::: CSSi ::: DOWNLOAD FILES

Medicare Learning Network - 2008 Chiropractic Misinformation

This special edition article is provided by the Centers for Medicare & Medicaid Services (CMS) to correct misinformation in the chiropractic community relating to Medicare and its regulations as they relate to chiropractic services.

New 2008 Policies for BCBS of Georgia

This document describes the new policies for BCBS of GA as of 5/16/08.

Medicare Physician Fee Schedule Calculation Process

This document explains how Medicare determines fee schedules.

Medicare Overpayments Brochure

This document explains how Medicare deals with overpayments.

Chiropractic National Coverage Determination for Medicare

This document covers all of the required information related to documentation requirements when treating a Medicare patient.

Cigna HealthCare Coverage Position

This document covers the proper diagnosis and rationale for the utilization of gait training as a therapy service.

Special Advisory Bulletin - Office of Inspector General, Practices of Business Consultants

If you are considering hiring a business or compliance consultant, please read this bulletin. The OIG issued this document to alert providers to certain marketing and other practices used by some independent consultants that should concern providers and that may put the Medicare and Medicaid programs at increased risk of abuse.

Corporate Integrity Agreement - Idaho Falls Chiropractic Clinic

This document covers the most common errors that chiropractors make while in practice and the penalties that are associated with those errors when Medicare and The Office of Inspector General are involved.

OIG Report to CMS - Chiropractic Services in the Medicare Program

This document was created to determine the underlying causes of, and potential ways to reduce, vulnerabilities associated with Medicare payments for chiropractic services. In this document the OIG recommends to CMS that chiropractic coverage in Medicare be limited to 18-24.

Office of Inspector General Advisory Opinion No. 06-01

This is an advisory opinion regarding a home health agency's practice of providing prospective customers with a free preoperative home safety assessment. This document discusses whether the free home safety assessment constitutes grounds for the imposition of sanctions under the civil monetary penalty.

Office of Inspector General Letter to Hospitals

This document addresses the views of the OIG when it comes to discounts and waivers or reduction of co-payments as it relates to patients experiencing financial hardship.

HIPAA Security Guidance

There are a number of security incidents related to the use of laptops and other portable and/or mobile devices and external hardware that store, contain or are used to access Electronic Protected Health Information (EPHI) under the responsibility of a HIPAA covered entity. This document describes the policies necessary to safeguard the EPHI.

Special Advisory Bulletin - Offering Gifts and Other Inducements to Beneficiaries

This document provides the standards for offering gifts and services to Federal Health Care Beneficiaries. This document comes directly from the Office of Inspector General and describes the penalties for non-compliance.

Centers for Medicare and Medicaid Services Recovery Audit Contractors Guidelines

This document provides detailed instructions to those where the Recovery Audit Contractors (RACs)are operating. The instructions include the medical review process and how the overpayment process is to be handled. These contractors are paid on a percentage of what they collect from providers and are to be rolled out nationwide in 2010.

2008 ABN for Medicare

This is the PDF format of the ABN. Please become a registerd user to view the training course on how to use this new form.

2008 ABN Announcement

This document is from CMS announcing the new ABN Form.

2008 ABN FAQs

This document is from CMS and answers the most common questions about the ABN form.

2008 ABN Instructions

This document provides all instructions for use of the new ABN Form.

Financial Hardship

This form may be used for recording a patient's financial hardship, thereby allowing the practice to offer a discount on active care rates. To read more on this, please go to the Downloads page and read the OIG Open Letter to Hospitals.

Medicare Documentation Checklist

This form allows the practice to check their current documentation against the actual requirements from Medicare to see what, if anything, may be missing.

Patient Authorization/Assignment of Benefits

This form is to be used for a Medicare patient to assign benefits to the practice.

S Code Instructions

This document explains how to use S codes and the V diagnosis for a wellness patient. Please go to the client's webinar page to view the training on "Coding Wellness Care".

BCBS of NC Blue Book

BCBS of NC Provider Manual

Medicare Missed Appointment Policy

This document discusses the ability of a practice to charge the patient for missed appointments.

