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Insurance News

Insurance issues dealing with CMS to private insurance.

If you can’t find the information you are looking for or need help with a question, contact the FCA Insurance and Legal Liaison Office.

 

 

ICD10 Diagnosis Code Update effective for Dates of Service beginning October 1, 2021

The CDC updates ICD10 diagnosis codes every October 1. Frequently the update is adding specificity to existing codes.  An example pertinent to most chiropractic physicians is Low Back Pain M54.5.  This code when billed for dates of service on and after October 1 will rejected as an invalid code by any payer requiring diagnostic coding on bills.  

Competitive Health Insurance Reform Act Becomes Law

(From a January 20th ACA Press Release) The Competitive Health Insurance Reform Act (H.R. 1418) passed the House of Representatives and the Senate last year and was signed into law on Jan. 13, removing the 75-year-old exemption that allowed health insurance companies to avoid federal antitrust laws.

Providers Cannot Charge Florida Medicaid Recipients for Personal Protective Equipment

This alert is to remind Florida Medicaid providers that they cannot charge a recipient for Personal Protective Equipment (PPE) used during the delivery of a Medicaid covered service. Reimbursement from Florida Medicaid is payment in full for all services. Additional information, including balanced billing prohibitions, is located in the Agency’s General Medicaid Policy.

The Skinny On Payment of Insurance Claims

It is often difficult, if not next to impossible, to traverse Florida laws on all times relevant for submitting, receiving, contesting, and payment of insurance claims.  Florida’s Department of Financial Services (DFS), Office of Consumer Affairs, has helped some in this regard by summarizing part of the payment of claims statute on their website, of which I have incorporated into this article along with other provisions that are not on the website.  Should the need arise, this is also where you go to file an Insurance Complaint.  Remember, in filing an appeal to a claim for overpayment or a denial, there are time limitations involved.  

Let’s try and maneuver through this process.

Florida Blue Clarifies Lines of Business Managed by ASH

FCA members (some non-network DCs) have reported calls from ASH representatives or recruiters, indicating, in some instances, that ASH is taking over all lines of business from Florida Blue.  

Florida Blue clarified for the FCA, the lines of business ASH maintains for the following Florida Blue health plans and networks: 

Florida Blue – ASH Federal – FAQs

The recent Florida Blue announcement expanding their chiropractic network management business to the Federal BCBS Plans with American Specialty Health (ASH), has raised many questions and calls have abounded. We reached out to Florida Blue for answers to the most frequently asked questions. Here is what they said:

Florida Blue Announces ASH Expansion

Last week Florida Blue announced its expansion of American Specialty Health Group, Inc. (ASH) network management for its Preferred Patient Care and Traditional (PPS) networks.  Per Florida Blue’s notice, “This includes those in the Federal Employee Program® and members of other Blue Cross and/or Blue Shield plans accessing through Blue Card®.”  This has caused a number of member calls from those concerned about the expansion.

FAQs – New TriWest / EmpowerChiro Veteran Beneficiary Provider Network

Many members have asked questions about the new TriWest / EmpowerChiro contract for chiropractic physicians wishing to participate in the Patient-Centered Community Care (PC3) / Veteran’s Choice programs coming to Florida.  See FCA Bulletin of 12/21/2018.  Based upon your questions, the FCA is working with EmpowerChiro to obtain answers to these Frequently Asked Questions:

Florida Supreme Court Strikes Attorney Fee Provision in Workers Compensation Statute

In a 55-page decision, the Florida Supreme Court on Thursday struck down the prevailing-party attorneys' fees provision of the state's workers' compensation law, finding the mandatory fee structure is an unconstitutional violation of a worker's due process rights.

PIP Law Update – Allstate Case Set to Be Heard by the Florida Supreme Court

Many of you have been keeping up with the various Allstate cases on interpretation of the policy provisions that incorporate (or don’t incorporate) the 2012 changes to the PIP statute – specifically, incorporation of the PIP fee schedule in clear and unambiguous language, into the policy of insurance.
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