css strategies january 2012

eNews January 2012

In this issue:







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California Medicare Part B
Thursday, February 2, 2012
9:00 am -11:00 am PST - register online   or   12:30 pm - 2:30 pm PST - register online

Essential Coding for the Chiropractic Practice
Thursday, February 9, 2012 continued on Thursday, February 23, 2012
9:00 am -11:00 am PST - register online   or   12:00 pm - 2:00 pm PST - register online

Systems for Improving Your Collections
Thursday, March 1, 2012 continued on Thursday, March 8, 2012
9:00 am -11:00 am PST - register online   or   12:00 pm - 2:00 pm PST - register online

California Personal Injury
Thursday, March 15, 2012
9:00 am -11:00 am PST - register online   or   12:30 pm - 2:30 pm PST - register online

California Workers' Compensation
Thursday, March 22, 2012
9:00 am -11:00 am PST - register online   or   12:30 pm - 2:30 pm PST - register online

This series will be held on Thursdays PST. Dates and times are subject to change without notice.

Unable to attend a Webinar in person? No problem! Purchase the CD recordings and notes via our website and watch them again and again. Additional information regarding the content and registration is available on our website.


• My article "Chiropractic Assistants - Partners in Healing" appears in the February 12, 2012 issue of Dynamic Chiropractic.

• Check out this video from Blue Shield of California entitled "Benefitting From Chiropractic Care", featuring Don Freeman, DC, Blue Shield of California

From the American Chiropractic Association

Part I: "The ACA Aggressively Pursues Concerns with ASHN and Requests You Take Action to Help"
The American Chiropractic Association (ACA) continues to aggressively pursue its advocacy efforts on behalf of doctors of chiropractic against certain chiropractic managed care networks. Based on concerns received from many states across the nation since fall 2010, American Specialty Health Network (ASHN) is one of the most frequently identified offenders.

According to reports, ASHN has created chaos for providers and patients by not thoroughly vetting its business arrangements through state Departments of Insurance and by implementing egregious practices such as those that would impose in-network type management upon out-of-network providers. In some states, employers were reportedly not notified that ASHN would be managing their employees' chiropractic benefits. In others, the insurer, even after the agreement to bring on ASHN, was unaware of the policies under which providers would be managed. The overall confusion from these practices has caused patients, providers, and employers to become very concerned.

To date, the ACA has received complaints of the following: lack of clear communication to providers, patients and employers resulting in coverage and payment errors; unwillingness to resolve confusion of patients and providers by coordinating services with payers; restriction of treatment not in keeping with standard chiropractic practice; disregard of state statutes; interfering with doctors' duty to exercise professional clinical judgment in managing patients' treatment plans; lack of appropriate, evidence-based clinical rationale for denial of treatment; untimely payment of claims.

The ACA recommends that providers contact their state Department of Insurance to make the voices heard on behalf of their patients. Resources to help providers are at the ACA Chiropractic Networks Action Center.

All providers are strongly encouraged to contact and/or send documentation to the ACA explaining the problems being encountered by calling (703) 812-0225 or by emailing.

Part II: "ASHN/Aetna Win is Expanded to Include Cigna"
ACA previously reported to members that Aetna and American Specialty Health Network (ASHN) were identified by the Connecticut Office of the Attorney General as companies that had improperly denied claims under a unique Connecticut law. The investigation by the Office of the Attorney General in response to complaints from DCs was based upon a Connecticut state statute which requires health insurance plans to cover chiropractic care "to the same extent" that coverage is provided for services rendered by a MD. As a result of this advocacy initiative, Aetna and ASHN, which contracted together as of July 1, 2011, agreed to review and reprocess claims that were inappropriately denied.

As a follow up to the above, the Office of the Attorney General has continued its investigation and found that Cigna, which has a claims administration contract dating back to April 1, 2010 with ASHN, also did not have all the payment codes to cover the services DCs are authorized to provide under the above mentioned law. Cigna addressed the issue in response to the investigation.

"As a result, providers will be paid for covered services and Cigna's enrollees will continue to receive the care to which they are entitled," stated Deputy Attorney General Nora Dannehy. The Office of the Attorney General will be working with the Department of Insurance to assure that Cigna and ASHN reconsider all denied claims back to April 1, 2010 that were previously processed under the inappropriate restrictive criteria. The investigation from the Office of the Attorney General noted that ASHN's restrictions "may have discouraged some chiropractors from submitting legitimate claims they knew ASHN would deny."

ACA is very concerned with any practices that withhold appropriate patient care and/or that violate state statutes or laws. If you have any information that you feel ACA should be aware of related to ASHN, please notify us by email.

• The 2012 CPT and HCPCS code up-dates are available through Palmetto at here.

List of Palmetto Part B Approved 5010 Errata Vendors are here.

Information on how to contact other MACs is here.