CMS Form 1965

Appeals Request Form

CMS Form 5011A-B

Request Form for ALJ

CMS Form 20027

Redetermination Form

CMS Form 20031

Transfer of Appeal Rights from patient to doctor.

CMS Form 20033

Reconsideration Form

Medicare Overpayment Refund Form

This form is required to return money to the Medicare carrier because of an overpayment.

Medicare Part B Spring 2008 Update

This presentation from Palmetto GBA covers changes going on in Medicare in Spring of 2008. It covers newly released RAC implementation dates for the whole country, NPI updates and much more.

Segmental Dysfunction Diagnosis Codes

This document contains a listing of all segmental dysfunction diagnosis codes in the 2008 version of the ICD-9 Manual

MedCost Provider Manual

This document contains the entire MedCost Provider manual.

June 2008 SC Medicare Part B Advisory

This release from Palmetto GBA contains information on their new phone numbers and other re-determination forms for claims re-submission.

2008 Office of Inspector General's Work Plan

This document describes how the OIG is planning to review chiropractor's claims and their billing practices in 2008.

CCI Edits as of 7/1/08

This file contains all of the current CCI edits for codes that are found to be mutually exclusive and therfore can not be billed together.

OIG Opinion On Gift Cards

In this opinion the OIG states that a hospital system's request to offer patient satisfaction gift cards is OK. In the opinion, the OIG also lists the numerous steps required to be able to compliantly offer this program to patients.

Random Number Generator

Use this website to randomly pick the files to audit. Instructions are included in this file.

CMS - ACA Medlearn Matters

This file contains the most commonly misunderstood issues surrounding chiropractic services within the Medicare system.

Medicare Request for Documentation

This file contains the latest requirements and procedures that need to be followed prior to submitting information to carriers or contractors.

Quadruple Visual Analogue Scale (QVAS)

The QVAS form is copyright protected. This document provides instructions for accessing it.

Fraud Alert - Rental of Space

This file contains information from the OIG regarding how to properly handle the contractual issues of renting space to somone you refer to.

Medicare Immediate Relatives Policy

These are expenses that constitute charges by immediate relatives of the beneficiary or by members of their household. The intent of this exclusion is to bar Medicare payment for items and services that would ordinarily be furnished gratuitously because of the relationship of the beneficiary to the person imposing the charge. This exclusion applies to items and services rendered by providers to immediate relatives of the owner(s) of the provider. It also applies to services rendered by physicians to their immediate relatives and items furnished by suppliers to immediate relatives of the owner(s) of the supplier.

Medicare Policy - CO, TX, NM, OK

This file contains the Medicare LCD policies for Colorado, Texas, New Mexico, and Oklahoma.

HIPAA Family and Friends

Even though HIPAA requires health care providers to protect patient privacy, providers are permitted, in most circumstances, to communicate with the patient's family, friends, or others involved in their care or payment for care. This guide is intended to clarify these HIPAA requirements so that health care providers do not unnecessarily withhold a patient's health information from these persons. This guide includes common questions and a table that summarizes the relevant requirements.

2009 OIG Work Plan

Medicare Payments for Chiropractic Services Billed With the Acute Treatment Modifier will be reviewed in 2009 by the Office of Inspector General.

BCBSF Chiropractic Policy

BCBS of Florida's Chiropractic policy

BCBSF Orthotic Policy

BCBSF Orthotics Policy starts at the bottom of page 15.

RAC Implementation Map

This is a complete map of the expansion of the Recovery Audit Contractor program that will audit providers based on their billing profile.

NC Cigna Medicare

Chiropractic policy for North Carolina Medicare including all allowed diagnosis codes.

BCBS of NC Modifier Guidelines

BCBS of North Carolina policy for modifier usage.

