PI FAX & Email ALERT 7/10/2007 BY SHAWN STEEL, CHIROPRACTIC ATTORNEY Telephone: 800-626-0003 / 310-697-9000 Website: Fax: 310-697-9010 Reducing Insurance Audits : Part 1 Bad Drug Alert: Avandia, diabetic drug vs. cardiac safety. According to Gary Lewkovich DC, insurance fraud investigations are growing expodentially. GlaxoSmithKline are charged with distorting We suspect that many of the “investigations” risk analysis. Avandia was designed to lower are “shakedowns” from dishonorable blood glucose levels in patients suffering from insurance carriers trying to “cow” honest Type 2 diabetes. The increase in cardiac doctors. problems after eight years and seven million patients later, scientists still don’t know if Audits are intimidating & time consuming. Avandia is safe or effective. Many doctors would rather “settle” than submit to the audit. Dr. John Buse, president elect of the American Diabetes Association warned back Lewkovich warns of the following red flags to in 1999 of possible cardiac danger. minimize your audit risk: Given that many of your patients are older OBVIOUS RED FLAGS and taking multiple prescriptions, it might be a good idea to see who is taking Avandia 1. Billing for serves never received 2. Billing for cervical x-rays exams when Pasadena DC wins big vs. St Farm a full-spine x-ray was performed 3. Bill with wrong diagnostic codes 4. Routinely billing for more than 3 Dr. Jo Ann Dorothy DC showed St Farm a procedures on most patients. thing or two. Her patient Richard Jimenez, 5. Billing for unusual or unapproved was struck by defendant making an unsafe modalities. left turn. Jimenez struck his right knee on the gearshift with enough force to break its Contact for the molding. His combined medical bills were complete article. $4923, including an orthopedist evaluation. ************************************* St Farm did not offer any money.
Nuggets from Sam Collins, Billing Expert The jury did, by awarding $62,000. The jury believed that Jimenez might require future CPT Code Update? knee replacement costing $50,000. Q: Is it appropriate to use codes 97110-97124 Jimenez vs. Case GC 028 466, Pasadena in addition to manipulation [CMT] when Judge Joseph DeVanon. performed to the same anatomic site? Practice Tip For unusual injuries, an ortho evaluation can A: According to the AMA via the CPT significantly raise value in PI cases. Assistant “ 97110-97124 represent distinctly =============================== separate and unrelated procedures not considered inclusive of the CMT described by Next PI Teleconference date is on: codes 98940-98943. “
Wednesday, August 8 at 1:00 pm For more information contact Sam Collins at E-mail to get your reservation.
Once again, the Nunawading Unit will be hosting Bush Nav Day 2011. Again this year it will be a 6 hour event, aimed at SES personnel looking for a bush navigation challenge. There will be teams participating using traditional compass skills, as well as teams who wish to use their GPS. The event follows Rogaine principles, however checkpoints will require various activities to be undertaken,
PIEDMONT COMMUNITY SERVICES Assessment / Social History Identifying Information Presenting Problem, Onset and History of ProblemInformation pertaining to this assessment was gathered from the mother, client, and chart. Client is referred to IIH from case management due to demonstrating disrespectful behaviors towards peers and adults. The mother reports that client is exhibiting aggr