Insurance News:

NYS WCB Announces Public Comment Period for Revised Medical Fee Schedule

by NYSCA Insurance Committee | 10/5/2018 9:28:54 AM

Please be aware that after initial public comment period, the Workers Compensation Board (WCB) has produced a revised proposed fee schedule. There are comments available for review on the State Register and the fee schedule is available for review on the WCB website.

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Insurance News:

Clarification Regarding Proposed Medical Fee Schedule

by NYS WCB | 10/1/2018 2:10:03 PM

Having reviewed public comments on the proposed medical fee schedule released in June, the New York State Workers' Compensation Board will be issuing a revised draft of the schedule on October 3, which will be followed by a 30-day public comment period.

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Insurance News:

Workers' Compensation Fee Schedule Update

by NYSCA Officers & WC Committee | 9/29/2018 10:10:30 PM

As you may recall, the NYS WCB proposed a much needed update to the fee schedule.

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Insurance News:

Further Updates on Aetna/NIA Prior Authorization Program

by NYSCA Insurance Committee | 9/25/2018 2:13:49 PM

Members of the NYSCA insurance committee met with Aetna and NIA to discuss the implementation of the new Pre-Authorization Program which went into effect on 09/01/18. There has been some confusion regarding different aspects of the program, resulting in our reaching out to Aetna to discuss your concerns.

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Insurance News:

Important Updates to ICD-10

by NYSCA Insurance Committee | 9/25/2018 1:26:43 PM

As of October 1, 2018 the following ICD-10 changes will go into effect.

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Insurance News:

Providers Invited to Webinar for Updated Aetna Physical Medicine Program

by NYSCA Insurance Committee | 9/17/2018 9:23:48 AM

Aetna will soon partner with National Imaging Associates, Inc. (NIA) to authorize physical therapy, occupational therapy and chiropractic services. The program is for commercial fully insured and Medicare plans. It begins September 1, 2018.  An Educational Webinar has been scheduled by Aetna for Wednesday, September 19, 2018 8:00 a.m. EST

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Insurance News:

Update on Claims Processing for the Aetna/NIA Prior Authorization Program

by NYSCA Insurance Committee | 9/17/2018 9:14:38 AM

Please note the following update relative to Aetna's new Prior Authorization Program which went into effect 9/1/18.


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Insurance News:

New TPAs for Workers' Compensation, Volunteer Firefighter, and Volunteer Ambulance Claims

by New York State Workers' Compensation Board | 9/17/2018 9:11:15 AM

As of September 10, 2018, the Special Funds Conservation Committee (SFCC) will no longer be administering workers’ compensation, volunteer firefighter, and volunteer ambulance worker claims. These claims are being transferred to new third-party administrators (TPAs), who will assume all claims administration services.

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Insurance News:

WC Update: Special Funds Closes Down

by NYSCA Insurance Committee | 9/14/2018 10:49:02 AM

As of 09/07/2018 Special Funds Conservation Committee has officially closed down operation. 

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Insurance News:

Changes to Aetna Program Effective 09/01/18

by NYSCA Insurance Committee | 8/27/2018 5:09:03 PM

Do you treat Aetna patients?  Are you aware that Aetna is changing their physical medicine program effective 9/1/18? The NYSCA has received numerous calls from our members regarding Aetna's change in their physical medicine program.  This change is significant and will impact your practice.

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Insurance News:

The NYSCA and Council Submit Comments on the Proposed NYS Workers' Comp Fee Schedule

by NYSCA Workers' Compensation Committee | 8/21/2018 10:15:29 AM

Comments from the NYSCA and Council, as well as from the ACA, were submitted to the New York State Workers' Compensation Board on August 6, 2018.

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Insurance News:

The NYSCA Co-Signs ACA Response to UHC Headache Policy

by American Chiropractic Association | 7/24/2018 2:37:51 PM

The American Chiropractic Association (ACA), supported by chiropractic organizations across the country, strongly opposes a new policy by UnitedHealthcare (UHC) that denies headache sufferers the option to treat their pain without drugs using spinal manipulative therapy (SMT).

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Insurance News:

The NYS WCB Announces Public Comment Period for Proposed Medical Fee Schedule

by NYSCA Workers' Compensation Committee | 6/7/2018 3:56:47 PM

The New York State Workers' Compensation Board (Board) has published  proposed changes to the Medical Fee Schedule in the June 6, 2018, State Register, and the Board will accept comments from the public for 60 days.