MAC - Medicare Administrative Contractor

Doing Business With New Medicare Carriers This article is intended to assist all providers that will be affected by Medicare Administrative Contractor (MAC) implementations. The Centers for Medicare & Medicaid Services (CMS) is providing this information to make you aware of what to expect as your FI or carrier transitions its work to a MAC. Knowing what to expect and preparing as outlined in this article will minimize disruption in your Medicare business.

Fraud and Abuse Control Program Annual Report For FY 2007

During FY 2007, the Federal Government won or negotiated approximately $1.8 billion in judgments and settlements, and it attained additional administrative impositions in health care fraud cases and proceedings. The Medicare Trust Fund received transfers of approximately $797 million during this period as a result of these efforts, as well as those of preceding years, in addition to $266 million in Federal Medicaid money similarly transferred separately to the Treasury as a result of these efforts.

S1001 HCPCS Code

S1001 definition on billing for orthotics when the cost is over and above the allowable.

CMS Survey

Providers are urged to participate in this annual Medicare Contractor Satisfaction Survey

CMS Claim Status Codes

Active Claim Status Codes for January 2009 implementation.

Chiro Sues

This is the full article from the SF Chronicle of a chiropractor who is suing a patient over a poor online review.

2009 CMS Update

2009 Coding & Reimbursement Update The 2009 Coding & Reimbursement Update contains a wealth of information that will be helpful to your office. Some of the articles in this publication include: Additions, Deletions and Changes for HCPCS, CDT, and CPT codes and modifiers; Proper use of modifiers: bilateral, professional and technical; Medicare Physician Fee Schedule Database Indicator Codes; DMEPOS Fee Schedule; Drug & Biological Fee Schedule and more.

Medicare Claims Processing Manual

Generally, chapter 1 describes policy applicable to Medicare fee-for-service claims, or what is known as the original or traditional Medicare program. See the Medicare Managed Care Manual for services to enrollees in managed care plans. Unless specified otherwise the instructions in this chapter apply to both providers and suppliers, and to the contractors that process their claims.

2008 ABN Sample

This is an example of a modified 2008 ABN Form.

Remittance Advice Remark Codes (RARC) and Claim Adjustment Reason Codes (CARC)

Change Request 6336 announces the latest update of Remittance Advice Remark Codes (RARCs) and Claim Adjustment Reason Codes (CARCs), effective April 1, 2009 for Medicare. Be sure billing staff are aware of these changes.

Signature Requirements

Medicare Documentation Signature Requirements 5/09.

United Health Group Testifies in the US Senate

Stephen Hemsley, UnitedHealth's chief executive, and Andy M. Slavitt of Ingenix, a susidiary of United Health Group, faced a skeptical Senate Panel. Read the whole NYTimes.com article.

CMS 1500 Form Instructions & Place of Service Codes

Complete guide to completing the CMS 1500 claim form, including places of service codes. (December 2008)

Tennessee False Claims OIG Review

Review by the OIG of this state's False Claims Act.

Medicare Audits Becoming Common in Deteriorating Economy

Article written by Dr. John Davila, published in American Chiropractor magazine May, 2009.

Railroad Medicare Redetermination/Reopening Claims

Railroad Medicare Instead of a Written Redetermination: Consider Having your Claim Reopened

Claim Adjustment Reason Code (CARC)

Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), and Medicare Remit Easy Print (MREP) Update, effective July 1, 2009.

Cuomo Announces Takedown of Insurance Fraud Ring Which Infiltrated New York

The Office of Attorney General announced the indictment of 12 people and 9 corporations.

2 Nurses

Read this article about two Texas nurses who were indicted for complaining about a physician.

Red Flags Program Template

This is the FTC's compliance template to help businesses and organizations at low risk for identity theft design their own Identity Theft Prevention Program.

Medicare GV Modifier - Hospice

Palmetto GBA, Ohio Part B Carrier - Hospice, Non-Attending Physician Denial

MLN - Recovery Audit Contractor (RAC)

Article explains the money that can be requested for repayment by CMS and how there is no limitation on the amount.

