Articles by ChiroCode and friends on topics related to chiropractic documentation, coding, billing, reimbursement and compliance.

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ICD-10-CM 2023 Code Changes for Chiropractic

There were several changes to the ICD-10-CM codeset for 2023 which went into effect October 1, 2023 and could impact chiropractic. At the time of publication, it was unknown how payers would respond to these changes. This article only discusses some of the changes to the ICD-10-CM codes. Changes to procedure codes such as “Prolonged Services” for office E/M visits are included in the 2023 ChiroCode DeskBook.

Medicare Improper Payment Report (2021)

The Medicare Improper Payment Report does not measure fraud, but rather, it estimates the payments that did not meet Medicare coverage, coding, and billing rules. The estimated Medicare FFS payment accuracy rate (claims paid correctly) from July 1, 2019 through June 30, 2020, was 93.74%, which is up slightly from last year. The estimated improper payment rate (claims paid incorrectly) was . . .

Chronic Pain Coding Today & in the Future

Properly documenting and coding chronic pain can be challenging. As is commonly the case with many conditions, over the years, there has been a shift in the identification of different types of pain, including chronic pain. Understanding where we are now and where we are going will help your organization prepare for the future by changing documentation patterns now.

Critical Evaluation and Management Changes Recently Announced by AMA

On March 9, 2021, the American Medical Association (AMA) announced some pretty significant changes in relation to reporting Evaluation and Management (E/M) services, particularly for Office or Other Outpatient Services (99202-99215). The AMA Editorial Panel had previously met to discuss how to address concerns and made changes surrounding Office or Other Outpatient Services which are retroactive to January 1, 2021. Learn more about those changes in this article.

Good and Bad News Regarding the 2021 Medicare Physician Fee Schedule

When the proposed Medicare Physician Fee Schedule came out last year, it really got everyone worried. In a time where we are all facing issues related to COVID, this seemed like a really big problem. Professional organizations lobbied and everyone tried to stop the proposed changes, and the 10.2% decrease didn’t happen, but other changes will still be taking place. So how bad is it really and how will it affect your organization?

HIPAA Penalty Changes

On January 5, 2021, H.R. 7898 was signed into law by President Trump. This new law modifies the HITECH Act such that when an organization experiences a breach, fines and/or penalties may be reduced if (for at least a year) they have instituted “recognized security practices” as defined within the law.

New ABN Form is Here

The anticipated changes to the Advanced Beneficiary Notice of Non-coverage (ABN) Form (CMS-R-131) have arrived. This important form is issued to the patient or client by providers, physicians, practitioners, and suppliers in situations where Medicare payment is expected to be denied.

You can begin using the new ABN immediately if you so wish. However, it becomes mandatory on August 31, 2020.

Watch for Payer Telehealth Coverage Changes

As our country moves forward with a phased approach to reopening, be sure to pay close attention to individual payer policies regarding how long these changes will remain in effect. Keep in mind that private payer, federal programs (Medicare, Medicaid), and Medicare Advantage plans can all have different timelines as well as different coverage.

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