Insurers and networks are constantly revising contracts and agreements. Your decision on whether to participate/sign an agreement is strictly an individual one and you should not consult or discuss whether to participate with any other practice, or inform any other practice whether or not you intend to participate or sign any insurer/network agreement. Some members have sought FCA recommendations as to whether or not they should sign various network contracts: Please understand that the FCA is prohibited by federal anti-trust laws from advising you in your individual decision-making process.
(From the ACA "Week in Review" of July 10, 2014) The Patient Protection and Affordable Care Act (PPACA) defines a grandfathered healthcare plan as those, "that were in existence on March 23, 2010 and haven't been changed in ways that substantially cut benefits or increase costs for consumers." A grandfathered plan can be job-based or individual. As a result, a clinic could have some patients with plans that are grandfathered, and other patients with the same insurer whose plans are not grandfathered depending on when they enrolled. Patients can determine if their plan is grandfathered by contacting their benefit administrator or reviewing materials that describe plan benefits.
In Optum's most recent quarterly newsletter,Optum Physical Health News, the company announced a change to its long-standing policy requiring modifier -51 be appended to 98943 when billed with spinal CMT codes 98940-98942.
by Christine C. Whitney, Esq., and David C. Mann, Esq.
A Needle in a Haystack Are you among the many Florida chiropractors who have been denied payment for manual therapy services? If so, you are not alone. The problem is that applicable regulations are unclear. A cursory review of Blue Cross and Blue Shield of Florida’s medical coverage guidelines might suggest that manual therapy is eligible for payment, even when performed by a licensed massage therapist. However, a closer investigation reveals that services provided by an LMT are NOT payable for members of the Federal Employee Plan (FEP).
Surprise visits by insurance company Special Investigative Units seem to
be on the rise. While providers are
required to cooperate, they are often caught off-guard while the SIU
investigators employ bullying tactics that disrupt both staff and
patients. This article serves to provide
some useful tools and information for if and when your office receives one of
those surprise visits.
Insurance News 
