NCCA PARTNERS

Daniel Lee

For free evaluation call 919-257-8394

dlee@navfin.com

“Trying to determine the value of your business the day you want to sell is like trying to plan for retirement the day you want to retire.”

Daniel Lee will help you to find out the true value of your practice through their business valuation tool.

Click here to view the informational flyer.

Why and When you should have your business evaluated?

• To better understand your business potential
• When you plan to SELL your business or BUY a business
• When considering funding opportunity
• To prepare for Taxable events such as gifting and grants
• To plan for the future of your business with a qualified Succession Plan
• To properly plan your Retirement

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Call them at (601) 936-0113.

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COVID-19

During the pandemic, the NCCA kept doctors of chiropractic, members and nonmembers, updated on the ever-changing guidelines, rules, and resources surrounding COVID-19. To compile and help navigate many regulations, guidelines, recommendations, and timely updates we decided to create this webpage. Now the time has come where much of the information housed on this page has either expired or no longer relevant, so you will notice that most of the information has been archived. You can find the links to experts on the subject matter below.

COVID-19 INFO

CURES ACT Toolkit

The 21st Century CURES Act is a federal law that is designed to promote “innovation in the healthcare technology ecosystem to deliver better information, more conveniently, to patients and clinicians. It also promotes transparency, using modern computers, smartphones, and software to provide opportunities for the American public to regain visibility in the services, quality, and costs of health care.” Please see the articles listed below for more information on the act and what it means for the chiropractic physician.

• What is the CURES Act?
• Interoperability
• Information Blocking & the Patient’s Records
• How-To Guide with Exceptions
• Info Blocking Graphic – Fact Versus Myth

Call 704-249-2263

Mark@MKNEmploymentLaw.com

Are You Vulnerable for a Workers Comp Insurance Audit?

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Dr. Debra Bell

Call 919-461-3933

Email drbell@wholefamilyofcary.com

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New Resource: Unpaid & Bundled Claims Webinar Resources 2/22/22

If you want to edit any of these items, copy them to your google drive instead of requesting “edit” permission.

• Webinar with Sheri Frost
• Slides/PowerPoint
• Modifier Checklist
• M99
• Regions of the body

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Are you having specific issues with an insurance company and your attempts to resolve them have been unsuccessful? Please use both forms:

• NCCA Insurance Incident Report Form
• Department of Insurance Complaint Form

2021 CPT Codes

Starting January 1st, the American Medical Association (AMA) implemented major changes to the 2021 Current Procedural Terminology (CPT) code for outpatient evaluation and management (E/M) services. So as of January 1st, 2021 practitioners will document office and outpatient E/M level codes 99202—99215 based on time or medical decision making (MDM). Click here to read a complete article with all the changes.

Coding & Billing Resources

• 2021 E/M Guidelines
• ACA Coding Policy Statement
• KMC University & Chirotouch Free Reference Tool
• ICD-10 Code Look Up
• ICD-10 Quick Sheet of Codes
• ICD-10 Quick Start Guide
• CMS ICD-10 Coding Resources
• How detailed documentation fixes calamitous chiropractic coding and billing

Education & Forms

• Election to Not File Health Insurance Claim
• Informed Consent Form Template
• Prompt Pay Law in North Carolina
• Affordable Care Act Translation Services: Who Has to Comply (As of December 2016)
• FAQs about Affordable Care Act Implementation (May 26, 2015)
• Billing & Coding for Extremity Adjusting (2017)
• Optum Per Diem Summary
• Optum Per Diem Slides
• Free Chiro E-course: “A Roadmap to Billing and Coding” (2019)

Telehealth

Due to evolving changes in telehealth coverage, and recent changes to E/M code requirements, doctors of chiropractic should call and verify benefits prior to performing any telehealth service to determine whether coverage exists for the service when performed by a chiropractor and what specific requirements must be met for reimbursement, including, but not limited to:

• What must be documented in the healthcare record;
• What modifier should be used;
• What place of service code should be entered; and
• Does the service require that the telehealth encounter be performed using audio or video technology, or technology capable of both?

INSURANCE FAQ

DHHS has announced the launch of NC Medicaid’s enrollment website, www.ncmedicaidplans.gov, in preparation for the launch of Medicaid Managed Care scheduled for July 1, 2021. Medicaid Managed Care open enrollment will begin on March 15, 2021, and will continue through May 14, 2021.

The purpose of the enrollment website is to help Medicaid beneficiaries learn more about Medicaid Managed Care. In 2015, the NC General Assembly enacted legislation directing NCDHHS to transition Medicaid and NC Health Choice from a primarily fee-for-service delivery system to managed care. Under managed care, the state contracts with insurance companies, which are paid a predetermined set rate per enrolled person to provide all services.

The enrollment website provides information about who will have to choose a health plan, who will stay in the traditional Medicaid program (NC Medicaid Direct), and who can choose between the two. It will also share the basic medical and behavioral health benefits that are offered. There will be a list of frequently asked questions and answers to help beneficiaries understand the changes. To learn more about North Carolina’s transformation to Medicaid Managed Care, visit the Medicaid Transformation webpage.

