DC’s billing for Foot Levelers to DMERC

I just got off the phone with a chiropractor who said that Medicare (DMERC) requested back all of the monies that he and others had been paid for claims that they had submitted for foot levelers using HCPCS code L3020. Foot Levelers are custom-made inserts that are placed in your shoe to help improve your body’s balance, posture, and alignment. Many chiropractors offer them to patients and do the scans right in their office. They send the images out to Foot Levelers (the company) and the inserts are sent back to the chiropractor. They then provide the inserts to the patient. If the patient has medical insurance it can be billed. Medicare has been reimbursing for the services.

Now they are stating that the code, L3020 is not appropriate for what the patient is being supplied with (the inserts) and that a chiropractor cannot prescribe them. They state that they must be prescribed by an MD or DO.

So far we’ve only heard this from one dr, but he states that he’s aware of others that have also received similar requests. He is planning on fighting the decision and is currently researching it.

Anyone else come across this issue yet?

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Today’s thoughts

Technology is an amazing thing. In my youth my Great grandmother told me about her father’s memories of the Civil War. Civil war mind you. Transportation was by horse or foot. No telephones. In my 65 years the changes have been absolutely amazing. I remember how apprehensive I was of my first computer. Could I learn how to operate it? Now it’s how I spend my days.

I got a new smart phone recently – a droid. I found it difficult to learn to use it until I gave it to my granddaughter and asked her to show me. I thought I bought a phone, but it’s so much more than a phone. What it offers is truly amazing. It has road maps for travel and it goes to where you are on the map automatically. I can talk to it and it gives me answers. That’s more than I get from my husband sometimes. I can say “restaurants Rome NY” and it googles a list of restaurants. It contains so much storage space in such a tiny instrument. It has a flashlight, a calendar, a calculator, internet service, email service, a still and video camera, my shopping list, my Bible, games, Sudoku, and of course GPS. Once you learn what apps are you can add any apps you want. The amazing part of it is that I have only learned a small portion of what it is capable of.

As technology grows I have to wonder how long my aging mind will keep up with the progress. I wish it could do my housework for me.

Free Local Advertising

Google offers us a place for absolutely free advertising on the internet that is not yet recognized by most businesses and can be used by both doctor’s offices or billing services. Google has actually built websites for millions of businesses that we only have to claim at no charge. It is the Google local search.

If you pull up a browser window and type in to the Google search bar either “doctors in Rome, NY” or “medical billing service Rome, NY” you will get a list of either doctors or medical billing services in Rome NY. At the very top are paid ads with a light highlighted area around them. Directly below the paid ads are “Google Places for businesses near Rome, NY”. You need to be listed first here and it costs you nothing.

Once you claim your business on Google Places you can upload videos, add photos, list your hours and much more. You can leave all kinds of information for your patients or potential clients. Google makes it very easy to set up. Now that most people are using the internet to search for everything you can’t afford to not claim your listing and add lots of great information to attract business.

You will need to set up a Google account if you don’t already have one. Just type in the Google search bar “Google Places” and it will bring up the website where you will be asked to log in or sign up for an account. Once you put in your phone number, you can go through the easy list of information to add. You can edit later on if you want to add photos or videos at a later time. It’s a great way to find new patients or clients.

Providers Come and Go

Sometimes it is easy to get discouraged in this business by providers who choose to stop using your service. Recently we’ve been seeing posts on our forum about billing services losing clients due to EMR. It is sometimes difficult to not take these setbacks personally and get discouraged. But you really shouldn’t.

In this business there are always providers who come and go. Some providers will stay with you for many many years but some will leave for reasons you may find very foolish. Personally Alice and I firmly believe that everything happens for a reason and God is in control so we truly don’t let it bother us. Who wants to mess with God’s plan?

We believe that the providers that leave are meant to leave and they leave for a reason. That doesn’t mean it’s a bad thing or that we don’t wish them well. We’ve always tried to be extremely cooperative when a provider leaves whether they are going to do it in house, or switch to another service. We always do the best job possible and so it’s pretty easy to keep our heads held high. Occasionally we get a provider that leaves and makes it difficult to end on friendly terms. We just try not to lose sight of who we are, and keep our level of professionalism.

So if you recently have lost a provider, take a look at your systems and the service you provide. See if there was anything you could have done differently to make things better, and move forward.
Use it as an opportunity to improve yourself. Many times it has nothing to do with the job that you were doing so try not to take it personally.

HIPAA 5010 – What it is and How it Will Affect You

This is a basic breakdown of the HIPAA 5010. There are much more technical requirements, information and explanations.

Well, most of you should know what 5010 is and how it will affect you. If you don’t you must have at least heard about it. It seems that all insurance carrier publications are overflowing with confusing information on this transition and the quickly approaching deadline. So we are going to try to break it down for those who still don’t really understand what it is and if they need to do something.

First – what is it? HIPAA 5010 is a federal mandate that requires health plans, clearinghouses, and providers to use new standards in electronic transactions including claims, remittance, eligibility, and claims status requests and responses. HIPAA 5010 is an upgrade from the current mandate, or HIPAA 4010A. The new mandate is supposed to increase transaction uniformity and streamline reimbursement transactions.

The deadline for this new mandate is January 1, 2012. All affected organizations and providers should have long ago begun at the very least testing if they are not already compliant with the 5010 mandate or as Ingenix says “As the deadline approaches, affected health care organizations need to upgrade and test their claims management systems to accommodate 5010 and prevent operational disruptions.” This means that if your current software is not compliant with 5010 then you will need to upgrade. And before we reach the deadline you will need to have tested your system to make sure it is compliant. Not doing so before the deadline may result in “operational disruptions” or in terms the provider will understand, mess up the accounts receivable.

