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eNews April 2014

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SPRING WEBINAR SCHEDULE: Systems for Building A Successful Practice

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

Practice Building Principles & Systems
DATE: Thursday, May 8, 2014     COST: $97.00 per attendee*
TIMES: 9:00 am -10:45 am PST register online or 12:00 pm - 1:45 pm PST register online

Scripts For Success
DATE: Thursday, May 15, 2014     COST: $97.00 per attendee*
TIMES: 9:00 am -10:45 am PST register online or 12:00 pm - 1:45 pm PST register online

The Power of the Front Desk
DATE: Thursday, May 22, 2014     COST: $97.00 per attendee*
9:00 am -10:45 am PST register online or 12:00 pm - 1:45 pm PST register online

Dream Team Power Tools
DATE: Thursday, May 29, 2014     COST: $97.00 per attendee*
TIMES: 9:00 am -10:45 am PST register online or 12:00 pm - 1:45 pm PST register online

Entire Series Modules I-IV
DATES: Thursday, May 8, 2014 through Thursday May 29, 2014     COST: $349.00 per attendee
TIMES: 9:00 am - 10:45 am PST register online or 12:00 pm - 1:45 pm PST register online

* First Year DC and Chiropractic Student Discounts Available.

Additional information regarding the content and registration is available on our website.

Unable to attend a Webinar in person? No problem!
Purchase the CD recordings and notes via our website and watch them again and again.


(DVD and Workshop Package)



I will be teaching "Billing, Coding and Documentation" at Life Chiropractic College-West.

  • Saturday, April 26, 2014
  • Sunday, June 1, 2014
  • Sunday, September 28, 2014
  • Saturday, December 13, 2014

You can received Continuing Education Units for these classes. Don't forget to register your C.A.s, too. Additional information at http://www.lifewest.org/

2014 California Intensive Coding & Collections DVD Training Package is now available for purchase. Previously recorded webinars and materials and forms on DVDs plus webinar handouts for all five webinars. A total of 14.25 hours of instruction. Includes 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

Save 15%! Buy the complete California Intensive Billing & Collections Webinars DVD Package

Buy all five webinars and save 15%! Or purchase just the webinar(s)you want at our online store.


"Doc Fix," ICD-10 Delay Signed Into Law
- ICD-10 has been delayed AGAIN! At this time it is scheduled to be implemented sometime in 2015. Please use the extra time you have to learn all that you can about ICD-10 and continue to prepare for the inevitable. I know that the powers that be did not ask me but maybe we should just skip ICD-10 and catch up with the rest of the world and start using ICD-11.

"ACA Needs Your Assistance Regarding Humana & the chiropractic Network Healthways
ACA has recently received an increase in the number and type of complaints regarding Humana and the chiropractic network, Healthways. If your office treats Humana patients or patients whose care is managed by Healthways, ACA would value your input so that we may further investigate the information we are receiving. ACA is currently working to resolve these issues and to make sure doctors of chiropractic are appropriately reimbursed for the care they provide.

If you can help ACA in this effort, please complete the following questionnaire. Completion of the questionnaire should take no more than 10 minutes. Knowing your time is limited, we sincerely thank you for taking time to assist us with our data gathering. Please click here.

Thank you for your assistance, ACA Insurance Relations Department"


New Feature: Simple Online Reset of User IDs and Passwords for PECOS, NPPES, and EHR
- Taken from the MNL Connects Issue dated Thursday, February 6, 2014. In response to provider concerns, and EUS Helpdesk call volume, CMS recently updated the process for retrieving forgotten user IDs and passwords for the Identity & Access Management (I&A) System, which controls access to the Provider Enrollment, Chain and Ownership System (PECOS), the National Plan and Provider Enumeration System (NPPES), and EHR (Electronic Health Record Incentive Programs). Forgotten user IDs and passwords can now be retrieved or reset online in seconds, without calling the EUS Helpdesk. When resetting your passwords, you will now have the option to answer 3 of your security questions or enter personal information. If you need to retrieve a forgotten user ID, you can either enter your email address on file and have it sent to you immediately, or you can enter personal information and have it displayed on screen.

