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eNews October 2013

In this issue:

    - Systems for Building a Successful Practice
    - California Part B Medicare - Good-bye Palmetto and Hello Noridian
    - ICD-10 Are You Ready October 14, 2014
    - New 1500 Claim Form
    - Correct Coding Initiative (CCI) Edits Effective 10/1/2013
    - HIPAA Up-Dates
    - Anthem Blue Cross/ ASH New Relationship
    - ACA Clarifies Aetna Policy on Manual Therapy (97140)
    - Understandable Health Care Reform Video
    - Why Parents Choose Chiropractic For Their Children
    - The Marketplace Countdown
    - Medicare Advantage Organizations - PQRS
    - Noridian Effective September 16, 2013
    - Temporary Total Disability Rates for 2014 Announced
    - DWC to Require Lien Claimants to use Uniform Assigned Name
    - CCA Announces and Important Win for Chiropractors

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These webinars 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.

webinar iconModule I - Practice Building Principles & Systems     course details

Tuesday, October 15, 2013 11:00 am - 12:45 pm PST register online

webinar iconModule II - Scripts for Success     course details

Tuesday, October 22, 2013 11:00 am - 12:45 pm PST register online

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

Tuesday, October 29, 2013 11:00 am - 12:45 pm PST 9 - 10:45 register online

webinar iconModule IV - Dream Team Power Tools     course details

Tuesday, November 5, 2013 11:00 am - 12:45 pm PST register online

Save 10% when you register for all four modules.

Four modules 11:00 am - 12:45 am PST
Tuesday, October 15, 2013 thru November 5, 2013 register online


Effective 9/16/2013 Noridian will be the California Part B Medicare Administrative Contractor and for the most part they will be processing claims in the same manner as Palmetto.

webinar iconCalifornia Medicare Part B    course details

Tuesday, October 8, 2013
9:00 am -11:15 am PST register online
12:30 pm - 2:45 pm PST register online

All other coding and collections webinars are available to purchase individually or as a package on-line.

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

(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.


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."


ICD-10: Are you ready? According to MLNMatters® Number: SE1239, Effective October 14, 2014 all providers who are covered by the Health Insurance Portability and Accountability Act (HIPAA) must make the transition, not just those who submit Medicare or Medicaid claims. This date is firm and not subject to change. If you are not ready, your claims will not be paid. Preparing now can help you avoid potential reimbursement issues.


In addition, here is a handout that will give you a basis overview of the structure of these codes.

New 1500 Claim Form Receives Final Approval According to the ACA Week in Review, June 27, 2013 The National Uniform Claim Committee (NUCC) announced on June 17, 2013 final approval of the Version 02/12 1500 Claim Form by the Office of Management and Budget. The revisions of the 1500 claim form in were made in order to accommodate the ICD-10 and Version 5010. You can find detailed list of the differences between Version 08/05 (the current form) and the new form, Version 02/12, can be found here. CMS implementation dates are as follows, but please note that these dates are subject to change (check with commercial payers to verify whether they will adhere to the same timeline):

Important Dates:

  • Jan. 6, 2014: Medicare begins receiving and processing paper claims submitted on the revised CMS 1500 claim form (version 02/12).
  • Jan. 6 through March 31, 2014: Dual use period during which Medicare continues to receive and process paper claims submitted on the old CMS 1500 claim form (version 08/05).
  • April 1, 2014: Medicare receives and processes paper claims submitted only on the revised CMS 1500 claim form (version 02/12).

NUCC's Reference Instruction Manual for Form Version 02/12

Correct Coding Initiative (CCI) Edits-Effective October 1, 2013 - The official instruction, CR8376, issued to your Medicare contractor regarding this change, may be viewed here on the CMS website. Remember that some third party payors utilize these edits.

HIPAA Up-Dates On January 17, 2013, HHS released new rules that protects patient privacy and secures health information.

