Chiropractic Billing and CERT Documentation. Presented by Part B Provider Outreach and Education

Transcription

1 Chiropractic Billing and CERT Documentation Presented by Part B Provider Outreach and Education

2 Workshop Protocol Phone lines are muted upon entry Enter attendee, city, and state in Chat (not Q&A) Throughout workshop Questions must be pertinent to workshop slide addressed All other questions/inquiries, call Part A or Part B Provider Contact Center (PCC) Address all written questions in Q&A section Workshop conclusion Take short poll Asking questions aloud use raise/lower hand feature MUTE phones do not place on HOLD Certificate of Attendance see last slide February 2012 NAS, LLC Proprietary 2

3 CEU Process Attend entire workshop Take short Poll Password: Provided at conclusion of workshop To retrieve Certificate, go to Workshops page CEU Certificate Enter password and print Don t need CEUs? Certificate of Attendance (last slide) February 2012 NAS, LLC Proprietary 3

4 DISCLAIMER This information release is the property of Noridian Administrative Services, LLC (NAS). It may be freely distributed in its entirety but may not be modified, sold for profit or used in commercial documents. The information is provided as is without any expressed or implied warranty. While all information in this document is believed to be correct at the time of writing, this document is for educational purposes only and does not purport to provide legal advice. All models, methodologies and guidelines are undergoing continuous improvement and modification by NAS and CMS. The most current edition of the information contained in this release can be found on the NAS website at and the CMS website at The identification of an organization or product in this information does not imply any form of endorsement. CPT codes, descriptors, and other data only are copyright 2012 American Medical Association. All rights reserved. Applicable FARS/DFARS apply. February 2012 NAS, LLC Proprietary

5 Objective Provide overview of Chiropractic billing, coding, and coverage Provide documentation requirements by NAS Medical Review (MR) and Comprehensive Error Rate Testing (CERT) audits February 2012 NAS, LLC Proprietary 5

6 Agenda General Coverage and Subluxation Coverage Categories Documentation Guidelines Claim Requirements Signature Guidelines Advance Beneficiary Notice of Noncoverage (ABN) Claim Review Programs Resources February 2012 NAS, LLC Proprietary 6

7 GENERAL COVERAGE AND SUBLUXATION February 2012 NAS, LLC Proprietary

8 Coverage Treatment of the spine, limited specifically by manual manipulation (use of hands), to correct a subluxation Hand held devices allowed Controlled manually No additional payment by Medicare Medicare does not recognize an extra charge for the device itself No other diagnostic/therapeutic service covered when furnished/ordered by chiropractic physician February 2012 NAS, LLC Proprietary 8

9 Subluxation Definition Medicare definition: Subluxation is defined as a motion segment in which alignment, movement integrity and or physiological function of the spine are altered although contact between joint surfaces remains intact Subluxation may be demonstrated by an x-ray or physical examination February 2012 NAS, LLC Proprietary 9

10 Acceptable Descriptive Terms* Off centered Misalignment Malpositioning Incomplete dislocation Rotation Spacing Abnormal, altered, decreased, increased Motion Limited, lost, restricted, flexion, extension, hyper mobility, hypomobility, aberrant *Not an all inclusive list February 2012 NAS, LLC Proprietary 10

11 Subluxation Levels Specify one or the other of subluxation levels: List exact bones involved such as: C2, L5, etc. List area if it implies certain bones such as: Lumbo-sacral Sacro-iliac February 2012 NAS, LLC Proprietary 11

12 Treatment Parameters Treatment should improve, arrest, or retard patient s condition Results should occur within a reasonable and generally predictable time period Extensive or prolonged services: Treatment course must be clearly documented Documentation must reflect need and support continued length of care February 2012 NAS, LLC Proprietary 12

