2/28/08

Medicare 2008 Fee Update - The Rest of the Story. CMS (Medicare) has posted the new 2008 fees on their web site. Most Part B contractors have also posted them. The new fees reflect the .5% increase in the national dollar conversion factor. Today, we are excerpting the new Allowed amounts for the three CMT codes for all regions in the USA. Our goal is to post them this weekend in a simple look-up table.

The 2008 fees (until June 30th) includes the December Congressional increase of .5% to the dollar conversion factor. However, and unfortunately, the new fee schedule also includes mandated adjustments and caps (by congress) to the national Relative Value Units. When both elements (adjusted RVU and the dollar conversion factor) are combined, the resulting dollar Allowed amount is less money for most codes.

Because we are in Arizona, I left my personal message with our congressional JOHN team: the Honorables John McCain (presidential candidate), Jon Kyl (senate minority whip) and John Shadegg (house). Our message? "With anymore congressional band-aid .5% raises that result in less dollars paid, many providers will stop seeing patients or go out of business. You are exacerbating the healthcare crisis. Please fix your egregious reimbursement problem."

My First Mistake This Year? - I thought a made a mistake regarding the 2008 Medicare Physician Fee Schedule by reporting a .5% increase. But today it appears that I did not make a mistake. Thus, my first mistake this year.

Last Thursday I sent out a two email messages to all clients and friends. The first email announced the modest increase of .5%. Then I had a phone call from a trusted client stating that a recent meeting within the ACA amongst the Medicare CAC representatives stated that the .5% increase was not a complete truth but only a part of a combined a 10% decrease. Assuming the heresy evidence to be correct, I sent a second email to correct/retract the first email (as we really don't like our clients to be confused). However, over this past weekend CMS posted their 2008 dollar conversion factor, which is $38.087 (a .5% increase from 2007).

Consequently, if the new information posted now by CMS is correct, then my first mail was correct and my second email was incorrect. I need to re-confirm the facts and the new CMS posting before sending a third email.

Information Overload - The Associated Press from New York has named it as the problem of the year.  I totally agree. We should all think twice before we "copy" someone in an email message or hit "reply all." As a consequence of my "information overload," various filters have been installed on my personal computer. My personal fax line and machine is now my preferred form for receiving information, especially if someone really wants assurance of getting thru to me.

The AP news reported that Basex Inc. did a forecast for 2008, and named "information overload" as the problem of the year. Their chief analyst Jonathan Spira declared, "It's too much of a good thing," and it has grown as a consequence of societal expectations for instantaneous responses.

More information available means more time wasted looking for the right information. He estimates that it cost the US economy $650 billion in 2006.

Information management is our mission and challenge at the Chirocode Institute. In 1995, our company with born as the Leavitt Crandall Institute. Our focus was a providing relevant information in helping doctors get paid. We still have the same mission. We do information sifting to get the "gems" and golden nuggets for our clients and subscribers. As we continue to do our job well, we will be in the health reimbursement information business for a long time.

We are committed to reducing "information overload." Additionally, we are committed to providing simple and easy access to relevant health care information for proper reimbursement. Accordingly, we will be launching a new internet product in 2008 for all codes and for all practitioners. Everything known about any code will soon be at one's fingertips.

Seasons Greetings - 2007 has been great and grand year. We have enjoyed being of service to many doctors across the USA. Someone recently asked me the rhetorical question, "How is life treating you?" My response was: "It doesn't really matter; What really matters is how I am treating life." Grace and I are taking time off to be with our posterity for a week. Rejoice, a King is Born. Click here to see our 2007 family reunion photo.

Winter Solstice - Today is the turning point in the sun's path for our planet earth. With this being longest night of the year, we all decided to all wear black (just for the fun of it). Interestingly, it also happens to be the birthday of an x-wife of someone in the ChiroCode office.

Medicare 2008 Deductible is $135 - The annual $135 deductible for Medicare Part B beneficiaries starts January 1st (that is up $4 from 2007). Therefore, if you are the first doctor seen in 2008, rejoice and be glad. You get the first $135 of covered charges.

For example: Your active treatment CMT is a covered service. If your Medicare "allowed" amount is $35, have the patient pay you and enter $35 as the "amount paid" in item/box 25 on the 1500 claim form).

