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FYI: When Will CMS Notify Clinicians about MIPS Eligibility

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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Medicare: New ABN to be Used in 60 Days

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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CMS Extends Deadline for 2016 PQRS EHR Submission

 

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Recoupment Audits

Edited: Gerald Stevens DC, MS, MPH

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Filing Paper Claims from NGS Medicare & CMS

 

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NY Workers' Compensation Update

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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Optum Health / UnitedHealthcare Update

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. A summation of our knowledge to date, as already conveyed to many of our members, has been posted in the members only section of NYSCA.com.  

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Social Security Number Removal Initiative

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 for transactions like billing, eligibility status, and claim status.

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Social Security Number Removal Initiative

What do you need to do to get ready?

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ICD10 Coding Update

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. All of this information, and a whole lot more can be found in our brand new 2017 ICD-10 Coding for Chiropractic book. Order your ChiroCode book today and get a free cheat sheet!

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ICD-10 Updates Coming Oct. 1

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. Of particular interest to DCs is the addition of numerous injury codes (chapter 19), musculoskeletal codes (chapter 13), and clarifications on “Excludes” notes and laterality. Doctors should review the 2017 ICD-10-CM Guidelines to familiarize themselves with the changes and make sure that all ICD-10 reference material is up to date.

Medicare Update: Comprehensive Error Rate Testing Chiropractic Services

The CERT program’s review of claims for chiropractic services has consistently yielded high improper payment rates. The majority of chiropractic services claims were the result of insufficient documentation, such as:

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Educational Resources to Assist Chiropractors with Medicare Billing

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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NYS Workers Compensation BPR project and Medical Portal update

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.  You can find dates and locations using this link: http://www.wcb.ny.gov/BPR/Roadshows.jsp
The WCB has developed a Medical Portal, which is currently being tested to handle authorizations.  Likely beginning use Fall 2016.  For those who can't make the live meetings, there is a Medical Portal webinar on July 12th.
Other areas of exploration and future changes discussed were:
  • Monitoring carrier compliance and performance metrics
  • Virtual (video) hearings to improve patient ease/access
  • Improved efforts for outreach and education to stakeholders, including online videos for patients
  • How technology could be leveraged to improve communications within the system
  • Updating the WCB website
  • Creating of a voluntary ending review to expedite the appeals process
  • Ways to make the IME process more impartial
  • Exploration and encouragement of expansion of the PPO model in WC

 

UnitedHealth Group/Optum Health updates

Attention NYSCA Members,

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Workers Comp Updates: Sedgwick and Broadspire erroneous denials

As many of you are aware 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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Medicare Provision for Reimbursement of Chiropractic Manipulation Services

News and Alerts NGS Medicare

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NYS WCB Online Medical Portal Update

On March 28, 2016 the NYS WCB hosted an informational webinar and feedback session regarding the web based Medical Portal they have been developing. It was attended by the NYSCA WC Committee. As you may know, this is part of the larger Business Process Reengineering Project that they have been undergoing and the NYSCA has been engaged in for several years.

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CMS Payment Adjustments & Hardship Information

 

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CMS Publishes New Series of Chiropractic Resources

The Centers for Medicare and Medicaid Services (CMS) recently published a series of three Special Edition educational articles for DCs submitting claims for services provided to Medicare beneficiaries. MLN Matters® articles SE1601, SE1602 and SE1603 provide guidance on improving billing and documentation of chiropractic services, increasing compliance with Medicare regulations and reducing the profession's claims error rate. Also available are ACA's related resources here.

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