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eNews April 2013

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These webinars 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.

webinar iconModule I - Practice Building Principles & Systems   course details

May 23, 2013 11:00 am - 12:45 pm PST register online

webinar iconModule II - Scripts for Success   course details

May 30, 2013 11:00 am - 12:45 pm PST register online

webinar iconModule III - The Power of the Front Desk     course details

June 06, 2013 11:00 am - 12:45 pm PST 9 - 10:45 register online

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June 13, 2013 11:00 am - 12:45 pm PST register online

Save 10% when you register for all four modules.

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Starting Thursday, May 23, 2013 register online


(DVD and WorkshopPackage) Reduced to Sell!

Acquire essential skills that every office needs to know, plus learn relationship-building techniques that turn patients into loyal, lifetime-referring patients.

(DVD and Webinar Package) Now available

Previously recorded webinars this year and materials and forms on DVDs plus webinar handouts for all five webinars. A total of 14 hours instruction and includes a binder with notes in addition to the DVDs

  • Essential Coding for the Chiropractic Practice
  • Systems for Improving Collections
  • California Personal Injury
  • California Medicare Part B
  • California Workers' Compensation


ACA Files Class Action Lawsuit Challenging ASHN's, CIGNA's Improper Practices According to the January 10, 2013 American Chiropractic Associations Week in Review: "The American Chiropractic Association (ACA) has filed a class action lawsuit against American Specialty Health Inc. and American Specialty Health Networks Inc. (collectively, "ASHN"), and CIGNA Corporation and Connecticut General Life Insurance Company (collectively, "CIGNA").

The litigation alleges a litany of problems with the defendants, including arbitrary reductions of care, lack of communication to providers and patients resulting in coverage and payment errors and interference with doctors' duty to exercise professional clinical judgment in managing patients' treatment plans. ACA's suit requests the court to award injunctive, declaratory and other equitable relief to ensure ASHN and CIGNA's compliance with ERISA as well as other state and federal laws and regulations." LEARN MORE


• MyPlan.com, recent survey ranked DC 45th out of 300 careers as having the highest job satisfaction among working professionals. LEARN MORE


CORRECTION GP Modifier may no longer be required as of 10/2012. Your Medicare Administrative Contractor may still require the use of the GP with the GY for all physical medicine and rehabilitation codes.

Importance of Preparing/Maintaining Legible Medical Records MLN Matters® Number: SE 1237

"Many claim denials occur because the providers or suppliers do not submit sufficient documentation to support the service or supply billed. Frequently, this documentation is insufficient to demonstrate medical necessity.

In accordance with Section 1862(a)(1)(A) of the Social Security Act (the Act), CMS must deny an item or service if it is not reasonable and necessary. (See item 1 in the 'References' section below.) When determining the medical necessity of the item or service billed, Medicare's review contractors must rely on the medical documentation submitted by the provider in support of a given claim. Therefore, legibility of clinical notes and other supporting documentation is critical to avoid Medicare FFS claim payment denials. (See item 2 in the 'References' section below.) LEARN MORE

Mandatory Payment Reductions in the Medicare Fee-for-Service (FFS) Program - "Sequestration" The Budget Control Act of 2011 requires, among other things, mandatory across-the-board reductions in Federal spending, also known as sequestration. The American Taxpayer Relief Act of 2012 postponed sequestration for 2 months. As required by law, President Obama issued a sequestration order on March 1, 2013. The Administration continues to urge Congress to take prompt action to address the current budget uncertainty and the economic hardships imposed by sequestration. This listserv message is directed at the Medicare FFS program (i.e., Part A and Part B).

In general, Medicare FFS claims with dates-of-service or dates-of-discharge on or after April 1, 2013, will incur a 2 percent reduction in Medicare payment. Claims for durable medical equipment (DME), prosthetics, orthotics, and supplies, including claims under the DME Competitive Bidding Program, will be reduced by 2 percent based upon whether the date-of-service, or the start date for rental equipment or multi-day supplies, is on or after April 1, 2013. The claims payment adjustment shall be applied to all claims after determining coinsurance, any applicable deductible, and any applicable Medicare Secondary Payment adjustments. Though beneficiary payments for deductibles and coinsurance are not subject to the 2 percent payment reduction, Medicare's payment to beneficiaries for unassigned claims is subject to the 2 percent reduction.