"Much has changed in health care since HIPAA was enacted over fifteen years ago," said HHS Secretary Kathleen Sebelius. "The new rule will help protect patient privacy and safeguard patients' health information in an ever expanding digital age."

The changes expand many of the requirements to business associates of these entities that receive protected health information, such as contractors and subcontractors. Some of the largest breaches reported to HHS have involved business associates. Penalties are increased for noncompliance based on the level of negligence with a maximum penalty of $1.5 million per violation.

The changes also provide the public with increased protection and control of personal health information. The HIPAA Privacy and Security Rules have focused on health care providers, health plans and other entities that process health insurance claims. Individual rights are expanded in important ways.

  • Patients can ask for a copy of their electronic medical record in an electronic form.
  • When individuals pay by cash they can instruct their provider not to share information about their treatment with their health plan.
  • Limits on how information is used and disclosed for marketing and fundraising purposes and prohibits the sale of an individuals' health information without their permission.


The Rulemaking may be viewed here in the Federal Register.

Anthem Blue Cross / ASH-New Relationship - News from the California Chiropractic Association:
Effective May 1, 2013, some Anthem Blue Cross PPO claims will be administrated by American Specialty Health. Participating providers will follow their usual procedure based upon their Tier Level with ASH.

Non-participating providers will need to submit a treatment plan after five visits in order for patients to be reimbursed for services. Non-participating providers should inform billing staff of the changes to the Anthem Blue Cross Claims for processing through ASH in order to avoid a delay in reimbursements to patients.

We urge those not familiar with the process to call ASH and obtain any details necessary for your office to make a smooth transition. Linda Coltrin, CCA Member Resource Specialist, and Brad Sullivan, DC, CCA Insurance Relations Chair are available to assist. Call 916.648.2730 or email lcoltrin@calchiro.org.

ACA Clarifies Aetna Policy on Manual Therapy (97140) As many of you are aware, effective March 1, 2013, Aetna stated that Manual Therapy (CPT code 97140) is not recommended for separate payment when submitted with Chiropractic Manipulative Treatment (CMT). Modifiers -59 and -25 do not override this policy.

AMA CPT's guidelines for use of 97140 with CMT indicates that if a patient presents with a need for manual therapy in a region other than the region in which manipulation occurred it may be covered. Modifier -59 is used to indicate this is the case and it must be thoroughly documented that the therapy occurred in a separate region and why. In addition you should be using the diagnosis pointer to indicate the regions that the services were performed to as related to the diagnosis. Send all appeals to Aetna's appeals address and not the billing address. If you are using Aetna's online software NaviNet, please be aware that only one date can be entered per submission and the provider should avoid entering any data in the box "any additional dates of service." As these claims are resubmitted with doctors showing 97140 provided in a separate region through good documentation.

Understandable Health Care Reform Video from the Kaiser Family Foundation. A recently released animated video has been made to assist the public in better understanding the new health care changes. Topics include implementation timelines, exchanges, taxes, fees and eligibility. Watch here.

Why Parents Choose Chiropractic for Their Children. Taken from the May 2, 2013 American Chiropractic Association's "Week in Review" - Fox UP -- the Fox News affiliate in Michigan's Upper Peninsula -- recently aired this story about pediatric chiropractic. The piece talks about the reasons children need chiropractic care, including birth traumas, injuries, bad falls or trouble breastfeeding.

The Marketplace Countdown - Taken from the American Chiropractic Associations August 22, 2013 issue of "Week in Review - As of Oct. 1, the new health insurance marketplace will open its doors to individuals shopping for affordable health plans. Some of your patients may be uninsured, underinsured, or self-employed and wonder what their options are. For details, your patients can simply create a marketplace account where they'll have access to general information about coverage, helpful definitions, and how the marketplace works. Once signed up, individuals will receive an email discussing how they can get ready to enroll. This webpage will provide those seeking coverage with easy-to-understand information on every state's marketplace, regardless of whether it is being run by the federal government or a state.

