10/16/2024
QUERIES (MEDICAL-LEGAL)
Query: Risk Adjustment Audit Request
I received a letter from the Risk Adjustment Department with Regence Health Plans, requesting medical records for 100 patients. I’m not familiar with this type of audit request. What are my obligations and/or options in response to this request?
Audit type: Medicare Risk Adjustment
Deadline to receive the records: 10 days from request
Episource Request #: L-xxxxxxxx
Number of charts requested: 100
DOS Requested: 01/01/2023 – current
Name Withheld
07/31/2024
QUERIES (MEDICAL-LEGAL)
Query: CMS/Noridian Chart Review
What are the actual consequences of not responding to a post-payment chart review request from CMS/Noridian? Noridian paperwork states just automatic recoupment of fees paid. Anything more serious? Ciox and Episource Medicare risk adjustment chart review requests? Ciox and Episource do not publish any consequences. Their risk adjustment oppressive chart requests (65 and 85 at a time) take staff time away from my regular duties.
Name Withheld
07/19/2024
QUERIES (MEDICAL-LEGAL)
Query: Requiring a Deposit on Booking
I am considering charging a deposit for new patients when they schedule an appointment. This fee would be deducted from their initial visit. However, if they were a no call/no show, or cancelled with less than 48 hours, they would lose the deposit. I initiated this policy in my veterinary practice about 5 years ago, and it has reduced our No call/no shows to nearly zero. I did not consider implementing this policy when I was accepting insurance because it was a bit tricky with the contracts I had.
However, since I am now self-pay, it should work. The question I have is regarding Medicare. I do not accept assignment and patients pay at the time of their visits. However, as per Medicare policy, we do file for covered services with traditional Medicare (NOT any Advantage plans) and Medicare reimburses the patients. Does anyone know if I can require a deposit for booking an appointment for a new Medicare patient?
Kathleen Neuhoff, DPM, South Bend, IN
05/23/2024
QUERIES (MEDICAL-LEGAL)
Query: Source for Malpractice Coverage
I was recently involved in a malpractice case that settled with the plaintiff. My current malpractice is dropping me and I am struggling to find malpractice coverage. I have considered going non-surgical as well. Has anyone had luck outside of the major malpractice carriers?
Name Withheld
04/02/2024
QUERIES (MEDICAL-LEGAL)
Query: How Long to Retain Medicare Charts
Being retired, I want to try to condense as many of my charts as possible. As far as Medicare is concerned, how many years do I have to retain my charts before I can dispose of them?
Jack Ressler, DPM, Boca Raton, FL
01/18/2024
QUERIES (MEDICAL-LEGAL)
Query: Difficulty Obtaining Credentialing with Anthem
I am having difficulty obtaining credentialing with Anthem to become an in-network provider. The stumbling block is my lack of board certification. I have explained that as a non-surgical, general practitioner podiatrist, a large percent of DPMs my age have no board certification, and that this should not block me from being credentialed. Any ideas on how I can persuade Anthem?
Stan Luksenburg, DPM, Cleveland, OH
01/17/2024
QUERIES (MEDICAL-LEGAL)
Query: CIOX Request for Non-Medicare Advantage Charts
I am inquiring if anyone has received a request from CIOX for non-Medicare Advantage patient charts. I received a request for three commercial BCBS patients, which they stated in their request "the records will be reviewed by certified coders working for Advantasure, our risk adjustment vendor. ...we want to clarify members' specific medical conditions and ensure we have the documentation required by CMS and DHS."
Is CIOX now reviewing commercial as well? I appreciate any input or advice.
Kimberlly Crayton, Office Manager
01/08/2024
QUERIES (MEDICAL-LEGAL)
Query: Hospital Working Against Podiatry
For the past year, most podiatrists who are on staff at our hospital were in a category which did not allow for clinical privileges. We opted for this due to a few reasons. The biggest was that the hospital would only call podiatry for inpatient wound consults, and would never call podiatry for any injuries, nor would they refer any injury follow-up care to podiatry. There was no monetary compensation from the hospital for on-call services.