The Centers for Medicare & Medicaid Services encourages Medicare physicians, practitioners, and suppliers who bill claims on an unassigned basis to discuss with beneficiaries the impact of sequestration on Medicare's reimbursement. Questions about reimbursement should be directed to your Medicare claims administration contractor. As indicated above, we are hopeful that Congress will take action to eliminate the mandatory payment reductions. LEARN MORE


Instead of a Written Redetermination: Consider Having Your Claim Reopened There is no need to appeal a claim if you have made a minor error or omission in filing the claim, which in turn caused the claim to be denied. In the case where a minor error or omission is involved, you may request that Palmetto GBA reopen the claim so the error or omission can be corrected rather than going through the written appeals process. Reopenings may be submitted in written form or over the telephone. What Type of Claims can be Reopened ? LEARN MORE

Redetermination Status Tool Now Available Online The Redetermination Status tool is available in the Self Service Tools section of the J1 Part B home page. Use this tool to find out if Palmetto GBA has received your Redetermination Request and whether your request is pending or completed. To access, all you need is the Internal Control Number (ICN) from your Medicare Remittance Notice for the claim you appealed. LEARN MORE

Advanced Beneficiary Notice of Noncoverage (ABN)
Requirements for Proper Completion and Delivery Webinar: April 25, 2013 Join Palmetto GBA on Thursday, April 25, 2013, at 12 p.m. PT. During the presentation, we will discuss the Medicare requirements for when and how to issue an Advance Beneficiary Notice of Noncoverage (ABN) LEARN MORE

CALIFORNIA PROVIDERS - News from the California Chiropractic Association (CCA)

SB 381 (Yee) - Manipulation Protection Bill SB 381
authored by Senator LelandYee and sponsored by the California Chiropractic Association, this bill would prohibit a health care practitioner from performing joint manipulation and spinal adjustment unless he or she is a licensed chiropractor, physician/surgeon or osteopathic physician/surgeon.

SB 626 (Beall) - Workers' Compensation Senate Bill 626
authored by Senator Jim Beall, D Campbell, this bill seeks to address last session's workers' compensation "reform" which impacted doctors of chiropractic and injured worker patients greatly.

SB 626 seeks to enact the following:
  - Doctors of chiropractic would be able to remain as the primary treating physician (PTP) after the patient has received 24 treatments.   - Requires that an Independent Medical Review (IMR) doctor must have the same California license type as the provider requesting the review.   - Would remove the confidentiality mask of the identity of the IMR doctor.   - Would permit a Workers' Compensation Appeals Board judge to over-rule an IMR decision.

If you have questions, please contact:
Kassie Donoghue, D.C., CCA Governmental Affairs Director at (916) 648-2727, ext 130 or kdonoghue@calchiro.orgor
Michelle Bancroft, CCA Governmental Affairs Assistant at (916) 648-2727, ext 136 or mbancroft@calchiro.org.


2013 Temporary total disability rates Newsline No. 58-12
The minimum and maximum temporary total disability (TTD) rates for 2013 increased on Jan. 1, 2013. The minimum TTD rate will increase to $160 and the maximum TTD rate will increase to $1,066.72 per week. Labor Code section 4453(a)(10) requires the rate for TTD be increased by an amount equal to the percentage increase in the state average weekly wage (SAWW) as compared to the prior year. LEARN MORE

Payors must negotiate in good faith with potential lien claimants - filing a lien is not a prerequisite Newsline No. 13-13 February 27, 2013
The Audit Unit of the Division of Workers' Compensation has received an increasing number of complaints from individuals and entities providing services on a lien basis in workers' compensation claims. The complainants report that some payors have adopted a policy of refusing to discuss negotiating the provider's liens until the provider of the services demonstrates it has filed a lien with the WCAB and paid the applicable lien filing or activation fee required by the enactment of SB 863. Such a policy is both unsupported by the plain language of Labor Code sections 4903.05 or 4903.06, and directly contrary to the legislative intent of those sections and existing law. LEARN MORE

Division of Workers' Compensation posts updated time of hire pamphlet
The Division of Workers' Compensation (DWC) has posted an updated time of hire pamphlet on its website. The updates reflect changes made to California's workers' compensation system by Senate Bill 863, which took effect Jan. 1, 2013.

The pamphlet is posted in English and Spanish versions, and meets the requirements under Labor Code section 3551 to notify new employees about California workers' compensation rights and benefits either at the time of hire or by the end of the first pay period. LEARN MORE

DWC, WCAB revise Policy and Procedural Manual Newsline No. 15-13 March 20, 2013
The Division of Workers' Compensation (DWC) and Workers' Compensation Appeals Board (WCAB) have revised their Policy and Procedural Manual (PPM) and posted it on the WCAB website. LEARN MORE

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Keeping a Watchful Eye on the Chiropractic Industry

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