Top 3 Compliance Mistakes That Can Cost You Big

Did you know that a whopping 25% of chiropractors face audits by Medicare every year? Non-compliance with coding and documentation rules can lead to denied claims, hefty fines, and even legal trouble. But fear not, fellow spinal adjusters! By understanding some common mistakes and utilizing valuable resources, you can ensure your practice thrives on the solid foundation of proper documentation.

In this blog post, we’ll be diving deep with Kathy Weidner, a renowned expert in chiropractic compliance coding, to explore the top 3 mistakes chiropractors make. We’ll also unveil how KMC University can be your knight in shining armor, helping you navigate the complexities of compliance and avoid a financial and legal nightmare.

Mistake #1: Medicare Mystery: Enrolling or Ignoring Part B?

Here’s a shocker: you cannot treat a Medicare Part B patient without being enrolled yourself. Many chiropractors mistakenly believe they can avoid enrolling by seeing only cash patients or using ABNs (Assignment of Benefits) for everything. But this is a recipe for disaster. An ABN is only valid for services no longer covered by Medicare, and guess what? Most chiropractic adjustments are covered under Part B! Failing to enroll simply means you can’t bill Medicare for your services, leaving you hanging for reimbursement.

Think of it this way: Imagine a patient with a valid Medicare card walks into your clinic. They need an adjustment for their chronic lower back pain – a service covered by Part B. If you’re not enrolled, you can’t submit a claim to Medicare. The patient might pay you upfront, but good luck collecting the remaining balance from Medicare. Now, multiply this scenario by dozens of patients each month, and you’ve got a serious financial headache brewing.

Mistake #2: Medicare Advantage Maze: In-Network or Out?

The world of Medicare can be confusing, especially with the rise of Medicare Advantage (Part C) plans. Some chiropractors believe they must participate in these plans to treat patients. Not true! These plans are offered by private insurance companies, and patients have the option to choose in-network or out-of-network providers.

Here’s the breakdown:

• In-Network: If you choose to participate in a specific Advantage plan, you agree to their terms and reimbursement rates. Patients with that plan will likely have lower out-of-pocket costs if they see you. But the flip side is the plan might dictate your treatment approach or limit the number of visits covered.
• Out-of-Network: You can choose to be out-of-network for all Advantage plans. Patients will likely have higher out-of-pocket costs to see you, but you have more control over your treatment decisions and fees.

The best option for you depends on your practice philosophy and patient base. Whichever path you choose, understand the rules and ensure you’re billing correctly.

Mistake #3: Code Quest: Google vs. Experts? Don’t Even Go There!

We’ve all been there – a complex coding question pops up, and Google beckons. But hold on, partner! Relying on unreliable internet searches or asking friends for advice can lead you down a dangerous path. Coding and documentation rules are intricate, and a seemingly minor mistake can snowball into denied claims and audits.

Think of it this way: Imagine confidently billing a specific code for a complex spinal adjustment based on a Google search. Months later, you receive an audit notice, and it turns out the code you used wasn’t appropriate for the service provided. Now you’re facing the hassle of justifying your billing, potentially having to repay received funds, and worst-case scenario, facing penalties. Yikes!

The Key to Compliance: Partnering with KMC University

Just like you wouldn’t perform a complicated spinal adjustment without proper training, tackling compliance shouldn’t be a solo mission. Here’s where KMC University, Kathy Weidner’s brainchild, comes in as your ultimate compliance companion.

KMC University offers a treasure trove of resources designed specifically for chiropractors:

• Comprehensive Online Courses: Dive deep into specific topics like Medicare billing or documentation best practices.
• Quick Answer Library: Stuck on a specific coding question? Get instant clarity with their library of expert-vetted answers.
• Template Toolbox: Streamline your documentation process with customizable templates for chiropractic notes, progress reports, and more.
• Training Videos: Learn at your own pace with informative video tutorials that explain complex topics in an easy-to-understand manner.
• Expert Consultations: Need one-on-one guidance? KMC University connects you with certified compliance specialists who can answer your specific questions and help you navigate complex situations.

Empower Your Practice, Safeguard Your Future

Now that you’re armed with knowledge about common compliance mistakes and the valuable resources available through KMC University, take action to safeguard your practice!

• Download KMC University’s Free Compliance Checklist: Identify any potential gaps in your current documentation and coding practices.
• Browse KMC University’s Course Catalog: Find a course that addresses your specific needs, whether it’s mastering Medicare billing or staying updated on the latest coding regulations.
• Schedule a Free Consultation with a KMC Specialist: Discuss your unique challenges and get personalized guidance on achieving compliance success.

Remember, prioritizing compliance isn’t just about avoiding penalties; it’s about protecting your practice’s financial stability and ensuring you can continue delivering exceptional chiropractic care to your patients with peace of mind.

Don’t wait until it’s too late. Take the first step towards a compliant and thriving chiropractic practice today!