In This Issue:
- Important Dates
- 2015 License Renewal: Avoiding Claim Denials
- Medicaid Program: Revised Authorization Requirements
- Register Now: ICD-10 Educational Opportunities in January
- Required Provider Training by December 31: Dual-eligible Products
- Coding Corner
- Compliance Corner
December 31, 2014: Time to renew your chiropractic license! Chiropractors whose licenses lapse will not be reimbursed for claims that occur during the lapsed period. Ultimately, network participation will be terminated if the license is not renewed (see article, below, for details).
- December 31, 2014: In compliance with the HealthPartners and UCare Models of Care (MOCs), ChiroCare providers are required to review each plans’ Special Needs Plans training materials and share with appropriate clinic staff. All of the training materials can be found at chirocare.com. (See article, below, for details.)
- January 1, 2015: Minnesota Statute 62J.495 requires that all hospitals and health care providers working in Minnesota have an interoperable EHR system in their clinical practice settings.
- January 1, 2015: ChiroCare’s Electronic Remittance Advice (ERA) will include enhancements to provide additional information related to electronic ACH banking and payment information, and will change the reporting of the MN Care Tax from a claim-level adjustment to a service line-level adjustment.
- January 1, 2015: Dates of service beginning January 1 will no longer require authorization for chiropractic care for providers treating Medicaid patients. Requests for authorization that are submitted unnecessarily to ChiroCare will be returned without a clinical review. (See article, below, or click here for details.)
- January 1, 2015: All Practitioner Manual updates will be posted. Once you log into ChiroCare Connect, select Administrative Services.
We wish you a successful 2015!
Chiropractic licenses not renewed on January 1, 2015, will result in claims being returned unprocessed. If the Minnesota Board of Chiropractic Examiners (MBCE) website does not show a 2015 renewal of your license by January 2, 2015, you will be required to fax a copy of your license renewal confirmation (e-mail from the MBCE) to our credentialing department at (916) 929-2285 before we can update your ChiroCare record and process any claims. In addition, claims previously returned to the office due to untimely license renewal will need to be re-submitted for processing. After a 30-day grace period, providers whose licenses have not been renewed will be terminated from the ChiroCare network.
Dates of service beginning January 1, 2015, will no longer require authorization for chiropractic care for providers treating Medicaid patients, regardless of whether the patient holds a HealthPartners or UCare (Medicaid) policy. Requests for authorization that are submitted unnecessarily to ChiroCare will be returned without a clinical review. Please note that care provided to Medicaid members, and paid for by ChiroCare, must be medically necessary and may be subject to medical necessity reviews. Reviews will be done at ChiroCare’s discretion throughout the course of treatment and will focus on cases that reach more than 15 billed visits. When treating members with a commercial or Medicare policy, including dual-eligible members with Medicare as primary insurance coverage, ChiroCare’s standard authorization requirements will apply. Details about the revised authorization requirements are provided on the 2015 Plan Summary documents that were recently posted to ChiroCare Connect.
Dr. Evan Gwilliam, vice president of ChiroCode Institute, is presenting two webinars in January to help ChiroCare’s network chiropractors jump the hurdles of navigating from ICD-9 to ICD-10.
Webinars will be held on:
- January 15, 2015, 12:30 p.m.-1:30 p.m. (CST)
- January 27, 2015, 12:30 p.m.-1:30 p.m. (CST)
- SAVE THE DATE! February 21, 2015, ICD-10 Boot Camp
Attend one or both sessions—-while they will be very similar, the information is complex. It’s important to note that ICD-10 has 141,000 codes—-more than eight times the 17,000 codes in ICD-9. Every ICD-9 code you are using, including 739 and 839 subluxations, is going to change. The implementation deadline is October 1, 2015.
HealthPartners and UCare sell dual-eligible products that qualify as Special Needs Plans (SNPs), e.g., Minnesota Senior Health Options (MSHO) and Minnesota Senior Care Plus (MSC+). Due to the unique makeup and needs of SNP members, plans are required to submit a Model of Care (MOC) plan that includes product-specific provider training. In compliance with the HealthPartners and UCare MOCs, ChiroCare providers are required to review each plan’s SNP training materials and share with appropriate clinic staff. The training deadline is December 31, 2014, and it is an annual requirement.
To comply with this provider requirement, we are providing training materials and the MSHO/Special Needs Plan Training Log on chirocare.com. While it is mandatory to complete and save a copy of the Training Log Tracking Sheet to demonstrate compliance, there are no tests or quizzes required for this training. Accurate documentation will be especially important if you face an audit in the future.
- CPT Codes. ChiroCare has posted a table, identifying CPT codes that represent the various levels of chiropractic manipulative treatment. For each code, the definition and the requirement for billing is provided.
- ChiroCode Institute: Providers can take advantage of free, weekly news alerts regarding coding and compliance by signing up for the ChiroCode Institute newsletter.
- ICD-10 Update. Please register for one or both ICD-10 webinars on January 15 and January 27, from 12:30 p.m.-1:30 p.m. (CST)
- New Year, New Security Risk Assessment? The Health Insurance Portability and Accountability Act (HIPAA) Security Rule requires covered entities to conduct a risk assessment of their health care organizations. A risk assessment helps ensure compliance with HIPAA’sadministrative, physical and technical safeguards. A risk assessment also helps reveal areas where protected health information (PHI) could be at risk. Watch theSecurity Risk Analysis video to learn more about the assessment process and its benefits.
- Compliance Hotline: ChiroCare has a 24/7 compliance hotline for providers, patients, ChiroCare employees, and other individuals who are concerned about a possible compliance issue. Doctors have a duty to report themselves if a breach occurs (e.g., a laptop with unencrypted patient data is stolen; a flash drive containing patient data disappears).
- Is Your Contact Information Up to Date? To ensure timely payments and receipt of up-to-date ChiroCare information, please complete a Practitioner Information Update Form if you:
- Change or add locations
- Have a new billing address
- Change or add e-mail addresses
- Change or add phone or fax numbers
- Change a tax ID or NPI number
Simply download and fill out the form, and fax to