FW: In Touch - December 2011

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From the ACA, Vern Saboe From: American Chiropractic Association [mailto:insinfo@...] Sent: Friday, December 16, 2011 1:28 PMvsaboe@...Subject: ACA: In Touch - December 2011 Having trouble viewing this email? Click here December 2011In This Issue Focused Perspective Insurance Matters Insurance Landscape from Our Vantage Point Business and Practice Talk Back Helpful Resources Dragon Medical Focused PerspectiveInsurers Announce New Reimbursement Policy for Multiple Therapies Bobby Gibson, Director of Operations United Healthcare (UHC) and Aetna recently sent out notices to providers detailing their new Multiple Therapy Reduction policies. These policies reduce the reimbursement for the practice expense portion of the relative value units (RVUs) for certain therapies beyond the first therapy billed. The rationale is that there is duplication of the practice expense portion of the RVU. UHC and Aetna are following the lead of the Centers for Medicare and Medicaid Services (CMS) after it initiated a similar policy on Jan. 1, 2011. CMS originally proposed a reduction of the second and any subsequent therapy practice expense portions by 50 percent. When that policy was proposed, ACA partnered with other provider organizations to contact Congress to oppose the policy. Due to the large amount of opposition, CMS decided to lessen the reduction to 20 percent rather than the proposed 50 percent. UHC's policy will affect claims with a date of service on or after March 1, 2012 and will affect claims paid by United. It will not affect claims on any plans in which Optum processes or pays the claims or plans in which providers are paid a flat per diem visit fee. Aetna's policy took effect November 14, 2011, and to the best of our knowledge affects all Aetna plans. To illustrate how this policy will play out, we have created the following hypothetical example: Contracted Rate for XYZ Therapy Service = $20 Percentage of Total RVU that the Practice Expense Portion Comprises = 50%*20% Reduction of the Practice Expense Portion = $2 New Reimbursement Amount = $18 * It is important to note that 50 percent is hypothetical. Some procedures have a practice expense that comprises greater than 50 percent of the total RVU and some less. To learn exactly which codes this affects under UHC, and to see the exact percentages for each, you can go directly to UHC's policy on the subject here (pages 17-18). To view Aetna's policy, please click here (page 2). ACA is currently investigating this issue and will keep members abreast of our efforts to address these policies. Insurance MattersVersion 5010 Delay Not an Early Christmas Present Hope , Insurance Quality Analyst II You may have already heard that CMS's Office of E-Health Standards and Services (OESS) will be delaying enforcement of compliance with the new HIPAA Version 5010 electronic transaction standards until March 31, 2012. However, it is important to note that the compliance date for use of the new standards is still Jan. 1, 2012. OESS encourages providers and payers to continue working with transaction partners to ensure their readiness to accept the new standards as of Jan. 1. Complaints against non compliant providers will be accepted and providers, " must produce evidence of either compliance or a good faith effort to become compliant with the new HIPAA standards, " if requested by OESS during the 90-day discretionary enforcement period. Providers who have not prepared for the transition need to do so immediately. For assistance with general Version 5010 readiness, see ACA's Version 5010 resources found on its ICD-10 site at www.acatoday.org/ICD-10. ACA has created a convenient checklist and FAQs to help members with the transition. Helpful points to note:Many providers are being inundated by emails and other communications suggesting they must purchase expensive software or make conversions to their present systems that may not be needed. If you have a billing clearinghouse, we suggest you call them and see if they plan to take care of the change to Version 5010 for your claims. If you do not presently have a billing clearinghouse or you would like information about ACA's Corporate Member clearinghouse, Infinedi, please contact ACA - or Infinedi directly - for more information as you prepare your clinic for Version 5010. Some providers are trying to send test claims in preparation for Version 5010 and finding that some payers are not prepared to receive them. Contacting these payers, particularly Blues plans, has revealed that some are not sure they will be prepared by the Jan. 1 compliance date. It is important for clinics to do all they can to PREPARE, and test claims with every entity they can. Keeping documentation of failed tests will equip you to respond to OESS should there be an inquiry, and you should continue checking back with any unprepared payers to ascertain their readiness. Many ACA members are still confused about the implementation dates for Version 5010 and ICD-10. Please understand