13 Excluded Chiropractic Services Beneficiary responsibility may bill patient direct Acupuncture Counseling/education Dietary advice/nutritional supplements Lab or other diagnostic tests Physical therapies (exercise, ultrasound, traction) Office visits Supplies (pillows or vitamins) Supportive (bracing, orthopedic) X-rays February 2012 NAS, LLC Proprietary 13

14 X-Ray Referral X-ray not required to demonstrate subluxation May be used if chiropractor chooses X-ray ordered by MD, DO, NPP Physician/practitioner name (Item 17) NPI (Item 17B) Medicare does not reimburse for x-rays ordered or taken by a Chiropractor February 2012 NAS, LLC Proprietary 14

15 X-Ray Demonstration of Subluxation X-ray should be taken no more than 12 months prior to initiation of treatment or 3 months following initiation of treatment Previous CT scan and/or MRI acceptable Also maintained by referring physician Enter x-ray date - Item 19 (narrative) February 2012 NAS, LLC Proprietary 15

16 Treatment Necessity Must demonstrate: Significant health problem of neuromusculoskeletal condition Statement of pain is insufficient Location of pain must be described and whether particular vertebra listed is capable of producing pain in area determined Direct therapeutic relationship to condition Provide reasonable expectation of recovery or function improvement Arrest / retard deterioration in condition Within a reasonable and generally predictable period of time February 2012 NAS, LLC Proprietary 16

17 Reasonable and Necessary Not All Inclusive Yes Spinal aches Strains Sprains Nerve pains Functional mechanical disabilities of spine No Rheumatoid arthritis Muscular Dystrophy Multiple Sclerosis Pneumonia Emphysema February 2012 NAS, LLC Proprietary 17

18 COVERAGE CATEGORIES February 2012 NAS, LLC Proprietary

19 Coverage Categories Acute Chronic Exacerbations Recurrence February 2012 NAS, LLC Proprietary 19

20 Coverage Categories Acute New injury identified - physical exam or x-ray First treatment date/diagnosis reasonably proximate Expectation is improvement, arrest of progression of patient s condition Initially, services might be frequent but taper off February 2012 NAS, LLC Proprietary 20

21 Coverage Categories 2 Chronic Condition exists for longer period Not expected to resolve completely Continued therapy can be expected to result in some functional improvement Once functional status remains stable or unchanged without expectation of additional objective clinical improvements Further manipulative treatment is maintenance therapy not a Medicare benefit February 2012 NAS, LLC Proprietary 21

22 Coverage Categories 3 Exacerbation Temporary deterioration of patient s condition Due to treated condition flare-up Nature of onset and pertinent factors to support medical necessity of treatment must be documented in chart Include date of occurrence Claim form must reflect dates Initial treatment - Item 14/electronic equivalent Exacerbation - Item 19/electronic equivalent February 2012 NAS, LLC Proprietary 22

23 Coverage Categories 4 Recurrence Return of previously treated condition Inactive 30 days or more May require therapy reinstitution Patient on recovery road, reinjures self E.g. mowing lawn February 2012 NAS, LLC Proprietary 23

24 Active Corrective Treatment When providing active/corrective treatment, a chiropractor must append AT modifier to CPT on claim AT modifier does not (in all instances) indicate that service(s) is reasonable and necessary After medical review, if appropriate, contractors may deny claim February 2012 NAS, LLC Proprietary 24

25 Maintenance Therapy Not a Medicare covered service Maintenance includes services: That seek to prevent disease Promote health Prolong or enhance the qualify of life Maintain or prevent deterioration of a chronic condition When further clinical improvement cannot reasonably be expected from continuous ongoing care Treatment is considered maintenance therapy when chiropractic treatment is supportive not corrective February 2012 NAS, LLC Proprietary 25

26 Maintenance Therapy 2 Mandatory Claim Submission rules Requires providers bill Medicare even if service might deny Do not append AT modifier Bill with additional diagnosis (optional) V57.9 (unspecified rehabilitation procedure) Obtain Advance Beneficiary Notice of Noncoverage (ABN) GA modifier February 2012 NAS, LLC Proprietary 26

