Seattle, WA, USA – Washington State chiropractor, Dr Tom Necela, is the first chiropractor to have completed the course of study leading to Certified Medical Professional Auditor status as offered by the National Alliance for Medical Auditing Specialists (NAMAS) according to program coordinator Donna Hurley.
A former Insurance Claims Analyst and Certified Professional Coder, Necela obtained the certification to further his mission of teaching his fellow colleagues how to protect themselves against insurance audits. Although the audit frenzy is widespread in all healthcare arenas, thanks in part to “hired guns” like Medicare’s Recovery Audit Contractors, who review chart records and are given a percentage of all repayments they can demand for improperly paid claims, the potential to devastate smaller physician offices is huge.
Among the hardest hit are chiropractors who have a deadly combination of a high claims error rate and a relatively small checkbook to foot legal bills for their defense. Some are worried that the current wave of audits that is sweeping healthcare may provide the “perfect storm” to sink the chiropractic profession entirely.
NAMAS had the foresight to recognize the demand for medical chart education and in 2007, NAMAS became the first organization to understand and create a national medical chart auditing credential based upon this need.
With EMR adaptation on the rise and Medicare rolling out of RAC contractors/
Although many of the attendees of the CPMA classes utilize their training to work for insurance companies and large healthcare organizations, Necela admits that he has no intention of taking this route. Instead, his goal for the certification was to obtain “insider” knowledge of what the auditors are looking for so that he could then go back and teach his fellow chiropractors how to best prepare for the upcoming wave of audits.
“When most chiropractors started in practice a decade or more ago” Necela admits, “requests for documentation, reports or additional chart notes were rare. Unfortunately, now you are not just at risk for your claim being denied due to improper or incomplete information. It’s much worse. The insurance company pays you, giving you a false belief that everything is fine, and then comes knocking on your door years later to conduct a post-payment audit and demand their money back.”
While tactics like this may sound unfair or look like foul play, many healthcare entities are now being subject to such investigations. For Dr. Tom Necela and his consulting firm, The Strategic Chiropractor, educating physicians on how to properly document their services in a defensible manner helps reduce this risk. “And the bonus” Necela adds, “is that during this process of helping chiropractors protect their hard earned income, we can usually assist them in getting paid better for what they do as well.”
