Evaluation and Management Coding for Chiropractic – part 2 – Medically Appropriate History and Examination
Even though history and examination no longer determine E/M code selection, they remain essential for complete and defensible chiropractic documentation. This article outlines what constitutes a “medically appropriate” history and exam in light of the 2021 E/M coding changes.
Evaluation and Management Coding for Chiropractic – part 1 – New vs. Established Patients
Understanding how to correctly code evaluation and management (E/M) services is essential for accurate billing and defensible documentation in a chiropractic setting. This article breaks down the difference between new and established patients, and how the 2021 E/M updates impact code selection.
What Every Chiropractic Physician Should Know About OIG Compliance
The Office of the Inspector General (OIG) plays a crucial role in preventing fraud, waste, and abuse in Medicare, Medicaid, and other HHS programs, overseeing approximately $2 trillion in government spending. Chiropractors can enhance compliance and minimize risk by following the OIG’s updated guidance, including implementing a comprehensive compliance plan and adhering to key regulatory standards.
Civil Monetary Penalties, OIG, and the Chiropractic Practice
The Office of Inspector General (OIG) has the authority to impose civil monetary penalties (CMP) for various forms of healthcare fraud and abuse, including submitting claims for medically unnecessary services or engaging in kickback schemes. CMPs can range from $10,000 to $100,000 per violation, and chiropractors are not exempt.
Exclusion Authority Requirements for Chiropractic Practices
The Office of Inspector General (OIG) has the authority to exclude individuals and entities from participating in Federal healthcare programs under Section 1128 of the Social Security Act, with exclusions often resulting from fraud, abuse, or other violations. Healthcare providers must regularly check the List of Excluded Individuals/Entities (LEIE) to avoid penalties, as employing or contracting with excluded individuals can lead to significant fines and repayment obligations.
Self-Referral Law for Chiropractic Physicians
The Physician Self-Referral Law (Stark Law) prohibits physicians from referring Medicare and Medicaid patients for designated health services to entities in which they or their immediate family members have a financial interest, covering services like radiology, physical therapy, and home health care. Violations can lead to severe penalties, including repayment of funds, monetary fines, and exclusion from federal health care program