As chiropractors, most of the problems you see today arise from lack of compliance with federal and state law.

Some problems are also from government and insurance payer requirements for billing, coding, and documentation.

For example:When a doctor fails to use proper codes or attach the correct modifier, the payer often denies payment. Medicare and insurance payers often initiate a post-payment review when they believe the chiropractor is failing to abide by their guidelines.

This review consists of a request for the chiropractor’s records and a subsequent review of the documentation. If the payer determines the chiropractor has submitted claims not supported by documentation or if the payer believes the wrong codes are used, the payer can deny payment and then seek to recoup the amounts previously paid to the chiropractor.

Common mistakes that trigger reviews and subsequent recoupment requests include:

• Lack of appropriate documentation,

• Over-utilization of services, and

• Improper waivers of co-pays and deductibles.

New laws, such as the Red Flags Rule, are often adopted by state or federal government and create new responsibilities for the chiropractor. Often, these laws go unnoticed until you find yourself already in violation of the law.

Most chiropractors are becoming increasingly frustrated with the amount of legislative obligations and payer rules. For many, understanding and complying with these rules and guidelines is challenging due to the overwhelming amount of seminars, lectures, Web sites, and opinions providing conflicting views on hot issues.

What can you do to help avert the Medicare or insurance audit, the recoupment recovery attempts by these payers, and the penalties for violating a law or guideline? The best answer is an effective, comprehensive Healthcare Compliance Program (HCP).

What is an HCP?

An HCP is a written document, usually drafted by a qualified healthcare attorney, which provides an easy-to-understand and comprehensive approach to educating the chiropractor and his staff on standards for billing, coding, documentation, federal fraud and abuse laws, and other related regulations.

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