Chiropractic Physicians are not allowed to opt-out of Medicare. However, in an attempt to avoid the regulations, billing requirements, and documentation requirements, some chiropractic physicians attempt to find the loopholes in this prohibition.
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The ICS now has heard from numerous members about the significant financial and administrative impact on their practices, resulting from a BCBSIL claims processing protocol that began in November 2017. When applied, this claim edit, described by BCBSIL as “code-auditing enhancement” via “clinically validating modifiers,” automatically denies some providers’ claims on codes that require the modifiers 25 or 59 (including XE, XS, XP, XU). The EOBs state the reason for the denial as: “The procedure code is inconsistent with the modifier used or a required modifier is missing…,” even though the modifiers are both present and consistent with CPT® and other guidelines followed by BCBSIL.
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Physical therapists in Illinois have introduced legislation, HB 4643 (Burke, D.), to allow physical therapists to independently treat patients(direct access) without a physician referral. This legislation would also allow physical therapists the independent authority to diagnose patients. Allowing a physical therapist to independently diagnose a patient would be unprecedented under Illinois law and would seriously compromise patient safety.
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“Dietetic and nutrition services” means the integration and application of food science and nutrition to individuals and groups. A chiropractic physician may provide dietetic and nutrition services, which includes nutrition counseling, assessment, and therapy. A chiropractic physician may also provide a medically prescribed diet (a diet in which nutrient levels need to be monitored, altered, or both, for an individual whose health is impaired by disease, injury or surgery), for any individuals other than residents of nursing homes.
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Many chiropractic physicians around the State of Illinois have been receiving denials from BlueCross BlueShield of Illinois (BCBSIL) for services rendered and billed with modifiers 25 or 59 (including XE, XS, XP, XU). The Illinois Chiropractic Society informed doctors about BCBSIL’s announced claim processing change in December, and we have been working diligently on this ongoing issue since early December. Because of its importance to the ICS and its members, we want to share our updated efforts and information.
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CMS recently released a reminder regarding the requirement that providers must notify CMS of ownership changes within 30 days. In addition to changes in ownership, providers must report changes in address locations and any adverse legal action within 30 days. A recent OIG study showed that over 75% of owner names are substantially inaccurate across all Medicare and Medicaid provider types.
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“Dry needling” is defined in the Illinois Physical Therapy Act as:“an advanced needling skill or technique limited to the treatment of myofascial pain, using a single-use, single insertion, sterile filiform needle (without the use of heat, cold, or any other added modality or medication), that is inserted into the skin or underlying tissues to stimulate trigger points.”
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Where can I find the Medicare Fee Schedule?
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