that these are two different issues with different deadlines for compliance. Version 5010 - deadline, Jan. 1 - is the new group of standards that will replace Version 4010 and be used for all electronic transactions. Version 5010 implementation does not apply to those who do not conduct HIPAA transactions electronically, including claims submission, electronic remittance, and eligibility and claims status verifications. ICD-10 is the expanded set of diagnosis codes that must be used by providers beginning on Oct. 1, 2013 and applies to all providers regardless of whether they conduct electronic transactions.Sources: " Centers for Medicare & Medicaid Services' Office of E-Health Standards and Services Announces 90-Day Period of Enforcement Discretion for Compliance with New HIPAA Transaction Standards. " Department of Health & Human Services Centers for Medicare & Medicaid Services. 17 Nov. 2011. http://www.cms.gov/ICD10/Downloads/CMSStatement5010EnforcementDiscretion111711.pdf Leppert, A., CPC-A. " CMS Delays HIPAA 5010 Enforcement. " HCPro Website. 17 Nov. 2011. http://www.hcpro.com/HOM-273443-6962/CMS-delays-HIPAA-5010-enforcement.html Insurers Get Report Cards Too - But Are They Making the Grade? Lenhardt, Associate Director, Insurance Advocacy For the last four years, the American Medical Association (AMA) has released an annual report card for seven major insurers. This year's National Insurer Report Card showed that insurers are paying claims inaccurately 1 in 5 times or 19.3 percent which is an increase from last year when mistakes were made on 17.3 percent of claims. To put this into perspective, commercial insurers were accurate 80.7 percent of the time, while Medicare boasts an accuracy of 96.2 percent. In dollars and cents, the AMA estimates that the increase in inaccurate payments added another $1.5 billion in health care costs. All in all, inaccuracies in claims processing costs the health care system $17 billion annually. Of the seven insurers included in the report - Aetna, Anthem, Cigna, HCSC (parent company for Blues plans in Illinois, New Mexico, Oklahoma, and Texas), Humana, Regence (parent company for Blues plans in Idaho, Oregon, Utah, and Washington),and United HealthGroup, only one showed an improvement from last year's report card-United HealthGroup (United). United also had the best accuracy scores - the remittance advice matched the contracted fee schedule 90.2 percent of the time. However, that is still well below Medicare's accuracy, and the cost associated with the errors is significant to providers. These costs are exactly why ACA encourages providers and billing staff to closely review all remittance advices and to ask whether the claim was paid correctly according to the contracted fee schedule, payment policies and claims edits. If there are errors, the practice should immediately appeal or have the claim reprocessed. In some cases, a phone call to the insurer to have the claim reprocessed may be all it takes. But there are many areas where a written appeal is necessary, and if so, ACA has resources that are designed to streamline the appeal process for providers. These resources include an appeal checklist, template appeal letters, coding clarifications, and more; all of which can be found on ACA's appeals webpage at www.acatoday.org/appeals. For more information, please contact ACA at insinfo@.... When Is a Patient Not " Just Like Other Patients? " Hope , Insurance Quality Analyst II At some point you have been or will be asked to treat family members, friends, employees, colleagues or some other person close to you. There are often concerns involving state laws and insurance company contractual provisions that must be considered prior to offering such treatment. But that's not all. Colleagues, friends, family and employees - parties of a close personal nature - are actually " patients " and the provider's moral and legal duties to them are the same as to any other patient, according to Perle, DC, professor of clinical sciences at the University of Bridgeport College of Chiropractic. Dr. Perle makes the logical analogy that, " You wouldn't treat a stranger without an examination and documentation. Why would you do it for someone you are close to? " So, treatment of such persons should be with the same care and attention to clinical detail as one would provide to every other patient who presents for care. That said, the billing for such services should not be treated the same as it presents ethical ramifications. ACA's policy states that, " Third-party billing for assessment and treatment of parties of a close personal nature-that would by common practice and reason be furnished gratuitously-gives an appearance of self-interest, which is a professional impropriety and therefore may be unethical. " Consider carefully all ramifications of treatment of and billing for parties of a close personal nature and when in doubt, a good resource may be to contact your malpractice carrier or your health care law attorney for guidance. To view ACA's current policy on third-party billing for