Insurance News

(From a Chiropractic Economics report of 05/25/2022) The Claims Journal – a respected insurance industry resource – published a May 18th webpost citing a recent study by the Workers Compensation Research Institute (WCRI) which found that “medical care costs less and claimants return to work more quickly when low back pain treatment is provided solely by chiropractors. Costs were also lower when chiropractors provided physical medicine services but other types of clinicians were in charge of evaluation and management, but the difference was not as dramatic.”

The Claims Journal went on to report:

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.  

(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.

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.

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.  

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:

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.

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: