Blog, Live Events May 2, 2021

Being 2021 Cures Act Compliant – HJRoss

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Hi everyone. This is Sam Collins, your coding and billing expert for chiropractic and the HJ Ross company. Giving you another episode with Congress secure and thank you Congress, secure on making sure we can give you information to keep you up to date on what’s changing. What’s new and what we need you to continue getting reimbursed. In fact, I’m going to pour many of you, who do you go to? Where do you get your information? Here’s where I’m always nervous. The internet is a good source, but is it always accurate? Is it always going to give you the right information? HJ Ross ChiroSecure. We’re here to make sure you get the right information. And thank you for having this show and giving this information. You may want to think about it at the end of today. Do you want to bring someone else in to help you with that?

So with that, let’s move to the slides. Let’s talk about what’s going on with the 20, 21 cures app. So in the slides here, you’ll see as the 2021 cures act, I want to talk about, and I want to be careful. I’m saying cures act, not the cares act. The cares act was the whole thing was getting additional money through Medicare. And I also want to talk about physical medicine modifiers, cause I’m getting a lot of providers who are having issues going Sam, I’m not getting paid. They’re telling I’m missing a modifier and Nita modifier. So I want to kind of cover. What’s been going on there as well. But a lot of people are always concerned about updates and changes. And this is where I mentioned to be careful when it comes to the internet or to some resources in general, I’m always going to say we have to be compliant.

Of course, we’ve got to do things properly within the guise of laws are state laws, national rules, but be careful of being a victim of fear-mongering. I teach continuing education seminars across the U S if you’ve never been to one, I welcome you to one, but that being said, I’ve been to programs myself. And when you get there, do you ever notice, sometimes they’re always just trying to scare you. If you don’t do this, you’re going to wear an orange jumpsuit and go to jail. I don’t like that connotation. Obviously, if you cheat and commit fraud, that’s one thing, but using an improper code is not fraud. That just means shucks. You’re not going to get paid. So be careful. Yes, we do have to understand the compliance of everything and make sure we understand it. Well, however, let’s be careful for instance, let’s take a look back who remembers HIPAA and I shouldn’t say remembers.

We have no, of course HIPAA is very important. There’s protocols that we have to follow that include things like patient privacy is what’s our policies and procedures. Are there any risks for patients coming in, but let’s be clear at the end of the day, what is HIPAA privacy of patient information now, does that require you need a 10,000 page manual and spend thousands and thousands of dollars? Not really. It’s a matter of having the right things in place to make sure that a patient’s records are protected. Well, this brings up, of course, a lot of us in a lot of you are using electronic health record systems, which by all means, I recommend to me using paper records is kind of akin to going to a bank and writing yourself a check for cash instead of an ATM. However, there’s some things we have to do to make sure it’s compliant.

By example, if you’re using electronic health records, how do you assure that the patient’s records are private? Well, for the most part, you have a system that doesn’t allow anyone to go into your system. They can’t log into your computer, don’t know your password, firewall protected all of those factors. So again, does it require a lot? Yes and no. So be careful of this that you have to always do more. Here’s why I’m bringing this up. HIPAA and electronic health records has meant that people and persons or patients should get more access to your records. And that’s what the 21st century cures act is about. It’s not new, it’s just being implemented now more aggressively or more in a way that’s giving patients more access. What this act specifies to be clear is that it’s that clinical notes in an electronic format must be made available in that format free of charge.

So if you have electronic health records, you do have to make sure now that there’s some type of portal where a patient can access their records at no charge, which I kind of like, if you think about it, that means as a consumer, what I go to my doctor, if I’m going to a doctor I’ve never been, how easy would it be for me to access records from my prior doctor so that they can see it. That’s better care for me. I like that. Now there’s no charge to patients because it shouldn’t cost you anything. So the requirement here, it’s a different from HIPAA because it includes not just patient data access, but in some cases it ends with a copy of records. So a regular HIPPA would be, Oh, give me a copy of my records. You got up to 14 days to do it.