Alert - This annual deductible is for Medicare Part B only. Patients who have Part C (Medicare Advantage) will vary from a -0- deductible to a high deductible of $2,000 to $4,000 in the Medicare Medical Savings Accounts (MSA) option. Look at and copy your patient's Medicare card. It is not always the old Part A and B. Patients are now switching to other options, which they can do at the designated Open Enrollment times (November 15, to December 31st)

GK Modifier Update - Its new description for 2008 is "Reasonable and necessary item/service associated with -GA or -GZ." There is new CMS information on GK for Part A (hospitals), but nothing yet for Part B (doctors). Noridian is a big time contractor, but they don't even have the new description for 2008. We all just need to wait.

Bah Humbug - Tonight is our annual ChiroCode Christmas party. We are going to enjoy Dickens' Christmas Carol, via Theater-in-the-Round. Before the theater we will be dining and "dancing." For all who cannot come, here is our "dancing" by Michael, Kimberly, Brent, and myself. Click here

FREE searching for ICD9 codes - Perhaps the BIGGEST little secret of our chirocode.com website is the FREE ICD-9 searching on our home page. A call from a client today emphasized this little secret. Not every code is in the ChiroCode DeskBook, but every code is here on the web, along with its short description. He needed a code for a fracture of the Medial Condyule (elbow). We took him to the web. He typed in 812 because that is the series for "Fracture of the Humerus." Instantly, all codes in the 812 series appeared on his screen. He found his code. He was excited. I was pleased.

Save with Medicare's MSA - Free from Medicare B...Free at at last! Today, My wife Grace and I switched from Medicare's Part A and Part B to Part C (The new Medicare Advantage option for a Medical Savings Account.) It is the biggest little secret in Medicare.

At last, we can be in control of and be the real purchasers of our healthcare needs. We have signed up and will soon have total control of the first levels of care. But, if we should have a catastrophic problem, we are covered at 100%, after meeting our $4,000 deductible of covered Medicare services.

There are only two insurance companies who have contracted with Medicare for participation in this MSA program for 2008, in the Phoenix AZ where we live: Advantra Savings (Coventry) and Uni-Care Save Well (Wellpoint/BCBS). We chose Advantra because it had the highest deductible plan, which is what I recommend to others.

Here is how it works. Starting January 2008, Medicare deposits $1,570/year into a new MSA bank account for me. It is mine to spend (or not spend) from with a Debit card. I can spend it on any IRS approved healthcare expenses, even those non-covered by Medicare. My MSA eliminates the need for the old supplemental Medigap policy, which saves me about $2,750/year. That is now money I can spend with my chiropractors, rather than pouring it down some insurance premium rat-hole. The MSA deposit and my premium savings (non need for Medigap) gives me about $4,300 in discretionary spending for 2008.

I am happy - I've have not been this happy since I re-registered politically as an Independent. No more governmental interference between me and my doctors, up to my $4,000 deductible of covered expenses. We feel like shouting "Hallelujah," as Grace and I will not get any more letters from Part B Noridian or our Medigap pen pals. We look forward to less in our mail box.

My doctors will be happy - No more claims to file with Medicare. No more hassles with payment reports, appeals or spurious audits. I can pay them at my time of service. However, I will expect that all my providers to:

1. at least be registered with Medicare as a Non-Participating provider, in the event that I bump the $4,000 deductible of covered services.
2. provide me with a completed 1500 claim form for my files
3. be able to accept my MSA debit card.

Advantra Savings by Coventry is in 13 states, by county. Click here for more information about their plan go to www.advantrasavings.net/msa. For more info from Medicare go to www.medicare.gov.

Viva la Medicare MSA!

Chiropractic Technician or Doctor? I was saddened today to take a Quick Question that ended up as a 45 minute Counseling session on the basics of coding. Here was a graduate of a college just 14 months ago. He had worked for another doctor, and now decided to start his own practice. Sadly, he did not know the difference between a diagnostic code and a procedure code, or how they worked together on the claim form. He was clueless on the basics of terminology and the simplest rules for coding and billing. How did he miss that basic business class in college? He had a current ChiroCode DeskBook, but had not opened it. It seemed like I was talking to a chiropractic technician who just wanted to "adjust," and not be a doctor.

Medicare 10.1% cut - Will Congress Fix It, and When? We went to press with the 2008 ChiroCode DeskBook with a prediction that Congress would act and keep the cut from happening. Today, my good friend Bill Carns (President of Practice Max) sent me a "new bulletin from our lobbyist in Washington." The current process is outlined, with high hopes of a present under the Christmas tree for all doctors.

