presented by: david klein, cpc, cpma, chc...on october 1, 2019 the 2020 icd-10 codes went into...
TRANSCRIPT
Presented by:
David Klein, CPC, CPMA, CHC
THIS PRESENTATION WAS CREATED IN ORDER TO HELP HEALTH CAREPROFESSIONALS, MEDICAL BILLING PERSONNEL, CODERS AND OTHERSUPPORT PERSONNEL TO BETTER UNDERSTAND THE RAPIDLY CHANGINGMEDICAL/HEALTHCARE ENVIRONMENT. DOCUMENTATION, BILLING AND CODINGDECISIONS SHOULD NOT BE SOLEY BASED UPON INFORMATION CONTAINEDIN THIS PRESENTATION. INDIVIDUAL CIRCUMSTANCES , LEGAL AND ETHICALCONSIDERATIONS AS WELL AS PAYER POLICIES SHOULD ALWAYS BECONSIDERED WHEN DETERMINING A PARTICULAR COURSE OF ACTION. THISPRESENTATION AND CONTENTS HERIN SHALL NOT BE CONSTRUED AS LEGALADVICE NOR AS ESTABLISHING A CLIENT-ATTORNEY RELATIONSHIP.RESOURCES ARE PROVIDED FOR EDUCATIONAL AND AWARENESS PURPOSESONLY, AND AS SUCH, ARE PROVIDED STRICTLY AS SAMPLES. IF YOU HAVEQUESTIONS OF A LEGAL NATURE, YOU SHOULD CONTACT AN ATTORNEY ATLAW. THE PRESENTER MAKES NO WARRANTIES, EXPRESS OR IMPLIED,REGARDING ANY SUCH RESOURCES. RECORDING, COPYING OR OTHERWISEREPRODUCING THIS PRESENTATION IN ANY WAY IS STRICTLY PROHIBITEDWITHOUT PRIOR WRITTEN CONSENT FROM DK CODING & COMPLAINCE, INC.
DISCLAIMER & TERMS
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It’s not Just Documentation that tells the Story
Everything we do in Practice Tells a Story, for
example:
✓ Cervical Sprain/Strain indicates whiplash injury
✓ Level 1 established Exam indicates a problem
that will self resolve
✓ -59 modifier indicates separate site/organ
system was treated
✓ Our fee schedule reflects how we value our
skills
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Patient Responsibility Insurance Responsibility
Problem 1: Insurance is paying for less and less
What’s Happening
in the Health Care Industry?
The Line is Shifting
The Line is Getting Clouded
Problem 2:Benefits are getting more complex
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The Impact on Practices
MONEY
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Compliance is like the speed limit →The faster you go the more likely you are to be pulled over...
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CERT Audits
RAC Audits
Types of Post Payment Audits
Commercial/ZPIC Audits
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Post Payment Audits are very seldom “Random”
How is a Practice Selected for an audit?
✓ Provider “profiling”
✓ Complaints from a disgruntled patient
✓ Complaints from a former employee
✓ Advertising
✓ Submitting claims for care of family
members and/or employees
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• Any healthcare provider submitting claims to any third-party payer – regardless of participation status.
• If you are an in-network provider, the carrier’s right to audit you is usually set forth in your Participating Provider Agreement.
• If you are an out-of-network provider, the carrier’s right to audit you stems from case state statutes and/or regulations.
The tools commonly employed by SIU Agents when conducting an Audit are:
• A request for production of records;• Submission of questionnaires/surveys to patients;• Conducting interviews with patients;• Conducting interviews of current and former
employees;• Telephone conferences and/or meetings with the
provider; and• In rare circumstances, sending an agent into a practice
undercover.
Contact your Healthcare Attorney and/or a Certified Auditor and Coder
◦ Make sure they have experience with the type of audit you are undergoing.
◦ Attorney Client Privilege
Do not simply send in the records – you must have a game plan
◦ Many times Providers send in too little or too much
◦ Drawing attention to key aspects of documentation is critical
If you have audit insurance, make sure to contact the carrier to find out
◦ Ask if your attorney is on the panel or can be added
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➢ Overutilization of E/M Codes
➢ No Transition from Passive to Active care
➢ Up-coding a service without justification
➢ Improper use of modifiers – e.g. -59 modifier
constantly used.