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Insurance News:

Proposals to Improve Medical Care for Injured Workers

by New York State Workers' Compensation Board | 4/20/2018 1:28:51 PM

To increase provider participation in the workers' compensation system and improve injured workers' access to timely, quality medical care, the Workers' Compensation Board (Board) is proposing an increase to provider fees and adoption of the universal CMS-1500 form to reduce administrative burden, among other measures.

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Insurance News:

Revised WC Medical Authorization Request Forms

by NYSCA Workers' Compensation Committee | 4/9/2018 8:28:06 AM

Please note that the WCB has updated a few common forms including the MG-2 and MG-2.1. They have been revised to include a place for providers to include their National Provider Information (NPI) number. The forms also expand the certification area by adding a space for more than one fax number or email address. 

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Insurance News:

Urgent: New CMS Billing Rules Effective 01/01/2018

by NYSCA Insurance Committee | 1/11/2018 10:45:18 AM

CMS has implemented a new rule to requires doctors of chiropractic to add a 2nd modifier when billing Medicare for non-covered physical medicine services.

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Insurance News:

MIPS - To Participate or Not Participate: That is the Question

by Wyn Staheli | ChiroCode | 1/10/2018 1:33:34 PM

Medicare’s Merit-based Incentive Payment System (MIPS) Final Rule increased the threshold for participation. With this increase, a significant number of providers fall into the exempt category and they are now breathing a sigh of relief. However, there’s one hidden tidbit which you may have missed...

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Insurance News:

2018 Permanent Impairment Guidelines for Schedule Loss of Use Evaluations

by NYSCA Insurance Committee | 1/5/2018 4:10:31 PM

The Workers’ Compensation Board has finalized the new Schedule Loss of Use Impairment Guidelines. Find out how this does (and does NOT) affect your practice.

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Insurance News:

Chiropractic Treatment Visit Note Standards

by Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP | 12/21/2017 10:34:14 AM

As we at ChiroCode worked to find an example of the perfect daily treatment visit note, we came across many authoritative sources. For your convenience, we have included them here. 

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Insurance News:

NYS WCB Chair Proposes Revised Impairment Guidelines

by New York State Workers' Compensation Board | 11/28/2017 10:16:12 AM

The NYS WCB Chair has proposed the addition of Impairment Guidelines to Title 12 of the NY Codes Rules & Regulations.

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Insurance News:

Deadline Approaching for Required Registration with WCB

by NYSCA Workers' Compensation Committee | 11/28/2017 9:16:08 AM

The Workers’ Compensation Board (Board) has initiated a registration process to update and maintain a current list of medical providers who are authorized to treat injured workers. Authorized providers are asked to register with the Board and update their office address(es) and contact information by December 29, 2017.


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Insurance News:

Quality Payment Program Year 2

by NY Medicare CAC Rep | 11/13/2017 10:21:14 AM

CMS has issued the final rule and comment period for the 2018 (year 2) Quality Payment Program.

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Insurance News:

New Health Care Provider Registration Coming Soon

by New York State Workers' Compensation Board | 11/8/2017 2:00:05 PM

The Workers’ Compensation Board (Board) has initiated a registration process to update and maintain a current list of medical providers who are authorized to treat injured workers. Authorized providers are asked to register with the Board and update their office address(es) and contact information by December 29, 2017. 

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Insurance News:

CMS Reveals New Medicare Card Design

by Centers for Medicare & Medicaid Services (CMS) | 9/26/2017 8:15:11 AM

Today, the Centers for Medicare & Medicaid Services (CMS) gave the public its first look at the newly designed Medicare card. The new Medicare card contains a unique, randomly-assigned number that replaces the current Social Security-based number.

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Insurance News:

Chair Proposes New Permanent Impairment Guidelines

by New York State Workers' Compensation Board | 9/7/2017 9:40:29 AM

In April 2017, Governor Cuomo signed into law the 2017-2018 Executive Budget, which contained several significant pieces of workers’ compensation reform. Included in the reforms was a requirement that new Permanency Impairment Guidelines be adopted by January 1, 2018.

