eNews January 2016

In this issue:

• WINTER WEBINAR SCHEDULE
• GENERAL ANNOUNCEMENTS
• NATIONAL NEWS
  
• NATIONAL MEDICARE
  
• CALIFORNIA MEDICARE
  
• CALIFORNIA WORKERS' COMPENSATION
  

Need training now? Relief is just a phone call away. We offer private on-site training, customized to meet your needs.

  WINTER WEBINAR SCHEDULE: Coding & Collections

These webinars will be held on Thursdays Pacific Time.

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 this valuable information again and again.

California Medicare part B

Registration Deadline: Thursday, January 21, 2015

Essential Coding

Registration Deadline: Thursday, January 28, 2016

California Personal Injury

Registration Deadline: Thursday, February 11, 2016

Systems For Improving Your Collections

Registration Deadline: Thursday, February 18, 2016

California Workers' Compensation

Registration Deadline: Thursday, March 10, 2016

AM Series - Coding & Collections

Registration Deadline: Thursday, January 21, 2016

PM Series - Coding & Collections

Registration Deadline: Thursday, January 21, 2016

*First Year DC, Chiropractic Student Discounts and multiple attendee discounts available.

Dates and times are subject to change without notice.

  GENERAL ANNOUNCEMENTS

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

Saturday, February 20, 2016
Saturday, June 4, 2016

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

  NATIONAL NEWS

• According to the just-released "Gallup-Palmer College of Chiropractic Inaugural Report: Americans' Perceptions of Chiropractic," an estimated 33.6 million Americans (14 percent) used chiropractic care within the last 12 months. Studies from other sources, including the 2012 National Health Interview Survey, have measured yearly chiropractic use at about 20.6 million Americans (8 percent). The full report, JMPT article, patient-education materials and more are available at www.palmer.edu/gallup-report.

 NATIONAL MEDICARE

• 2016 Deductible for Part B Medicare claims will be $166.

• EHR Incentive Program: 2016 Payment Adjustments and Reconsiderations Providers eligible to participate in the Medicare Electronic Health Record (EHR) Incentive Program must demonstrate meaningful use in either the Medicare EHR Incentive Program or in the Medicaid EHR Incentive Program (or be granted a hardship exception) to avoid a payment adjustment. LEARN MORE

• "Medicare Enrollment for Physicians and Other Part B Suppliers" Fact Sheet - Revised The "Medicare Enrollment for Physicians and Other Part B Suppliers" Fact Sheet (ICN 903768) was revised and is now available in a downloadable format. This fact sheet is designed to provide education on Medicare enrollment information and how to ensure that physicians and other Part B suppliers are qualified and eligible to enroll in the Medicare Program. It includes information on how to enroll in the Medicare Program, how to report changes, and a list of resources. LEARN MORE

• 2016 PQRS Payment Adjustment and Informal Review Process In 2016, CMS will apply a negative payment adjustment to individual eligible professionals, Comprehensive Primary Care practice sites, and group practices participating in the Physician Quality Reporting System (PQRS) group practice reporting option, including Accountable Care Organizations that did not satisfactorily report PQRS in 2014. Individuals and groups that receive the 2016 negative payment adjustment will not receive a 2014 PQRS incentive payment. LEARN MORE

• The "Medicare Appeals Process" Fact Sheet (ICN 006562) was revised and is now available in downloadable format. This fact sheet is designed to provide education on the five levels of claim appeals in Original Medicare (Medicare Part A and Part B). It includes details explaining how the Medicare appeals process applies to providers, participating physicians, and participating suppliers, in addition to including more information on available appeals-related resources. LEARN MORE

• 2016 Federal Court Review Amount in Controversy The amount that must remain in controversy for review in Federal District Court requested on or before December 31, 2015, is $1,460. This amount will increase to $1,500 for appeals to Federal District Court filed on or after January 1, 2016.