➢ Billing for Tests as a matter of course
➢ Pattern Billing
➢ Overutilization in general
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Step 1:
Know the Rules and how you compare to your Peers to the best of your ability
Solving the Problem
Requires 3 Basic Steps
Step 2:
Lift the cloud… so the line can be seen and know where your reimbursement should be
Step 3:
Do everything you can to protect your Practice from Recoupment
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Quality Payment Program
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Documentation Errors By Chiropractic According to OIG 2005
Report
ElementPercentage of Documentation Errors
by Doctors of Chiropractic
Evaluation: Improper of missing 34%
Diagnosis: Improper or missing 33%
Treatment Plan: Insufficient 83%
Medical Necessity: not shown or miscoded
67%
Contraindications not checked 66%
While the Error rate reduced from 94% in 2005 to 51% in 2015 the
same issues seem to be affecting documentation by Chiropractors.
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Know The Rules
There Is Way Too MuchMis-Information
The Code Definitions -- CPT-4 and ICD-10 – became “Federal Law” as a result of the HIPAA Transactions Rule in 2002. See 45 CFR 162.923(a), 162.1001-1011.
Three Coding Resources Every Office should have
AMA’s CPT, Professional Edition
HCPCS Level II (for DME and other items)
ICD-10-CM
*Consider also: AMA CPT Assistant
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Example:
Professional CPT Manual 2019
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CPT Assistant, May 2010 page 9
Medicine: Physical Medicine and Rehabilitation, 97110, 98940 (Q&A)
Question: Is it appropriate to report codes 97110-97124, if the procedure were performed at the same region as Chiropractic Manipulative Treatment (CMT)?
Answer: Yes. The physical medicine and rehabilitation procedure codes, 97110-97124, represent distinctly separate and unrelated procedures, which are not considered inclusive of CMT as described by codes 98940-98943. Therefore, when the procedure is distinct from the manipulation, it would be appropriate to report codes 97110-97124 in addition to CMT, when performed at the same anatomic site (i.e., separate body regions are not required).
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97110 -
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility
CPT Assistant Summer 1995: 7, Feb 1997: 10, Nov 1998: 37,Dec 1999: 11, Mar 2005: 11, Apr 2005: 14, Aug 2005: 11, Dec 2005: 8,Mar 2006: 15, Aug 2006: 11, May 2008: 13, Dec 2009: 15, May 2010: 9,Mar 2012: 9, Mar 2014: 15
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CPT Assistant, August 2005 page 11
Medicare Coding Update: Units of Service Reporting of Outpatient
Rehabilitation CPT Codes
“…From a CPT coding perspective, some of the physical medicine services are timed codes based on a 15-minute unit. Multiple units can be billed on a date of service for one or more procedures based on the aggregate amount of time spent by a qualified healthcare professional in direct contact with the patient. As with any 15-minute timed code, it is important to recognize that a substantial portion of 15 minutes must be spent in performing the pre-, intra-, and post service work in order to report the timed code. If only a few minutes are spent performing the physical medicine service, either the code should not be billed or modifier 52 should be appended to the code (See December 2003 CPT Assistant, "Coding Communication: Physical Medicine and Rehabilitation Services, Part I")”
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97110 -
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility
CPT Assistant Summer 1995: 7, Feb 1997: 10, Nov 1998: 37,Dec 1999: 11, Mar 2005: 11, Apr 2005: 14, Aug 2005: 11, Dec 2005: 8,Mar 2006: 15, Aug 2006: 11, May 2008: 13, Dec 2009: 15, May 2010: 9,Mar 2012: 9, Mar 2014: 15
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AMA CPT Assistant, March 2014 page 15
Frequently Asked Questions: Medicine: Physical Medicine and Rehabilitation
Question:
When reporting the Physical Medicine and Rehabilitation time-based codes (97110-97548), is it appropriate to report these services with modifier 52, Reduced Services, if less than 15 minutes was spent treating the patient, or when the treatment lasts less than eight minutes? When taking into consideration the following statement published in the August 2005 issue of CPT® Assistant, "For the purpose of determining the total time of a service, incremental intervals of treatment at the same visit may be accumulated," how would the following scenario be reported: At 8 am, the therapist provides seven minutes of treatment described by code 97110; at 8:15 am, the therapist provides 23 minutes of treatment described by code 97112; and at 8:45 am, another eight minutes of treatment described by code 97110 was provided?
