Mario P. Fucinari DC, CPCO, CPPM, CIC, Author at Illinois Chiropractic Society

Medical Necessity Requirements

Posted by Mario P. Fucinari DC, CPCO, CPPM, CIC | Apr 1, 2016 | Billing and Collections, Insurance, Medicare and Medicaid, zall | 0 |

On December 23, 2015, the Centers for Medicare and Medicaid Services (CMS) released a new instructional video describing their policies and procedures for establishing the medical necessity of chiropractic care.1 The video was released on the heels of a new study released by the Office of Inspector General (OIG), “CMS Should use Targeted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic Services”2, which revealed extrapolated data suggesting fraud and abuse in chiropractic Medicare utilization.

Post ICD-10: Implementation

Posted by Mario P. Fucinari DC, CPCO, CPPM, CIC | Feb 1, 2016 | Coding, zall | 0 |

Since the implementation of ICD-10, the interpretation of code usage and policies pertaining to billing procedures are becoming evident with each carrier.

NGS Clarifies -59 Modifiers

Posted by Mario P. Fucinari DC, CPCO, CPPM, CIC | Jun 29, 2015 | Coding, Medicare and Medicaid, Videos, zall | 0 |

This video will help chiropractic physicians understand how to account for the X modifier codes that have replaced the -59 modifier billed to NGS/CMS.

Are Your Medicare Notes Functional

Posted by Mario P. Fucinari DC, CPCO, CPPM, CIC | Jun 8, 2015 | Insurance, Medicare and Medicaid, zall | 0 |

Many are seeing increased denials of care for medical necessity in Medicare. A closer look at the reasons for the denials reveals a change in Medicare’s interpretation of medical necessity and progress in care. The evolution of their interpretation actually complements what chiropractors have been saying for several years – we do not only treat pain!

59 Modifier Comes Under Fire in Medicare

Posted by Mario P. Fucinari DC, CPCO, CPPM, CIC | Apr 8, 2015 | Medicare and Medicaid, zall | 0 |

The 59 modifier is used to indicate to the carrier that a “distinct procedure code” is involved and the procedures should be paid separately.

Is Your Practice Guilty of Deflate-Gate

Posted by Mario P. Fucinari DC, CPCO, CPPM, CIC | Apr 8, 2015 | Coding, Insurance, zall | 0 |

Many can say that some in practice may be guilty of “Deflate-gate” by not following regulations, thus cheapening the quality of care they deliver and maybe even giving them an illegal edge.

Is PQRS Really Worth It?

Posted by Mario P. Fucinari DC, CPCO, CPPM, CIC | Mar 19, 2015 | Medicare and Medicaid, zall | 0 |

To help cut down on the costs of health care in Medicare, the government is enacting programs to enhance the value of its purchasing dollars in health care.

ICD-10 Final Rule Released

Posted by Mario P. Fucinari DC, CPCO, CPPM, CIC | Dec 1, 2014 | Coding, zall | 0 |

The Centers for Medicare and Medicaid Services (CMS) has recently released its final rule indicating implementation of ICD-10 will occur on October 1, 2015.