ACA Insurance Relations Looks Into FEP Denial of G0283 - According to the "ACA Week in Review" dated 2/28/2014,"...recent expansion of coverage under FEP, some reports have ACA investigating how local plans are handling claims for federal workers. It has been reported that Blue Cross Blue Shield/Federal Employee Health Benefit Plan (BCBS FEP) administered by Anthem, is no longer accepting the G0283 HCPCS Code (Electrical stimulation, unattended). Such a limitation is not outlined in the revised, 2014 FEP Benefits Brochure, so ACA has opened an investigation into this matter. ACA will be posting information as it is received so providers have guidance for claims billing. If you have questions, contact Insurance Relations at insinfo@acatoday.org.

Windows XP Users: HIPAA & Meaningful Use Compliance at Risk
- After April 8, 2014, Microsoft Corporation will no longer offer technical support, including security updates and patches, for Windows XP. This may lead to violations of the Health Insurance Portability and Accountability Act (HIPAA) Security Rule that requires providers to protect electronic patient health information. If you are reporting on Meaningful Use and using Windows XP you need to be in compliance with the HIPAA requirements and if you continue using Windows XP after April 8, 2014 you may be at risk of being non-compliant with MU criteria. You need to be aware of the risk involved and have a detailed plan to minimize your risk. The "Guidance on Risk Analysis Requirements under the HIPAA Security Rule" can be found at http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/rafinalguidancepdf.pdf. HHS has a FAQ page on their site at http://www.hhs.gov/ocr/privacy/hipaa/faq/securityrule/2014.html.

CCI Edits - Quarterly Update July 1, 2014 MLN Matters® Number: MM8558
- The Centers for Medicare & Medicaid Services (CMS) developed the National CCI to promote national correct coding methodologies and to control improper coding that leads to inappropriate payment in Part B claims. The coding policies developed are based on coding conventions defined in the American Medical Association's Current Procedural Terminology manual, national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practice, and review of current coding practice. LEARN MORE >

These edits don't only apply to Part B claims, but also apply to third party payor who use the CCI Edits for processing claims. The new 2014 California Workers' Compensation is applying the CCI Edits to all services provided on or after January 1, 2014.

ACA to Appeal Following Setback in Class Action Lawsuit Against ASHN, CIGNA Press Release April 03, 2014 -Arlington, Va. - The American Chiropractic Association (ACA) today announced its intention to appeal the recent dismissal of its claims against American Specialty Health Inc. and American Specialty Health Networks Inc. (collectively, "ASHN"), and CIGNA Corporation and Connecticut General Life Insurance Company (collectively, "CIGNA"). Significantly, the dismissal was based upon a variety of procedural considerations--not the substance of ACA's claims.

"ACA's legal counsel is optimistic about the chances of a successful appeal, noting that this area of the law is the subject of increasing judicial focus.

"Recently, there have been several significant rulings recognizing that providers are entitled to assert claims under ERISA to challenge benefit determinations by insurers, including with regard to recoupments of previously issued payments"," said Brian Hufford, Esq., of Zuckerman Spaeder LLP, who represents ACA in the class action suit.

"We believe that federal courts are increasingly recognizing that individual providers and associations such as the ACA have standing to assert the claims brought in this action."

ACA's litigation against ASHN and CIGNA alleges, among other things, that CIGNA--in violation of ERISA--failed to comply with terms and conditions of its plan to afford subscribers or their health care providers an opportunity to obtain a "full and fair review" of denied or reduced reimbursement, and failed to make appropriate and non-misleading disclosures to subscribers or their health care providers.

"ACA took this action against ASHN and CIGNA because it is patients who suffer most when doctors must choose between providing necessary care and adhering to requirements imposed by payers," said ACA President Anthony Hamm, DC. "We will not rest until patients receive the care they need and have paid for through their insurance premiums."