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AMA Answer:
“When codes do not contain specific language in the guidelines, code descriptors, or parenthetical statements other than an increment of time, the guidelines for time in the introduction section of the CPT code set provide the following instructions: "A unit of time is attained when the mid-point is passed. For example, an hour is attained when 31 minutes have elapsed (more than midway between zero and sixty minutes). A second hour is attained when a total of 91 minutes have elapsed. When codes are ranked in sequential typical times and the actual time is between two typical times, the code with the typical time closest to the actual time is used (CPT 2014; page xv)." Therefore, in response to the first question and based on the time guidelines provided in the CPT code set, it is not appropriate to append modifier 52, Reduced Services, to codes 97110-97546. To further clarify, in order to report code 97110, Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility, a minimum of eight minutes of therapeutic exercises need to be performed. Services of less than eight minutes would not be reported…”
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Extraspinal CMT: 98943
December 2013 page 15Medicine: Chiropractic Manipulative Treatment
Question: Is modifier 51, Multiple Procedures, applicable to chiropractic manipulative treatment (CMT) codes (98940-98943)? The National Correct Coding Initiative (NCCI) edits indicate that modifier 51 does not apply to these procedures as they are considered separate and distinct; however, these codes do not appear in the list of CPT codes exempt from modifier 51 in CPT® 2013.
Answer: Modifier 51 should not be appended to the CMT codes. These are separate and distinct procedures and the use of modifier 51 does not apply. ♦
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How do I code for Cupping?
November 2016 page 9c
Question: Is code 97799, Unlisted physical medicine/rehabilitation service or procedure, the appropriate code to use to report a cupping procedure (suction cups) performed by an acupuncturist?
Answer: No, cupping is considered a modality (ie, any physical agent applied to produce therapeutic changes to biologic tissue) and should be reported with code 97039, Unlisted modality (specify type and time if constant attendance). When reporting an unlisted procedure code, it is necessary to submit supporting documentation (e.g., procedure report) along with the claim to provide an adequate description of the nature, extent, and need for the procedure; and the time, effort, and equipment necessary to provide the service.
2013 Definition:
L0631 - “Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior panels, posterior extends from sacrococcygeal junction to a T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen straps, pendulous abdomen design, prefabricated, includes fitting and adjustment.”
2014 Definition:
L0631 - Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to T-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise
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On October 1, 2019 the 2020 ICD-10 codes went into effect. This year there were 273 new codes, 30 revised codes and 21 deleted codes, bringing the total number of codes up to 72,184. Fortunately, these changes are unlikely to have much impact on the average Physical Medicine Practice however, here are a couple of them to be aware of:
Guideline Section 1.19.c: ◦ For physeal fractures, assign only the code
identifying the type of physeal fracture. Do not assign a separate code to identify the specific bone that is fractured.
Code revision: ◦ Z45.42: “Neuropacemaker” is changed to
“neurostimulator” and brain, peripheral nerve, and spinal cord are removed.
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We have noticed an increase in payers using some established ICD-10 guidelines to deny claims.
When a code includes an Excludes1 note, that means that the code that follows cannot be used with it. For example, M54.6 Pain the thoracic spine includes an Excludes1 note for M51- disc disorders. These codes should not appear on the same claim, even though some of the M51 codes are for the lumbar spine.
Pain diagnoses: Diagnosis codes such as M54.2 Cervicalgia, or M54.5 Low back pain are considered short term and more of a symptom than a definitive diagnosis.
Providers should identify the cause of the pain and report a more definitive diagnosis instead. Reporting a symptom diagnoses does not do much to establish medical necessity.
