NCCA PARTNERS

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DIAMOND SPONSOR

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PREMIUM SPONSOR

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PLATINUM

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GOLD

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SILVER

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BRONZE

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ASSOCIATE DOCTOR RESOURCES

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*DISCLAIMER: Neither this article nor the informational samples and documents in the NC Hiring Toolkit constitute legal advice from the Law Office of Mark N. Kerkhoff, PLLC (“Law Firm” or “Author”) or North Carolina Chiropractic Association (“NCCA”) applicable to any particular scenario or situation. This article along with all other information in the Toolkit (including but not limited to samples or documents) constitutes general information on legal topics and do not and are not intended to constitute legal advice that may or may not apply to any individual’s unique situation and should not be used as a substitute for legal advice from a licensed attorney.

BUSINESS VALUATION

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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CASH PRACTICE
ChiroHealthUSA is a provider-owned network designed with doctors in mind. Their network model allows doctors to offer legal, network-based discounts to cash, under-insured and”out of network” patients who are members. Members covered by Medicare and federal programs are eligible for discounts on non-covered services. The network approach to discounts reduces the risks of compliance and OIG violations related in inducements, improper down-coding, dual fee schedules, and potentially inappropriate time-of-service discounts.

Call them at (601) 936-0113.

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COVID-19

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 INFORMATION

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.

EMPLOYMENT LAW & HR COUNSEL
INSURANCE

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.

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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:

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

Education & Forms

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

MEDICAID

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.

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 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.

MEDICARE FAQ

MEDICARE

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:

For info on using the AT modifier:

For more billing info and assistance:

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

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

MEDICARE FAQ

NEW DOCTORS
New to practice or new to North Carolina? The NCCA has compiled questions and resources that are specific to you. Don’t see something here that you need help with? Email Heather Wrenn at heatherw@ncchiro.org

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.

NC HEALTHCONNEX

NCHealthConnex Update as of 8/16/22

The NC Legislature temporarily suspended the enforcement provision in the Statewide Health Information Exchange Act. Providers – even those not yet connected to NC HealthConnex – may continue to see patients without fear that the state will enforce the “condition of receiving state funds” provision in the Act.  Please note that the January 1, 2023 deadline to connect to NC HealthConnex remains unchanged. Chiropractors are still subject to this deadline. Providers who have begun the technical process of connecting to NC HealthConnex by submitting a participation agreement are considered to be making good faith efforts to fulfill the connection mandate.

The requirement for chiropractors to connect to NCHealthConnex has now been delayed until January 1, 2023. The first step in connection is reviewing and signing the Participation Agreement.

Complete information on HealthConnex

NC SALES TAX GUIDE

Use this guide to learn how to register to remit sales in your practice, as well as, use of tax, forms that have to be filled out, to learn what products are taxable and exempt. Please note, the linked pdf is for general information only. We recommmend contacting NCDOR for more questions.

NO SURPRISES ACT

The Good Faith Estimates (GFE) provision of the No Surprises Act (Public Law 116-260 was designed to give health consumers predictability in how much they will be charged for the healthcare services they will be receiving prior to their appointment. As of January 1, 2022, all licensed or certified health providers, including chiropractors, need to give a GFE of charges to every new and continuing patient who is either uninsured or is not planning to submit a claim to their insurance for the healthcare services they seek. There are certain rules chiropractors and others must now follow regarding what information must be provided.

No Surprises Act FAQs

FOR DOCUMENTS AND MORE INFORMATION

OFFICE COMPLIANCE

Dave Hemmah with Abyde

Email dhemmah@abyde.com

HIPAA Resources & Education with Abyde

 

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HIPAA Support Specialist: Dr. Ty Talcott,CHPSE

Call (469) 371-8804

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HIPAA Resources & Education

Office Compliance

Daily Office Notes

Need help with creating complaint daily exam notes or what they should contain? Check out these examples:

Compliance Resources

PERSONAL INJURY

Dr. Chad Robertson

drchad@queencitychiro.com

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David E. Vtipil, Attorney

Call (919) 661-9000

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Need help or want to report an incident to the NCCA? Complete the NCCA PI Incident Report Form.

Education and Forms

PERSONAL INJURY FAQ

RADIATION

Paul Davis, DC, CCEP, CCNA

Call him at 704-664-6932

drdavis@davisspine.net

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Dr. Norbert Dombrowsky, DACBR

Call him at (772) 600-7827

Email his assitant Eva contact@proimaging.us

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Education and Forms

Resources

Improve Your X-Rays Education

SOCIAL MEDIA

Utilize our digital advertising resources and helpful documents by visiting our Marketing Hub

SPANISH FOR CHIROPRACTIC OFFICE

Need help communicating with your Spanish-speaking patients, discussing scans, and explaining adjustments?

Access the Spanish for the Chiropractic Office which consists of a 76-page PDF manual and accompanying audio files. In addition to a special section devoted to pronunciation, this manual contains the following work-specific language sections ctic jargon PDF and the audio recordings of the most frequently used phrases.

WORKERS' COMPENSATION

Charles Hecht, DC

Call (919) 933-8633

drcharleshecht@yahoo.com

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David E. Vtipil, Attorney

Call (919) 661-9000

 

Industrial Commission Worker’s Compensation Fee Schedule

Education and Forms

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