Providers who believe they and/or their patients have been affected by ASHN and/or CIGNA's improper practices can visit the Chiropractic Networks Action Center to submit a complaint to ACA.


The New 1500 Claim Form Version (02/12) - Required for PAPER Medicare claims effective for claims received on or after April 1, 2014. - By now you should have received instructions from your Medicare Administrative Contractor (MAC) providing you with changes. The items that have changed significantly are as follows:

  • Item 21 can accommodate 12 diagnosis. The labeling is now alphabetically labeled A-L and they order is listed horizontally not vertically.
  • Also there is a section above the "D" in item 21 which says "ICD ind" which is followed by a set of vertical dotted lines. You will need to place "9" in between the broken lines to indicate that you are using ICD-9. When ICD-10 does finally go into effect you will place a "0" in this space.
  • If you are providing the patient with diagnostic services such as labs and or X-rays line 17 in addition to the provider's information you will be required to use place a "qualifier" to the left of the dotted vertical line in Item 17 to indicate they type of provider being reported in this field:
    • DN = Referring Provider
    • DK = Ordering Provider (this is the appropriate qualifier for DME claims) or
    • DQ = Supervising Provider

A detailed list of the differences between Version 08/05 (the current form) and the new form, Version 02/12, can be found at http://www.nucc.org/images/stories/PDF/1500_claim_form_change_log_2012_02.pdf
or at

2014 Fee Schedule Changes - Since the January 2014 issue of Strategies the fee schedule has been finalized for the remainder of 2014. If you don't already have the current fees for 2014, you should be able to find them on-line through your Medicare Administrator's (MAC) website.

H.R. 4302 was signed into law the "Protecting Access to Medicare Act of 2014," on April 1, 2014, averting a 24% reduction in Medicare physician payments. The "doc fix" is a temporary fix to the Sustainable Growth Rate (SGR) allows for continuation of the 0.5 percent update, previously implemented on Jan. 1, 2014, through Dec. 31, 2014 and a zero percent update from Jan. 1, 2015 through March 31, 2015.

Important PQRS Updates Made for 2014 There have been significant updates and revisions have to the Physician Quality Reporting System (PQRS) measures applicable to chiropractic practices for 2014. In addition to revisions to the 2013 codes we now have a third set to report on "Blood Pressure Screening & Follow-Up". If you have not already learned how to report these codes and how they will affect your practice I suggest that you register or purchase the PQRS training by Susan McClelland. To purchase or attend one of her webinars follow this link: http://tinyurl.com/a832fhk.

Claim Status Category and Claim Status Codes Updates - Revised - MLN Matters® Number: MM8582 Revised These changes are effective April 1, 2014. LEARN MORE >


Noridian's EDISS Connect' is Coming For All Submitters and Vendors EDISS will soon be releasing their enhanced online registration and testing tool. 'EDISS Connect' will replace their existing Total Onboarding (TOB) application, and will provide a much more streamlined and user-friendly experience.

"While EDISS Connect will have a different look and feel, as well as a new URL, this transition will have minimal impact to Submitters. There will be no need to re-register your existing transactions. EDISS will educate the transition date and URL in the near future. More information at http://www.edissweb.com/cgp/ and http://www.edissweb.com/cgp/registration/


I attended the 21st Annual Division of Workers' Compensation Educational Conference in February. I most likely one of a very few attendees representing the Chiropractic profession and needless to say I learned a lot.

We now have a new Official Medical Fee Schedule for all services rendered on or after January 1, 2014. I attended the one hour "Fee Schedules" class. For the most part we are now using CPT and no longer using the now retired Official Medical Fee Schedule that was put in place on April 1, 1999. There are a few exceptions. The process for determining the new fees is very complex. The process for determining the fees can be found on the DWC's website at http://www.dir.ca.gov/dwc/OMFS9904.htm#7. You will need to go to the orange "update" button to read the regulations at http://www.dir.ca.gov/dwc/FeeSchedules/Physician/January2014/RBRVS_TextOfRegs.pdf to access the various different tables that you will need to determine the fees for your office which are based on the current Medicare fee schedule.