So how do you know if you need to do something to prepare for HIPAA 5010? Well, if you submit all claims on paper and you don’t receive any ERA’s then you don’t need to do anything. HIPAA 5010 is for electronic transactions only. That was pretty easy.

If you do submit claims electronically or do receive ERA’s then you need to see if your system is compliant. Most people submit claims thru a clearinghouse. If you use a clearinghouse then you need to check with your clearinghouse to make sure they are compliant or to see where they are in the testing phase. Most of the major clearinghouses are prepared. You should also make sure that the practice management system that you use to create your electronic batches is going to be compliant as well. Make sure there is nothing that you need to do on your end.

If you receive your ERA’s thru a clearinghouse, again you just need to make sure that they are compliant or are on track to be compliant. If you receive any ERA’s directly from the insurance carriers you should check with them to see if there is anything that you need to do on your end.
Some providers or billing services submit claims using their own software as a clearinghouse. If you are one of these people you will need to make sure your software is updated by checking with your vendor.
Chances are by now your vendor should have contacted you with information but if they haven’t you shouldn’t wait. Contact them ASAP. Ask if there is going to need to be an upgrade to your system. Ask if the upgrade has already passed testing. Do not wait until you find out you are not compliant. Call and ask.

Don’t be intimidated by all the confusing information that you are being bombarded with. If you receive something that you don’t understand and you are worried that it does affect you, call the sender and ask for an explanation. Check your current system and make sure you are ready.

Marketing Your Medical Billing Service

Just wanted to let everyone know what we are currently working on. Posts on our forum show us that new billers need the most help with marketing their medical billing services. Many established services also need help marketing. The biggest problem established services have is that many already have enough business for several years. Then something will happen that forces them to look for new accounts. Either a doctor will retire or an account will decide to move their billing in-house. No matter the cause of the change, billing services will find that things change including accounts. It’s easy to go along for several years with the accounts you have and find it works well. Then something unexpected happens and you need to find some new business and often you need to find it quickly.

We’re currently working on two marketing projects. The first is a 24 week marketing program where we will send marketing materials every week for 24 weeks. Every four weeks the billers enrolled in our program will receive a 10 page newsletter in the mail with lots of marketing ideas and tips. Other weeks we will be sending samples of sales materials that get attention. By the end of the 24 weeks members should have a great marketing plan working for them. We will be announcing this program in August.

The second marketing project is a new book on fresh new marketing techniques for this new economy. With money tight, we need to be using new tactics to attract accounts. We expect to have this new marketing book ready for purchase by September.

“Pricing Your Medical Billing Service” Now Available

We are excited to announce we have completed our 12th book on medical billing and it is now ready for you to download! “Pricing Your Medical Billing Service” explains to you the pros and cons of each of the four methods of charging your clients and steers you clear of illegal practices. It enlightens you of all the things to take into consideration when you quote a price for your billing services to a provider. We cover patient billing, calculating rates, tying it into your contract, separate fees, monthly fees, set up fees, minimum monthly charges and credentialing. And you can download this book immediately to your computer. This book is a real bargain at only $37.00 with a special limited time offer of a $10 discount on either of our next two books if you purchase by July 15.

Hidden on the last page of “Pricing Your Medical Billing Service” is a coupon code for a $10 discount on either “PT, OT & ST Billing Made Easy” or “Denials, Appeals and Adjustments”. We are currently working on these two books and will be releasing them in the next few weeks. Remember this coupon is only going to be available thru July 15, 2011. Get your copy now!

Billing for Autism

We recently had someone ask us to post about diagnoses that are hard to get services reimbursed for, specifically mental health diagnoses. It is not terribly common, at least not in our experience, but it does happen. Some insurance plans, such as self funded plans, actually spell out exactly what they will and will not cover, sometimes right down to the diagnosis. It seems like it should be discriminatory but it isn’t.

We actually billed for an individual counseling session, 90806, with a diagnosis of 314.01, Attention Deficit Disorder of Childhood with Hyperactivity. It was denied stating it was not a covered service. The plan was administered by our local Blue Cross Blue Shield. Not understanding why it wouldn’t be a covered service we called the customer service line to inquire why. We were advised that the cpt code 90806 was not a covered service under that plan with a diagnosis of 314.01. They explained that it was a self funded plan and that they specifically had outlined that ADHD was not a covered diagnosis for mental health treatment and that there were no appeal rights.

We have heard from others that this has happened to them with a diagnosis of Autism. We personally haven’t experienced that diagnosis being denied. Like I said, at first glance it seems discriminatory. There are all kinds of laws out there trying to make mental health services equal to medical services. Unfortunately most of these laws are enacted due to very horrible circumstances. For example, in New York State they enacted Timothy’s Law after the unfortunate suicide of a young man who was denied coverage for mental health services by his insurance carrier.

These laws don’t help with this situation because it isn’t that the mental health services are being denied, or even not as good as the medical coverage. It is only certain diagnoses that are not covered. Therefore, they are not denying mental health coverage to the patient. Also, we have found that there are no appeal rights since it is a plan exclusion. It is not that they are determining it on a case by case basis.

It is not only mental health that this is happening. We have also seen it happen to services billed by optometrists as well. It just seems that with mental health it is more discriminatory since mental health services have been fighting to be seen as medical for a long time. I wish I had better advice to give to people who have experienced this issue. Unfortunately this is an area where all hands seem to be tied.

If you have had any experience with this type of thing, we would love to hear from you.

Chiropractic Webinar

Michele and I have been asked to put on a Chiropractic Webinar July 7 at 4 PM EST entitled – “Electronic Billing & Reports, and What Could Go Wrong” for the ChiroCode Institute. If you are interested in watching this webinar, let me know and I get directions.