Many doctors have been notified of a Medicare audit conducted by Strategic Health Solutions. Strategic Health Solutions has been contracted to perform and provide medical review functions of Medicare and Medicaid programs. Strategic Health is currently performing medical review of records through the project Y4P0434 for Chiropractic Services.
With Medicare’s Merit-based Incentive Payment System (MIPS) beginning in 2017, many are asking about PQRS in 2017. Although it seems clear that PQRS ends on 12/31/2016, the G-code quality reporting will continue under MIPS.
The FCA Help Desk has received several calls this week regarding a request for records from StrategicHealthSolutions, an audit contractor for CMS (Medicare). Please be aware of a potential request for records and do NOT ignore. The FCA Help Desk is gathering Information to assist our members in responding. If you wish to discuss this with Mollie Frawley, FCA Help Desk Coordinator, please email her at email@example.com with your best contact information AND your FCA member number or your Florida DC license number.
Read more for helpful steps to take if you receive an audit letter.
In addition to the September 12th change in billing First Coast, there are at least 3 other changes that are time sensitive in nature. October 1 begins the need for more specificity in coding ICD-10. November 30th is the last day to appeal your PQRS status for 2015. Failure to respond to re-validation requests may require re-enrolling in Medicare with no grace period for billing. For more information, read on.
The September 12, 2016 coding and billing changes by First Coast Service Options (FCSO) have raised several common questions listed below. These questions are better understood with a better understanding of both the documentation AND billing underlying mandates for covered chiropractic services:
Does the September 12th date apply to dates of service or claims submission dates?
Do you have a list of common NMS codes we can use?
Do I have to have a NMS condition for each subluxation region billed?
Can I use the same NMS condition for the different subluxation regions billed? For example low back pain for lumbar, sacrum and ilia?
In what order must I bill the diagnoses on the bill?
How do I bill when the primary insurer is PIP or Workers’ Compensation and they require different codes and billing instructions than Medicare?
Why can I only point to ONE diagnosis code in Field 14 on the bill? When did this start?
If you will not be attesting to or meeting Meaningful Use through the implementation of a certified Electronic Health Record during 2015, you may be eligible for a "Hardship Exemption" that would avoid that reimbursement reduction in 2017. The deadline for applying for this exemption has been moved to July 1,2016.