Issue 4
February 16, 2006
Thank You

Participating in the demonstration project means extra effort and sacrifice by each of you. At the ACA, we want to thank each and every doctor who is participating for their willingness to stand up and represent the profession. Bravo!

Long-term, the outcome of this demonstration project will have serious repercussions for the entire profession as to whether we will be allowed to be reimbursed for our full scope of practice under Medicare or not. We encourage you to spread the word and encourage participation in the demo at every opportunity!

Let us know of any and all problems you may be encountering by emailing us at demo@acatoday.org or calling Jaime Mulligan, ACA Legal Affairs Manager, or Amy Hanley, Asst. Director of Government Relations, at 1-800-986-4636.

Together, chiropractors can accomplish anything.

1. “INCIDENT TO” REQUIREMENTS ARE IN EFFECT, BUT DCS CAN STILL PARTICIPATE IN THE PROJECT, WHEN CAS ARE PERFORMING THERAPIES, BY USING THE GY MODIFIER
2. DEMO BILLING DOS AND DON’TS
3. KEEP CHECKING ALL OF YOUR CARRIER LCDS
4. CHANGE REQUEST 4226: THERAPY CODE CHANGES THAT MAY AFFECT DCs in THE DEMO
5. MAKE SURE YOU’RE USING THE RIGHT FEE SCHEDULE: CALL YOUR CARRIER OR CHECK THEIR WEBSITE

1. “INCIDENT TO” REQUIREMENTS ARE IN EFFECT, BUT DCS CAN STILL PARTICIPATE IN THE PROJECT, WHEN CAS ARE PERFORMING THERAPIES, BY USING THE GY MODIFIER

Doctors of chiropractic in the demonstration areas WILL NOT be reimbursed for therapy services provided by a chiropractic assistant or other non-qualified personnel.

HOWEVER: Please note that, based on conversations ACA had with CMS, doctors of chiropractic can have an employee who does not meet the “incident to” requirements perform the therapies---just bill the services with the GY modifier indicating that the procedure is a non-covered and non-reimbursable service.

For background, visit http://www.acatoday.org/government/medicare/regulatory/incident_to.shtml or check on the “Incident To” section on http://www.acatoday.org/demo .

2. DEMO BILLING DOS AND DON’TS

Both ACA and CMS are working to make sure that DCs and billing staff have all the information they need to succeed in the demonstration project. ACA Medicare Advisor, Susan McClelland, developed a list of demo billing dos and don’ts, now available on the ACA demo webpage: http://www.acatoday.org/demo/DemoDosDonts.pdf. Some excerpts:

• DO use the AT modifier on ALL services that are NOT Maintenance Care

If you do not append the AT modifier to non-maintenance services under the MDP, YOU WILL NOT BE PAID.

• DO use the GP modifier when billing therapy services

If you bill therapy services without the GP modifier, YOU WILL NOT BE PAID.

• DO use the GY modifier on therapies, if performed by a CA

If a CA is providing therapy, the service(s) must be billed on the “regular” Medicare claim (with the
spinal CMT services) and have a GY modifier appended (e.g., 97035 GPGY). If a physician or PT
provides the therapy, the service is reimbursable; however, if a CA provides the therapy, YOU WILL NOT BE PAID.

• DO use G0283 instead of 97014 when billing for unattended/supervised estim

If you use 97014 to indicate unattended/supervised electrical stimulation, YOU WILL NOT BE PAID.

• DO NOT use Modifier 51 on extraspinal manipulation (98943)

If you bill extraspinal manipulation (98943) with a 51 modifier, YOU WILL NOT BE PAID.

• DO use modifier 59 on 97140, 97124, and 97112 when combined with CMT and provided to separate body regions

If you bill manual therapy techniques (97140), massage (97124), or neuromuscular reeducation (97112) on the same date of service as CMT (98940-98943), and do not append the 59 modifier, YOU WILL NOT BE PAID. (However, PLEASE NOTE, to bill them separately; they must be applied to separate body regions. Then, to indicate this, you must append the 59 modifier and use appropriate diagnosis pointers in Box 24E.)