Once the majority of podiatrists opted to give up clinical privileges, only a handful of podiatrists were left taking call for a service that is fairly busy. The hospital then began paying these few podiatrists for on-call services. Recently, the hospital administration enacted a change to the By-laws which removed the option to remain on-staff while having no clinical privileges. The options forced upon all podiatrists was to take call for wounds or to resign. They also decided to discontinue paying podiatrists for on-call services. Has anyone been faced with a similar situation? I'm wondering about the ethics and legality of the hospital administration's actions.
Name Withheld
01/04/2024
QUERIES (MEDICAL-LEGAL)
Query: Nerve Biopsies from the Thigh
Last year, a new device for diabetic neuropathy was released by the Abbott Corporation. According to published reports, this device is quite successful in reducing neuropathic pain. However, it is recommended that nerve biopsies be done from the proximal thigh. Where does this leave podiatry with our anatomic state-mandated laws?
Steven Finer, DPM, Philadelphia, PA
01/01/2024
QUERIES (MEDICAL-LEGAL)
Query: Texting Patients' Names to Other Podiatrists
Is a podiatrist able to text patients' names to other podiatrists or is this a HIPAA violation?
Daniel Chaskin,DPM, Flushing, NY
Editor's comment: PM News does not provide legal advice. SMS texting can potentially violate HIPAA rules if it involves the transmission of protected health information (PHI) without proper safeguards. To have HIPAA-secure texting, message data must be encrypted, patient consent must be obtained, and access safeguards must be in place.
08/24/2023
QUERIES (MEDICAL-LEGAL)
Query: Business Insurance Discrimination
My business operating insurance has gone up a substantial amount of money ($500) because my class code is not “medical”, but “podiatry”. Has anyone else had this problem?
Jeffrey Klirsfeld, DPM, Levittown, NY
08/17/2023
QUERIES (MEDICAL-LEGAL)
Query: Pros and Cons of Not Renewing a DEA License
I would love to hear from subscribers on the Pros and Cons of not renewing a DEA license.
David Cohen, DPM, Baltimore, MD
08/07/2023
QUERIES (MEDICAL-LEGAL)
Query: Source for Cost-Effective DEA Training Course
Which resource is the most cost-effective and simple to do for the new mandatory DEA training?
Christopher Forsbach, DPM, Saint Louis, MO
07/24/2023
QUERIES (MEDICAL-LEGAL)
Query: DEA License Renewal
How important is it to continue to keep a DEA license? If I do not renew it, how easy is it to renew a DEA license in years to come if I were to need it?
Jennifer Gross-Edwards, DPM, Bethlehem, PA
07/19/2023
QUERIES (MEDICAL-LEGAL)
Query: Medica Medical Records Review Request
We have had many requests in the past from Ciox for records review and never charged them for these records in the past. Just recently, we got a request from Medica Medical Records Review-Medicare Risk Adjustment for the complete charting notes/records on 177 patients seen from Jan 1 through Dec. 31, 2022. They stated that this request is "for the MRA Health Plan's Chart Review program." We then proceeded to send them a bill for $25 for each record they requested.
They just came back to us with a "Notice of Past Due Request," stating that an immediate response is required and that they have engaged with Optum and Ciox Health to conduct the medical chart review and that we are obligated to send them these charting notes. Are we obligated to copy these hundreds of pages, including demographics, progress notes, operative and pathology notes, etc. at no charge?
Tom Silver, DPM, Minneapolis, MN
05/29/2023
QUERIES (MEDICAL-LEGAL)
Query: Episource Record Request Review
Does anyone have experience with an Episource record request review? They advise that their chart review will include an audit of clinical documentation and a diagnostic coding review. It sounds like they may be critically reviewing doctor notes as well as combing for data extraction. I am concerned that if my notes don't pass muster by their "certified" coders, they will request a return of fees paid! I requested a fee of $50 per chart for 66 charts to discourage the request, but they agreed to it.
