A Consistent Strategy for Maximum Reimbursement – HJ Ross

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Ah, great. Thank you. Greetings everyone. This is Sam Collins, your coding and billing expert for chiropractic the HJ Ross company. And of course, ChiroSecure. If you’ve not seen me already, I’m glad to be back, but I’m glad to also be part of what’s going on for you to give you some strategies that are happening for this new year. So what’s going on? What are we changing? What do we need to do to make sure our offices do well? And that’s what I want to spend some time with you on what are we doing to make sure that happens on an individual basis in each office. So we’ve got to develop protocols that help us do that because there’s always some updates and changes in 2021 is no different. So if you think of it, what is the state of chiropractic? Where have we been?

Where are we going? So for those that know me, of course, you know, my dad was a chiropractor. I’m a chiropractor as well. And so I’ve been around this a long time, especially now, cause I’m 60, but I’m sure some of you are my age. Probably remember this. I remember as a kid, people coming to me and saying, you know, your father is not a doctor doctor. And of course I knew that was derogatory. But at the same token, I knew my father was a doctor. People called him doctor. He treated people. And of course that’s changed quite a bit over time. Think of the evolution of chiropractic, where we are and the place in society and in healthcare that we inhabit. And I’ll say that is nothing more evidenced by this. This was on the show jeopardy just about three weeks ago where it says this therapeutic process involving back end joint manipulation is partly from the Greek word hand.

The good news, everyone followed her that question and knew it real well. But then just a week ago, here was the question in 1895, D D Palmer was in an alignment for the first was, was in alignment as the first type of this medical professional. And in fact, everyone, again, knew that answer. That’s exciting to me to see where we are at in the profession, the acceptance. However, how do we make sure that we’re getting paid, not dealing with denials with this acceptance comes other responsibilities and changes. So one of the things that we deal with that they should, the Ross company, we do seminars. We have a service, we call the network. We help you to make sure you’re always updated. Unfortunately, if you, many of you rely on sources that aren’t always accurate, or maybe you have an old book thing. If you’re buying a book every year, you’ve got to buy a new one, we do a digital coding that you don’t have to buy a new book.

It automatically updates because coding matters how we get paid, how we document, what we do is based on the code. So what do we use codes for? Well, coding tracks, the incidence of disease. It gives accuracy to medical records. It gives insurance reimbursement. It indicates the severity and the problems the patient has. So we’ll have to understand that we have coding in two ways, ICD meaning the diagnosis codes, which are on their patient as well as CPT. The things we do at each of those determine the relevance of our services. And more importantly, probably just the cost or what we are paid. So let’s talk about diagnosis first, as you’re probably aware of diagnosis is aren’t stagnant. They do update. However, let’s focus in on what do insurances pay for insurances, such as Aetna under their chiropractic policy says the member must have a neuro musculoskeletal disorder.

So regardless that chiropractic can treat the human condition, insurance reimbursement is limited to neuromusculoskeletal for the most part, with all carriers. In fact, even Medicare stakes as such, except Medicare does indicate subluxation. Now subluxation may not be required with all carriers, but it’s inherent. Medicare is the one that says it must be part of the claim. However, Medicare says that shouldn’t be the only thing. It’s the primary. It says we must demonstrate significant health problems in neuromusculoskeletal condition. The statement of pain alone is insufficient. So understand pain is not a good diagnosis in the sense of really what’s going on with the patient it’s accurate, but is it really accurate of why the pain is there? Even Cigna in their chiropractic bulletin says this the services they’d get a diagnosis and treatment of a muscular skeleton related disorders that affect these on the nervous system in general health.

So notice it’s general health, but it’s still going back to neuromusculoskeletal even HIPAA gets in on this HIPAA says of course poor the, uh, the act of 96 requires a valid ICD identifier and all claim encounter form. So we have to have it if nothing else, just because that’s how it’s going to be declined. But more importantly, it describes what we’re doing and what’s going on. Well, here’s what I want to help you with these codes. Oh, there’s one more. I forgot one more just blue cross blue shield association. And you notice for this one, it says the diagnosis codes, the diagnosis codes update annually in October, and it requires a seventh character update to diagnosis for every new episode as well. Here’s what I want to point out. You do have to be sure. Do I have an accurate diagnosis as well? Because they do update so every year as I’m sure you’re all aware when ICD 10 hit the diagnosis is update every October 1st, they did an ICD nine, but didn’t make as much difference there.

So every year we, that updates in 2016, we had about 2000 updates the next year three 60. And you might think, Oh my God, how many updates? Well, just like with ICD 10 changes, it is not something that you have to be concerned with in this sense, in this sense, what I want you to be mindful is does it affect the codes that I am billing? That’s really the bigger issue is when these changes happen, it’s a lot, but does it affect what I’m billing will each year, 2019, there were changes in every year. There’s a change, but I don’t want you to panic it away so long as you have a resource for the information. And that’s what we try to do with Kyra secure with our network services to make sure you’re always updated well this year, no difference. And you may or may not be aware of what has occurred already, but the changes occurred October 1st.

Well, what are these changes? Well, we have to be careful of is don’t rely on lists that you’re all used to. And that’s where I think we often fail ourselves. We do not indicate our changes because we’re using the same lists we have often for years. And so by example, right, reliance on a list like this is probably going to kit some problems. If it’s a code that you use regularly. So by example, you might have a list like this and you’re looking okay, common chiropractic let’s by the way, this was put out by the company Evercore and it’s for their company, the oral care claims as well as for claims related to United health care as well.

So bottom line is this. We have to make sure it’s updated. So here’s something I will point out on this particular claim on this claim. You’ll notice the first code or not claim or list. You’ll notice our 51, our 51 of course is the old code for headache. Cause that changed this year. And this is what I want you to be aware of. Are you using the correct codes? Well, as I said, the code updated October 1st, so our 51 was deleted and they added two new codes. So now think of it. If you buy a new book, did you get that book in October? You didn’t, you won’t get it till January. So you’re already behind the eight ball here. So here’s the new codes. We have our 51 zero and our 51 nine. So I want to make sure you can see what are the new codes.

So when you’re billing for a claim where the services were on or after October 1st, you have to use this new code. Well, that’s one of the things we do with our, uh, diet, uh, digital coding for chiropractic on HD Ross. We do a manual, but we don’t print a book anymore. You know where we don’t print a book books, they’ll get stale books out date, our online, when this updates, it automatically updates. So when you go there, if you were to type in the code, it will tell you it’s deleted. Or if you were to search the data will tell you what data changed. So let’s talk about these two new codes, an orthostatic headache ordinance specified headache. So orthostatic headache, what does that mean? You might think, Hmm. Now orthostatic headache is a condition which a person develops a headache while vertical, but it relieves when they’re horizontal.

So there’s clearly a vascular response, but the headache code that we’re probably gonna use most likely is this one R 51 nine, that says unspecified. So now what does unspecified mean? It means it’s a headache code for that for a code or it’s a headache code for headaches that don’t have a code Fort specifically, by example, there’s already a code for migraines. Therefore, this doesn’t change migraines. This is for something other than migraine or tension, headache, or Metro headache, those types. And so what are the synonyms for this? And this is what I want you to understand. This headache code is very broad because it includes all of these synonyms notice, cervical genic, headache, facial pain, okay. Sinus pain. So it’s all painted in the head, not necessarily traditional where you think, Oh, headache, temples. So bear in mind if you have a headache like migraine, migraine, but if it’s not a migraine or attention or one that’s named use the unspecified, which is now our 51 nine.

So please update your list. Cause I know that’s a code you use commonly. What were some other updates I wanted to make you aware of where I’m still finding problems. This actually updated a year ago, but there’s new codes for my algebra. Now my algebra is a pretty significant code. Has a greater value diagnostic related value then does say cervicalgia or back pain because it’s specific. So you’ll see now that there’s some new codes, it used to be M 79 one. Now you’ll notice it’s M 79, 10, 11, 12, and 18. And you may think, okay, well what do these mean? Well, the 12 and 18, the 12 is pretty obvious myalgia of the neck and head. Okay. That’s simple enough. But what if it’s about the neck and head? Well, there’s another code for muscles of mastication or TMJ. So that’s good. But then what about this?

