Insurance news
Is Modifier -59 going away?
Written by Editor   
Wednesday, November 26, 2014 01:32 PM

Anyone who uses modifier 59 needs to be aware that due to problems with the incorrect usage of this modifier (which by the way is also revised for 2015,) CMS has added four new HCPCS modifiers. An announcement by CMS stated that "CMS is establishing four new HCPCS modifiers to define subsets of the -59 modifier, a modifier used to define a “Distinct Procedural Service.” 

These new codes are:

Assignment of Benefits Form Available to You
Written by Editor   
Tuesday, November 18, 2014 01:43 PM
How thorough is your Assignment of Benefits form? ACA’s comprehensive form explains to patients that they are responsible for the care rendered. The form also ensures that insurer payments come directly to you, if allowed by the insurer. It also allows you to act on the patient's behalf to exercise all available ERISA appeal rights, an extremely important provision. Download it for your practice today! Note: All providers should assure that this form complies with all state laws.
Medicare: The difference between opting out and non-participation
Written by Editor   
Tuesday, November 18, 2014 01:28 PM

Chiropractors cannot “opt out” of Medicare. They can choose to not participate, but that is different from opting out. DCs may also choose to not treat patients who have Medicare.  At first glance, it may seem as if opting out would be as simple as signing a form that says you don’t want anything to do with Medicare. However, in a guidance manual issued by the Centers for Medicare and Medicaid Services (CMS), the section that describes what you must agree to in order to opt out has nine bullet points and is preceded by an equally long section describing what private contracts with patients must include. Opting out is a convoluted and difficult process. Again, chiropractors cannot opt out, and of those care providers who are eligible to opt out, fewer than 2 percent choose to do so.

DCs must either classify themselves as participating or non-participating in the Medicare program.

Remember to Add ICD-10 Implementation to Your 2015 Budget
Written by Editor   
Thursday, November 06, 2014 10:31 AM

The offical transition to the ICD-10 coding set takes place next October. Many providers have already spent a good deal of money preparing for the inevitable, but even so, you need to make certain that select ICD-10 costs are included in your 2015 budget.  

Planning to spend on ICD-10 implementation is more complicated than buying new software and ICD-10 coding books. Medical practices especially will need to allocate resources — time and money — in four key areas:

  1. Coding
  2. Revenue cycle
  3. Project management
  4. IT

Here are but some of the potentials you should consider:

CMS to Pay Docs for Care Coordination, Telehealth
Written by Editor   
Thursday, November 06, 2014 09:25 AM

Doctors will be paid for Medicare care coordination, wellness and behavioral health telehealth visits. But, under final rules issued by the CMS late Friday, physicians also could see all Medicare payments cut by roughly 21% in April if the Medicare sustainable growth rate formula cuts are allowed to take effect.

As proposed earlier this year, Medicare will cover wellness and behavioral health telehealth visits starting in January, according to the final rule for Medicare's physician fees. Doctors also will be able to bill Medicare $40 per patient per month for care coordination for patients with multiple chronic conditions. The new payments are for non-face-to-face services.  Of course, these payments do not apply to Doctors of Chiropractic because of the federal limitation that requires medicare to ONLY pay for one service for chiropractors–the application of CMT.

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