Name Withheld
05/13/2023
QUERIES (MEDICAL-LEGAL)
Query: Obligation to Participate in Medicare Advantage Plan?
If we are contracted with a particular commercial payer, are we required to accept their Medicare Advantage plans?
Eric Trattner, DPM, Twinsburg, OH
05/11/2023
QUERIES (MEDICAL-LEGAL)
Query: Obligation to Provide Records to Ciox?
For those of you who charge Ciox for chart review, are you a participating provider? Upon review of my contract with providers, it clearly states that records are to be furnished upon request at no cost, and if refused, the contract will be terminated. If this is the case, what is our recourse?
Daniel Kormylo, DPM, Rocky Point, NY
04/25/2023
QUERIES (MEDICAL-LEGAL)
Mr. Sullivan, describing new DEA registration requirements, stated it wasn't required after June 26, 2026. Am I reading something wrong? So you only need the 8 hours if your renewal falls between June 2023 and June 2026?
Glenn McClendon, DPM, Conway, AR
Editor's comment: PM News does not provide legal advice. Since DEA registration is for three (3) years, every physician registrant is required to take this one-time training to renew that registration.
04/06/2023
QUERIES (MEDICAL-LEGAL)
Query: Post-Operative Fluoroscopic Scans as a Standard of Care?
It seems that recently, fluoroscopes have been gaining popularity in podiatry offices. My question is would post-operative fluoroscopic scans be considered the standard of care vs. 3-view weight-bearing x-rays?
Ivar E. Roth DPM, MPH, Newport Beach, CA
01/14/2023
QUERIES (MEDICAL-LEGAL)
Query: Request for 33 Charts for “Risk Adjustment”
I received a record request today for 33 charts for “risk adjustment.” This is the largest request I have ever received. Texas law allows me to charge for the records, and I charge up to the allowable limit. I was just curious, what is the largest request others have received?
Fight the Good Fight!
Dave Williams, DPM, El Paso, TX
12/06/2022
QUERIES (MEDICAL-LEGAL)
Query: Is a DEA Registration Required?
My DEA registration will expire in January. I am preparing to retire in the next year or so. I do not prescribe schedule II meds as I no longer perform significantly painful procedures not covered by ibuprofen. Do hospitals, malpractice insurance companies, or health insurance companies require DEA registration? Are there any other consequences I may not be aware of?
John Moglia, DPM, Berkeley Heights, NJ
08/22/2022
QUERIES (MEDICAL-LEGAL)
Query: New York Health Care Worker Bonus Program
An employee just brought to our attention this program in NY State to reward our loyal employees by paying them to stay at work, the "Health Care Worker Bonus Program." This applies to providers that take Medicaid or Medicaid managed care. The problem is that no one I spoke to so far has heard of it. What is involved? What is the paperwork burden to us?
I’m wondering if anyone has some insight or has submitted for the first vesting period, since the due date for it is September 2, 2022.
Justin Sussner, DPM, Suffern, NY
06/16/2022
QUERIES (MEDICAL-LEGAL)
Query: Service Fee for Credit Cards
Everywhere I go, I am being hit with a 3% surcharge on my credit card transactions. Are we legally allowed to do the same?
Michael Cherella, DPM, Medford, NJ
Editor's Comment: PM News does not provide legal advice. This is a state regulated issue. If your state allows it, you need to inform the patient beforehand of this charge. It's important to note that you can't add the fees in states whose laws ban them, including California, Colorado, Connecticut, Florida, Kansas, Maine, Massachusetts, New York, Oklahoma, and Texas. In addition, Mastercard and Visa allow this practice, while American Express does not. Therefore, you should contact an attorney prior to instituting this practice.
04/27/2022
QUERIES (MEDICAL-LEGAL)
Query: Tricare Chart Audit
I received a request for post-payment audit review of about 100 charts. I was told, ”The U.S. Government does not pay for medical records for post-payment audit review.” I am not aware of that and maybe I overlooked it in some of the signed paperwork. Is anyone else aware of this or has seen this in writing?
Name Withheld
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