Upcoming Changes

There are a number of changes for chiropractic physicians in Illinois in the coming months. In addition to the looming changes with BCBS-IL and Orthonet, Cigna and ASHN, and other carriers, there are a number of other changes to a variety of programs.

Medicare Payment Reduction (Sequestration)

The Budget Control Act of 2011 established mandatory governmental spending cuts beginning January 1, 2013 (part of the “Fiscal Cliff”). However, Congress and President Obama postponed the deadline for the sequestration portion to March 1. As a result, beginning on April 1, 2013, Medicare payments will be reduced by 2%. According to CMS, “The claims payment adjustment shall be applied to all claims after determining coinsurance, any applicable deductible, and any applicable Medicare Secondary Payment adjustments.” Therefore:

1. Doctors should collect patients’ deductibles and co-insurance amounts without adjustment;
2. Medicare will pay only 98% of the remaining amount;
3. The 2% reduction may NOT be passed on to the patient; and
4. CMS is encouraging physicians to discuss these cuts with their patients.

BCBS-IL / Orthonet

The Illinois Chiropractic Society met again with BCBS-IL in late February. We reiterated our many concerns with the announced Orthonet pre-authorization program, and we have continued our dialogue since that meeting. We are continuing to encourage our doctors to inform their patients by utilizing the patient advocacy document we prepared for that purpose. You can access the document online here: Understanding the Changes Coming to Your BCBS-IL Coverage.

In addition to our ongoing advocacy efforts, the ICS continues to wait for answers from the Illinois Department of Insurance and Health and Human Services to our requests for advisory opinions regarding whether this program will violate the Affordable Care Act’s provider non-discrimination clause, which will become law January 2014. We will keep members apprised of any new developments.

Medicare Local Carrier Change

According to National Government Services, they (NGS) will assume responsibility for the Illinois Medicare Part B workload on September 7, 2013. NGS will handle provider claims processing, enrollment agreements, customer service, and payments on and after that date, regardless of the date of service. Additionally, any claims, enrollment agreements, payments, etc. that are “in-process” on September 7 will be automatically transferred to NGS by WPS. The Illinois Chiropractic Society will continue to update our members regarding this transition and will offer courses around Illinois to educate doctors about NGS LCD rules and processes. Watch for future announcements.

1500 Claim Form Changing

Although we are waiting for CMS to give the final approval, the National Uniform Claim Committee has indicated that the new 1500 Claim Form will be required beginning October 1, 2013. You can read more about this change in Dr. Mario Fucinari’s article “The New 1500 Claim Form“.

ICD-10 Implementation

ICD-10 codes are set to replace ICD-9 on October 1, 2014. Although the final implementation is less than 18 months away, the ICS is encouraging our doctors to begin the process of education today. CMS recommends the following steps:

1. Develop an implementation strategy that includes an assessment of the impact on your organization, a detailed timeline, and budget.
2. Check with your billing service, clearinghouse, or practice management software vendor about their compliance plans.
3. Providers who handle billing and software development internally should plan for medical records/coding, clinical, IT, and ¬finance staff to coordinate on ICD-10 transition efforts.

The changes with the diagnosis codes will be extensive because ICD-10 codes will outnumber the current structure by a factor of 6 (14,000 to 68,000 ICD-10-CM) due to a greater level of required detail. The good news for chiropractic physicians in Illinois is that the ICS will be offering a wide array of courses on this subject beginning in late 2013 and into 2014, including an ICD-10 introduction webinar on August 27, 2013.

Electronic Health Records

Changes Beginning in 2014, software vendors will be required to meet the new 2014 Edition Standards and Certification Criteria in order to maintain their certification for the EHR incentive program. The result of these changes means that all health care providers who are working toward attesting to meaningful use will undergo a software upgrade. The new standard will impact:

• Privacy and Security,
• Record Access,
• Interoperability,
• Data Portability,
• Safety and Usability,
• Clinical Quality Measures,
• EHR Technology Price Transparency,
• Reducing Regulatory Burden and Increasing Flexibility, and
• Test Result Transparency.

An example of the coming changes to access to records is a new measure which requires providers to provide all patients (even if the patients do not request access) the ability to view online, download and transmit their health information within 4 business days of the information being available to the provider.

Additionally, providers who have attested for at least two years (including 2013) will be mandated to attest using the Stage 2 Meaningful Use requirements.

PQRS “Mandate”

Editor’s Note: This article was written prior to the deadline. Currently, ICD-10 is the only standard for submitting diagnosis codes on claim forms.

Providers who do not participate in the Physician Quality Reporting Initiative in 2013 will be subject to a 1.5% reduction in Medicare reimbursement in 2015. For more information on PQRS, see Dr. Mario Fucinari’s article “Government Shifts its Focus Under PPACA”and visit www.illinoiscme.com for our online PQRS education.