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ICD-10 Compliance Step 2


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ICD-10 Compliance Step 1


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Announcing the NYS WCB BPR Roadshows!

In lieu of holding Summer District Dialogue sessions, the BPR team is going on the road to update interested stakeholders on the status of the BPR project. Roadshow sessions will be held in each District Office beginning in mid-June and ending the first week of July.

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ACA Efforts Result in Federal Agency's Clarification of PPACA Language on Access to Non-MD/DO Providers


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Position Paper: Workers’ Compensation/ No-fault Fee Schedule Proposed Update

On May 4, in a report issued by the New York State Assembly Labor and Insurance Committees regarding the proposed Workers Compensation fee schedule changes, the Assembly Majority clearly recommended that the new fee schedule not be adopted, as requested by both NYSCA and the Council. In support of their decision to oppose the new fee schedule, the report included specific references to testimony jointly offered by the NYSCA and the Council, who testified at a hearing in the fall, along with other specialty groups. The summary of our joint testimony is on pages 16-17 of the report.  Both Jason Brown, DC, of the NYSCA and Bryan Ludwig, DC, of the Council and testified and raised numerous concerns about the new fee schedule, in particular its proposed linkage to the Medicare fee schedule. The report also specifically cited the testimony of Dr. Brown, detailing many of his concerns and objections. Here is a link to the full report: This is very good news for the profession!

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Senate Clears Legislation to Prevent Medicare Payment Cuts

Chiropractic documentation education, new quality-reporting incentives included in measure

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Attention Medicare Providers: Update on the 2015 Medicare Physician Fee Schedule Provisions that Expired on April 1

On April 1, 2015, the Medicare Physician Fee Schedule (MPFS) was updated using the Sustainable Growth Rate (SGR) methodology as required by current law. The SGR methodology required a 21% decrease in all MPFS payments beginning April 1, 2015. The Centers for Medicare & Medicaid Services (CMS) took steps to limit the impact on Medicare providers and beneficiaries by holding claims paid under the MPFS with dates of service on and after April 1, 2015. In the absence of additional legislation to avert the negative update, CMS must update payment systems to comply with the law, and implement the negative update.

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Update on the Status of Medicare Provisions Expiring on April 1

The negative 21% payment rate adjustment under current law for the Medicare Physician Fee Schedule is scheduled to take effect on April 1, 2015.  CMS is taking steps to limit the impact on Medicare providers and beneficiaries by holding claims for a short period of time beginning on April 1st.  Holding claims for a short period of time allows CMS to implement any subsequent Congressional action while minimizing claims reprocessing and disruption of physician cash flow in the event of legislation addressing the 21% payment reduction.  Under current law, electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt. As we stated in our recent email to physicians, CMS will provide more information about next steps by April 11, 2015.

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Congress Fails to Pass Legislation to Prevent Medicare Payment Cuts

CMS to hold claims until April to avert reimbursement cuts

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Service-Specific Prepayment Review Results For CPT Codes 98940 & 98941 For September-December 2014

Providers in Connecticut (98941), Queens, NY (98940), Downstate NY (98941) and Upstate NY (98941)

National Government Services’ Medical Review Department is currently conducting a prepayment review on JK Part B chiropractic services in the states of CT and NY. This article includes the results of these reviews for September, October, November and December 2014.

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WCB Chair Announces Board Adoption of ICD-10 Timetable to be Consistent with Medicare and Medicaid


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BREAKING: CMS bends on reporting periods for meaningful use

The CMS just blinked in the ongoing cold war between providers and the agency over meaningful-use requirements for electronic health-record systems.

The CMS announced Thursday that it is considering proposals to shorten the meaningful-use reporting period to 90 days in 2015, something providers and others have been requesting. 

Shortening the period essentially means providers can meet the meaningful-use requirements and avoid financial penalties with software in place for less time than is currently required.

The College of Healthcare Information Management Executives, a key advocate for changes in the reporting period, was positive about the announcement. “It is indeed” what the organization was looking for, said Jeff Smith, the organization's vice president of public policy. 

In a separate statement, Russ Branzell, CHIME's president and CEO, said, “Meaningful use has the potential to be a transformative program for the nation's healthcare delivery system and we commend CMS for recognizing the need for a course-correction.”

The Medical Group Management Association and the American Medical Association praised the CMS for agreeing to modify the window, and they urged the agency to issue the new rule quickly. The MGMA noted that the number of physicians who have attested to meeting the program's Stage 2 requirements dropped sharply from the number who cleared the first bar.The AMA, meanwhile, also took a broader swipe at the program, saying that it fails to "help physicians improve care for their patients." 

The CMS also is considering changing reporting periods to the calendar year to “allow eligible hospitals more time to incorporate 2014 Edition software into their workflows and to better align with other CMS quality programs,” and will “modify other aspects of the program” that may lessen providers' reporting burdens. 

The CMS clarified that the rulemaking on reporting period flexibility will be separate from the upcoming third-stage meaningful-use rule, which may be released in March. 

The changes may mollify calls from providers and legislators to change reporting periods. Rep. Renee Ellmers (R-N.C.) and 29 fellow House Republicans had sent a letter to Sylvia Matthews Burwell grousing about the reporting periods in the program. Bipartisan legislation also had been introduced by Ellmers and then-Rep. Jim Matheson (D-Utah) to change the reporting periods. 

Follow Darius Tahir on Twitter: @dariustahir

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Instructions on how to access the 2015 Medicare Fee Schedule

Please review these instructions for how to access the 2015 Medicare Physician Fee Schedule (MPFS)

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Medicare: 2015 PQRS and Fee Schedule

The Patient Protection and Affordable Care Act (PPACA) mandated that non-participation or unsuccessful/unsatisfactory reporting in Medicare’s Physician Quality Reporting System (PQRS), formerly referred to as PQRI, will result in negative payment adjustments to Medicare reimbursement beginning in 2015. In the 2012 Medicare Physician Fee Schedule Final Rule, the Centers for Medicare and Medicaid Services (CMS) ruled that providers who did not successfully/satisfactorily participate in PQRS by the 2013 reporting period will have their Medicare reimbursement decreased by 1.5 percent beginning on January 1, 2015. Non-participation or unsuccessful/ unsatisfactory reporting during the 2014 performance period will result in a 2% reduction in a provider's 2016 Medicare reimbursement, and further non-participation or unsuccessful/unsatisfactory reporting this year (Jan. 1 -  Dec. 31, 2015) will affect a provider's 2017 Medicare reimbursement by applying a payment reduction of 2%.

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Revalidation of Chiropractic Provider Enrollment in the State Medicaid Program


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Medicare 2015 Physician Fee Schedule

The 2015 Medicare fee schedule has not yet been finalized. Once it is finalized, there will be a number of different fee schedules depending on your practice’s location, PQRS participation, and EHR/Meaningful Use participation. We will keep you informed as updates become available.

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Medicare Update December 2014

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
  • 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.


Non-Acute Pain MTGs and Revised MTGs Became Effective December 15, 2014

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


Optum Physical Health announces the STarT Back Screening Tool

As referenced in the 2014 third quarter Optum newsletter, effective in the fourth quarter of 2014, Optum Physical Health (OptumTM) 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.


ACA Releases 2nd Edition ICD-10 Toolkit Featuring Updated Resources

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 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