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Pi fax & email alert
PI FAX & Email ALERT
BY SHAWN STEEL, CHIROPRACTIC ATTORNEY
Telephone: 800-626-0003 / 310-697-9000
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
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
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
$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?
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
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