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eNews July 2011

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California Medicare Part B
July 12, 2011
9:00 am -11:00 am PST - register online or 12:30 pm - 2:30 pm PST - register online

California Personal Injury
July 19, 2011
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
July 26, 2011 (Part I ) continued on August 2, 2011 (Part II )
9:00 am -11:00 am PST - register online or 12:00 pm - 2:00 pm PST - register online

Systems for Improving Your Collections
August 9, 2011 (Part I ) continued on August 23, 2011 (Part II )
9:00 am -11:00 am PST - register online or 12:00 pm - 2:00 pm PST - register online

California Workers' Compensation
August 30, 2011
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 Tuesdays 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.


• Join me in Peoria, Illinois for the DC Generations-The Parker Family Seminars September 8-10, 2011. I will presenting Coding & Collections and Medicare. For additional information and to register please visit www.dcgenerations.com

• My article "Keeping Up With the Joneses: The Times They Are a Changin'" appeared in the May 20, 2011 issue of Dynamic Chiropractic. You can find the article at http://www.chiropracticsuccesssystems.com/articles.html To receive a sample Up-date form, please email your request to lisabilodeau@chiropracticsuccesssystems with "UF" in the subject box.

• My article "Managing Medicare: Winners Never Quit, Quitters Never Win" appeared in the July 1, 2011 issue of Dynamic Chiropractic. You can find the article at http://www.chiropracticsuccesssystems.com/articles.html. To receive a checklist and sample cover letter, please email your request to lisabilodeau@chiropracticsuccesssystems with "MCCL" in the subject box.


• HHS to Reduce Premiums, Make it Easier for Americans with Pre-Existing Conditions to Get Health Insurance. The U.S. Department of Health and Human Services (HHS) announced new steps to reduce premiums and make it easier for Americans to enroll in the Pre-Existing Condition Insurance Plan.

HHS NEWS FOR IMMEDIATE RELEASE Tuesday, May 31, 2011 Contact: HHS Press Office (202) 690-6343

Premiums for the Federally-administered Pre-Existing Condition Insurance Plan (PCIP) will drop as much as 40 percent in 18 States, and eligibility standards will be eased in 23 States and the District of Columbia to ensure more Americans with pre-existing conditions have access to affordable health insurance. The Pre-Existing Condition Insurance Plan was created under the Affordable Care Act and serves as a bridge to 2014 when insurers will no longer be allowed to deny coverage to people with any pre-existing condition, like cancer, diabetes, and asthma.

To further enhance the program, beginning this fall, HHS will begin paying agents and brokers for successfully connecting eligible people with the PCIP program. HHS is also working with insurers to notify people about the PCIP option in their State when their application for health insurance is denied. The program covers a broad range of health benefits and is designed as a bridge for people with pre-existing conditions who cannot obtain health insurance coverage in today's private insurance market. In 2014, all Americans --regardless of their health status--will have access to affordable coverage either through their employer or through new competitive marketplaces called Exchanges, and insurers will be prohibited from charging more or denying coverage to anyone based on their health status.

For more information, including eligibility, plan benefits and rates, as well as information on how to apply, visit http://www.pcip.gov/ and click on "Find Your State." Then select your State from a map of the United States or from the drop-down menu. To find a chart showing changes to PCIP premiums in the States with Federally-administered PCIP programs, visit http://www.healthcare.gov/news/factsheets/pcip05312011a.html. The PCIP Call Center is open from 8 a.m. to 11 p.m. Eastern Time. Call toll-free 1-866-717-5826 (TTY 1-866-561-1604). A HHS press release regarding the PCIP changes can be found here: http://www.hhs.gov/news/.

• ACA Challenges UnitedHealthcare's Unfair Practices by Joining Class Action Lawsuit. The American Chiropractic Association's (ACA) Board of Governors has voted to join an existing class action lawsuit against UnitedHealthcare (United) initiated by the Ohio State Chiropractic Association, the Congress of Chiropractic State Associations and others. ACA's involvement will expand the litigation to include problems with United's claims review, tiering and payment policies.

ACA urges providers who believe that they and/or their patients have been affected by United or Optum's unfair practices to visit the Chiropractic Networks Action Center (CNAC), where they will find instructions and forms that can be used to submit a complaint. CNAC can be accessed by going to: http://www.acatoday.org/CNAC. Affected providers urged to submit complaints via ACA's Web site.

Additional information can be found at http://www.acatoday.org/press_css.cfm?CID=4386

• Compliance deadline for New Version of HIPAA Administrative Transactions Approaching. This will have an impact on your practice management systems upgrades. Now is the time to check with your practice management software company to find out if they will be read on the deadline of January 1, 2012.