27 DOCUMENTATION GUIDELINES February 2012 NAS, LLC Proprietary

28 Documentation Documentation requirements apply whether subluxation is demonstrated by x-ray or physical exam Applies to initial visit and subsequent visits February 2012 NAS, LLC Proprietary 28

29 Documentation Initial Visit History Chief complaint Symptoms that caused patient to seek chiropractic treatment Ask if patient has had prior chiropractic treatments Present illness may include: Mechanism of trauma Quality and character of problem/symptoms Intensity of symptoms Frequency and duration of symptoms Aggravating or relieving factors of symptoms Prior interventions, treatments including medications Secondary complaints Symptoms must bear a direct relationship to level of subluxation February 2012 NAS, LLC Proprietary 29

30 Initial Visit 2 Family history (if pertinent) Past health history may include: General health statement Prior illness(es) Surgical history Prior injuries or traumas Prior chiropractic care Physical exam Clearly document treatment given on day of visit What was adjusted February 2012 NAS, LLC Proprietary 30

31 Initial Visit 3 Physical exam may use P.A.R.T Pain, tenderness, location, quality and intensity Asymmetry / misalignment Range of motion abnormality, changes Tissue, tone changes 2 of 4 criteria under P.A.R.T. required one of which must be: Asymmetry / misalignment OR range of motion abnormality Reminder: Must use P.A.R.T. or X-Ray to prove subluxation Must be documented to support chiropractic care February 2012 NAS, LLC Proprietary 31

32 Initial Visit 4 Diagnosis Primary diagnosis must be subluxation Head, Cervical, Thoracic, Lumbar, Sacral or Pelvic Secondary Diagnosis should come from Category I, II or III diagnosis list List primary and secondary DX for each region treated and billed Treatment plan Therapeutic modalities education and exercise training Level of care recommended duration and frequency of visits Specific goals to be achieved with treatment Objective measures to evaluate treatment effectiveness Date of initial treatment February 2012 NAS, LLC Proprietary 32

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34 Subsequent Visits History Review of chief complaint Changes since last visit System review Physical exam Exam of area of spine involved in diagnosis Assessment of change in patient condition since last visit Evaluation of treatment effectiveness Document treatment details on day of visit What specifically was adjusted Clearly document treatment necessity February 2012 NAS, LLC Proprietary 34

35 Subsequent Visits 2 Reminder: Even if diagnosis is same as last visit document each time The word same is not acceptable If diagnosis changes from prior visit Explain if it relates to past history and how If new diagnosis, redo P.A.R.T. exam Is new diagnosis due to a new injury? Explain and add new Initial Treatment Date Item 14 on claim February 2012 NAS, LLC Proprietary 35

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37 Keys to Successful Documentation Complete and legible documentation Clearly identify medical necessity Utilize standard abbreviations Include plan of treatment Computerized documentation may not provide individualized information Detail specific date of service elements Clarify which services necessary Medical Review seeing claims billing for 2 to 4 levels Documentation must support each level billed Billing 2 regions? Must have 2 primary/secondary diagnoses Time line (short, moderate, long term) matches diagnosis and documentation February 2012 NAS, LLC Proprietary 37

38 Reminder Documentation requirements apply whether subluxation is demonstrated by x- ray or physical exam Applies to initial visit and subsequent visits Medicare requirements and NAS LCD requirements apply whether chiropractor is Participating or Nonparticipating with Medicare February 2012 NAS, LLC Proprietary 38

39 What is NAS Medical Review Seeing? Claims billed from 2 to 4 levels Billing 2 regions? Must have 2 primary/secondary diagnoses Documentation doesn t support multiple levels Documentation must support each level Time line (short, moderate, long term) matches diagnosis and documentation February 2012 NAS, LLC Proprietary 39