"Over the past few weeks, I've received several inquiries asking whether Congress will act to once again prevent a scheduled cut in physician payments under Medicare from taking effect on January 1. This is what is generally referred to as the SGR (Sustainable Growth Rate) problem. Here's the latest.

Strong bi-partisan and bi-cameral support continues to exist for preventing the scheduled 10.1% cut in physician fee schedule payments. The Bush Administration has indicated it supports Congressional intervention to prevent the cut from taking place. The votes are there to prevent the cut from taking place.

I continue to believe that Congress will enact legislation before adjourning for the year that will "fix" the SGR problem. Several policy and procedural hurdles must be crossed in order for this to happen.

The Senate Finance Committee (the Senate Committee with jurisdiction over the Medicare program) has tentatively scheduled a Committee meeting for next week to consider legislation that would eliminate the SGR cut for at least 2008 and possibly 2009 as well. It is expected that a number of other Medicare issues will also be on the agenda during this meeting. The Chairman hopes to present a package of Medicare changes to the Committee that will enjoy broad bi-partisan support in both the Committee and the full Senate. Behind the scenes work continues on just what exactly will be in that package besides the SGR fix.

Given the relatively short time between now and the end of the year, whatever Medicare package is presented will have to be something that can avoid a filibuster and move quickly. Anything passed by the Senate would still have to be reconciled with the House and that process, too, must move quickly.

As you might imagine, the Medicare fix is not the only issue Congress needs to address before the end of the year. Consequently, I expect that sometime within the next few weeks, Congress will take a number of "must pass" pieces of legislation (including some tax and appropriations bills) and put them into a single bill. Members will be presented with a single up or down vote on dozens of unrelated legislative initiatives which in turn will be presented to the President in a single package for him to sign or veto collectively.

We often refer to these types of legislative vehicles as Christmas Trees. The term comes from the fact that many different pieces of legislation get "hung" on the legislative vehicle like Christmas ornaments and we typically pass these types of bills just about the time the yuletide log is getting lit.

We should know by Christmas Eve whether physicians will find a present under their tree Christmas morning in the form of an SGR fix, or whether there will be coal in their stockings."

Zip Codes and Rejected Claims: Noridian Medicare (and perhaps other carriers too) have a new policy for the zip code on the 1500 claim form. They posted it on their site on Sept 26, 2007 (posting is termed official notification) with an October 1st implementation date. Conseqently, now claims without the ZIP code dash plus 4 digits will not pass thru the computer edits as a cleam claim. Now, all software programs that print out a 1500 paper claim will need a patch. Electonic claims programs will also need to be updated.
In the mean time, offices who have nine digits without the dash are adding the dash manually. I smile. This all underscores the reality check, that claims are processed by computers and not by people.

Medical Savings Account (MSA) – Medicare’s Biggest Little Secret It provides patients and their doctors an escape hatch from the usual Medicare Part B policies and stress. When patients opt into this program within Part C, they opt out of the traditional Part A & B programs. Patients are in control and pay from their MSA, including traditional non-covered Medicare services. It avoids billing hassles and headaches. It eliminates the need for MediGap coverage. Unused MSA funds carry-over for future expenses. Annual sign-ups end Dec 31st. Click here to view the full article.

ACOEM Guidelines ACOEM Guidelines are under a blistering attack by peers. Workers' Comp. in California and other states use the American College of Occupational and Evironmental Medicine (ACOEM) guidelines. From a chiropractic perspective, it has many flaws (as most DCs know). Significantly, it is now under attack by its peers in the International Journal of Occupational and Environmental Health. Thanks to Dr. Warren Jahn at the College on Forensic Science for this info and link.
www.ijoeh.com/pfds/IJOEH_1304_LaDou02.pdf

ChiroCode Seminar Cruise Today we signed the contract for a special seminar on a Royal Caribbean ship (to Alaska from Seattle). It will be a week long event, June 6-13th, 2008. We will post the details soon. About four others will be joining me as our ChiroCode Guest Faculty. Our focus will be on getting paid with clean claims and appeals. Even without a guest faculty, it will be a splendid event.

Phoenix Auto Show What a grand time spent with four grandsons (ages 2, 4, 6, and 8) at the annual big Phoenix Auto Show. They were impressed with TomCar (Israel's version of our Jeep for civilians), imported this year. It is rugged. It survived all four of them--under, in, around and thru (over and over). My favorite car was the new Audi R8 Roadster; the most beautiful car for 2008.