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Insurance News:

New Medicare Cards with New Numbers: 3 Changes You May Need to Make

by Centers for Medicare & Medicaid Services (CMS) | 7/14/2017 1:03:19 PM

The Medicare Access and CHIP Reauthorization Act of 2015 requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. You may need to change your systems.

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Insurance News:

Compliance with Medicare Documentation Continues-CMS

by reprint from CMS- Dr Piering posted | 7/6/2017 1:00:49 PM

CMS continues to deny many chiropractic claims because they do not meet Medicare requirements. During the 2015 reporting period, the Medicare FFS improper payment rate for chiropractic services was 51.7 percent.

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Insurance News:

5 Ways for Healthcare Providers to Get Ready for New Medicare Cards

by Centers for Medicare & Medicaid Services (CMS) | 6/19/2017 12:10:31 PM

Medicare is taking steps to remove Social Security numbers from Medicare cards. Through this initiative the Centers for Medicare & Medicaid Services (CMS) will prevent fraud, fight identity theft and protect essential program funding and the private healthcare and financial information of our Medicare beneficiaries.  

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Insurance News:

Medicare Update: Revised ABN Effective Date 6/21/2017

by NGS Medicare | 6/2/2017 2:57:47 PM

The Advance Beneficiary Notice of Noncoverage (ABN), Form CMS-R-131, is issued by providers (including independent laboratories, home health agencies, and hospices), physicians, practitioners, and suppliers to Original Medicare (fee for service) beneficiaries in situations where Medicare payment is expected to be denied.

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Insurance News:

Legislative Update - Budget Worker's Compensation Reform

by NYSCA Legislative Committee | 4/17/2017 10:47:14 AM

The final NYS budget passed both houses late last Sunday night. Despite no significant workers’ compensation reforms being included in the original proposed budget bills, there were many last minute negotiations regarding worker’s compensation reform that we followed closely. 

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Insurance News:

2017 MAC Satisfaction Indicator (MSI) - JK Now Available!!

by CMS.gov | 4/17/2017 10:45:36 AM

CMS is once again conducting their annual survey of Medicare Administrative Contractors (MAC) performance and requesting feedback from the provider community we serve through the MAC Satisfaction Indicator (MSI).

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Insurance News:

FYI: When Will CMS Notify Clinicians about MIPS Eligibility

by CMS.gov | 3/31/2017 8:58:40 AM

The Centers for Medicare and Medicaid Services (CMS) has yet to release critical 2017 Merit-Based Incentive Payment System (MIPS) eligibility information to allow providers to determine if they fall under the low-volume threshold exemption.

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Insurance News:

Medicare: New ABN to be Used in 60 Days

by CMS.gov | 3/31/2017 8:51:43 AM

The Centers for Medicare and Medicaid Services (CMS) announced on March 28 that the Advance Beneficiary Notice of Noncoverage (ABN) Form and instructions were approved for renewal. The effective date for use of the updated ABN form is May 27.

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Insurance News:

CMS Extends Deadline for 2016 PQRS EHR Submission

by Centers for Medicare & Medicaid Services (CMS) | 2/6/2017 1:46:17 PM

CMS is extending the submission deadline until March 13, 2017 for 2016 Quality Reporting Document Architecture (QRDA) data submission for the EHR reporting mechanism.

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Insurance News:

Recoupment Audits

by Joseph Merckling, DC | 2/6/2017 9:51:08 AM

It has come to the attention of NYSCA that some members have received requests from insurance companies for over-payment recoupment audits involving claims that were processed several years ago.

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Insurance News:

Filing Paper Claims from NGS Medicare & CMS

by NYSCA Insurance Committee | 1/31/2017 12:01:50 PM

An update from the NYSCA Medicare Committee:  For those who are submitting  paper claims for treatment rendered to Medicare patients please read the following.

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Insurance News:

NY Workers' Compensation Update

by NYSCA Workers' Comp Committee | 1/23/2017 12:26:37 PM

As Governor Cuomo delivered his State of the State addresses, one of the issues again highlighted was workers compensation reform. As you know, this impacts your patients and your practice. The NYSCA, working with the NY Chiropractic Council, has recently met with the WCB to welcome its new Chair and discuss the issues facing the chiropractic patient. NYSCA's WC Committee will continue to address the issues we face.