40 Chiropractic Services Local Coverage Determination (LCD) AZ, ID, MT, ND, SD, UT, and WY (Effective 02/01/12) L24288 AK, OR, and WA (Effective 02/27/12) When appropriate, NAS MR completes pre-payment review Providers identified through data analysis and or audits February 2012 NAS, LLC Proprietary 40

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42 MR Documentation Concerns Be careful with software generated documentation Some include identical entries for different patients or for different dates of service Be careful with check-off sheets Difficult to read Lack findings Too generic Lack enough space to list specific required information Non-encounter specific repetitive entries that do not contain policy required components, will be denied upon review Whichever documentation style is used, it must include required elements to support medical necessity for service(s) rendered February 2012 NAS, LLC Proprietary 42

43 CLAIM REQUIREMENTS February 2012 NAS, LLC Proprietary

44 Mandatory Claims Submission Per Omnibus Budget Reconciliation Act (OBRA) of 1989, effective September 1, 1990 providers must submit Medicare claims for all covered and all potentially covered services on behalf of Medicare beneficiaries Providers may not charge for this If seeing Medicare patients for covered services, provider must enroll in Medicare Providers not acquiring a Medicare billing number is not a protection from CMS requirements February 2012 NAS, LLC Proprietary 44

45 Mandatory Claims Submission 2 Agreements between patients waiving federal requirements does not protect Medicare providers from compliance fraud Chiropractors may bill patients direct for noncovered or statutorily excluded services by Medicare Providers must bill Medicare for non-covered services if beneficiary requests provider to file claim(s) Secondary coverage requires a denial from Medicare prior to processing claims February 2012 NAS, LLC Proprietary 45

46 Payment Inquiries Questions Can a PAR Chiropractor use a sliding payment scale? Answers Cannot collect more than PAR allowed or NON PAR limiting charge for In hardship cases, provider could bill with Modifier 52 (reduced services) Can a Chiropractor use a 30% discount, if patient pays cash at time of service? Medicare fee schedule can be lower than private insured; but never higher If codes involved, no cash payment up front as mandate to bill Medicare up front (even if maintenance therapy). All other services/procedures, Medicare doesn t get involved; up to each practice February 2012 NAS, LLC Proprietary 46

47 Manipulation Codes CMT; spinal, one to two regions CMT; spinal, three to four regions CMT; spinal, five regions non covered Extraspinal, one or more regions Primary Diagnosis Codes Head Cervical Thoracic Lumbar Sacral Pelvic Select secondary diagnosis from Category I, II, or III

48 Claim Requirements 2 Item 21 Diagnosis No decimals or descriptions Must be to highest level of specificity Up to 4 diagnoses on paper claim Up to 12 electronically Each region billed to Medicare requires 2 diagnoses One primary and corresponding secondary diagnosis List the most clinically significant primary and secondary diagnoses Document additional diagnoses in clinical record as appropriate February 2012 NAS, LLC Proprietary 48

49 Claim Requirements 3 Item 14 initial treatment date (ITD) examples 12/01/10 Patient seen, neck and back pain 03/01/11 Patient has recurrence and is seen again after lapse in time ITD for this course of treatment is 03/01/11 Item 17/17B Referring/ordering physician s name/npi (if necessary) Physician assuming order responsibility Item 19 X-ray date and/or descriptions 6-digit or 8-digit x-ray date Descriptions e.g. specific subluxation level Additional diagnoses if needed February 2012 NAS, LLC Proprietary 49

50 Claim Requirements 4 Item 24E Select the most significant primary diagnosis and enter 1, 2, 3, OR 4 as appropriate Item 24J Rendering provider NPI Always 10 digit numeric number Item 33B Group/Solo provider NPI Group or Incorporated Solo (LLC, PC) Separate NPI from rendering NPI in 24J Solo provider NPI same as NPI in 24J Always 10 digit numeric number February 2012 NAS, LLC Proprietary 50