Whereas now the patient gets essentially immediate access kind of open notes. Now think of it from a pure consumer standpoint. I think it’s pretty cool. I like it. I like the ability to do this. In fact, my wife just recently went into the doctor and I loved how she could go in and see her entire record. Pretty good. That way you can see everything they’re writing. And a lot of people have complained. Well, they won’t understand my notes. Well, they found out that 90% of people can understand your notes. The whole point is just giving access. So keep in mind now that you have, or if you have an electronic health record system, you need to check with who is ever doing your record, keeping, meaning the company that you’re using, how did they create access to it? And I’ll say that Cairo touch, at least from what the people I’ve talked to has created an update to it, and just make sure that you have the update that patients now get access.

You have to obviously have something where the patient understands. They have to exert privacy as well. Don’t share their password with anyone, that type of thing, but allows them to get access. So what do they get access to? Well, their chart notes. And so what they’ve come up with is there’s eight core types of notes they get access to, which is pretty much anything in the file. Consultation notes, if you will obviously discharge summary notes, which again, we probably don’t use, but of course, history and physical imaging narratives. Now not the images themselves necessarily, but at least the reports that go with it. Any laboratory reports, pathology reports, if any, and of course your day to day procedure notes. And of course this means your progress notes. So this gives you all the types of things that are going to be in the record. What I want you to note here, this is not including payment records and all that.

This is so chart notes, your clinical record. So the key factor here is making sure that patients have access to it. So again, make sure if you’re using electronic health records that you’re providing that there are exemptions. However, so there are certain exemptions and you want to be aware of there’s things that there are times that you may not want to make a patient have access to it for certain reasons. Part of that could be psychotherapy notes. Those aren’t going to be accessible because there could be other issues. There are things that are written. Remember a person that has AIDS has exemptions from who you send to, but not for them to get action. And of course, if there’s any civil criminal or administrative action, meaning a hearing that could prohibit some use. So there are some exceptions here. I also want to bring up, you know, that we have to do, but let’s make sure what does it require?

And that’s why I wanted to talk to you about it today because it doesn’t appear that we’re getting enough information or correct information. Well, this requirement began April 5th. So April 5th, you please make sure that that access. Now remember that means if a patient’s requesting access, figure out a way to get it to them. If your system’s not doing that, talk to your system provider, because they’ve got to do this. This is part of making a compliant health record system that is electronic bear in mind by third party, there’s going to be an app that they should be able to use by October of next year, not this year. So October of next year, that kind of makes sense how cool it be. You can go to an app and all your records are there. Here would be my takeaway on this though. I like it.

I really do. Why don’t insurance companies have to do the same thing. Shouldn’t they have an app or access where a patient should be able to log in and see exactly what their benefits are. I’ve been talking to state and national associations about bringing some legislation to that, because I think if we’re going to give people actual access, they should have access to, to what their benefits. So patients don’t have to guess of what is or isn’t being covered, how much it’s going to cost. There should be complete transparency of that. So again, there can be exemptions to it, as I mentioned, psychotherapy and otherwise, but again, by April 5th, well here’s where the exemptions line preventing harm. If there’s some, then do you think that might be harmful to the patient? If they access it, don’t be afraid to not allow access, just make sure you document why sort of the patient makes it an issue.

You can give that issue. There could be an extra security exemption. If you feel someone’s trying to exchange it in a way that just doesn’t meet what you think it is. So again, you could always kind of limit access there. It could be just completely feasible if you can fulfill the request in some way. So right now, some of you may have an electronic health record system. Maybe right now it’s in feasible because the system’s not up to date. Is that going to be up to you? Not necessarily at this point, but at some point you have to make sure that if a feasibility does go away, how about there’s an exception, you know, for it that there’s reasonable necessary measures because of it that it’s unavailable. You know, the system goes down. I mean, things of that nature, they’re going to be exempt. They can’t say, Hey, your system went down for a day.