“Code signs and symptoms when a related definitive diagnosis has not been established (confirmed) by the provider” (section I.B.6)
Example: R45.2 Unhappiness
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“Signs and symptoms that are associated routinely with a disease process should not be assigned as additional codes” (section I.B.7)
Example: R68.84 Jaw pain would not be coded with M26.62 temporomandibular joint arthralgia
“Additional signs and symptoms that may not be associated routinely with a disease process should be coded when present.” (sectionI.B.8)
Example: R11.0 Nausea and S13.4xxA Sprain of ligaments of the cervical spine
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“Do not code diagnoses documented as ‘probable’, ‘suspected’, ‘questionable’, ‘rule out’, or ‘working diagnosis’ or other similar terms indicating uncertainty.” (section IV.I)
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Medicare
Medicare is the Gold Standard – Based on The Code of Federal Regulations (CFR)
• National Coverage Determinations
• Local Coverage Determinations
• Medicare Carrier Manuals
• Med Learn Matters
• National Correct Coding Initiative (NCCI)
• Office of Inspector General (OIG)
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How to Use Medicare Effectively
http://www.cms.gov/medicare-coverage-database/overview-and-quick-
search.aspx?CoverageSelection=Local&ArticleType=All&PolicyType=F
inal&s=Pennsylvania&CptHcpcsCode=97110&bc=gAAAAAAAAAAAAA
%3d%3d&=&
Lookup an LCD:
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Medicare Coverage Database
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Select The State
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Choose the CPT Code or Keyword
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Choose the Correct LCD
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View the LCD
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Don’t Just Limit it to Chiropractic
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CPT code 97035 (ultrasound therapy)
Therapeutic ultrasound is a deep heating modality that produces a sound wave of 0.8 to 3.0 MHz. In the human body ultrasound has several pronounced effects on biologic tissues. It is attenuated by certain tissues and reflected by bone. Thus, tissues lying immediately next to bone may receive as much as 30% greater dosage of ultrasound than tissue not adjacent to bone. Because of the increased extensibility ultrasound produces in tissues of high collagen content, combined with the close proximity of joint capsules, tendons, and ligaments to cortical bone where tissue may receive a more intense irradiation, ultrasound is an ideal modality for increasing mobility in those tissues.
It is considered reasonable and necessary that ultrasound may be pulsed or continuous width; and for it to be used in conjunction with therapeutic procedures, not as an isolated treatment.
Specific indications for the use of ultrasound application include but are not limited to:•limited joint motion that requires an increase in extensibility•symptomatic soft tissue calcification•neuromasPhonophoresis (the use of ultrasound to enhance the delivery of topically applied drugs) will be reimbursed as ultrasound therapy. Separate payment will not be made for the contact medium or drugs.
If no objective or subjective improvement is noted after 6 treatments, a change in treatment plan (alternative strategies) should be implemented or documentation should support the need for continued use of ultrasound. Documentation must clearly support the need for ultrasound more than 12 visits.
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Other LCD’s Can Prove Helpful
• Twelve (12) chiropractic manipulation treatments for Group A diagnoses.• Eighteen (18) chiropractic manipulation treatments for Group B diagnoses.• Twenty-four (24) chiropractic manipulation treatments for Group C diagnoses.• Thirty (30) chiropractic manipulation treatments for Group D diagnoses.
M54.5 Low back painM54.6 Pain in thoracic spineM54.89 Other dorsalgiaM54.9 Dorsalgia, unspecifiedM62.40 Contracture of muscle, unspecified site
M47.23 Other spondylosis with radiculopathy, cervicothoracic regionM47.24 Other spondylosis with radiculopathy, thoracic regionM47.25 Other spondylosis with radiculopathy, thoracolumbar regionM47.811 Spondylosis without myelopathy or radiculopathy, occipito-atlanto-axial region
Example Group A Diagnoses:
Example Group B Diagnoses:
Consider Novitas Solutions, Inc. LCD
M48.01 Spinal stenosis, occipito-atlanto-axial regionM48.02 Spinal stenosis, cervical regionM48.03 Spinal stenosis, cervicothoracic regionM50.10 Cervical disc disorder with radiculopathy, unspecified cervical regionM50.11 Cervical disc disorder with radiculopathy, high cervical region
M54.14 Radiculopathy, thoracic regionM54.15 Radiculopathy, thoracolumbar regionM54.16 Radiculopathy, lumbar regionM54.17 Radiculopathy, lumbosacral regionM54.30 Sciatica, unspecified sideM54.31 Sciatica, right sideM54.32 Sciatica, left sideM54.40 Lumbago with sciatica, unspecified side
Example: Group C Diagnoses
Example: Group D Diagnoses
For custom fabricated orthoses, there must be detailed documentation in the treating physician’s records to support the medical necessity of custom fabricated rather than a prefabricated orthosis.