The code that says other site, and this is where people get confused. Other site means a place you can name, but is not otherwise diagnosed here. It’s something outside the jaw or the neck. So that could mean myalgia, the lumbar spine, myalgia of the shoulders, myalgia of the hips. It’s myalgia where you can name it. What I want you to be careful of is don’t use M 79, 10. That code is actually not on any payers list, include Medicare and others. The reason why is when you say myalgia unspecified, it means there’s muscle pain. And I don’t know where, so I want you to be careful that to not use that code because you should be able to tell me, where is it? Is it in the neck? It is in the jaw or where else is it so long as you can tell me where it is?

It’s N 79 18. Well, another area I run into problems and I deal a lot with people because we have a service called a network. Or once as a member, you can call me, email me, fax me with questions, coding, billing, documentation, you name it. We help with everything. And one of the issues that come up is, Hey Sam, I got a denial for my disc code. Well, this codes for the cervical spine made updates and now the cervical disc codes have a code for each level. So before you just start coding cervical disc, tell me what this is. It see two to four. Is it four or five? Five, six, six, seven, or even C 71 because there’s specific codes for each. So please make sure the list that you have do you have all those variations? Because if you use the wrong code, it’s going to get denied.

And there were old codes for it that just don’t exist anymore. And here’s one more tip that comes up. This one’s happened me quite a bit over the last few weeks where offices are getting denied because they say your coding doesn’t match the coding protocols. And they question w what do they mean by protocol Sam? Well, here’s the protocols. Some codes have what we called an exclude and an exclude that the type one is a code that you cannot code together. And so I’m going to give you a simple thing to always remember, whenever you see neck pain, low back pain or upper back pain. In other words, back pain codes, you should never code those with this. You will notice it’s a good exclude notice. M 54 two indicates cervicalgia due to inadvertent people, intervertebral disc. So any type of M 54 code of any type, don’t use it with a disc code.

In other words, I think it’s simply this way. If someone has a disc, that’s an issue, frankly, you don’t have to tell them it’s painful. That’s kind of inherent. So the big issue is if you’re coding disc leaf pain alone. Now let’s say you’re suspicious. It’s a disc, but you’re not sure yet. Cause you didn’t do a scan or an x-ray. Then you would cocaine. And then once you discover the disc coding, you understand that’s exclusion. So not only do you have to be aware of as codes update, you need to be aware of what about the exclusions. And often that’s part of the problem because that’s something most of us never made a big issue of. So do be mindful for diagnosis to make that happen. Well, what can happen here when you even use a correct code? So people will call me and say, Hey, Sam, I build the right code, but they’re still denying me.

What has happened often when you have the correct code, you know why they’re still denying it. It’s not medically necessary. Now, what is medically necessary? Mean lots of issues. Are you coding? All the things that are there that would make it necessary. By example, if you told someone that neck pain, would that be sufficient for an eight week course of care? I would say inherently not there’s not enough severity that goes along with that. So no severity, no changes there. So be mindful that again, just simple codes often will be a problem for severity. So medical necessity. And then also this though, what about the flip flare-ups or exacerbations cause severe problems or chronic problems will be a little bit more, but how do we inform the insurance of that? Well, that’s how we change the dates in block 14, update our notes. In addition though, think of what phase of care are you in?

These are the common areas that we run into problems with that I help offices with deal with that we can work one-on-one because each has their own unique thing. There’s no one simple letter or one simple protocol, but it’s unique to the condition of your patient. So even though you may have built the right code, there still may be issues because do you have the right information? So I want you to think of doing this when it comes to diagnosis. This is for tips from Sam, for you to do number one, make sure your diagnosis is to the highest level of specificity. And all that refers to is that sometimes the code can be as little as three characters, sometimes as many as seven. And if you’re missing a digit, it kicks back. So if you use our 51 right now, it’s coming out because it has to be our 51 nine or let’s say it’s a sprain strain code.

It has to have an a D or S on the end. And of course what’s the difference of those. That’s maybe something you’re not familiar with and how to use it. I would suggest get more information there. In addition, diagnosis should be reasonable and accurate for the condition. In fact, I’m going to emphasize this. Look at the last sentence here. My algebra for instance, has a higher value in Medicare then does algebra meaning cervicalgia. In other words, if you tell me the neck hurts, that’s fine, but why does it hurt? If you told me it hurts because of a disc? Well, you don’t have to tell me it hurts. That’s much more severe. So always think of given the reason for pain. If you’re coding pain alone, that means you don’t know why. And if there’s any complicating factors, if there’s comorbidities, think of it, this period right now, we’re all dealing with COVID.

