January 2011

President Obama Signs the Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010

2.2 Percent Medicare Physician Fee Schedule Increase for June 1, 2010, Through November 30, 2010

Last Friday, President Obama signed into law the "Preservation of Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010," which establishes a 2.2 percent increase to the Medicare Physician Fee Schedule (MPFS) payment rates retroactive from June 1 through November 30, 2010. The Centers for Medicare & Medicaid Services (CMS) has directed Medicare claims administration contractors to discontinue processing claims at the negative update rates and to temporarily hold all claims for services rendered June 1, 2010, and later, until the new 2.2 percent update rates are tested and loaded into the Medicare contractors' claims processing systems.

Effective testing of the new 2.2 percent update will ensure that claims are correctly paid at the new rates. WPS Medicare expects to begin processing claims at the new rates no later than July 1, 2010. Claims for services rendered prior to June 1, 2010, will continue to be processed and paid as usual.                                      

Claims containing June 2010 dates of service which have been paid at the negative update rates will be reprocessed as soon as possible. Under current law, Medicare payments to physicians and other providers paid under the MPFS are based upon the lesser of the submitted charge on the claim or the MPFS amount. Claims containing June dates of service that were submitted with charges greater than or equal to the new 2.2 percent update rates will be automatically reprocessed.

Affected physicians/providers who submitted claims containing June dates of service with charges less than the 2.2 percent update amount will need to contact their local Medicare contractor to request an adjustment. Submitted charges on claims cannot be altered without a request from the physician/provider. Physicians/providers should not resubmit claims already submitted to their Medicare contractor.

As of this writing, the new Medicare fee schedule containing the 2.2 percent increase has not been posted on the WPS Medicare website. As soon as we receive it, we will send it out to you.

Source: WPS Medicare, www.wpsmedicare.com

February 25, 2009

Results of the 2009 MAC Workers’ Compensation Survey

MAC Will Not Ignore Pattern of Discriminatory Activity of Employers and WC Carriers

By: Dr. Donald Reno, MAC President

In late January, the MAC Weekly Review contained a survey regarding Michigan’s workers’ compensation system – we specifically wanted to gather information regarding chiropractic participation with workers’ comp and ways to increase this participation. The survey was developed by MAC Board of Directors member Dr. Dennis Whitford of Mt. Pleasant, our representative to the Workers’ Compensation Health Care Services Advisory Committee. This important body is charged with reviewing rules and regulations pertaining to health care benefits and services under workers’ comp.

The results show that access to chiropractic care in Michigan’s workers’ compensation system is sorely lacking. The results show:

 73 percent of respondent doctors do not see as many Workers’ Comp patients as they would like
 93 percent would take on more Workers’ Comp cases if patients had direct access to chiropractic services
 63 percent have had a patient told by their employer, after the “10-Day Rule” has expired,” not to see a chiropractor
 51 percent have had a patient told by the workers’ comp carrier, after the “10-Day Rule” has expired, not to see a chiropractor
 73 percent have had trouble collecting from workers’ comp carriers
 49 percent have had a patient told they do not have a work injury because they have a pre-existing condition
 51 percent have had a workers’ comp carrier deny a service based on an arbitrary managed care fee/utilization schedule

On February 10, Dr. Whitford presented this information to the Workers’ Compensation Health Care Services Advisory Committee. His first suggestion was to mandate a notification of the workers’ comp rules to all injured workers. Second, he let the Committee know that the MAC is not going to let this pattern of discriminatory activity of carriers continue.

As a result of Dr. Whitford’s efforts and the findings of this survey, the State is now working with him to survey third-party payers on their policies toward chiropractic care. The MAC is committed to ending discrimination against doctors of chiropractic and their patients.

If you have any additional evidence of discrimination by employers or workers’ comp carriers, please fill out the MAC Insurance Complaint Form, which can be found online at www.chiromi.com/insurance.
 

Attention DCs Who Bill BCBSM for 97012 and Other Physical Medicine Codes!

In the May 2008 edition of the BCBSM Record, on page 31, the following appeared: When billing chiropractic claims, include all required documentation. Chiropractors who bill using procedure code *97012 and other physical therapy codes must include the following in their documentation in the patient record to be reimbursed for this service:

• The device used to apply the therapy
• The location of the therapy (for example, cervical, thoracic, or lumbar region of the spine
• The time of treatment (duration of the treatment)
• The medical reasoning (for example, to reduce a disc bulge or reduce scarring)

 Please note: The documentation must be included in the patient record. It is not necessary to send it with the claims.

 * CPT codes, descriptions and two-digit numeric modifiers only are © 2007 American Medical Association. All rights reserved.