Monthly Archives: July 2015

ASK THE EXPERT: ICD10 for Cash Practices and the Effect to Personal Injury and Workers’ Compensation


Q. I am a ‘cash only’ practice and do not contract with any payers. Do I still need to use ICD-10?
A. While technically you do not have to do so under the HIPAA federal regulations, it is still a good idea to include ICD-10 codes on the bill you provide to your patient. The reason for this is that some patients may submit claims to their insurance company on their own behalf and if the codes are not the current and correct ICD10 the patient will not receive any reimbursement.

Q. What benefits are there for Non-covered Entities (this includes workers’ compensation and personal injury claims) to transition to ICD-10?

A. According to AHIMA, there are several benefits for non-covered entities and notes that CMS plans to work with these organizations to encourage ICD-10 use.
Benefits: The increased detail in ICD-10 provides significant value to non-covered entities. For example, the expanded injury codes will be useful to automobile insurance and workers' compensation programs. Non-covered entities stand to achieve the same benefits of using more detailed, up-to-date code sets as covered entities, including better data for:
• Measuring the quality, safety, and efficacy of care
• Designing payment systems and processing claims for reimbursement
• Conducting research, epidemiological studies, and clinical trials
• Setting health policy
• Operational and strategic planning and designing healthcare delivery systems
• Monitoring resource utilization
• Improving clinical, financial, and administrative performance
• Preventing and detecting healthcare fraud and abuse
• Tracking public health and risks
In addition, ICD-9-CM will no longer be maintained once ICD-10 is implemented; meaning the usefulness of the ICD-9-CM code set will rapidly decline. ICD-9-CM products and resources also will become increasingly difficult to obtain. Those non-covered entities that continue to use ICD-9-CM after the ICD-10 compliance date will compromise their ability to compare data with covered entities.

Q. What will happen if our clinic does not switch to ICD-10?
A. Claims that are submitted by HIPAA covered entities (all claims except cash, PI and WC), without ICD-10 diagnosis after October 1, 2015 will not be processed.

With a wealth of information at your disposal included in your Digital Coding subscription, we have complied an extended demonstration on how to navigate each portal and use the tools available to members with ease.

In this how-to video meet HJ Ross' principal coding expert, Dr. Sam Collins, and take a tour of the only online chiropractic specific coding & billing resource of its kind.

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Federal Employees Blue Cross and Blue Shield

Is also complying with section 2706 wherein they cover services within scope, here is the direct quote from their updated plan booklet - “We now cover any licensed medical practitioner for covered services performed within the scope of that license, as required by Section 2706(a) of the Public Health Service Act (PHSA). Previously, benefits for certain medical practitioners were limited to services performed in Medically Underserved Areas (MUAs)”.

Veterans and Chiropractic Care

There has been a noticeable increase in referrals from the VA to providers, including doctors of chiropractic, through the VA's Veterans Choice Program, which allows eligible veterans to receive care from non-VA entities and providers in certain circumstances (where there is no direct DC services offered in the local VA facility, 47 facilities do). These plans do require a referral and payments use a fee schedule based upon a discount off the local Medicare fee schedule covering all services that a DC is licensed to perform in their particular state. Currently, VA payment rates for chiropractic services are the lesser of 85% of the Medicare reimbursement rate or 60% of billed charges. If a Medicare reimbursement rate has not been established, reimbursement shall be the lesser of 85% of the VA Medical Center Fee Schedule or 60% of billed charges.

Patient Protection Affordable Care Act

Verify your network status with these plans as most state exchange plans will have benefits for “in network” providers only.

Based on section 2706 regardless of the inclusion of chiropractic or acupuncture benefits, insurance plans are to pay for other services within scope of a licensed health care provider for services that are paid to other providers. Such as exams, x-rays, therapies, weight loss counseling etc. If they are not be

sure to inquire how they are exempt from this federal rule. There can be some exemptions but for this provision it is a narrow allowance.

As January 2015 6.6 million people have signed up for and this does not include states that run their own exchanges therefore

Be Aware of Virtual Credit Card Fees

Many providers accept credit cards as a form of payment, but need to be aware of the associated fees when accepting virtual credit card payments from insurers for reimbursement purposes. Virtual credit cards are unique card numbers generated for a specific one-time transaction and linked to real accounts with card issuers. Clinics need to be aware that these transactions carry significant fees compared to traditional forms of payment--up to five percent of the transaction amount--and may include additional fees to offset fraud risk when card numbers are entered manually, which in effect reduces reimbursement to the clinic. It also effectively transfers the cost of the transaction from the payer to the clinic.