◦ Custom fitted - Prefabricated item that requires substantial modification e.g., has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by certified orthotist or an individual with equivalent expertise.
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Substantial modification is defined as changes made to achieve an individualized fit of the item that requires the expertise of a certified orthotist or an individual who has equivalent specialized training in the provision of orthotics such as a physician, treating practitioner, an occupational therapist, or physical therapist in compliance with all applicable Federal and State licensure and regulatory requirements. A certified orthotist is defined as an individual who is certified by the American Board for Certification in Orthotics and Prosthetics, Inc., or by the Board for Orthotist/Prosthetist Certification.
◦ Only a certified Orthotist (ABC or BOC)
◦ Equivalent Specialized Training: Physician, Treating Practitioner, Occupational Therapist, Physical Therapist –(those within the Medical Practices Act who have training in the provisions of orthotics)
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The new modifiers are:
• XE Separate Encounter, a service that is distinct because it occurred during a separate encounter
• XS Separate Structure, a service that is distinct because it was performed on a separate organ/structure
• XP Separate Practitioner, a service that is distinct because it was performed by a different practitioner
• XU Unusual Non-Overlapping Service, the use of a service that is distinct because it does not overlap usual components of the main service
It is unclear at this time if other/all payers will adopt the new
modifiers and as such this change will only affect Medicare.
Medicare Changes to Modifier 59
LCD’s Can Include:
Code specific instruction
Definitions
Documentation Guidelines
Special Instructions
Medical Necessity Guidelines
Special Warnings
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In 2002 The US Department of Health and Human Services (HHS) answered this question in a Q&A:
Question:
Are appointment reminders allowed under the HIPAA Privacy Rule without authorizations?
Answer:
“Yes, appointment reminders are considered part of treatment of an individual and, therefore, can be made without an authorization.”
Source: HHS_AppointmentReminder_QA
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The 2013 Omnibus final rule states the following regarding your Notice of Privacy Practices (NPP):
“In particular, §164.520(b)(1)(iii) requires a separate statement in the notice if the covered entity intends to contact the individual to provide appointment reminders or information about treatment alternatives or other health related benefits or services.”
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Know What your Provider Agreements Say
⚫ Delegation of Services to Unlicensed Personnel
⚫ Clinical Policy Bulletins
⚫ Appeal Processes
⚫ Fee Schedules
⚫ Active vs. Passive Care
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Example – CPT 97012
97012 - traction, mechanical
CPT Assistant further defines mechanical traction: “The force used to create a degree of tension of soft tissues and/or to allow for separation between joint surfaces. The degree of traction is controlled through the amount of force (pounds) allowed, duration (time), and angle of pull (degrees) using mechanical means. Terms often used in describing pelvic/cervical traction are intermittent or static (describing the length of time traction is applied), or autotraction (use of the body's own weight to create the force).”
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1.Policy
Aetna considers autotraction devices experimental and investigational because there is insufficient evidence to support their clinical value in treating low back pain (LBP) or for other indications.
2. Note: Brand names of autotraction devices include the Anatomotor, the Arthrotonic stabilizer, the Quantum 400 inter-segmental traction table, and the Spinalator, Spinalign massage inter-segmental traction table.
Aetna Clinical Policy Bulletin:Lumbar Traction Devices
Number: 0569
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Horizon Policy
CMT E&M Services: According to CPT guidelines, CMT codes include a pre-manipulation patient assessment. An E&M service may be reported in addition to CMT if the member’s condition requires a significant, separately identifiable E&M service that is above and beyond the usual pre-service and post service work associated with the CMT. In such instances the provider should append modifier 25 to the E&M code and ensure that the appropriate documentation is included in the patient’s medical record in accordance with CMS guidelines. It is appropriate to separately and additionally report an E&M service only in the following conditions:
1. Initial evaluation of a new member or condition; or a reevaluation of an established patient’s progress under a current treatment plan every thirty (30) days;
2. Acute exacerbation of symptoms or a significant change in the member's condition; or
3. A distinct and different indication which is separately identifiable and unrelated to the manipulation.
Discounts
What kind of Discounts Can I offer?
