Noridian Medicare has updated their LCD for chiropractic and has also corrected the error for denied claims in Jurisdiction E (California and Nevada)
The site has been updated to reflect the changes.
There was an addition of codes M43.01 to M43.09 for spondylolysis, M50.91 unspecified disc disorder high cervical and M60.89 other myositis multiple regions
The Network has received information from several offices that they have received their first payments on the improperly denied claims by Noridian Medicare Jurisdiction E. Medicare has not officially published any notice but with these payments being reported it a appears to be corrected and back on track.
Recently the Office of Inspector General (OIG) for the Dept of Health and Human Services (HHS) did a study and found that the Office of Civil Rights (OCR), which has responsibility for HIPAA compliance, is not doing enough to ensure covered entities (CEs), including healthcare providers and insurers, are effectively following HIPAA requirements. They found that most activities were reactive, not proactive. The OCR agreed with report's recommendations and that they need to do more oversight actvities.
Look for more HIPAA compliance audits and enforcement activities in the coming months as funding for these activities is provided to the OCR.
Have you gotten all your compliance requirements met? This includes: establishing your policies and procedures; implementing them within your practice; ensuring everyone has taken training; ensuring all your business associates have signed a BA Agreement and have security controls in place; and performing a risk assessment; just to name the major requirements.
Make plans in the near term to address all HIPAA compliance requirements.
NOTE: All the 50 State Attorneys General office are also ramping up to do their own HIPAA compliance audits and enforcement, in addition to the OCR's activities.
See the full report at http://oig.hhs.gov/oei/reports/oei-09-10-00510.pdf
Noridian Medicare Part B for Jurisdiction E which are for the states of CA, HI, NV, American Samoa, Guam and Northern Mariana Islands has an error that they are incorrectly denying chiropractic. The LCD is being updated to contain the appropriate diagnosis codes. Once complete, Noridian will identify the claims denied incorrectly and adjust them. No action is required on the provider end at this time. These denials all indicated CO50 = medical necessity
This has not affected other states managed by Medicare or specifically Jurisdiction F Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah Washington and Wyoming.