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Medicare Updates and Reminders: Time Sensitive
Wednesday, 19 October 2016
In addition to the September 12th change in billing First Coast, there are at least 3 other changes that are time sensitive in nature. October 1 begins the need for more specificity in coding ICD-10.  November 30th is the last day to appeal your PQRS status for 2015.  Failure to respond to re-validation requests may require re-enrolling in Medicare with no grace period for billing.  For more information, read on.
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FAQ’s and Coding Tips for Billing Medicare After the 09/12/2016 LCD Change
Tuesday, 20 September 2016
The September 12, 2016 coding and billing changes by First Coast Service Options (FCSO) have raised several common questions listed below.  These questions are better understood with a better understanding of both the documentation AND billing underlying mandates for covered chiropractic services:
  • Does the September 12th date apply to dates of service or claims submission dates?
  • Do you have a list of common NMS codes we can use?
  • Do I have to have a NMS condition for each subluxation region billed?
  • Can I use the same NMS condition for the different subluxation regions billed? For example low back pain for lumbar, sacrum and ilia?
  • In what order must I bill the diagnoses on the bill?
  • How do I bill when the primary insurer is PIP or Workers’ Compensation and they require different codes and billing instructions than Medicare?
  • Why can I only point to ONE diagnosis code in Field 14 on the bill? When did this start?

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PIP Update – New EMC Case
Friday, 02 September 2016
Must a patient/insured obtain an EMC determination in order to have access to the full $10,000 in PIP benefits?  Or is it the insurer’s duty to obtain findings that it is not an EMC?

This week the Fourth District Court of Appeal held that YES, the patient/insured must have an EMC determination in order to access the full $10,000 in PIP benefits; that if there is no EMC or if it is silent, the patient/insured is capped at $2,500 in PIP benefits.  Medical Center of the Palm Beaches, d/b/a Central Palm Beach Physicians & Urgent Care, Inc., a/a/o Carmen Santiago v. USAA. To get the full picture and access the opinion, read on.

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ALERT: Mandatory changes related to Medicare billing effective 9/12/16
Wednesday, 31 August 2016
Florida Regular Medicare Billing Information for September 12, 2016

The First Coast Local Coverage Determination (LCD) for Chiropractic Services has been updated, to be effective for dates of service on and after September 12, 2016.
 
Of immediate importance are the primary diagnosis codes which have changed for billing.     

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Are You Prepared for Mandatory Section 1557 Compliance?
Monday, 15 August 2016
The final rule implementing Section 1557 of the Patient Protection and Affordable Care Act went into effect on Monday, July 18, 2016. Section 1557 is intended to promote equity in health care and prevent discrimination on the basis of race, color, national origin, sex, age or disability in health programs or activities that receive federal financial assistance. Compliance requires posting certain notices in your office and there are consequences for failure to do so if you are not exempt.

Entities that are subject to the Final Rule include physician practices. Read on for a brief outline of the requirements and guidance on who is exempt from this rule.
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