• CCI Edits, Version 22.1, Effective April 1, 2016 - Quarterly Update MLN Matters® Number: MM9377 Effective Date: April 1, 2016 Implementation Date: April 4, 2016 LEARN MORE

  CALIFORNIA MEDICARE

• Chiropractic Service 98942 - Widespread Service Specific Probe Review Notification Noridian Healthcare Solutions (Noridian) is initiating a service specific probe review for CPT® 98942 - Chiropractic manipulative treatment (CMT); spinal, 5 regions. This will affect all states/territories with the following CPT® 98942. Noridian Part B Medical Review has analyzed national and local data in conjunction with the findings from Comprehensive Error Rate Testing (CERT) to identify atypical billing. LEARN MORE

• Windows 10 Upgrade and PC-ACE Pro32 For All PC-ACE Pro32 Users On July 29, 2015, Microsoft will make Windows 10 available to current users of Windows 7 and Windows 8.1. Because the product will be distributed via download, and at no cost for many existing Windows users, there may be a high number of early adopters. Due to the fast release timeframe, the necessary testing needed to ensure compatibility with Windows 10 was not completed for the PC-ACE Pro32 July 2015 (2.7) release. Compatibility testing will instead be done as part of the October 2015 (2.8) release.

• PC-ACE Pro32 Quarterly Update For All PC-ACE Pro32 User An updated version of HIPAA-compliant PC-ACE Pro32 software, NAS15.02, is available for download from the EDI Support Services website at www.edissweb.com. An update to PC-ACE Pro32 is available every quarter (i.e., January, April, July and October). These updates are important to do quarterly in order for your PC-ACE Pro32 program to stay current. The update may be run immediately or saved to your PC. Remember, this update file should not be saved in the current WINPCACE folder on the drive where the PC-ACE Pro32 is installed.

  CALIFORNIA WORKERS COMPENSATION

• DWC Enacting New Online QME Form 106 Panel Process, Posts Training Video and FAQs on Website The Division of Workers' Compensation (DWC) will implement a new online panel process for represented initial panel requests on October 1, 2015. DWC will no longer accept or process paper submissions postmarked after September 3, 2015. The new process requires parties in a represented case to submit initial QME panel requests online and immediately receive a QME panel. The requesting party will then serve the panel request form, any required documentation and the QME panel on all parties with a proof of service. LEARN MORE

• OAL Approves DWC Final Qualified Medical Evaluator Regulations The Office of Administrative Law (OAL) has approved the Division of Workers' Compensation's (DWC) final version of the Qualified Medical Evaluator (QME) regulations. The effective date of the new regulations is September 1, 2015.

The new QME regulations establish a mandatory online QME panel request process for claims where the injured worker is represented by an attorney. A party making such a request through the DWC website will immediately be issued a QME panel ready for service on all parties. In addition, the approved regulations simplify the QME Form 105 for unrepresented injured workers, which must still be mailed to the DWC Medical Unit for processing, and make minor changes to the QME appointment form, the reappointment form, and the QME unavailability form. LEARN MORE

• OAL Approves DWC Revised Benefit Notice Regulations The Office of Administrative Law (OAL) has approved the Division of Workers' Compensation (DWC) revised benefit notice regulations. The regulations are found in Title 8, California Code of Regulations, Sections 9810, 9811, 9812, 9813, 9814, 9815, 9881.1, and 10139.

The final regulations were approved on August 22, 2015 and will be effective for all benefit notices required to be sent on or after January 1, 2016.

Significant reforms to the benefit notice process in the amended regulations include:

• Elimination of the requirement to provide Fact Sheets as attachments to notices
• Reduction of the requirement to provide a QME panel request form with notices
• Elimination of the warning notice language at the top of notices
• Allowance for employees and their attorneys to choose to receive electronic service of notices.

LEARN MORE

• DWC Posts Adjustments to Official Medical Fee Schedule for Physician Services/Non-Physician Practitioner Services The Division of Workers' Compensation (DWC) has posted an order adjusting the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1. The order adopting the OMFS adjustments is effective for services rendered on or after October 1, 2015 and can be found on the DWC website. LEARN MORE

• DWC Posts Adjustments to Official Medical Fee Schedule (Physician Services / Non-Physician Practitioner Services) The Division of Workers' Compensation (DWC) has posted an order adjusting the Official Medical Fee Schedule (OMFS) to conform to changes in the Medicare payment system as required by Labor Code section 5307.1. CMS Medicare National Physician Fee Schedule Relative Value File (RVU file) RVU15D October 2015 quarterly update released October 2, 2015 LEARN MORE