Well, I’m sorry that day I could not give access or a content blocking it to allow someone to get content, to exchange information, to fill that access. And what they’re referring to is there could be times where not probably in a Cairo setting, but in a medical setting, some of that data is used for other issues that we don’t want someone to have access to. At least at that point in time, there could also be because of fees or additional costs that profit margin could be there. What if you’re saying, in order for me to do this, maybe it costs me an extra $10,000. Well, that would certainly be in feasible as well. I don’t think that may be the case for us, but it could be. And then a licensing exemption, which means your licensed interoperability, you’re thinking, well, what do we mean by licensing?

Well, again, more information on the it side, whether or not we’ve created a license for them to access it. I’m going to point out for chiropractic offices. This is pretty much not going to be the case here. What I’m going to suggest is if you have electronic health records, you do indeed make to make sure whomever you’re using to verify with them how they have complied with this. Now, my concern is for us, is there going to be additional cost here? I think so. Because like anything, if someone’s doing something extra, are they going to probably say, Hey, there’s an added cost to it. Maybe, hopefully it’s kind of included in your already ongoing fees, but do make sure they’ve applied it now. Here’s the thing though. And this is where I think people are confused. If you are using paper records, you could take a nap.

And what I mean by that is it simply doesn’t apply to you. This is for electronic records. If you’re using paper records, it has little to no impact on you. Even if you’re doing paper records, you know, you’re scanning it to a PDF. Those are electronic sort of, but there’s still paper. They still have to be printed, kind of like microfilm. So bear in mind what I’m talking about as an office using full on treatment notes that are electronic, that the patient gets access to. If it’s the type where it’s scanned, that’s not really electronic, that’s still a paper record. So I went through all that. For many of you, almost Sam, I’m not using electronic records. It doesn’t apply to you for those that are doing electronic records. It does though. So do keep in mind, get with your system, see how they’re making this work, see where there’s an app.

Here’s the beauty of this with that type of access. Do you think with an app, could they make our access as providers that much easier as well? Anything that’s going to be done to allow us to get easier access, to given a patient records and make updates, I think is going to be a positive. And I think this is just going to allow things to get better and better. Imagine at the point where you start maybe taking notes on a phone, could you not dictate maybe a little bit faster than you could type? And then later you might edit a few things. Think of the simplicity of that. Instead of having to do it, a lot of cut and paste, you just narrate as you go. I kind of like it. So the cures act does apply if you are doing electronic health records, giving patient access.

But if you’re doing paper records, be careful and remember like me, I’m a 60 year old guy. Many of us don’t have electronic health record, not saying all. So an older practice that is thinking, Hey, I’m going to retire in a few years. My suggestion is maybe you just stick with paper records so that you don’t have all these extra things that you might have to do, which shouldn’t be too hard because they’re built in, but don’t feel forced. You are not required to do electronic health records. You may absolutely continue to do paper records as you always had. And just because you take some records on computer, doesn’t make an electronic health record. I’m talking about a true electronic health record EHR system that matches all those protocols. All right, well, let’s the other topic for today? Physical medicine and rehabilitation codes, which of course are the codes nine seven zero one zero through nine seven, seven, nine, nine.

All the PT codes. I like to say PT codes though. Technically they’re not, you know what? I don’t like to say PT codes, cause they’re not physical therapy codes. They are physical medicine codes and they can be done by a doctor of chiropractic they’re within your scope and they can not be eliminated. And this is why I don’t like the term physical therapy. Cause that sounds like a physical therapist is doing. It’s why they’re called physical medicine codes. Well, what’s going on? Well, there’s a modifier for these. It’s not used by all carers. And that’s what I want to clarify. I’ve had a number of people contact me and say, Hey, Sam, I’ve had issues with United healthcare and any affiliate of United health care, by the way, that includes United healthcare, Optum and UMR. If you’re billing any of those companies, you have to bill modifier GP on the therapy code, or it won’t be paid.

