New York Seminar 2015

Date: Thursday, September 17, 2015

Time: 1:00 PM - 5:00 PM

Location:  Farmingdale, New York

Location address: Office of Dr. Beth A. John

341 Conklin Street

Farmingdale, NY 11735

Office phone: (516) 249-2310 for direction purposes only

To register or for questions please call: (618) 395-3162

Chiropractors Transitioning from ICD-9 to ICD-10

August 17, 2015
Chiropractic Medicare 2015ICD-10 Change and Easy Transition

     As we approach the ICD-10 deadline, let us do a little preparation so the transition from ICD-9 to ICD-10 is easy. First question..... How many of you wish to become Coding Experts? I suspect NONE want to become Coding Experts.... so you will enjoy this article and it may even take a little pressure off.

     Secondly, to really take a little pressure off, CMS (Centers for Medicare & Medicaid Services Office of the Administrator) presented a letter to all Medicare Providers dated July 7, 2015 that contains a paragraph as follows:

    “For 12 months after ICD-10 implementation, Medicare review contractors will NOT deny physician or other practitioner claims billed under the Part B physician fee schedule through either automated medical review or complex medical record review based solely on the specificity of the ICD-10 diagnosis code as long as the physician/practitioner used a code from the right family.  However, a valid ICD-10 code will be required on all codes starting October 1, 2015” 

     That clearly means that after October 2015 NO ICD-9 codes may be used on any claim, not only to Medicare, but all insurances.  The transition must be 100%.  Prior to October 1, 2015, NO ICD-10 code are acceptable.  Wednesday evening, September 30 will be the end of ICD-9 codes forever.

     To prevent delays in payment, it is important to bill all your Medicare and insurance claims as quickly as possible prior to October 1, 2015.  So Thursday morning, October 1, 2015, all your patient diagnosis must be changed as you see the patient and do their S.O.A.P. notes.  If you bill each day electronically, make sure no ICD-9 codes appear on any claims.

     All certified software have special migration programs making it much easier to switch to ICD-10.  ChiroTouch, as an example, uses ICD-10 wizard in the diagnosis window to practice matching your present diagnosis with the new ICD-10 diagnosis.  Even though you are adding new ICD-10 diagnosis prior to October 1, no permanent changes go into the official records or any claim prior to October 1, as it is designed for practice only.

 As Chiropractors, remember, we are not reimbursed in Medicare to “treat” patient symptoms, but to locate and correct vertebral subluxations.  Your diagnosis should be a Chiropractic diagnosis with subluxations, degenerative joint disease, sprain/strain, neuritis, etc.  Practice makes perfect.....and we will soon get used to it. 

Help! My patient has Medicare and Medicaid, what do I do?

From time to time our office receives this question. You are a Non-participating chiropractor, your patient has Medicare and Medicaid, and you are unsure how to bill. 

Remember: ALWAYS BILL MEDICARE FOR A COVERED SERVICE. As a chiropractor, the only covered service in Medicare is the manual manipulation. However, the question was how to bill, so let's get to that.

As a Fee-For-Service Non-participating Provider in Medicare, you must accept assignment on a patient with Medicare Medicaid. You are allowed to collect unmet deductibles for Medicare. (Most of the time we take a small monthly payment plan for these individuals to meet that as they are on a budget.) They are on a fixed income and have met certain income criteria to be on the federal programs, no matter what the age. You must bill the covered service (the chiropractic adjustment) and mark box 13 as signed and 27 as accept assignment. For all other services you provide (that are not covered such as x-rays and therapies) make sure to have them sign the ABN notifying them at the time that these are not covered services, you are not required to bill those, and you may collect payment for those services.

Reference for Medi-Medi payment/billing requirements: (https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Medicare_Beneficiaries_Dual_Eligibles_At_a_Glance.pdf)

            "Assignment - You must accept assignment for services furnished to dual eligible beneficiaries. Assignment means that you are paid the Medicare-allowed amount as payment in full for all Part B claims for all covered services for all Medicare beneficiaries. You may not collect from the beneficiary any amount other than the unmet deductible and coinsurance. Prohibited Billing Under Section 1902(n)(3)(B) of the Social Security Act, as modified by Section 4714 of the Balanced Budget Act of 1997, Medicare and Medicaid payments you receive for furnishing services to a QMB are considered payments in full. You may not balance bill QMBs for any Medicare cost sharing (including deductibles, coinsurance, and copayments) for these services. You are subject to sanctions if you bill a QMB for amounts above the Medicare and Medicaid payments (even when Medicaid pays nothing)."

Reference for covered services: (https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c15.pdf)

            "30.5 - Chiropractor’s Services (Rev. 23, Issued: 10-08-04, Effective: 10-01-04, Implementation: 10-04-04) B3-2020.26 A chiropractor must be licensed or legally authorized to furnish chiropractic services by the State or jurisdiction in which the services are furnished. In addition, a licensed chiropractor must meet the following uniform minimum standards to be considered a physician for Medicare coverage. Coverage extends only to treatment by means of manual manipulation of the spine to correct a subluxation provided such treatment is legal in the State where performed. All other services furnished or ordered by chiropractors are not covered. If a chiropractor orders, takes, or interprets an x-ray or other diagnostic procedure to demonstrate a subluxation of the spine, the x-ray can be used for documentation. However, there is no coverage or payment for these services or for any other diagnostic or therapeutic service ordered or furnished by the chiropractor. For detailed information on using x-rays to determine subluxation, see §240.1.2. In addition, in performing manual manipulation of the spine, some chiropractors use manual devices that are hand-held with the thrust of the force of the device being controlled manually. While such manual manipulation may be covered, there is no separate payment permitted for use of this device."

Reference for ABN use: (https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Chiropractors_fact_sheet.pdf)

                "Option #2: A beneficiary selects option #2 when s/he agrees to pay out of pocket for the service in question and does not want a claim sent to Medicare. In accordance with the ABN, the provider would not file a claim, and the beneficiary would not have appeal rights since no claim is being submitted. (Please note that the patient can change his/her mind at a future time and request the claim be submitted.)"