Remember to assure your patients that they can receive assistance through navigators or certified application counselors. For overall facts and testimonials regarding how the Affordable Care Act will affect your state, click here. As we move through this time of change, ACA's goal is to help members meet patient needs effectively by providing solid, reliable resources. Click here for a document to email to your patients to help guide them through this process


• Medicare Advantage Organizations and others that sequestration DOES NOT mandate a 2% reduction of reimbursement to Medicare Advantage contracted providers. CMS clarified in a May 1, 2013 memo The Medicare Advantage plans themselves are subject to the 2% reductions; however Medicare Advantage plans CANNOT pass along the sequestration cuts to providers unless your contracts permit the pass-through (many contracts do not). Review you MA contracts and if you determine that your contract DOES NOT permit these cuts, you should consider challenging these reductions as contrary to your participation and network agreement. Call your provider rep and find out the name of the legal representative and draft a letter that these reductions are NOT allowed per your contract.

PQRS - Please start using these codes this year so that you and your patients don't get penalized.

I have provided you with many articles about this in past issues.


Noridian is JE IN - Palmetto J1B is OUT as of September 16, 2013. Continue to send all claims to Palmetto until September 16, 2013.

System Dark Day for Palmetto GBA Part B Providers as a Result of the JE A/B MAC Transition On September 16, 2013, the Palmetto GBA Part B workload will be transitioned to the new Noridian JE A/B MAC. In order to transition these workloads successfully, it is necessary to impose one (1) system dark day. Read the complete update.

I have attended a Noridian "Meet and Greet" event and they have assured us that there will be a smooth transition. They will continue using the same LCD that Palmetto uses. If you were on the List Serve with Palmetto you should have been receiving notifications from Noridian. If you have not you will want to join the Noridian list serve as soon as possible so that you don't experience a delay in receiving your Medicare payments. You can contact Noridian with your questions at JEQuestions@noridian.com OR call their Implementation Hotline at (800) 361-8289. Additional information can be found at www.Noridianmedicare.com/jeb.

Endeavor Provider Portal Tutorials Available - Endeavor is Noridian's version of OPS (On-Line Provider Services). Providers are encouraged to watch the provider portal, Endeavor, tutorials available on the Schedule of Events section of the implementation website.

Minimizing Provider Impact. Noridian's goal is to minimize the impact on providers. A few of the steps they are taking to minimize or eliminate impact to providers during the transition from Palmetto GBA to Noridian include:

  • Local Coverage Determination content will not change due to the implementation
  • Provider portal login information has been transferred
  • Electronic Funds Transfer (EFT) Authorization Agreements are not required from providers as part of the transition but will be evaluated as part of the normal enrollment and revalidation process
  • Listserv registrations have been provided to Noridian and used to send weekly implementation information

Some required changes include telephone numbers, addresses, forms and website material. New telephone numbers and addresses for JE will be posted to our website a few weeks prior to cutover. Key information like outreach events, implementation dates and other details will be available in many ways:

  • Website: www.noridianmedicare.com/jeb; which includes what's new, what's changing, a schedule of outreach and training events, questions and answers, and up-to-date information on implementation activities.
  • Listserv: Provides a summary of newly released implementation information and encourages provider attendance at upcoming outreach events.
  • Outreach: Noridian offers web-based and in-person "meet-and-greet" workshops, provider meetings, and Ask-the-Contractor Teleconferences to share implementation information and answer questions.
  • Tutorial: An "Implementation 101" presentation has been recorded and includes Noridian introductions, EDISS activities, enrollment information, communication channels, and questions and answers regarding the implementation.
  • Telephone Hotline: Providers can ask JE implementation-related questions by calling (800) 361-8289 between 8 a.m. - 5 p.m. PST, Monday-Friday. As a reminder, claims processing related questions should continue to go to Palmetto GBA until the cutover occurs for Part A on August 26, 2013 and Part B on September 16, 2013.
  • Email: Submit implementation-related questions to JEquestions@noridian.com

Effective September 16, 2013, you will have access to our single toll free customer service number 1-855-609-9960 that will allow you to connect to any of the following departments.