• DIR, DWC Post Final, Approved Regulations Regarding Transition of Regulations and Forms to ICD-10 The Department of Industrial Relations (DIR) and its Division of Workers' Compensation (DWC) today posted the final approved regulations regarding transitioning the California workers' compensation system from the ICD-9 system of diagnosis to the ICD-10 system of diagnosis, effective October 1, 2015. LEARN MORE

• DWC Launches New Online QME Form 106 Panel Process October 1 The Division of Workers' Compensation (DWC) will implement a new online panel process for represented initial panel requests on October 1. It requires parties in a represented case to submit initial Qualified Medical Examiner (QME) panel requests online and immediately receive a QME panel. The requesting party will then serve the panel request form, any required documentation and the QME on all parties with a proof of service. LEARN MORE

• DWC Posts Revised Benefit Notice Manual on Website The Audit Unit of the Division of Workers' Compensation (DWC) has completed its revision of the Benefit Notice Manual containing the sample benefit notices. LEARN MORE

• DWC Reinstating Lien Activation Fees on November 9 The Division of Workers' Compensation (DWC) will reinstate statutorily required lien activation fees that have been enjoined by the U.S. District Court for the past two years on Monday, November 9.

In Angelotti Chiropractic v. Baker et. al., Plaintiff Angelotti and other lien claimants sued the Director of the Department of Industrial Relations (DIR) and others, alleging that the lien activation fees under Labor Code §4903.6 violated the U.S. Constitution. U.S. District Court Judge George Wu dismissed two of the grounds alleged by plaintiffs, under the taking and due process clauses of the constitution, but he issued a preliminary injunction against enforcement of the activation fees on equal protection grounds, which injunction became effective on November 19, 2013. LEARN MORE

• DWC Posts Adjustments to Official Medical Fee Schedule (Physician Services / Non-Physician Practitioner Services) The Division of Workers' Compensation (DWC) has posted an order adjusting the Physician Services/Non-Physician Practitioner Services section of the Official Medical Fee Schedule (OMFS) to conform to relevant 2016 changes in the Medicare payment system as required by Labor Code section 5307.1.

The Physician and Non-Physician Practitioner Fee Schedule based on the federal Resource Based Relative Value Scale (RBRVS) was adopted pursuant to the requirements of Senate Bill 863 (SB 863) and became effective for services rendered on or after January 1, 2014. As mandated by SB 863, the fee schedule starts with separate conversion factors for surgery, radiology, and "all other services" in 2014 and transitions to a single conversion factor (CF) beginning 2017, for all services except anesthesia, which has its own CF. The 2016 transition conversion factors reflect a blend of 25 percent pre-2014 OMFS CF and 75 percent 120% RBRVS Medicare CF. LEARN MORE

• DWC Updates Supplemental Job Displacement Benefit Voucher Form With Notice of the Return-to-Work Supplement Program The Division of Workers' Compensation (DWC) has posted a revised Supplemental Job Displacement Benefit voucher form on its website. The voucher form has been updated to conform to Title 8, California Code of Regulations, section 17303. LEARN MORE

• DWC Posts Spanish Version of Revised Benefit Notices on Website The Audit and Enforcement Unit of the Division of Workers' Compensation (DWC) has posted the Spanish version of the revised benefit notice manual on the DWC website. The English version was previously posted. LEARN MORE

• DWC Posts Updated Spanish Version of Revised Benefit Notices on Website The Audit and Enforcement Unit of the Division of Workers' Compensation (DWC) updated the Spanish version of the revised sample benefit notice manual on the DWC website.

This update adds URL addresses to link directly to the Spanish version of the Injured Worker Guidebook and the corresponding chapters required in the notices. Links to the QME form and instructions in Spanish have also been updated. LEARN MORE

• Mileage Rate for Medical and Medical-legal Travel Expenses Decreases Effective January 1, 2016 The Division of Workers' Compensation (DWC) is announcing the decrease of the mileage rate for medical and medical-legal travel expenses by three and one-half cents to 54.0 cents per mile effective January 1, 2016. LEARN MORE

SYSTEMS FOR BUILDING A SUCCESSFUL PRACTICE (DVD and Workshop Package) CLEARANCE $100.00 while supply lasts.

Chiropractic Success Systems™ ©2004-2016
P.O. Box 581, Petaluma, California 94953-0581
Phone: (707) 778-0861   | Fax: (855) 898-0627