the treatment of parties of a close personal nature, click here. This article is for informational purposes only and does not constitute legal advice. Members should seek the advice of a licensed attorney in their jurisdiction regarding specific medical ethics issues. Sources:Perle, M., DC, MS, FICC. " The Ethics of Treating Friends, Family, Colleagues and Employees. " ACA News May 2009. ACA - The Ethics of Treating Friends, Family, Colleagues and Employees Insurance Landscape from Our Vantage PointChiropractic Networks Lenhardt, Associate Director, Insurance Advocacy Over the last several months, many of our members have contacted ACA regarding their concerns with several chiropractic networks. The concerns expressed include, but are not limited to:lack of clear communication to providers, patients and employersrestriction of treatment not in keeping with standard chiropractic practiceinterfering with doctors' duty to exercise professional clinical judgment in managing patients' treatment planslack of appropriate, evidence-based clinical rationale for denial of treatmentuntimely payment of claimsYou may have heard us say this before-ACA is committed to advocating on behalf of the chiropractic profession to ensure the concerns of providers and patients are heard by regulators and other interested parties. But, do you know that YOU enable us to do this effectively? Without doctors, chiropractic assistants, and billing managers STOPPING, just for a few minutes, to tell us what they are experiencing, we cannot represent the profession as effectively as you need us to. Won't you be one of the ones who STOPS this week, or marks your calendar to contact us soon? Remember, YOU make ACA's advocacy efforts strong! Additional information regarding ACA's efforts and how to submit information to ACA's Insurance Relations department can be found at ACA's Chiropractic Network Action Center. Local Liaison Program - Coordinating Efforts between State Associations and ACA P. Slavik, DC As the Director of the ACA Local Liaison Program (LLP), which now covers 26 states, I have the opportunity to meet with our insurance liaisons on a bi-monthly basis. During our meetings in which we strategize regarding the challenges the profession is facing in their state, we also bring to their attention the issues occurring in other states, as well as national news. This partnership between the states that participate and ACA has resulted in a lot of progress - both for ACA and for the states. Those states and U.S. territories participating in the Program now include: Ala., Alaska, Ariz., Calif., Colo., Conn., Fla., Ga., Ill., Ind., Ky., Maine, Mich., Minn., Miss., Mo., N.Y., N.C., Ohio, R.I., S.D., Tenn., Texas, Vt., & V.I. You can view a map of the states with their respective liaisons here. During one of our recent meetings, we were given an update on the progress of health care reform in Mississippi. Dr. is the ACA liaison in the state, and through his state legislator he was able to secure a meeting with the Mississippi Commissioner of Insurance, Mike Chaney. During that meeting Dr. (along with ACA Delegate Dr. Al Norville and Dr. Ray Foxworth) was able to discuss the importance of doctors of chiropractic in health care reform. Most importantly, this meeting was instrumental in positioning the chiropractic profession as the state begins establishing its health insurance exchange. It appears that Commissioner Chaney understood the importance of the message as well as the necessity of direct access for patients to obtain the services of a doctor of chiropractic. We are hopeful that this meeting will result in a doctor of chiropractic being appointed to the panel establishing the recommendations for the implementation of health care reform measures in Mississippi. Health care reform is a federal program that will ultimately be implemented at the state and local levels. CA's also have a unique position, in that they often speak with patients in positions that can influence how the chiropractic profession is viewed and may ultimately be positioned in reform efforts in each state. If your clinic has patients who express an interest in assisting the profession, be prepared ahead of time in knowing what to share with them. ACA's position with regard to health care reform is that doctors of chiropractic are physician-level providers and that the essential benefits delineated in the health care reform law should be reimbursable to any provider who can perform these services under their state laws. As the Patient Protection and Affordable Care Act (PPACA) also contains a provider non-discrimination provision, ACA advocates that covered services should not be provider based, but rather condition based, utilizing any appropriate, evidence-based examination or treatment necessary to meet a patient's needs, so long as it is within the provider's education, training, and licensure. Please call ACA if you have any questions, or you can read about ACA's health care reform efforts here. Business and PracticeBetter Informed Patients Make Better Patients