If you have received a letter from Medicare stating that you will have your fee reduced due to failure to certify with meaningful use through Electronic Health Records you can visit http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/paymentadj_hardship.html.

• Eligible Professional Payment Adjustment Reconsideration Instructions
• Eligible Professional Payment Adjustment Reconsideration Application

Although the categories may not fit your situation, there is a tab for other where you can explain your reason for not meeting the EHR/Meaningful use requirement. As many of us have small practices that this may pose a financial hardship for it is worth a try. The application is simple to fill out and can be emailed. This is only for those doctors who have received the payment adjustment letter for meaningful use. The deadline is February 28, 2015.

The new Non-Acute Pain Medical Treatment Guidelines (NAP MTG), as well as the revisions to the existing Medical Treatment Guidelines (MTGs), went into effect on December 15, 2014.

The Chair began the formal adoption process in June 2014, with the publication of a proposed regulation in the New York State Register. The process amends 12 NYCRR 324.2 to incorporate the Non-Acute Pain MTG as well as revisions to the third editions of the Mid and Low Back, Neck, Shoulder, and Knee MTGs and the second edition of the Carpal Tunnel Syndrome MTG. Additionally, Intrathecal Drug Delivery (Pain Pumps) have been added to the list of procedures requiring prior authorization. For your review, complete copies of the new NAP MTG, revised MTGs and the Amendment of 12 NYCRR 324.2 are available on the Board’s website.

The new NAP MTG presents a comprehensive approach to the management of patients with chronic pain, including best practice recommendations for the appropriate use of narcotics. This is a particularly important topic in light of the opioid epidemic facing the nation, including New York’s injured workers.

As was announced last month, e-learning training programs have been developed to facilitate compliance with both the new NAP MTG and revised MTGs recommendations. The training consists of medical courses that enable providers to earn CME credits, as well as courses for non-medical professionals. These programs are free and have been available on the Board’s website since November 12, 2014. In addition, the Non-Acute Pain Medical Treatment Guidelines training is available with free CME credits on MSSNY’s website. Please take advantage of the training, if you have not already done so. The Board will make an official announcement when the training is available for physical therapists and chiropractors.

If you have any questions concerning the Guidelines, please contact the Board’s Medical Director’s Office at (800) 781-2362.

Robert E. Beloten
Chair

The New York State Assembly Insurance and Labor Committees will be holding a joint hearing in late December to examine the proposed Worker’s Compensation fee schedule. As you are aware, we have been working diligently on the changes that the Worker’s Compensation Board has been promulgating since 2007, and we have met several times with the Workers’ Compensation Board specifically on the fee schedule issue. We will be presenting testimony at the hearing. We are in the process of preparing testimony for submission. In addition, we will be testifying in person, in conjunction with the New York Chiropractic Council, at this hearing.

Arlington, Va. – The American Chiropractic Association (ACA), the New York State Chiropractic Association (NYSCA), and National Government Services, Inc., the Jurisdiction K Medicare Administrative Contractor (MAC), jointly presented a special Medicare documentation seminar in Queens, N.Y. The event provided in-depth instruction on how to properly bill and document chiropractic services under the Medicare program.

Recent government reports show a need for the chiropractic profession to improve its documentation skills. A bill introduced this month in the U.S. House of Representatives calls for HHS to develop a training program for doctors of chiropractic (DCs) whose claim error rates are higher than the profession’s national average. DCs who avail themselves to ACA-sponsored programs will avoid pre-authorization requirements that non-compliant providers could eventually face.

The program presented in New York featured ACA Medicare Committee representatives Michael Jacklitch, DC, Steven Conway, DC, as well as National Government Services representatives Kathy Dunphy, Laurence Clark, MD, and Greg McKinney, MD. Organizers viewed it as a possible template for the future national education program that HHS seeks to establish.

Of particular focus during the training is how DCs should document ongoing treatments and maintenance therapy. Government reports show that a high percentage of chiropractic Medicare documentation does not meet regulatory requirements. “ACA is on record supporting quality documentation tenets, ensuring a much lower error rate with Medicare claims,” said ACA President Anthony Hamm, DC. “Proper documentation will ensure that our claims data is accurate and complete.”