There are basically six steps to determining the fees for your office and seven if you are in a Health Professional Shortage Area which will qualify you for a bonus. In addition they are applying the National Correct Coding Edits which are up-dated quarterly.

The best way to stay abreast of the changes is to sign up for the DWC's newsletter service at http://www.dir.ca.gov/email/listsub.asp?choice=1. This will ensure that you receive notices of proposed changes, changes, public forums, public workshops for injured workers and much more.

Mileage rate for medical and medical-legal travel expenses decreased effective January 1, 2014 The mileage rate for medical and medical-legal travel expenses decreased one-half cent to 56 cents per mile effective January 1, 2014. This rate must be paid for travel on or after January 1, 2014 regardless of the date of injury. LEARN MORE >

The Office of Administrative Law Has Approved DWC's Final Versions of the Independent Medical Review and Independent Bill Review Regulations - The Office of Administrative Law (OAL) approved the Independent Medical Review (IMR) and Independent Bill Review (IBR) regulations. Both sets of regulations were filed with the Secretary of State on February 12, 2014 and are effective immediately. Prior to March 1, 2014, any version of the IMR Application form adopted by the Administrative Director under section 9792.10.2 may still be used. LEARN MORE >

DWC Posts Non-substantive Changes to the Supplemental Job Displacement Benefit Voucher Forms - The Office of Administrative Law (OAL) approved on February 5 the Division of Workers' Compensation's proposed changes to the Supplemental Job Displacement Forms removing the agency logo. Effective February 5, the following forms may be produced without a logo and may be produced on the claims administrator's letterhead: LEARN MORE >

DWC Reminds Parties to Include Required Documents when Filing IMR and IBR Applications, Will Cease to Issue Reminder Letters - An injured worker, or someone she or he designates, may request independent medical review (IMR) if utilization review (UR) denies or modifies a requested medical treatment for an accepted claim. The claims administrator must send the injured worker a notice of the UR denial along with a partially completed IMR request form. To request IMR, the worker must submit the signed application for IMR and mail the following information within 30 days of receiving the utilization denial: LEARN MORE >

Office of Administrative Law has Approved DWC's Final Version of the Predesignation of Personal Physicians and Reporting Duties of the Primary Treating Physician Rulemaking - The Office of Administrative Law (OAL) has approved changes to the current regulations concerning Predesignation of Personal Physicians and Reporting Duties of the Primary Treating Physician. The amended regulations were filed by OAL with the Secretary of State on February 12, 2014 and will take effect on July 1, 2014.

The final regulations change certain criteria that an employee must meet to predesignate a personal physician or medical group for work-related injuries or illnesses to conform to SB 863. The amendments also interpret and clarify what is meant by "chiropractic visits" under Labor Code section 4604.5 and limit the number of chiropractic visits an injured worker may have unless a specific exception applies.

DWC Announces Changes to Panel QME Request Process to Comply with Navarro v. City of Montebello - On April 2, 2014, the Workers' Compensation Appeals Board (WCAB) issued an en banc decision in Navarro v. City of Montebello which invalidated part of QME Regulation 35.5(e). Pursuant to the WCAB's ruling that the applicable Labor Code provisions do not require an employee to return to the same panel QME for an evaluation of a subsequent claim of injury, the DWC Medical Unit will now issue new QME panels for claims made after an evaluation has taken place. Initial QME panel requests must be submitted using QME Form 106 for represented cases or QME Form 105 for unrepresented cases.

To avoid unnecessary rejection of appropriate requests, in cases in which additional panels are required in different specialties, parties and attorneys are reminded to use QME Form 31.7. LEARN MORE >

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Keeping a Watchful Eye on the Chiropractic Industry

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