ICD-10 Implementation Handbooks Now Available
CMS has developed four Implementation Handbooks as additional resources to assist the health care industry with the transition from ICD-9 to ICD-10 codes. Each guide provides detailed information for planning and executing the ICD-10 transition process. Use the guides as a reference whether you're in the midst of the transition or just beginning the process.

The appendix of each handbook references relevant templates which are available for download in both Excel and PDF files below. The templates are customizable and have been created to help entities clarify staff roles, set internal deadlines and responsibilities and assess vendor readiness.

View the step-by-step plans and relevant templates for each of the following audiences impacted by the transition:

Large Provider Practices and the relevant templates

Small/Medium Provider Practices and the relevant templates

Version 5010 and ICD-10 Resources
CMS has developed a variety of new resources to help prepare you for the transition to Version 5010 and ICD-10

• Two FAQ fact sheets on transition basics for ICD-10:

• A fact sheet on Version 5010 readiness

• A fact sheet for non-covered entities with background on the ICD-10 transition, potential benefits to adopting the new coding, and resources for more information

• A step by step Version 5010 and ICD-10 compliance timeline available in a new widget

CMS encourages you to download or share the widget and take advantage of printer-friendly versions of the timelines available for large provider practices and for small provider practices

2012 ICD-10-CM Code Updates Now Available from CMS
The Centers for Medicare & Medicaid Services (CMS) has posted the 2012 ICD-10-CM code updates to the CMS Web site, including the 2012 ICD-10-CM index and tabular, code titles, addendum, general equivalence mappings (GEMs) and reimbursement mappings files.

The 2012 ICD-10-CM files contain information on the new diagnosis coding system, ICD-10-CM, that is being developed as a replacement for ICD-9-CM, volumes 1 and 2.

These files are available on the 2012 ICD-10-CM and GEMs Web page. To access the files, scroll to the bottom of the page to the Downloads section.

The 2012 ICD-10-PCS (procedure) files were posted in June on the 2012 ICD-10-PCS and GEMs Web page


2012 Part B Deductible is now $140.
Yes, this is correct, it has gone DOWN.

2012 Fee Schedules CMS is temporarily holding 2012 Medicare reimbursements pending congressional action to reverse cuts to providers. CMS will notify providers on or before January 11, 2012, with more information about the status of Congressional action to avert the fee reduction and next steps regarding the claims hold. As on numerous occasions in the past, the Centers for Medicare & Medicaid Services (CMS) will instruct Medicare Administrative Contractors (MACs) to hold claims containing 2012 services paid under the Medicare Physician Fee Schedule for the first 10 business days of January (i.e., January 1, 2012, through January 17, 2012).

The hold should have minimal impact on provider cash flow because, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 days for paper claims) after the date of receipt. Medicare Physician Fee Schedule claims for services rendered on or before December 31, 2011, are unaffected by the 2012 claims hold and will be processed and paid under normal procedures and time frames.

CMS will notify you on or before January 11, 2012, with more information about the status of Congressional action to avert the negative update and next steps regarding the claims hold.

New Advance Beneficiary Notice of Noncoverage (ABN) required as of January 1, 2012.
You must use the new version CMS-R-131 (03/11). Your Medicare Administrative Contractor (MAC) may offer training via their website.

CMS has the revised form in English and Spanish, instructions, and implementation announcement: http://www.cms.gov/BNI/02_ABN.asp

Palmetto has on-line training available here.

Extension of the 2012 Annual Participation Enrollment Program CMS is extending the 2012 Annual Participation Enrollment Program. The participation enrollment period will now end February 14, 2012, instead of December 31, 2011.

Revised Medicare Provider-Supplier Enrollment Applications as of July 1, 2011 Revised versions of the Medicare Provider-Supplier Enrollment Applications (CMS-855) and the new CMS-855O application form are now available on the CMS Provider-Supplier Web site. Providers and suppliers enrolling for the sole purpose to order and refer are required to begin using the new CMS-855O form immediately. Providers and suppliers using the other CMS-855 forms to enroll in Medicare are encouraged to begin using the revised forms, though may continue to use the old forms through October 2011.

January 1, 2012 Version 5010 Deadline
The compliance deadline for the transition to Version 5010 is January 1, 2012. Though the Centers for Medicare & Medicaid Services (CMS) has announced an enforcement discretionary period of 90 days for Version 5010 compliance, the deadline remains January 1, 2012. Enforcement will not be exercised until April 1, 2012; however, it is important that organizations continue to complete the transition to Version 5010 as soon as possible, if they have not done so already.

Additional Version 5010 Resources
CMS is committed to helping organizations make a smooth transition to Version 5010 and ICD-10. The CMS ICD-10 Web site has been updated to include a new Web page dedicated to Version 5010 information and resources.