This is not just a technology change that can be handled by your software but the changes may have an impact on the business side of your practice. An example of one of the changes is that you will not longer be able to have a post office box (P.O.) in the billing provider address field unless you report in the Pay-to Address-field of the transaction. Additional information can be found at http://www.cms.gov/versions5010andD0/.

• Chiropractors Make Career Cast 2011 List of 10-least Stressful Jobs.

• General Equivalence Mappings (GEMS) act mainly as a crosswalk between ICD-9 and ICD-10 have been created by the CMS and CDC to ensure that consistency in the national data is maintained. It will allow you to look up an ICD-9 code and provide you with the most appropriate ICD-10 matches and vice versa. They are NOT a substitute for learning the new ICD-10 codes. LEARN MORE →.


• G8644 "Eligible professional doesn't have prescribing privileges" Earlier this year I received phone calls and email about how to use this "required" code on Chiropractic Medicare claims. The ACA has confirmed and clarified that CMS (Centers for Medicare and Medicaid Services) that as long as your primary taxonomy code is listed chiropractor you do NOT have to submit any claims with this exemption code.

• H.E.A.T.- If you have not heard this term before it stands for Health Care Fraud Prevention and Enforcement Action Team and is part of the US Department of Justices on going effort to prevent Medicare fraud. To find out what is happening in your state visit http://www.stopmedicarefraud.gov/HEATnews/index.html. In addition here is a notice that I received via my CA Yahoo Group that I found very interesting. "The OIG has made the HEAT Provider Compliance Training Webcast Video available in 16 short modules.

This will allow users to select a topic area to view without having to watch the entire 3 hour and 45 minute video. http://go.usa.gov/Dzr

The module topic areas include:
Welcome Remarks 4:37
Overview of OIG 9:56
Navigating the Fraud and Abuse Laws 26:26
Compliance Program Basics 17:01
Operating an Effective Compliance Program 15:59
Understanding Program Exclusions 10:26
Navigating the Government 5:10
Overview of Centers for Medicare and Medicaid Services 34:24
Importance of Documentation 17:06
OIG Subpoenas Audits Surveys and Self Disclosure Protocol 17:42
Health Care Fraud Enforcement Panel 6:08
Health Care Fraud Enforcement Panel with CMS Deputy Admin 13:43
Health Care Fraud Enforcement Panel with Special Agent 15:10
Health Care Fraud Enforcement Panel with Asst. US Attorney 17:08
Health Care Fraud Enforcement Panel - Fraud Control Unit 11:15
Adjournment 0:59

That's all we have for now. If we can be of further assistance, please send an e-mail to public.affairs@oig.hhs.gov I hope your day is going well. -- Marc Wolfson, Office of External Affairs"


• There is now a IVR (Interactive Voice Response) system now has an on line conversation tool to use for entering your PTAN, Medicare number, and beneficiary's name. To use the tool go to http://www.palmettogba.com/palmetto/ivrt.nsf/Main?OpenForm


• "Is CSAA back to its old habits?" is the topic of Chiropractic Attorney Shawn Steel's October 12, 2010 PI - Main & Fax Alert newsletter and "CCA Challenges CSAA and State Farm Med-Pay Payment Policies -- Companies Ignore Policyholder-Signed Assignment of Benefits" appears as a topic in the California Chiropractic Association's Summer 2011 Advantage Newsletter.

Both articles discuss the potential negative impact that their policies may have on your practice. I have received a number of calls from offices stating that CSAA has been ignoring the patient's authorization for payment to come directly to their office. Remember that you should always complete an insurance verification form for all your personal injury cases within 24 hours of the patient's initial visit and you should always ask the carrier if the will send payment directly to the provider's office with a valid assignment of benefits on file (box #13 on the CMS-1500 form or electronic equivalent is complete). If they say that they will not honor the assignment of benefits then you may ask the patient to pay for all services in full at the time of service and that you will submit the bills to the carrier for them so that they can receive their reimbursement. Additional information is available at www.shawnsteel.com and www.calchiro.org.


• JET File- Newsline No. 25-11 The Division of Workers' Compensation (DWC) is preparing for the June 27 launch of JET File, a new fast, flexible and reliable electronic filing option for the workers' compensation courts. Designed and built in conjunction with external users for those annually filing 100 or more of any one of the six most common court forms, JET File offers many advantages for claims administrators, representatives, lien claimants and self-insured employers. JET File will also produce a broader impact on the workers' compensation courts by reducing the amount of paper received at the division's 24 district offices.

"It is important to encourage more participation in electronic filing as a way to improve the efficiency of EAMS and the service we provide," said Christine Baker, acting director of the Department of Industrial Relations. "In talking with our constituents and stakeholders, it was clear that we had the same goals, and these mutual interests resulted in working together to make JET File a reality."