How much have we noticed people with pre-existing and underlying conditions have many more problems so-called coma? Well, that happens in chiropractic. Also patient variable, weight, patient diabetic. Do they respond differently? If they’re older arthritis, scoliosis, curvature changes. Think of all those things I just mentioned. There’s a co-author of one of those. If someone has a reverse osmosis, there’s a code for that. You know how you would find that if even if you’re not a network member with me, go to our digital coding and type in kyphosis and it’ll bring all those up. So you can figure out where do I need to use it in Heil. And then also remember that medical necessity is based on diagnosis. What does the insurance company know about the patient? What you tell them? So your diagnosis is invariably important because that diagnosis is going to indicate the length and amount of care you can give the patient.

And that’s where I deal with a lot of denials. Some they’ll send me a Sam, they’re denying my claim and you have cervicalgia. But yet when we talk about it, there’s my LJ. There’s radicular, apathy, cervical brachial syndrome, all these conditions that often aren’t put into the claim form, but are part of the notes. So here’s going to be the strategy I’m looking for. You can have staff member keep up with all these changes in needs. I mean, think about that. You’re the doctor. You’re trying to treat patients. You’re doing some seminars. You’re doing zoom seminars. Now you’ve got a list you had from someone, but that list is now old. Who’s going to keep up every October 1st to look at those codes. I’m not so sure that’s efficient. So what are you going to do? Well, what are the resources that you need? Do I need to buy more books?

Do I need to join some sort of coding group group? Now what I would say just is don’t buy a book, see that big book. How do you find anything? Allow me to be your helper. I will say like this, like Jerry Maguire, help me help you. I am the coding and billing expert. I’ve done continuing education seminars. Now for 20 years, I’m on the United healthcare Optum health coding and reimbursement committee. I sit on the who, ICD 11 committee. In addition, I’m certified in most States to do audits for chiropractic offices, that deal with issues. So become part of our service, which means I become part of your office. You can hire me to be part of your office. We have something called the network. And what I’m going to say to you is give yourself some time to hire another staff person for literally a little over a dollar a day.

I think that’s well worth it. In fact, we’re going to offer you that for 30 days for you, we offer three levels of services to our network. We offer one where it’s just the call in. You can reach me, email me whatever way you want. In addition, we have one that includes seminars, as well as our digital coding and our digital coding works really well. If you’re not sure of the diagnosis, there’s literary a picture of the body. So if you’re not sure, click on the head, it brings up all the codes in the head, but you can also do a search for a keyword. What I’m going to suggest. Give me a try. Let me have a chance to show you what we can do for you, because we want to make sure your practices enhance pyro secure and myself for that matter has a very vested interest in your success.

It’s why ChiroSecure does programs like this to help their insureds, to understand what’s out there. What’s going on. What’s changing. Make your practice Bible. Cause think of it. If you’re not practicing, there is no PowerSecure. If you’re not practicing, there is no continued education or need for what I do. So what I’m going to do is help make you money. If you join this, there’s a free 30 day trial. Take a look at the website. You’ll just go into our network. Plus slash the network. Plus 30 day trial. I’d give two links here. If you need to. You’re welcome to call us to get that as well. It’s 805 six, two 33 35. And what I will guarantee you is this. After one call, you’ll find will make you money because when you call us there’s problems, but realize those problems are always attached to claims and reimbursement.

And we want to assure that you’re doing it right. Chiropractic care works really well and you know what you’re doing there, but do you have an expert on your side to do the billing allow which day Ross to be that expert in myself and I’ll guarantee. We’ll give you some help. I’m going to say thanks for the time. Remember my tips, the new codes, the changes. Remember there’s updates for 2021 coming for ENM codes. So lots of things changing and going, but all that are positive. We want to be here to help you. And I want to say, thanks everyone for spending a few minutes with me. I’ll look forward to seeing you next time. This is Sam Collins. Check it out.

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