Have Joy in Thanksgiving This Week Here is what Washington said about it....lest we forget.

National Thanksgiving Proclamation, from George Washington, 1789. “Whereas it is the duty of all nations to acknowledge the providence of Almighty God, to obey His will, to be grateful for His benefits, and humbly implore His protection and favor… that we may then unite in most humbly offering our prayers and supplications to the great Lord and Ruler of Nations, and beseech Him to pardon our national and other transgressions…to protect and guide all sovereigns and nations, and bless them with good governments, peace and concord... and generally to grant unto all mankind such a degree of temporal prosperity as He alone knows to be best.”

Have a great holiday and joy in the peace of our Creator, D H Leavitt

Off to the Press The 2008 ChiroCode DeskBook is now at the printer, and it looks like it could be mailed out by the end of December. It is promised for January, so all should go well.

If Doctors Would Only Read Their ChiroCode DeskBook “I could probably retire if our subscribers and doctors would only read their ChiroCode DeskBook.” Such was my sigh and lament today as I got off the phone with one of our good doctors. It is so very hard sometimes to change habits or to get people to read instructions.

These are my basic three rules for ICD-9 coding:

1. Never code from the alphabetic list only
2. Never code from the alphabetic list only
3. Never code from the alphabetic list only

Hopefully, I might now have your attention.  Here are the real rules or “General Coding Guidelines” from the official HHS Guidelines for ICD-9-CM Coding, Section 1, B. They were first published in 2005, and are reprinted in your annual ChiroCode DeskBook. Their first three rules are:

1. "Use both Alphabetic Index and Tabular List. Use both the Alphabetic Index and the Tabular List when locating and assigning a code. Reliance on only the Alphabetic List leads to errors in code assignment and less specificity in code selection."
2. "Locate each term in the Alphabetic Index. Locate each term in the Alphabetic Index and be guided by instructional notations that appear in both the Alphabetic Index and Tabular List."
3. "Level of Detail in Coding – Diagnosis and procedure codes are to used at their highest number of digits available. ….(i.e. 3rd, 4th or 5th)"

Initially, it seemed that they made an error in printing by repeating the title heading in the first sentence of rule #1 and #2.  Now I believe it was by real intent. From a psychological perspective, repetition brings conviction.

It is my plea to all who do coding to follow these first three steps. In my phone call today, my good doctor was searching through all the codes in Alphabetic Indexes only. He became frustrated. He had totally ignored the Tabular (numeric) List. It was not in his searching habit. As we went to the numeric List together, he found the correct code.  Hopefully, he also discovered that it is essential to use both the Index and the List. Only by using both can one “be guided by instructional notations.” Now that he has discovered a new truth, perhaps he can start using both as a new habit!

Then I am a step closer to retirement.   

Encyclopedia and Google During a Berky family dinner table discussion, the word "encyclopedia" came up in conversation. My 8 year old grandson James, who is a book worm, asked, "encyclopedia? what's that?" His mother LaReita explained to James that encyclopedia is a book where you could find information about a subject - before there was Google. James said, "Oh! I get it!"

What a different world we and our grandchildren live in today! What if she tried to explain "card catalogs" sometime? James would think that would be so strange!

Insurance Fair Conduct Act Congratulations to the citizens in the state of Washington who pay insurance premiums. They voted to retain their "Insurance Fair Conduct" Act. They have known from experience who their real enemies are--enemies who spend $11 million to get ride of the new law. That is a lot of money wasted to preserve their payer tactics of delays, denials and defending claims. All they really should have been doing is simply PAY the clean claims promptly.

According to the Wall Street Journal earlier this year, the national estimate for Denial Management being spent by the insurance industry (the payers) was at 11 BILLION. Interestingly, the funds payers spent on this event was as 11 MILLION (assuming the stats are somewhat correct). I wonder if this 11 million is a part of the 11 billion, or just more of  precious consumer insurance premium dollars being poured down a rat-hole?

My good friend Dr Tom Klapp says that is really not about money, but how much money.  It appears that the new law functionally denied the fat-cats of financial fun with fantastic float.