51 Missed Appointments Physicians may charge Medicare beneficiaries same as non-medicare patients Charges cannot be billed to Medicare February 2012 NAS, LLC Proprietary 51

52 Record Maintenance Providers required to maintain records CMS suggests 7 years from date of service Existing requirements Record retention considered part of normal business practice 42 Code of Federal Regulations (CFR) Section (d) February 2012 NAS, LLC Proprietary 52

53 Cannot opt out Medicare Reminders for Chiropractors Can choose to be participating or nonparticipating Reimbursement is bound by Medicare Physician Fee Schedule (MPFS) See MPFS for state specific allowed amounts Must abide by Mandatory Claim Submission Laws February 2012 NAS, LLC Proprietary 53

54 Medicare Reminders for Chiropractors 2 Can only order or refer for services within scope of practice (i.e. to another chiropractor for manipulations) Cannot order or refer for CT, PET, or MRI scans, order or refer for durable medical equipment, order prescriptions, or order laboratory services X-rays may be taken to demonstrate subluxation, but no coverage or reimbursement February 2012 NAS, LLC Proprietary 54

55 SIGNATURE GUIDELINES February 2012 NAS, LLC Proprietary

56 Definitions and Guidelines Handwritten signature Mark or sign by an individual on a document to signify knowledge, approval, acceptance or obligation Signature log Identifies the author associated with initials or illegible signature Include with requested documentation Attestation statement Must be signed and dated by author of medical record entry and contain appropriate beneficiary information Include with requested documentation CR Internet Only Manual (IOM) Medicare Program Integrity Manual, Publication , Chapter 3, Section February 2012 NAS, LLC Proprietary 56

57 Electronic Signatures Electronic Signatures are acceptable Needs to be verification or electronic acceptance noted to be valid signature Method used shall be a hand written or an electronic signature Stamp signatures are not acceptable Medicare B News Issue 263: Signature Guidelines for Medical Review Purposes Revised CR 6698 February 2012 NAS, LLC Proprietary 57

58 Signatures Physicians/NPPs should not add late signatures to medical records, other than a short delay that occurs during transcription process Use signature authentication process Retroactive orders are not acceptable If labs are ordered, notate in medical record what the physician/npp ordered Labs ordered too generic and a CERT error February 2012 NAS, LLC Proprietary 58

59 ADVANCE BENEFICIARY NOTICE OF NONCOVERAGE (ABN) February 2012 NAS, LLC Proprietary

60 Revised CMS ABN (CMS-R-131) March 2011 Form available NI/02_ABN.asp v/bni/ February 2012 NAS, LLC Proprietary 60

61 CMS ABN Guide LNProducts/download s/abn_booklet_icn pdf February 2012 NAS, LLC Proprietary 61

62 What is an ABN? Written notice that a health care provider gives to Medicare beneficiary prior to service being rendered Indicates provider believes Medicare will not pay for some or all services Only for Medicare Fee For Service beneficiaries Indicates beneficiary will be financially responsible if claim is denied for medical necessity February 2012 NAS, LLC Proprietary 62

63 ABN 2 ABN must State specific procedure & estimated cost Specific reason why provider believes Medicare likely to deny payment Signed by beneficiary & dated before procedure/service performed Cannot change ABN form except Copy on provider letterhead Personalize to practice header sections D, E, & F February 2012 NAS, LLC Proprietary 63

64 ABN 3 ABN allows beneficiary to make informed decision about whether to receive service ABN serves as proof beneficiary had knowledge prior to receiving service that Medicare might not pay If health care provider does not deliver valid ABN when required, beneficiary cannot be billed for service ABNs cannot be used when beneficiary would otherwise not be liable for payments because full payment made through bundled payments E.g. National Correct Coding Initiative (NCCI) Provider write off amounts cannot be passed along to beneficiary February 2012 NAS, LLC Proprietary 64