In fact, what the denial will state is that there’s a missing or incomplete modifier. And the frustration is when you call them and say, Hey, what are you talking about? What’s the missing modifier? You know what they’ll say? Oh, we can’t tell you, goodness. This is why I do the services I do for continued education or a network. We’re here to make sure you know that now for some of you, what I’m going to recommend go to the HJ Ross company website, HJ Ross, put your email in, or at least checked our new section because all of this information, including what I’m doing for the cures act, we’ve updated as soon as it came out. Well, who requires this GP modifier, as I mentioned, United healthcare and all their friends affiliates, who else does veterans. Okay. And I’m sure some of you have noticed the veterans care though on the West coast is tri West East coast.

And when I say East coast, that means North and East of Texas. You have to use Optum. But to any of those, you have to bill with a GP also on any therapy code. And remember that GP goes in addition to any other modifier, you maintenance. So if you need to put a 59 or an excess, like on massage or manual therapy, you would also include the GP with it. It can go GP 59 or 59 GP order doesn’t matter. So the GP is required for United healthcare, veterans, Medicare, but hold on, you go on, see him. Medicare doesn’t cover therapies. I know. So remember you put the GYN modifier for Medicare cause it’s excluded. But in order to get a denial for a secondary to pay, you will not get patient responsibility unless you put a GP. So do make sure. In addition to Medicare, putting a guy on a therapy, you also put a GP.

If it is a physical medicine code. Well here’s some other places that it’s required. And this is where I wanted to bring it up because this has been some talk. If you’re in Michigan or what, if you have a patient that has a blue cross blue shield of Michigan, even though you’re in Tennessee or Florida or someplace else, whatever you build a blue cross blue shield of Michigan, they too require the GP modifier. And this is the new one. Beginning, April 1st blue cross of California will also require it. Now I want to be clear for anyone that’s California. I didn’t say blue shield. I said blue cross. You remember in California? They’re separate. So the frustration here is that in many ways, I would say, why don’t we just make it, do it or don’t do it. So be careful if you’re billing, Aetna or Cigna, you don’t put the GP, but if you’re billing United VA Medicare blue, cross blue shield of Michigan blue cross of California, you do include it.

So it becomes nuanced a bit. Now some people ask me, Hey Sam, well, can I just put a GP? I don’t recommend that because if you put a modifier on any code, you’re telling them something unique. So if you put a GP when you don’t need it, what I’ve noticed is some payers will come back and say, we’re not paying the code because there’s an invalid modifier. They don’t use it. So it’d be very conscientious of making sure you have the correct modifiers for the claim and for physical medicine for these payers. It’s an absolute requirement. And again, a lot of that starting now over time, may other payers step up and change? Maybe if they do check with me, go to our new section because I want to make sure you’re getting paid. I’ve had so many offices in the last few days, contact me saying, what’s going on?

Why am I getting denied? Well, that’s why I wanted to bring it to you today to make sure you were up to date. Here’s what I’m going to recommend. Give me a chance to help you. I do these once a month with you on what’s updating, but go to the Take a look. We do seminars. We do a program and I’m going to recommend try this, just take your phone and scan it. You can go in now and go directly to our website. We offer a service called the network. Have you ever had an expert on staff? That’s part of your team while you can, for a very low price, let’s take a look there. Make me part of your team that you can get ahold of me every day because realize all these questions I just answered for you. Now imagine how many more that you have. My goal is even though there’s a cost to join, you’ll make it back within one or two calls. We’re always here to help. I’m going to say thank you everyone for spending some time with me. Don’t forget. Go to our website, Take a look there at our network services and other things we offer. We’re always here to help. Thank you, ChiroSecure. I’ll see you all next time. Thank you very much.