Also, from an accounting perspective (I'm an ole bank auditor), in the past when dollars were received from us premium payers by insurance companies, they were placed on the accounting ledger as PREMIUMS received. However, they have now been reclassified it as INCOME. No longer are they holding our premium dollars for us to use in a "pool." That is the past history, and it is an illusion that too many premium payers still suffer from, in today's world.

In essence, our problems as consumers commenced when those whom we trusted with our money (gold) commenced treating our gold as their gold. Consequently, the old law of the "Golden Rule" became polluted and tarnished. Because they perceive it as their gold, they are making their rules. Hence, the humanist's view of the Golden Rule: "Those who have the Gold, make the Rules."

Perhaps the time has come for a renewal for consumer driven Co-ops or Mutuals.

Herein, we consumers can keep our gold, and make (or help make) our own rules.

Viva la Customer Driven health care!

Click here to read the bill.

Click here to see who wasted 11 million of consumer dollars.  Click here to see that the fuss was all about,
http://www.leg.wa.gov/pub/billinfo/2007-08/Pdf/Bills/Session%20Law%202007/5726-S.SL.pdf

Fax Is Great: Information overload is a burden to many, including me. If folks really want to get thru to me (without filters and screens) they should send me a fax, rather than email. Candidly, one luxury in my life is a personal fax line (602-944-3337). It come right to my desk.

Revised Medicare Modifiers Good news. Medicare is now going to follow its own rules...with supporting codes. It is about time. Perhaps nothing made me happier than to see the revisions for two HCPCS modifiers: -GK and -GY for the CMT codes.

-GY is now defined as: "Item or service statutorily excluded, does not meet the definition of an Medicare benefit or, for non-Medicare insurers, is not a contract benefit". (This is much better wording).

-GK is now defined as: "Reasonable and necessary item/service associated with -GA or GZ modifier." Hallelujah! Now, when -GK is also appended with the -GA or -GZ, it sends a clear notice to the payers that the service is still clinically necessary and owed by the patient. The modifier -GA is for much more than just Maintenance care. Now the updated modifier -GK can help solve a big problem of many carriers who had processed all -GA services as only non-Maintenance care. As doctors and carriers use these new modifier codes, confusion can be avoided. Updated beneficiary statements can now clarify to the patient their proper financial responsibility.

2008 Medicare Fees Medicare Fees for 2008 are scheduled to go down $3.83 for each adjusted RVU valued at 1.0. The new Fee schedule released by CMS (calculated in accordance with Congressional instructions) will be less for 2008, due to "budget neutrality" and the "work factor" adjustments.

Additionally, the RVU for 98940 is down .01, the 98941 is down .01, and 98942 is down .01. The 2008 national dollar conversion factor for all RVUs after their adjustments for the geographic practice cost index (GPCI) and the work factor is $34.0682. In 2007 it was $37.8975. That is $3.83 less for each procedure with an adjusted RVU of 1.0. Translation to chiropractic: If the local adjusted RVU for 98940 is the same as the national UN-adjusted RVU, the new fee would be $23.14. Here is a typical formula and calculation: RVU of .68 x $34.0682 = $23.14.

We support and encourage all political processes to commence a correction. Congress needs to hear from all doctors, loud and clear. Absolutely.

Daylight Savings Time Here in Arizona, we have opted out of our nation's Daylight Savings games. Dr. Baker in Tucson says, "We have so much daylight, that we don't have to save it." We are MST all year long. Now the rest of the Mountain states can be with us for about five months, and we can be hour closer to Central and Eastern time zones.

2008 Revisions to Payment Policies under the Physician Fee Schedule, by CMS I confess that I love reading this publication. I just reviewed this proposed document by CMS (going into print in the Federal Register on Nov 27) with many of the final CMS Medicare Fee Schedule regulations. That means that they are taking the 1,481 pages that I read (double spaced in 12 point type) and condensing to only about 600 printed pages in fine print. There were three sections that popped out at me:

