We had previously advised membership that Medicare had begun covering acupuncture in certain specified situations as of Jan. 21, 2020. Acupuncture is to be allowed for chronic low back pain for 12 visits with an additional eight if improvement is shown, with no more than 20 visits allowed annually.
CMS announced on Tuesday that Medicare will cover acupuncture for chronic low back pain for dates of service on or after Jan. 21, 2020.
The 2020 Medicare fee schedule, deductible and premiums have been released.
As of Sept. 1, 2019, Horizon NJ Health, Horizons’ Medicaid subsidiary, is no longer accepting faxed pre-authorization requests. There is an online process that must be utilized to request care.
The 2019 Medicare fee schedule and deductible have been released.
Horizon NJ Health, Horizon’s Medicaid managed care subsidiary, has announced that it will no longer reimburse CPT code 98943, extra-spinal manipulation, as of April 1, 2018.
Audits of all kinds have been expanding in both frequency and depth. The ANJC is seeking to understand what is being sought in these audits and how doctors can best pass them. We are currently focusing on the wide variety of Medicare audits.
Many ANJC members have received letters from Clover, a Medicare Advantage insurance carrier, stating that files had been audited, overpayments were issued to the doctor and will be recouped.
by Matt Minnella, ANJC Director of Insurance and Regulatory Affairs
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.
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.
Medicare Forms & Templates
Medicare Documentation Samples:
Pain Rating Forms:
Functional Outcome Assessment Forms:
Novitas Policy Changes 2012
There were significant changes to the Chiropractic Policy and local coverage determinations by our regional Medicare contractor Novitas. Below are 6 webinars Dr. Rich Healy created reviewing these changes. A brief summary of the most significant changes is here.