Data Breach Notification Letter (MS Word format - To open, please read instructions)

PLEASE READ: This letter is MS Word format for easy modification. Click once and choose Save. Open MS Word. Then open the saved file and modify it. This letter is to be sent to anyone affected by a breach of protected health information (PHI).

CMS-855B

The Centers for Medicare & Medicaid Services (CMS) issued revised Medicare enrollment applications for physicians, non-physician practitioners and other suppliers (except DMEPOS suppliers) using the CMS-855B and/or the CMS-855I to enroll or make a change in their enrollment information.

Foot Levelers PX Notes

Foot Levelers PX Class Notes

HIPAA Business Associates Agreement

HIPAA business associates agreement form, 2/17/2010.

DOJ Press Release

This file contains the Department of Justice press release on a fraud conviction in Michigan regarding false claims.

Medicare Fraud and Abuse Brochure

Resources for information pertaining to Medicare fraud and abuse and what to do if you suspect or become aware of incidents of potential fraud or abuse.

GCC Notes

Documenting Medical Necessity for Medicare patients and risk management, presented by Dr. John Davila at the GCC on 12-4-2009.

OIG Review

OIG Plans to Review Medicare, Medicaid Auditing Programs HealthLeaders Media

KCS - October 2009

Compliant Game Plan - The 4 secrets to thriving as a subluxation based chiropractor in an active care world, presented at KY Chiropractic Society, October, 2009.

Medicare Advantage Appeals

Advisory Opinion from the Office of Inspector General on Appeals in the Medicare Advantage Program.

Health Insurance Announcement by Cuomo

Article announcing new national database that would help determine how much insurance companies should reimburse patients who go out of network to see a doctor.

FTC Red Flags

This is the full press release from the Federal Trade Commission on the delay to enforce the Red Flags/Idenetity Theft rules until June 1, 2010.

FAIR to set out of network fee schedules

New database for out-of-network pay set to replace disputed Ingenix system. The independent project claims it's fairer than the previous system, run by a UnitedHealth Group-owned company. The effect on physician payments remains unknown.

Take RAC Seriously

Florida hospitals had a front-row seat to the genesis of the Recovery Audit Contractor (RAC) program due to the Sunshine State's participation in the three-year RAC demonstration project. FierceHealthFinance recently spoke with Bruce Rueben, CEO of the Florida Hospital Association, to find out what his member hospitals have learned from the RAC program so far.

Feds Ignored Medicare Scam Warnings for Years

Feds ignored Medicare scam warnings for years: By KELLI KENNEDY (AP) MIAMI � For three years, the federal agency in charge of preventing Medicare fraud repeatedly ignored internal watchdog warnings about swindlers stealing millions of dollars by scamming several programs, documents show. The Centers for Medicare and Medicaid Services received roughly 30 warnings from inspectors over three years during the Bush and Obama administrations but didn't respond to half of them, even after repeated letters, according to records provided to The Associated Press by U.S. Sen. Charles Grassley's office.

GCC Winter Program, 2009

"Navigating Compliance, Necessity & Documentation", a 6 hour presentation by Dr. John Davila at the GCC December 5-6, 2009.

OIG Fraud

The OIG also found that during the demonstration project, RACs received no formal training from CMS regarding the identification and referral of potential fraud. However, CMS did provide the permanent RACs with a presentation about fraud. CMS is planning to provide the permanent RACs with further education and training on the identification and referral of potential fraud, although no date or agenda has been determined.

Medicare Audit Factors

The 9 factors that cause Medicare audits.

Palmer 2010 Notes - Documentation

Notes from 3 hour presentation on Documentation at the 2/21/2010 Palmer Homecoming Event.

Palmer HC 2 hr Medicare Program

Notes from Palmer Homecoming Program "Medicare Part B Medical Records Signature Requirements", presented by Dr. John Davila 8-15-2010.

Palmer HC 4 hr Coding & Documentation Program

Notes from Palmer Homecoming Program, "Coding and Documentation", presented by Dr. John Davila 8-15-2010.

Parker Notes 8-20-10

Notes from Dr. Davila's 12 hour presentation at Parker College on 8-20-10.