No-Fault Changes Finally Take Effect

For many years, the NYSCA in conjunction with our lobbyist have been working tirelessly to gain Chiropractic parity in reimbursement with other health care providers.

Last year through the hard work of many in our association, we were able to secure a significant increase of the conversion factors for Physical Medicine when treating Workers compensation and motor vehicle injuries.

As many of you are aware Work Comp adopted these changes last year but the no-fault insurance carries petitioned the Department of Financial Services for a deferral until October 1st 2020 in order to make rate adjustments in response to a perceived increase in costs. This was granted by DFS although the move was opposed by the NYSCA.

The wait is over and effective Oct. 1st, 2020, the new conversion factor for Physical Medicine will be in effect for No-Fault as well.

To provide you with the most accurate information, the NYSCA in conjunction with NYCC will be presenting webinars on September 2nd and again in October.

These webinars will be an overview of conversion factors, RVU values (relative value unit) and the documentation required for each of the most commonly used codes in many of our offices.

Here is a brief example of what we will discuss.

Conversion factors for Region 1 and 2 will be 7.69; region 3, 8.79; and region 4, 9.55. Each procedure is given a value based on a number of “units” which is then multiplied by the RVU to determine it’s allowable fee.

The New Patient max RVU allowed will be 18 units, re-exams 15 and office visits 12.

Here is an example of how to calculate the fee; spinal manipulation code of 98940 (1 to 2 spinal areas) has an RVU value of 4.57; in region 4 the conversion factor is 9.55.

Using the formula of your area’s conversion factor (CF) and the procedures RVU (CFxRVU) you can determine your reimbursement which in this case is 4.57 x 9.55 = $43.64 for the spinal manipulation as a stand alone procedure.

We are not limited to just that fee on a visit as follow up visits are allowed up to 12 units per visit. The example above that gives us 7.43 RVU's still left to bill if you provide the services to justify that level of billing. A provider may add in things like Therapeutic Exercise or other appropriate services, and now, get reimbursed for services previously not possible.

We will do our best to keep our members up to date on what is covered and what is excluded from treatment. Since we are unable to provide all this information in this newsletter we anticipate the webinars will be full.

Please do your best to sign up as soon as you get the e-mail for registration.

Learn more about this topic during the NYSCA 2020 Fall Symposium during the presentation "Documentation and Coding for No-Fault as of October 1st," scheduled for Sunday,  October 18, 2020 at 10am. Register online here

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