• Medicaid Chiropractic Policy

Effective March 1, 2018, all North Carolina Medicaid and NC Health Choice beneficiaries must be 12 years of age or older to receive chiropractic services. Please note that prior approval is not required. Beneficiaries with Medicaid for Pregnant Women coverage are eligible for chiropractic service, but prior approval is required.

• Medicaid Visit Limits
• Ordering, Prescribing & Referring Providers Clarification

Medicaid Managed Care Model Program Update 4/23/2019

North Carolina is transitioning into a managed care model for its Medicaid program due to House Bill 372 which was passed in 2015. In 2019, the state of North Carolina was divided into six regions for the purpose of Medicaid transition to Medicaid Managed Care. Four companies have been awarded contracts that span the state: Blue Cross Blue Shield, UnitedHealthCare, Wellcare, and AmeriHealth. Carolina Complete Health Network has been awarded contracts for two regions.

Medicaid recipients will have the opportunity to choose which health plan they prefer. If they do not choose then one will be assigned to them. To ensure that you can see patients from any network, a provider would need to enroll in all five networks.

• Contact information for all Five Networks
• Quick Reference Guide
• Medicaid Fact Sheet
• Information for your patients regarding the transition

MEDICARE FAQ

Ces Soyring

Contact her at success4conference@yahoo.com

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Did You Know?

G codes for Medicare have not been needed since 2016. Many chiropractors have still been utilizing these codes and are now starting to see claims rejected.

Medicare Provider Types:

There are two types of Medicare Part B providers: participating (Par) and non-participating (Non-Par). The vast majority of providers who provide Medicare-covered services (97.8 percent in calendar year 2018, according to data from CMS) are participating providers. Whether to be par or non-par basically comes down to this: how you collect your fees.

2022 Medicare Fees

The 2022 Medicare fees have been published. There are now too many variations to make it feasible for the NCCA to publish the Medicare Fees. Instead, please go to the PalmettoGBA website to determine your Medicare fees. For Palmetto GBA Provider Inquiries call 855-696-0705.

Medicare Diagnosis Codes and Billing Guidance

On May 7, 2019 Medicare updated their information on chiropractic coding and their 2018 program that measured errors in payments. This is important because Medicare reported a 41 percent error rate on chiropractic fee-for-service claims (mostly due to documentation issues).

Overview and insight into what Medicare is looking for:

• SE1601: Medicare Coverage for Chiropractic Services – Medical Record Documentation Requirements for Initial and Subsequent Visits

For info on using the AT modifier:

• SE 1602: Use of the AT modifier for Chiropractic Billing (New Information Along with Information in MM3449)

For more billing info and assistance:

• SE1603: Educational Resources to Assist Chiropractors with Medicare Billing

Subluxation Code Denial

The NCCA has received questions regarding denials of claims from Medicare. Please be aware that if you are billing subluxation codes for 3-4 regions, you must include 3-4 regions in the diagnosis.

Education and Forms

• Billing for Services when Medicare is a Second Payer
• Advance Beneficiary Notice of Noncoverage (ABN) Form (2020)
• A Quick Guide for Chiropractic Billers: Understanding Modifiers and Timed Coding (June 2019)
• Differences between Medicare Status: Non-Participating and Opting Out (2018)
• Q&A Regarding BCBS and Medicare Advantage (April 2015)
• Chiropractic: Provider Compliance Articles
• Medicare Access and Chip Reauthorization Act of 2015 (MACRA) Quality Payment Program (QPP) Final Rule Overview
• CMS Medicare Physician Fee Schedule
• Improving the Documentation of Chiropractic Services educational video gives a thorough presentation on medical necessity and proper documentation

Need Medicare Audit Support? Contact Attorney Knicole Emanual of Gordon & Rees at 919-573-6037 or kemanual@gordonrees.com

MEDICARE FAQ

• “The Growing Role of Doctors of Chiropractic in On-Site Corporate Health Clinics” by Chiropractic Foundation.
• Celebrating International Women’s Day
• African American History Month & Chiropractic

• 10 Things New (All) Practice Owners Need to Know by ChiroHealthUSA
• How do I set up my practice and how do I register?
• What is the National Provider Identifier (NPI) and how do I get one?
• Do I need a privilege license?
• How do I get my EIN (Employers Identification Number) and do I need one?
• Chiropractors cannot opt out of the Medicare system. Chiropractors can be participating or non-participating providers. How do I enroll?
• What guidelines and rules do I need to follow to use my X-ray equipment? If so then you are required to have all equipment registered with the Radiology Protection Section of DHHS. For more including how to register, medical X-ray inspection checklist, and safety program guidelines click here.
• What do I include in my office Radiation Safety Policy?
• What employment law posters do I need to display?
• Do I have to have malpractice insurance?
• Do you need to purchase Workers’ Comp insurance? Does your current coverage make you vulnerable for an audit? Click here.
• How to best examine and communicate with new patients?
• The Initial Patient Exam

Take advantage of great resources by NCMIC, Startingintopractice.com. Accounts are free and offer a protected space for new graduates (as well as old grads) to access information whether starting out on their own or joining an existing practice without being marketed to. Quick and easy info that gives them a baseline on a variety of topics with the ability to request a topic if the library doesn’t include what they are looking for.

There are many questions that can be found on this Resources page under the various topics. Click here for a quick reference guide of common questions and where the answers are located.