65 ABN 4 ABN is not required for services that are statutorily excluded examples include: Vitamins Pillows X-rays taken by Chiropractor ABN must not be used for all services February 2012 NAS, LLC Proprietary 65

66 ABN For Extended Course of Treatment Single ABN acceptable when: ABN identifies all items/services and duration of period of treatment No changes to treatment No new services are added Nothing is added or deleted ANY changes in treatment or services require a new ABN be given Single ABN for extended course of treatment is valid for one year February 2012 NAS, LLC Proprietary 66

67 ABN Modifiers GA GX Expect Medicare will deny an item or service as not reasonable and necessary Signed ABN is on file beneficiary liability Used to report when a voluntary ABN was issued for a non- covered or statutorily excluded service May be used with GY beneficiary liability GY Item/service is non-covered (excluded) from the Medicare program beneficiary liability No ABN needed Auto-denied by NAS GZ Expect Medicare will deny an item or service as not reasonable and necessary Signed ABN is not on file Will not change financial responsibility CO provider liability February 2012 NAS, LLC Proprietary 67

68 CLAIM REVIEW PROGRAMS February 2012 NAS, LLC Proprietary

69 Review Programs Guide Medicare Claims Review Programs Booklet October LNProducts/download s/mcrp_booklet.pdf February 2012 NAS, LLC Proprietary 69

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71 CERT Documentation Contacts CERT Contractor Information CERT Documentation Office Attn: CID # 9090 Junction Drive, Ste 9 Annapolis Junction, MD Fax Number: Phone Number: NAS Contact Information NAS Medicare Part B: CERTQuestion@noridian.com Subject line should read "CERT Question" Body should include providers name, contact person, address, city/state & telephone number Reminder: Do not include Protected Health Info (PHI) February 2012 NAS, LLC Proprietary 73

72 CERT Error Examples Billed AT, DOS June 16, 2011 Missing initial and subsequent treatment plans for DOS December 4, June 16, 2011 No new injury reported Missing initial and subsequent documentation of treatment plan in patient medical record Medical records with treatment plans never sent to NAS Services deemed not reasonable and necessary February 2012 NAS, LLC Proprietary 72

73 CERT Error Examples 2 Multiple DOS Missing documentation to support initial visit, patient history, treatment plan Many daily notes not legible and included abbreviations not able to be interpreted NAS requested copies of initial visit and evaluation Received typewritten treatment plan no signature Missing provider signature attestation document Upon request, provider sent duplicate documentation now altered with addition of provider signature Documentation fails to meet requirements for medical necessity per LCD guidelines Documentation that cannot be deciphered does not support medical necessity and service will be denied February 2012 NAS, LLC Proprietary 73

74 CERT Error Examples 3 Submitted documentation included progress note and treatment notes missing items include: Evaluation; plan of treatment including past health history Quality and character of symptoms/problems Onset date; duration; intensity; frequency; location and radiation of prior symptoms Aggravating or relieving factors; interventions; treatments; medications; secondary complaints prior to this DOS to support continued chiropractic treatment Documentation states injuries related to deep cleaning house This is mechanism of trauma not a complaint Chiropractor statement Recommended treatment on as needed basis Return PRN is not a treatment plan Per LCD, patient must have significant neuromusculoskeletal condition necessitating treatment Manipulative services rendered must have direct therapeutic relationship to patient s condition February 2012 NAS, LLC Proprietary 74

75 CERT Error Examples 4 Multiple DOS reviewed Areas for CMT never documented No treatment plan Whatever therapy was given appears to be maintenance Inappropriate/invalid ABNs given Service is always listed as an adjustment with no rationale given for why service will be denied No prices listed advising beneficiary of liability amounts Submitted office note missing documentation describing regions of spine that were manipulated Billed to 4 regions Also missing, requested initial evaluations and initial treatment plan February 2012 NAS, LLC Proprietary 75