1. Diagnostic X-rays for detecting a subluxation by an MD/DO comes to an end. Yep, it's over. It's now dead. Page 601 starts the discussion and proclaims the final rule. No longer can a patient get Medicare to pay for their x-ray to detect a subluxation by going to an MD/DO. It is an interesting rationale. The bottom line is shifting more $$ costs to the patient and saving Medicare money.
2. The Chiropractic Demonstration Project that end March 2007 was discussed (page 593). The data impact analysis and report by CMS will be given to Congress in 2009. They declared that they will follow the law to determine if an "aggregate" in dollars spent did not "exceed the amount that would have been paid...if...not implemented." The law gave no methodology to determine the impact, and so they are going to use their own (that has me concerned). If the dollars spent went beyond "budget neutrality," then dollars will be taken back from 98940-98942 codes in 2010 & 2011. I pray for professional people in this process. I also pray that none will be like the drunkard, who only uses a lamp post at night to support his position, rather than for illumination.
3. Medical Nutrition Therapy (MNT) coverage was clarified for a "registered dietitian or nutritional professional...when referred...by the treating physician," but with some exceptions for "face-to-face assessments and interventions in accordance with nationally-accept protocols." Well, that sure seems to rule-out any innovations. I'm sure glad to not be in that loop, or I might be dead by now. There are MNT codes for these folks who are not physicians. Doctors typically use their own E/M counseling codes anyway.

2008 HCPCS Codes At last, the new 2008 HCPCS codes arrived last night via the internet. I just finished reviewing them all, and excerpting those for our 2008 ChiroCode DeskBook. My eyes are tired. My head is spinning. There are about 300 new codes. Excerpts that are chiro-appropriate are being taken from three categories: supplies, services, and documentation. Here is an initial overview:

New Supply codes are for adhesive bandages (finally), cervical collar with inflatable air bladder, foot pressure off-loading support device, orthoses for finger/hand/wrist, etc.

New Service codes are for: computerized hand held electrodiagnostic testing, alcohol and substance abuse testing/counseling, DXA studies, etc.

New Documentation codes are for entry into the electronic medical records: About 45 of the 110 new codes in this group could be chiro-appropriate for our book (e.g. Neurological exams, lower extremities, footwear evaluation, body mass index, pain assessment, treatment plans, blood pressure,.etc.). Probably these are for the new pay for performance bonuses, detailing what is in the chart in support of quality E/M services. Demonstrating that my doctors have jumped through all the hoops and hurdles.

I will send these to our ChiroCode advisory committee for review, and then to Brent for publishing in the 2008 ChiroCode DeskBook.

Computer Problems Solved Thanks be to God for experienced experts! After months of frustrations with routers for our computers, our angel (geek & guru) Craig Wason arrived. Our problems were not in hardware, but in software instructions and hand-shaking. We also learned about new terrorist virus programs that will harass us all. I have grave concerns about security and privacy for the future of internet services. I hope that all of our clients, subscribers and friends will have minimal problems and become prepared to cope well with our changing world.

Workers' Comp. Question doctor called us regarding a Workers' Comp. claim question in his state. We gave him the "Directory" for subscribers with the contact information for his Workers' Comp. We recommended getting their specific information and policy on the matter at hand. He called them, but they recommended that he speak to the ChiroCode Institute. Then as a courtesy, they transferred his call to us. So now we are the authority for that state. Wow, what a responsibility!

Big Pharma Here is a most delightful ranting and railing on big Pharma by Bill Maher. It's Guaranteed to make you laugh and smile.  Every health advocate ought to see.       http://youtube.com/watch?v=rHXXTCc-IVg

First Impressions "You never get a second chance to make a first impression", is a grand truth we taught in seminars for receptionists. Kim Klapp's email today reported about her sad experience in an optical shop as a client.  Those who attended to her needs violated about every rule in the book of Common Courtesy.  Conversely, it is our hope and goal that all who call our office with an order or question, feel that they are special and appreciated.  Every CA ought to listen to her teleclass someday.

Fall Has Arrived in Phoenix It now seems like heaven. The 2007 summer record breaking heat wave is over. We had over 100 days of 110 degrees or more. We can go outside and breath the cool air. Cold water from the tap is now less than 80 degrees. And we can't fry eggs on the sidewalks anymore this year.

It Did Happen Another myth is now false. I attended the annual 2007 ACCC meeting and learned from Mike Miscoe that the old phrase "If it is not documented, it did not happen," is not really true anymore. In a court room, a patient and the doctor both testified that the services in dispute with a payer were actually given. Such a testimony of truth was good enough for the judge, and ruled that "it did happen." Consequently, that old phrase must be updated to: "If it is not documented, PERHAPS it did not happen." Conclusion: save stress, court time and legal fees, and document anyway. Call us if needed.

Free Resources We have moved some of the free resources from this column to FREE Resources where they properly belong (e.g. Medicare Fees by state for their Allowed Amounts and Limiting Charges).