“The format of this presentation allowed for an open dialogue between attendees, National Government Services leaders, and the ACA Medicare Committee to determine how processes may be improved for all concerned. NYSCA looks forward to working with the ACA and National Government Services not only to provide additional meetings but in implementing improvements,” said NYSCA past president and New York Carrier Advisory Committee representative, Mariangela Penna, DC.

Dunphy, National Government Services director of congressional affairs, added, “We appreciate the ACA’s willingness to work proactively toward improving billing practices and look forward to continuing to work with the organization and its members to reduce error rates on chiropractic claims billed to Medicare.”

ACA plans to conduct additional seminars with National Government Services in the Northeast, and is open to working with other MACs that wish to hold similar programs in other jurisdictions.

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The American Chiropractic Association (ACA), based in Arlington, VA, is the largest professional association in the United States advocating for more than 130,000 doctors of chiropractic (DCs), chiropractic assistants (CAs) and chiropractic students. ACA promotes the highest standards of ethics and patient care, contributing to the health and well-being of millions of chiropractic patients. Visit us at www.acatoday.org.

As referenced in the 2014 third quarter Optum newsletter, effective in the fourth quarter of 2014, Optum Physical Health (Optum^TM) will include reporting of the STarT Back Screening Tool (SBST) as part of the electronic clinical submissions for those providers who are required to submit.

For your information, I have attached the letter that has been sent to Optum providers detailing the inclusion of the SBST in the “Patient Completes this Section” of the electronic Patient Summary Form (PSF). The PSF incorporates a version of the SBST that should be used for most adult patients with musculoskeletal disorders.

There will be a slight delay in the deployment of this tool. The SBST will be visible to providers logging on to the portal on December 7, 2014 rather than the November 23, 2014 date noted in the letter.

If your members have questions, please direct them to Optum’s Member Provider Services (MPS) at (800) 873-4575 or their support clinician.

Arlington, Va. -- The American Chiropractic Association (ACA) has released a 2nd edition ICD-10 Toolkit to prepare doctors of chiropractic for a seamless transition to ICD-10 coding beginning Oct. 1, 2015.

Beginning Oct. 1, 2015, the ICD-9 codes currently used to describe diagnoses and treatment plans can no longer be used by HIPAA covered entities. The conversion to ICD-10 will enable U.S. health care providers to report greater specificity and clinical information. The new coding system includes updated health care terminology and provides higher quality data for processing claims and making clinical decisions. It may also enhance the ability to provide data that proves the effectiveness and positive outcomes achieved by chiropractic services.

To ensure that the chiropractic profession is prepared for and understands ICD-10, ACA has updated its online ICD-10 resources, featuring a 2nd edition ICD-10 Toolkit with a Mapping Tool that simplifies the conversion of diagnosis codes from ICD-9 to ICD-10. If you have previously purchased the Toolkit or the Mapping Tool, you will now receive both as part of this update. Check lists, printable worksheets and an introductory training webinar are available to ACA members. An intermediate training webinar will soon be available for purchase.

"ACA will work to ensure that the chiropractic profession is well-prepared for the ICD-10 transition," says ACA President Anthony Hamm, DC. "Beginning Oct. 1, 2015, all claims submitted to HIPAA covered entities will be rejected unless they contain the proper ICD-10 code. With this in mind, ACA will continue to provide the needed resources for DCs to efficiently and confidently transition to ICD-10 compliance."

ACA will provide the chiropractic profession with up-to-date information and resources in its publications and online at www.acatoday.org/ICD-10. Visit the FAQs page for more information or call the ACA at 703-276-8800.



About ACA

The American Chiropractic Association (ACA), based in Arlington, Va., is the largest professional association in the United States advocating for more than 130,000 doctors of chiropractic (DCs), chiropractic assistants (CAs) and chiropractic doctoral students. ACA promotes the highest standards of ethics and patient care, contributing to the health and well-being of millions of chiropractic patients. Visit us at www.acatoday.org.