b'CODING Update ComplianceLEGAL NUTRITIONUpdateANJC NewsANJC Leadership ANJC News! NUTRITION LEGAL EASEANJC Scholarships REHAB Update CHIRO AssistExecutive Directors Update LEGAL Q&A2020 ANJC AWARDSLegislative UpdateINSURANCE Update INSURANCE Update WINTER 2021By Matt Minnella Insurance Update TECHNIQUE UpdateANJC Director of Insurance & Regulatory AffairsMedicare G Codes/PQRS/QPP:In the initial days of 2021the Dec. 9 updates. Aetna states that they will automatically we heard from several members that they were receivingreprocess these claims to correct the issue. At this time, they MedicareQ&AMedicare Updatedenials from Medicare due to including the G8730 code onanticipate this will be completed by the end of January 2021. their claims. This was a reporting code under the PhysiciansPlease email Matt Minnella at matt@anjc.info if you receivedOUR HEALTHQuality Reporting System (PQRS). This G code has beenerrant denials that were processed after Dec. 9 or if you have eliminated by Medicare. However, as of 2018, you would onlyoutstanding errant denials after January 2021 so we may be required to submit any of the G codes if you were eligibleaddress the issues with Aetna and NIA. to participate in the MIPS/QPP programs (which PQRS wasE/M Code Documentation Requirement Changes:rolled into in 2017). The threshold for eligibility is a minimum of 200 unique Medicare patients AND at least $90,000 inEffective Jan. 1, 2021, CPT code 99201 will be deleted, allowable Medicare charges per year. We are not aware ofand there will be new documentation requirements for the any DCs that have met these thresholds soit is likely yourremaining evaluation and management (E/M) codes. The office can stop entering the G codes altogether. You can checkchanges are intended to reduce the administrative burden on your eligibility status here to be sure: https://qpp.cms.gov/ providers and simplify the documentation of these codes. participation-lookup For much more detail on these changes and the new documentation rules, please see the webinar ANJCs Coding and Compliance consultant Dave Klein presented in November 2020. This is available for viewing on the ANJC website under Education Upcoming Webinars Recorded Webinars New E/M Documentation Rules. Medicare Fee Schedule 2021:Medicare has releasedthe 2021 Physicians Fee Schedule (PFS). We had previously reported that there was an anticipated 10% reduction in the Medicare PFS for a wide variety of professions. This is due to the changes to E/M requirements that will increase Medicares expenditures on E/M codes beginning in 2021. Medicare is required by law to maintaina relatively balanced budget year to year and so cuts had to be made to balance the increased E/M expenditure.We had shared with membership via email several times the Aetna-NIA Errant Claim Denials:As previously reported,ACAs campaign to contact federal legislators to support a beginning Nov. 9, 2020, NIA switched from approvingbill that would delay these cuts for two years. This legislation units within certain categories of procedure codes in theirwas not passed. However, the Consolidated Appropriations pre-certification process to approving a number of units thatAct of 2021 (COVID Relief Bill) was passed and included some would represent any allowed CPT code to be billed. From thismitigation of the fee schedule reduction.point forward, the units approved equate to individual CPTThe bill added 3.75% back to the Medicare PFS that were codes that you can bill. If 20 units are approved, you can billscheduled to be cut by 10% only for 2021. Medicare has since 20 CPT codes during the allowed period of time.updated the 2021 fee schedule to reflect the changes per this Recently, we have heard from membership that somenew legislation. Remember, this reduction in the percentage providers are receiving denials from Aetna for not havingof the cuts is for 2021 so, barring further legislation to address received pre-certification on claims where the provider did inthis issue the fees will be reduced again for 2022. fact receive pre-certification from NIA. The ANJC has reachedWe have broken down the chiropractic codes specifically for out to both Aetna and NIA regarding this issue. Aetna hasyou on the ANJC website (www.anjc.info) under the Insurance advised that their systems were not updated to match the new News & Updates section and provided the breakdown authorization process from NIA until Dec. 9, 2020, (one monthfor you below. You can download the entire fee schedule after NIAs changeover) which caused these denials.or search for specific codes at the website of our Medicare Aetna has advised that claims after Dec. 9, 2020 should beAdministrative Contractor, Novitas Solutions, here:processed correctly going forward. They also advise that therehttps://www.novitas-solutions.com/webcenter/portal/were more than 1,200 claims processed incorrectly prior toMedicareJL/FeeLookup10 I Winter 2021 www.anjc.info'