals is also illegal, and both state and federal laws make alliances with mobile diagnostic labs or similar ventures somewhat hazardous if the doctor is simply routing patients through the lab in exchange for a kickback. The substance of the alliance is more important than the form utilized. Be wary of such alliances, and have your attorney review any proposals. 4. I WILL COMPLETE ANY CORPORATE HOUSECLEANING. If you are organized as a corporation, then you need to have at least one shareholder's meeting per year, and at least one Board of Directors meeting. If you are a licensed healthcare professional, your corporation needs to be organized as a "professional services corporation." Make sure your minute book is up to date. If you need assistance, contact Peick & Associates, P.S. 425-462-0660, email jpeick@peick-usa.com. 5. I WILL UPDATE MY PERSONAL INJURY I ACCOUNTS RECEIVABLES. Providers who are paid by L&I or other PPO styled payers often retain the original billing charge on their books, and seek to collect the "excess" billing when a personal injury case is settled or resolved. While it is commonplace to be reimbursed by attorneys, it is still illegal under L&I regulations for this excess to be paid from the worker's recovery. Most PPO contracts prohibit providers from charging or collecting more from the patient whom is being paid or allowed by their PPO. Collecting the excess from the PI recovery violates your PPO contract. Reduce your risk of inadvertently violating the law or your contracts by deleting excess charges arising from discounts, etc., from your PI accounts receivables. 6. I WILL SUPPORT THE WSCA. The WSCA is working for you and your practice. Get involved in its committees. Support its programs. Be aware of what is happening in your profession. Make 2001 a year to remember! PEICK & ASSOCIATES, P.S. practices law in the State of Washington in the areas of personal injury and wrongful death, and assists healthcare providers in business consulting, fraud/abuse defense, disciplinary proceedings and other healthcare law issues. We serve as Legal Counsel to the Washington State Chiropractic Association. Our offices are located at 2000- 112th Avenue NE, Bellevue, Washington 98004; 425-462-0660. Visit our website at www.peick-usa.com.