76 CERT Error Examples billed, submitted documentation includes office notes missing documentation includes: Initial visit note; treatment plan; documentation of evaluation of treatment effectiveness NAS requested documentation of initial visit; treatment plan Received note stating beneficiary is not on an ongoing treatment plan will be treated as needed This does not meet documentation requirements for initial visit and treatment plan Per LCD, patient must have significant neuromusculoskeletal condition necessitating treatment Manipulative services rendered must have direct therapeutic relationship to patients condition February 2012 NAS, LLC Proprietary 76

77 CERT Error Examples billed submitted documentation included signed progress notes; missing: Initial evaluation and initial treatment plan Received unsigned typed progress notes NAS requested initial evaluation; initial treatment plan and signature attestation Requested documentation never received Service denied not meeting medical necessity LCD documentation requirements not met February 2012 NAS, LLC Proprietary 77

78 CERT Audit Reminder CERT post pay audit contractor Requests specific records/documentation Send to CERT contractor timely: Chief complaint/plan of Care Chart/Treatment notes Proof of medical necessity Referring/Ordering physician notes (if any) Documentation must support CPT level February 2012 NAS, LLC Proprietary 78

79 OIG 2012 Work Plan* Chiropractors Part B Payments End Stage Renal Disease Oversight of Dialysis Facilities Full report located at: Plan-2012.pdf *Not an all inclusive list February 2012 NAS, LLC Proprietary 79

80 Addressing Misinformation CMS addresses misinformation about Chiropractic services LNProducts/download s/chiropractors_fact_ sheet.pdf February 2012 NAS, LLC Proprietary 80

81 RESOURCES February 2012 NAS, LLC Proprietary

82 PCC and IVR Contact Provider Contact Center (PCC) Monday Friday 8 a.m. 4 p.m. in Respective Time Zone Interactive Voice Response (IVR) Monday Friday 6 a.m. 8 a.m. CT For general information, contact IVR system. For inquiries that cannot be answered through the IVR, providers and suppliers may call our customer service line to speak with a Customer Service Representative (CSR) February 2012 NAS, LLC Proprietary 82

83 IVR Check History Check Status Claim Volume Pending Approved to Pay Finalized Counts Claim Status Date of Death Deductible Status Earnings To Date HMO (Medicare Advantage) Home Health Hospice Hours of Operation Medicare Part B Addresses MSP Information Part B Eligibility PT, OT, SLP Information Reference Telephone Numbers Redetermination & Reconsideration Information Skilled Nursing Touch Tone Three Key Combination Chart Website Referrals February 2012 NAS, LLC Proprietary 83

84 Join NAS Lists Stay on top of what s new Benefits of signing up are: Latest news and information from NAS and CMS Up-to-date Medicare regulations Workshop and educational event notices Medical policy updates Payment and reimbursement updates NAS hours of availability and related notifications February 2012 NAS, LLC Proprietary 85

85 CMS Website Resources Internet Only Manual (IOM) Chiropractic Guidelines Publication , Chapter 15, Section 30.5 and Publication , Chapter 12, Section 220 Change Requests (CRs) / Transmittals / MLN articles February 2012 NAS, LLC Proprietary 85

86 CMS Website Resources 2 MLN Products MLN Products Catalog Web Based training MLN Publications Addressing Misinformation Regarding Chiropractic Services and Medicare February 2012 NAS, LLC Proprietary 86

87 Reminder: CEU Process Attend entire workshop Take short Poll Password: Provided at conclusion of workshop To retrieve Certificate, go to Workshops page CEU Certificate Enter password and print February 2012 NAS, LLC Proprietary 87

88 Thank You What Questions Do You Have? February 2012 NAS, LLC Proprietary

89 Certificate of Attendance is hereby granted to to certify that he/she has completed to satisfaction Chiropractic Billing and CERT Documentation February 23, 2012 Facilitator(s): Lori Weber, CPC