CMS has also posted a new fact sheet which discusses steps providers should be taking now to ensure a timely transition to Version 5010 by January 1, 2012

Other materials on Version 5010 include the following fact sheets:
• FAQs: Versions 5010 and D.0 Transition Basics
• Versions 5010, D.0, and 3.0 Overview
• Version 5010: Testing Readiness, What You Need to Know
• Talking to Your Vendors About ICD-10 and Version 5010

Additional Resources
Stay on top of deadlines and action items for Version 5010 and ICD-10 by referencing the following resources on the CMS ICD-10 Web site:
• Interactive Widget: A user-friendly tool that outlines the steps to take to ensure compliance with Version 5010 and ICD-10
• Timelines: Printer-friendly checklists that complement the widget, which are available for large providers small providers , payers and vendors
• Implementation Handbooks: Detailed step-by-step guides on how to implement ICD-10, which have been customized for different audiences including small/medium provider practices large provider practices, small hospitals and payers

Revalidation of Medicare Provider Enrollment
The Centers for Medicare & Medicaid Services (CMS) has reevaluated the revalidation requirement in the Affordable Care Act, and believe it affords the flexibility to extend the revalidation period for another two years. This will allow for a smoother process for provider and contractors. Revalidation notices will now be sent through March 2015.
Important: This does not affect those providers which have already received a revalidation notice. If you have received a revalidation notice from your contractor, respond to the request by completing the application either through Internet-based Provider Enrollment, Chain, and Ownership System (PECOS) or completing the appropriate 855 application form.

The first set of revalidation notices went to providers who are billing, but are not currently in the PECOS. To identify these providers, contractors searched their local systems and if a Provider Transaction Access Number (PTAN) for a physician was not in PECOS, a revalidation request for that physician was sent. We ask all providers who receive a request for revalidation to respond to that request.

For providers not in PECOS, the revalidation letter will be sent to the special payments or primary practice address because we don't have a correspondence address. For providers in PECOS, the revalidation letter will be sent to the special payments and correspondence addresses simultaneously; if these are the same it will also be mailed to the primary practice address. If you believe you are not in PECOS and have not yet received a revalidation letter, contact your Medicare contractor. Contact information.

• Free Medicare Billing Software
The PC-ACE Pro32 Version 2.32 file will be automatically effective with ASC X12 5010 on Sunday, January 1, 2012. What is PC-ACE Pro32? PC-Ace or Pro32 is a 'stand alone' software package that creates a patient database and allows your office to electronically submit claims to Medicare Part A and Part B. It is available for free from Medicare Administrative Contractors (MACs) upon request for use by Medicare providers for billing Medicare claims.

How is PC-ACE Pro32 becoming compliant with ACS X12 5010 on Sunday, January 1, 2012?
Effective January 1, 2012, the only available output format for PC-ACE Pro32 Version 2.32 will be the 5010 version. The January 1, 2012 changeover was established as part of the version 2.32 (ASC X12 5010) update, prior to issuance of the Office of E-Health Standards and Services (OESS) 90-Day Discretionary Enforcement announcement. This Pro32 v2.32 update file includes software changes necessary to ensure your Pro32 claims are submitted in the ASC X12 837 v5010 format. All Trading Partners should be on the current version of PC-ACE Pro 32 as the software is set up to automatically expire every eight months therefore requiring the new version to be downloaded/installed no later than January 1, 2012.

PC-ACE Pro32 software version for ASC X12 v5010 has several CMS Medicare mandates and enhancements:
• The current Pro32 upgrade is applicable to (January 2007) and later versions for the PC-ACE Pro32 software
• ASC X12 version 5010 Errata production software changes:
• ASC X12 version 4010A1 no longer an option after January 1, 2012
• Zip code requires full 9-position value
• Billing provider must include physical address. Post office and lock boxes are not permitted.
• ZIP code on all Facility Reference file records must include full 9-position value

5010/D.0 Implementation Calendar
For a complete list of past 5010 National Provider Calls, please visit the 5010 National Provider Calls section of our Versions 5010 & D.0 Web site. Links to more information on Version 5010, NCPDP D.0 and NCPDP 3.0 are available at www.CMS.gov/Versions5010andD0.


No change for mileage rate for medical and medical-legal travel expenses in 2012 The current mileage rate of 55.5¢ for medical and medical-legal travel expenses will remain unchanged in 2012. This rate must be paid for travel on or after Jan. 1, 2012 regardless of the date of injury. The form can be found at http://www.dir.ca.gov/dwc/forms.html


Show your new patients how important they are to you by calling them to see how they are doing after their first adjustments. Not too many other professions that I am aware of do this. Not only is it very impressive but it is also an opportunity to address any concerns that the patient might have, especially if they have any unmet expectations. If you would like a copy of the First Adjustment Call Slip, please email your request to me at lisabilodeau@chiropracticsuccesssystems.com and write FACS in the subject box.

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