DWC has built the receiving end of this new filing option and large filers can now decide how to connect to it by choosing one of three JET streams:

  • JET stream 1: Use vendor developed software. In this stream filers purchase software from an authorized vendor and use that software to JET File directly
  • JET stream 2: Use the services of a third party filer. In this stream filers use the services an authorized third party filer (TPF) who files on their behalf
  • JET stream 3: Create their own JET stream using technical specifications posted on the DWC Web site. Users of this stream create their own JET Filing mechanism so they don't need to buy software or use a TPF. This is for the tech savvy entities that want maximum control of their filings.

In addition to breaking the paper barrier by eliminating associated wait times and costs, benefits for JET Filers include:

  • Ability to submit one or many documents in a single transmission
  • Receive electronic response of success or errors
  • Receive case number electronically upon successful submission of an application
  • Holds and reprocesses DORs for up to 15 days to get a court date
  • Use OCR forms or e-forms (if in the e-forms trial) as needed.

The vision for JET File was crystallized in early 2010 when DWC and its working group of claims administrators, attorneys, service providers, lien claimants and others sought ways to improve filing. Months of work on technical requirements, development and testing for JET File followed.

"Stakeholders declared their intent to succeed jointly with DWC by working side by side over the long haul to launch this electronic filing method," said Court Administrator Keven Star. "DWC leadership is thrilled the entities that developed their software did it so well and so quickly. Now the array of options for external electronic filers is greatly enhanced by something new that can be used by a multitude of professionals."

In addition to directly benefitting those users who can immediately take advantage of JET File, this new method benefits the workers' compensation court system overall by reducing the amount of paper going into DWC's 24 district offices around the state, freeing DWC staff to focus on other tasks related to assisting injured workers and employers resolve their disputes.

More information--including a video introduction, accepted forms, authorized vendors, business rules, the trading partner agreement and technical specifications--is available on the JET File Web page.

Smaller filers can take advantage of electronic filing by joining the e-forms trial, and capacity is still available. Users can get help finding out which electronic filing method best suits their business needs by reviewing the electronic filing walkthrough video on the DWC's e-team Web page.

• Temporary total disability rate for 2012 will increase to $1010.50-Newsline No. 24-11 The minimum and maximum temporary total disability (TTD) rates for 2012 will increase on Jan. 1, 2012. The minimum TTD rate will increase to $151.57 and the maximum TTD rate will increase to $1010.50 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. The SAWW is defined as the average weekly wage paid to employees covered by unemployment insurance as reported by the U.S. Department of Labor for California for the 12 months ending March 31 in the year preceding the injury. In the 12 months ending March 31, 2011 the SAWW increased from $979.90 to $1003.55.

Under Labor Code section 4659(c), workers with dates of injury on or after Jan. 1, 2003 who are receiving life pensions (LP) or permanent total disability (PTD) benefits are also entitled to have their weekly LP or PTD rate adjusted based on the SAWW.

The SAWW may be verified at the U.S. Department of Labor Web site. For the 12 months preceding March 31, 1002011: http://ows.doleta.gov/unemploy/content/data_stats/datasum11/DataSum_2011_1.pdf


"Forwarding Order Expired". Have you ever received a bill that you sent to an insurance carrier or patient back from the post office stating that the "Forwarding Order Expired"? When was the last time you asked your patients to review the information in their file for accuracy? I recommend that you make an effort to verify the accuracy of each patient's records annually and while you are doing it, incorporate some of the data that will be required when you move to EHR.

Here are the areas you should review, ensuring the data in each patient's records is current, accurate, and properly documented: Demographic and communication information, current condition including diagnosis and date of onset, and current insurance information.

I have found that many patients are put off when they are asked to fill out an "Update Form." They will look at me and say, "Everything is the same." They don't even know what we have or don't have in their records. If your office has good practice-management software but has not gone paperless yet, print out the information you currently have in their records [name, address, phone number(s), e-mail address(es), employment information, emergency contact information, student status, chief complaints, insurance information] and ask them to review the information and make any changes directly on the form. If you are paperless have them review the information when they sign-in for accuracy and notify you of any changes. Don't forget to have the doctor verify that the DX and date of onset are current.

For those offices that don't have practice management software or the ability to print out basic patient information, I recommend that you give the patient an update form (if you would like a free sample form, please send me an e-mail to lisabilodeau@chiropracticsuccesssystems.com with "UD" in the subject box) on a clipboard and ask them to complete it. If they don't want to fill it out and instead say, "Everything is the same" - in other words, nothing has changed - politely ask them to put their name on the form and write "Same" across it, and sign and date it. I would also stress to them that by doing so, they are accepting complete responsibility for any inaccurate information that may be in their file.

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