  • General inquiries
  • Electronic Data Interchange Support Services (EDISS)
  • Provider Enrollment
  • Phone Reopenings
  • User Security

This same toll free number (855-609-9960) will allow you to connect to our IVR system. Offering one consistent toll free number to all providers streamlines the process and offers consistency in providing the best customer service experience. The PCC Customer Service Representatives (CSRs) hours of operation are Monday-Friday between the hours of 6 a.m. - 5 p.m. Pacific Standard Time (PT).

Availability for IVR general inquiry and eligibility services are 24/7. Availability for all other services requiring FISS or MCS system access are available Monday-Friday 4 a.m. - 7 p.m. PT for all states except NV/HI. NV/HI Part B will be able to perform MCS transactions from 4 a.m. - 9 p.m. PT.

IVR Per instructions in the Internet Only Manual (IOM) Medicare Contractor Beneficiary and Provider Communications Manual, Publication 100-09, Chapter 6, Section 50.1, CMS requires providers to use the IVR for claim status and eligibility inquiries. It offers not only these services but additional important information to the provider community. IVR Instructions and/or flow chart will be published shortly.

Provider TTY Telephone Number. In addition to the single toll-free customer service number, also effective September 16, 2013 for Part B and in accordance with Section 508 of the Rehabilitation Act of 1973 and the Workforce Investment Act of 1998, Noridian will provide TeleTypewriter Equipment (TTY). TTY is a special device that permits hard of hearing and speech impaired individuals to use the telephone by allowing them to type messages back and forth to a Customer Service Representative (CSR). The TTY number is 1-855-549-9874.

Telephone Reopening Request Guidelines Beginning September 16, 2013, Part B providers can contact Noridian Telephone Reopening through a single toll free service phone number, 855-609-9960, which includes the Part A and B Provider Contact Centers (PCC), Electronic Data Interchange Support Services (EDISS), Provider Enrollment and User Security.


• Temporary Total Disability Rates For 2014 Announced The minimum and maximum temporary total disability (TTD) rates for 2014 will increase on Jan. 1, 2014. The minimum TTD rate will increase from $160 to $161.19 and the maximum TTD rate will increase from $1,066.72 to $1,074.64 per week. LEARN MORE

DWC to require lien claimants to use Uniform Assigned Name Newsline No. 42-13 On June 29, 2013, DWC will begin requiring lien claimants to use a Uniform Assigned Name (UAN). This is a uniform naming convention which ensures that parties are properly associated to cases in EAMS, and is currently used by attorneys and claims administrators. After June 29, 2013, a lien claimant must use a UAN when electronically filing a Notice and Request for Allowance of Lien and Application for Adjudication or their attempt to do so will result in failure. This requirement will extend to OCR-filed documents on July 1, 2013. LEARN MORE

CCA Important Win for Chiropractors - On Tuesday, July 16, 2013 CCA notified Ms. Destie Overpeck, the Administrative Director (AD) for the Division of Workers' Compensation (DWC), about a discrepancy in the information provided in its SB 863 FAQs regarding when a doctor of chiropractic must stop being the primary treating physician. In one part of their website the "FAQs for SB 863" accurately describe that for dates of injury on or after January 1, 2004 a patient will have to designate a new, non-chiropractic provider as PTP. However, the "FAQs for Employees" attempted to expand the definition of what counted as a "chiropractic visit" to include visits that are limited to only evaluation and management. This additional language was part of the regulations promulgated by the DWC; however, those regulations were never sent to the Office of Administrative Law (OAL) and therefore, are not a part of the regulations. CCA asked that the inappropriate language be removed. On Friday, July 19, 2013 Ms. Overpeck responded to the request and agreed to correct the FAQ. Join the CCA today!!

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Keeping a Watchful Eye on the Chiropractic Industry

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