Discounts often include:
◦ Waivers of deductibles and copays
◦ Free care
Historical concerns – dual-fee schedule and provider contracts
More Recently…Anti-inducement laws
Audits
Payers sending out letters
◦ Applies to
Out-of-network practices
Non-covered care focused practices
Rule of Thumb – If you treat insured patients, then discounts is an issue
Problem – other businesses don’t involve claims being filed with insurance
Federal government does recognize certain kinds of discounts
General rules
◦ Policy must be in writing
◦ Consistently applied #1 requirement
1.Hardship
2.Prompt Pay
3.Discount Medical Plans
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OIG Advisory – February 8, 2008
http://www.oig.hhs.gov/fraud/docs/advisoryopinions/2008/AdvOpn08-03A.pdf
Background – hospital posed a question to the OIG regarding prompt pay discounts.
Tip:
✓Get a copy of the
OIG Advisory
Opinion 08-03A
off of the Internet
and save it to
your local
computer.
It’s a discount that:
"is designed to reduce the Health System's accounts receivables and costs of debt collection, and to boost its cash flow."
"bear[s] a reasonable relationship to the amount of collection costs that would be avoided."
% of Bill Discounted on Payments Made Prior to Discharge
Balances $0 -- $999 = 10%
Balances = $1,000 = 15%
% of Bill Discounted on Payments Made Post-Discharge But
Within 30 days of Discount Offer
Balances $0 -- $999 = 5%
Balances = $1,000 = 10%
Discount would be offered by the hospital without regard to the "reason for the patient's admission" or "length of stay."
Hospital certified that it "would not advertise the discount opportunity."
Patients and their representatives would only be informed of the Prompt Pay Discount's availability "during the course of the actual billing process."
◦ Limited Pre-Payment Discount – e.g., Cap it at a
dollar amount
◦ Time-of-Service Discount
◦ Auto-Draft Discount – Full Past Pay
◦ Auto-Draft Discount – Equal Payments
◦ Payment Assurance Discount – patient provides a
credit card as assurance of payment.
Prompt Pay Discounts
Talk With Your Attorney
“Fr”
Services?
Not Advertised
In Writing &
Consistently Applied
ReasonableNot
Based on
Length of
Care
“Non-Covered
Services” Only?
Notify
Payer?
HRSA - Health Resources and Services Administration.
HRSA is the "primary Federal agency for improving access to health care services for people who are uninsured, isolated or medically vulnerable."
HRSA has developed a Hardship Application based on federal poverty guidelines
HRSA Sliding Fee Scale
Certain health centers, in order to receive assistance from federal government must:
Using a discounted/sliding fee schedule to help patients in financial need
Posting a sign that no one who is unable to pay will be denied access to services
General guidelines:
◦ Patient’s Income and Expenses
◦ Family Size
◦Amount of Medical Bills
“Providers may establish any number of
incremental percentages (discount pay
class) as they find appropriate between
100-200% of poverty….”
Pg. 3
“Patients above 200% of poverty may be charged the full fee for the service(s), or; providers may continue to charge incremental percentages for services when patient income is above 200% of poverty, until 100% of the full fee is reached.”
Pg. 3
“The reasonableness of … the percent of a full
fee that is assessed, may be subject to
review/challenge by federal reviewers during
routine reviews by duly authorized federal
staff, or their state counterparts.”
Pg. 3
“The simplest approach is to accept the
patient’s word at the time the request is
made. On future visits, it may be
appropriate to require some form of
verification.”
Pg. 4
“Many … providers count only the mother,
father, and dependent children under 18 as
the family. Other adults in the household,
even though related, are considered
separately.”
Pg. 4
Discount Medical Plans
Acts just like an insurance plan except thePatients pay you directly
You get credentialed
Set your “network” fee schedule
Post that you are a network provider
Make sure to go with a licensed and bonded discount Medical Plan – e.g. ChiroHealth USA
Patient must sign up with the plan
Fees are generally reasonable - $59 per year
They can now enjoy the “in-network” fee schedule
