For reference, this is a link to download a letter sent to membership in October 2016 by ANJC President Dr. Steve Clarke.
As you are aware, the ANJC and an individual chiropractor previously filed suit against the Horizon OMNIA Plan alleging violation of a number of state statutes as well as the Section 2706 of the federal Patient Protection and Affordable Care Act (“PPACA” or “Obamacare”). The basis of the lawsuit was discrimination against chiropractors for placing a disparately high number of chiropractors in Tier 2 of the OMNIA Plan which has high patient cost sharing obligations compared to Tier 1 with lower patient cost sharing when compared to other similar providers such as physical and occupational therapists.
CMS has released an updated Advanced Beneficiary Notice of Non-coverage (ABN) form (Form CMS-R-131). There are no substantive changes to the form or its usage. However, the updated form has added language informing beneficiaries of their rights to CMS nondiscrimination practices and how to request the ABN in an alternative format if needed. The new form also includes the updated expiration date of the form which is 03/2020.
Nominations are now open for ANJC President, Vice President, State Board Seats and Alternates, and Regional Board seats (NE, NW, Central and South). Please see click the link above for more information.
As previously advised, as of April 17th 2017 the New Jersey Department of Banking and Insurance (DOBI) mandates a uniform appeal process using specific forms for pre- and post-service appeals created and provided by the NJ DOBI. Shortly after implementation, it came to our attention that nearly all carriers made changes to their Decision Point Review (DPR) plans following this change. Certain changes found are clearly detrimental to medical providers treating PIP patients and most importantly, to the patients themselves.
For the sixth consecutive year, ANJC is making available six $1,000 scholarships, including the “Sigmund Miller Spirit of Chiropractic Award,” for chiropractic students who reside and have a home-base in New Jersey, and plan to return to New Jersey to practice.
On Tuesday, May 09, 2017, the ANJC’s General Counsel Jeffrey Randolph engaged in oral arguments with a Deputy Attorney General of the New Jersey Attorney General’s Office before the NJ Appellate Court in the ANJC vs. the State Health Benefits Commission et al. case.
A new bill in the U.S. House of Representatives would improve the quality of America’s health care infrastructure by further integrating doctors of chiropractic (DCs) through the nation’s official delivery and research networks.
We have been advised that there will be oral arguments heard in our case against the State Health Benefits Commission et al. for implementing a $35 cap on out-of-network chiropractic services. The arguments are scheduled for Tuesday, May 9, 2017 in Trenton.
As previously advised, the NJDOBI is instituting a uniform appeals process for PIP claims. This new uniform appeal process will be in effect as of April 17, 2017. Jeffrey Randolph Esq., General Counsel to the ANJC, has created a webinar explaining the changes and new process.
The American College of Physicians (ACP) has just issued a new guideline for physicians to follow recommending non-drug treatments, including spinal manipulation, as the first step in treating patients with low back pain.
On Oct. 17, 2016, the New Jersey Department of Banking and Insurance (DOBI) published in the N.J. Register amendments to the PIP regulations implementing a new, mandatory appeal process for PIP claims to take effect April 17th.
The ANJC held a statewide conference call on November 30th to address questions about the Horizon Class Action Settlement.
The 2017 Medicare fee schedule has been released.
There are significant changes coming to the Medicare system of reimbursement beginning in 2017. This comes in the form of what is called the Quality Payment Program.
For the sixth consecutive year, ANJC is making available six $1,000 scholarships, including the second annual “Sigmund Miller Spirit of Chiropractic Award,” for chiropractic students who reside and have a home-base in NJ, and plan to return to NJ to practice.
Since our last update on the State Health Benefits Plan we have obtained the resolutions passed by the SHBP Plan Design Committee at their 8/29/16 meeting via OPRA request. Three of the seven resolutions have possible bearing on ANJC members.
There are changes to the ICD-10 diagnosis codes going into effect October 1st, 2016. CMS will be requiring codes to be submitted to the greatest available specificity beginning on October 1st. Also, there have been a number of codes added and deleted from the ICD-10 code set.