P. Slavik, DC It is crucial for doctors to talk to patients about their clinical findings, lab results, x-ray findings, and treatment plan, but patients must also be informed of their insurance coverage. Patients need to be fully informed as to what their financial liability is when seeking care from any health care provider, and chiropractic offices are no exception. The first step in informing a patient is obtaining insurance benefit information for them that pertains specifically to the care that will be delivered. Health insurance policies today have become complex and varied. For example, many high deductible health plans have health savings accounts (HSA) attached to them. Patients may present payment with a " swipe card " from their HSA (which works like a credit card). When calling the insurer for benefit details, it is essential to ask the right questions based on the care that will be delivered because the customer service representative may only respond with generic benefit details. ACA has a form to assist you in verifying benefits that can be found here. Today, many benefit verifications can be performed online on insurers' websites, but be aware that what you obtain in this manner may not be as specific as you need it to be, so a phone call may be necessary. When calling the insurer, be sure to obtain a reference number for the call and the customer service representative's name and specific extension (if applicable) for future reference. If accessing the information online, be sure to print the information and retain it in the patient's file. This will be important information to have on hand if the benefit information is ever disputed, or if a complaint is filed with a state department of insurance or the department of labor. The ACA encourages all doctors of chiropractic to have their patients sign an assignment of benefits form/consent form, which allows for the provider to represent the patient in ERISA and other insurance related disputes. An example of this essential form can be found here. The New Year is a good time to have every patient sign a new assignment/consent form while they update their demographic information for your billing records. Once you have obtained the detailed plan benefits, you are equipped to clearly communicate to the patient what they can expect their insurance to cover and what their responsibility will be. When a patient is informed about their benefits, they are more likely to follow through with a recommended treatment plan. Hidden costs may cause a patient to prematurely discontinue care if they think somehow the clinic left them with " surprise " charges. It is also a good business practice-and in keeping with most insurer and provider network policies-to inform the patient, and have them agree in writing (usually on a designated form), that any non-covered services will be their financial responsibility. This may include items such as orthotics, other DME, and wellness care. Be sure that every staff member is familiar with each insurer's non-covered services policies and the forms that allow the clinic to bill the patient. Additionally, when viewing Explanation of Benefit (EOB) documents it is important to ascertain if the insurer applied the correct co-payment amount and if the co-payment charged to the patient at the time of the service exceeds the total " allowed amount " for the visit on the EOB. If a provider is contracted with an insurer, the provider is not allowed to charge the patient in excess of the allowed amount, even if the quoted co-payment exceeds this amount. In some cases, the provider may owe the patient a refund. Be sure to post payments to patient accounts correctly, reflecting the information from the EOB after verifying its accuracy. The ACA is here to assist you if you need help. This article is for informational purposes only and does not constitute legal advice. Members should seek the advice of a licensed attorney in their jurisdiction regarding specific billing issues. Self-Audits - Tools You Can Use Lenhardt, Associate Director, Insurance Advocacy These days, " audit " may seem like a bad word. Commercial payers and Medicare auditors can cause nightmares for providers and their staff while requested documentation is prepared - and then there is the wait for the results. Practices can ease some of this stress and respond to audit requests from payers with confidence by being as prepared as possible. One way to do this is by performing regular self-audits. Self-audits can be performed at any interval by staff. Although performing a self-audit requires a firm grasp on proper coding and documentation, doing so often catches errors that occur in the day to day rush of running a practice and caring for patients. Audits can be performed on every chart for a particular date of service, or randomly on a less frequent basis. They can be performed for proper coding, to check for documentation components, and/or for compliance with provider/insurer contracts and policies. To make it easier for practices, ACA has developed a few self-audit