We also encourage you to consult the ACA Documentation Manual and the ACA Chiropractic Coding Solutions Manual 2006 for help with filing claims properly.

Questions? Email demo@acatoday.org .

3. KEEP CHECKING ALL OF YOUR CARRIER LCDs

ACA encourages all doctors and billing staff in these areas to make sure they check corresponding local coverage determinations (LCDs) on any of the expanded services allowed under the demonstration project. Doctors must follow the local policy as outlined in these documents in order to be reimbursed for these services. Please check your carrier’s website for complete information. (To find your carrier, please visit the State Specific Information available at http://www.acatoday.org/demo.) We have provided some links here that take you to some of your state’s local coverage determinations:

· Maine: http://www.cms.hhs.gov/mcd/results_index.asp?from='lmrpcontractor'&contractor=
30&name=National+Heritage+Insurance+Company++(31142,+Carrier)&letter_range=4
· Illinois: http://www.wpsic.com/medicare/policies/illinois/index.shtml
· Iowa: http://www.noridianmedicare.com/provider/pubs/med_b/policy.html
· Virginia: http://www.trailblazerhealth.com/lmrp.asp?lmrptype=va
· New Mexico: http://www.oknmmedicare.com/provider/medpolb/polmanindex1.asp

Checking on these policies can mean the difference between payment and non-payment. For example, if you are submitting a therapy service claim with one of the diagnosis (ICD9) codes listed by Medicare as one of the codes for usage in the demonstration project, you could still be denied if your diagnosis code does not determine medical necessity as outlined in your local LCD for therapy services.

Essentially, make sure that your claim is not only in line with national policy, but is also appropriate where your local policy is concerned.

4. CHANGE REQUEST 4226: THERAPY CODE CHANGES THAT MAY AFFECT DCs in THE DEMO

Through our conversations with CMS, ACA has learned that a recent Change Request (number 4226, available at http://www.cms.hhs.gov/Transmittals/Downloads/R805CP.PDF) has some updates to the therapy code list that may affect DCs in the demonstration project. CMS has assured us that there will be a Medlearn Matters article delineating changes specifically related to the demo in the near future. Visit http://www.cms.hhs.gov/MedlearnMattersArticles/2006MMA/List.asp#TopOfPage to see all the Medlearn articles from 2006. You can also continue to check http://www.acatoday.org/demo for updates.

In the meantime, you should know that:

· Code 97504 is replaced with code 97760
· Code 97703 is replaced with code 97762
· Code 97020 (microwave) is deleted and combined with code 97024
· Code 95858 is deleted
· Codes 97039 and 97139 are no longer subject to the fee schedule pricing, but are now paid based on carrier recommendations

5. MAKE SURE YOU’RE USING THE RIGHT FEE SCHEDULE: CALL YOUR CARRIER OR CHECK THEIR WEBSITE

President Bush signed legislation last week that not only reverses the 4.4 percent Medicare physician payment reduction, which went into effect on the first of year, but will also provide automatic reprocessing of claims retroactive to Jan. 1, 2006. The legislation was included in the Deficit Reduction Act. To make sure you are using the proper fee schedule, please contact your carrier. For information on the issue, you can visit http://www.acatoday.org/government/medicare/feeschedule.

We need you! If you aren’t a member of the ACA, please consider joining today by calling 1(800)986-INFO or visiting http://www.acatoday.org/pdf/MembershipApp2005.pdf.

We do have a membership category for chiropractic assistants!

The ACA Demo e-Alert is an online newsletter designed for doctors and billing staff practicing in the areas of the Medicare chiropractic demonstration project. This e-Alert will go out periodically to help individuals in these areas understand the regulations and billing procedures, as well as communicate the latest news from Centers for Medicare & Medicaid Services (CMS). ACA discusses details of the demonstration project regularly with CMS and other entities, and wants to ensure that the people on the frontline of this important initiative have access to all the information they need.

Jaeni Aarden
Executive Director
New Mexico Chiropractic Association
P. O. Box 21100
Albuquerque, NM 87154
505-280-0689
Fax 505-828-1128
Jaeni13@aol.com
www.nmchiroassoc.com