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Insurance News:

Optum Health / UnitedHealthcare Update

by NYSCA Insurance Committee | 1/17/2017 9:59:30 AM

As some of you are aware, there are some changes coming to the Optum Health / UnitedHealthcare program which may impact your practice. The NYSCA Insurance Committee has responded to dozens of calls to assist our members in understanding these impending changes. 

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Insurance News:

Inappropriate Billing of Qualified Medicare Beneficiaries MLN Matters®

by Medicare Learning Network® Publications & Multimedia | 12/9/2016 1:18:13 PM

Federal law bars Medicare providers from charging individuals enrolled in the Qualified Medicare Beneficiary Program (QMB) for Medicare Part A and B deductibles, coinsurances, or copays.

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Insurance News:

Social Security Number Removal Initiative

by CMS.gov | 10/4/2016 8:41:28 AM

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. A new randomly generated Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number on new Medicare cards.

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Insurance News:

Social Security Number Removal Initiative

by CMS.gov | 10/4/2016 8:37:04 AM

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires CMS to remove Social Security Numbers (SSNs) from all Medicare cards by April 2019. A new randomly generated Medicare Beneficiary Identifier (MBI) will replace the SSN-based Health Insurance Claim Number on new Medicare cards.

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Insurance News:

ICD10 Coding Update

by Dr. Evan Gwilliam and Chiro-Code | 10/2/2016 10:46:42 PM

There are thousands of code changes going into effect on October 1.  Here is a list of the 70 or so that are most relevant to chiropractors.

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Insurance News:

ICD-10 Updates Coming Oct. 1

by American Chiropractic Association | 9/2/2016 7:57:14 AM

Doctors of chiropractic should be aware that there are some significant updates regarding ICD-10 that go into effect Oct. 1 due to the partial code freeze being lifted.

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Insurance News:

Medicare Update: Comprehensive Error Rate Testing Chiropractic Services

by | 9/2/2016 7:35:28 AM

The CERT program’s review of claims for chiropractic services has consistently yielded high improper payment rates. Please read the attached article on current Medicare documentation requirements

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Insurance News:

Educational Resources to Assist Chiropractors with Medicare Billing

by Center for Medicare and Medicaid Services | 6/22/2016 6:48:45 PM

This Special Edition (SE) MLN Matters® article is intended for Chiropractors submitting claims to Medicare Administrative Contractors (MACs) for chiropractic services provided to Medicare beneficiaries. CMS is providing this article in order to provide education for chiropractic billers on accessing the correct resources for proper billing. This article is intended to be a comprehensive resource for chiropractic documentation and billing.

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Insurance News:

NYS Workers Compensation BPR project and Medical Portal update

by NYSCA Workers' Compensation Committee | 6/7/2016 9:37:36 PM

The NYSCA WC Committee attended the first informational meeting of the second phase of the WC Business Process Re-engineering (BPR) project. In an effort to reach out to stakeholders, the WCB will be traveling with this presentation throughout the state. Interested parties are encouraged to attend and provide feedback.

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Insurance News:

UnitedHealth Group/Optum Health updates

by NYSCA Insurance Committee | 4/21/2016 12:32:48 PM

UnitedHealth Group / Optum has been implementing a 'per diem' capitated reimbursement methodology for many of it's health plans as it relates to chiropractic services in various states throughout the country.

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Insurance News:

Workers Comp Updates: Sedgwick and Broadspire erroneous denials

by NYSCA Workers' Compensation Committee | 4/18/2016 3:11:57 PM

The NYSCA Workers' Compensation Committee has been working with Broadspire and Sedgwick after issues were identified with inappropriate denials of Chiropractic Manipulative Therapy rendered within the recommendations of New York's Medical Treatment Guidelines.

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Insurance News:

Medicare Provision for Reimbursement of Chiropractic Manipulation Services

by CMS.gov | 4/6/2016 3:23:24 PM

NGS has reported that they have identified claims where a second manipulation service was billed and paid for a single beneficiary for the same date of services. It is important to note that chiropractic manipulation services are reimbursable only once per day.

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Insurance News:

NYS WCB Online Medical Portal Update

by NYSCA Workers' Compensation Committee | 3/28/2016 12:16:09 PM

On March 28, 2016 the NYS WCB hosted an informational webinar and feedback session regarding the web based Medical Portal they have been developing.  Continue reading for more information.

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