tools that can be helpful when reviewing records. While these tools are not all-inclusive, they provide a place to start when initiating a self-audit program. To access these tools and other information on audits and recoupment requests, please visit ACA's audit webpage at www.acatoday.org/audits. This article is for informational purposes only and does not constitute legal advice. Members should seek the advice of a licensed attorney in their jurisdiction regarding specific billing issues. Health and Wellness: Take the Lead! The need for increased patient awareness about health and wellness has never been more evident than today. With rates of diabetes, heart disease and obesity rapidly increasing in this country, patients need information and coaching NOW on how to appropriately manage their health. To help DCs address these issues, ACA and the highly respected National Wellness Institute (NWI) have teamed up to provide an educational seminar that will allow DCs become certified health and wellness specialists. Starting this January, DCs will have the opportunity to earn their certification and immediately start filling a crucial void in the health care system. With more emphasis being put on preventative care than ever before, this certification offers DCs the chance to provide a patient service that will ultimately play a leading role in how health professionals approach primary care in the future. This initiative aims to teach DCs different strategies and programs that can be implemented in their practice to ensure their patients are making educated decisions when it comes to their health. The time for the profession to demonstrate the value of chiropractic care is now. Register today! Session Dates and Locations: University of Bridgeport College of Chiropractic, Bridgeport, CT Jan. 14, 2012 Feb. 11, 2012 March 10, 2012 April 14, 2012 Register Here University of Western States, Portland, ORJan. 21, 2012 Feb. 18, 2012 March 3, 2012 March 31, 2012Register Here Talk BackThe ACA Insurance Relations Department wants to hear from you! Information from members is the lifeblood of our Department, and in future editions we will continue to publish questions, concerns, or other feedback that readers share with us. Did you know we routinely help members with coding, billing, and appeals questions free of charge? If you would like to submit comments about this publication or have an insurance-related question, please send an e-mail toInsInfo@... with the subject line " In Touch " . Feedback this month:Thanks so much for your well thought out response. I recently purchased coding support from a company and asked the same question (I didn't know we had your service available at that time). Your response was vastly superior to theirs and I really do appreciate it. It is things like this that make the check written to the ACA seem so easy!Dr. Josh um - ville, MO Helpful ResourcesResources for InsurersDid you know that ACA offers resources for insurers, such as the Guide for Insurance Professionals - a booklet that provides comprehensive information about the chiropractic profession? Did you also know that ACA, in an effort to provide correct information to the investigators, case managers, and claims adjusters in the insurance industry attends the International Association of Special Investigation Units (IASIU) annual meeting where we distribute the Guide and other resources? All of this information and more can be found here. In Touch ArchivesHave you missed an edition of In Touch or accidentally deleted it from your inbox? Previous editions of In Touch are archived on the ACA website and can be accessed at www.acatoday.org/InTouch. Dragon Medical - Calculate the time and money you'll save!More providers win recoupment cases who have transcribed notes than those who have handwritten ones. Why? They tend to be more legible and therefore tell the complete story in a manner others can read. But, dictation takes time and money. Why not save your money? With Dragon Medical you dictate and the voice-to-text software types as you speak. As you see your documentation being written, you can edit it if you see the need. You can also create macros - commands that replicate larger portions of text that you say often such as describing the pain scale. Not sure? Give the folks at Mighty Oak Technology a call and explore this at YOUR pace and see if it's right for you. You can even speak with other DCs who have made the change and talk to them about how Dragon Medical has helped them. Dragon Medical comes in a Windows compatible version or in the new Apple compatible MacSpeech. Contact ACA's partners at Mighty Oak Technology, Inc. at www.MightyOakInc.com or by emailing: Judy@.... Copyright © American Chiropractic Association | 1701 Clarendon Blvd. Arlington , VA 22209 | 703 276 8800. Forward emailThis email was sent to vsaboe@... by insinfo@... | Update Profile/Email Address | Instant removal with SafeUnsubscribe™ | Privacy Policy.The American Chiropractic Association | 1701 Clarendon Blvd. | 1701 Clarendon Blvd. | Arlington | VA | 22209