Arlington, Va. – Both the U.S. House of Representatives and the U.S. Senate have reintroduced legislation to increase access to Medicare-covered services provided by doctors of chiropractic. The Chiropractic Medicare Coverage Modernization Act (H.R. 1610/ S. 799) would bring Medicare’s coverage of chiropractic into alignment with most other federal programs and private health plans, giving seniors improved coverage of non-drug treatments to alleviate pain and improve function.

Insurance Updates Effective January 1, 2023

2023 brings forth continued positive changes for doctors of chiropractic practicing in New York. Across the state certain health plans have increased fee schedules and enhanced coverage. In addition, a few third-party administrators have been eliminated, and unreasonable utilization review has been discontinued. Reasonable reimbursement and the elimination of administrative burdens affords us more time to assist our patients in achieving their goals. With significant involvement from our members, the NYSCA continues our drive to parity and fairness in reimbursement and administrative practices.

For those of you who got an early start, please go back and check the fees again as the revised fee schedule has just been posted. Please make sure you are using the most up to date fee schedule when sending your claims to Medicare or billing your patient prior to submitting claims if you are non-participating.

NYSCA members have asked for updates on the Medicare fee schedule. As of now, there are no changes and no changes are anticipated until the House leadership is sorted out.

Many of our members have contacted the NYSCA Insurance Committee after receiving notice from the NY Workers' Compensation Board to renew their authorization to treat injured workers. This was covered extensively at the NYSCA workers' compensation presentation at the Fall Convention and during our workers' compensation webinars.  

The NYSCA Insurance Committee (The NIC) continues to receive numerous calls and emails from our members seeking assistance implementing the new workers' compensation requirements. Our webinars and Lunch and Learn presentations have been well attended. This article will be limited to workers' compensation cases, and offers some pearls which you may find beneficial. The new MVP program (effective 1/1/23) has been addressed in a separate article.

Warm Greetings from the NYSCA Insurance Committee! This summer has brought forth several important changes and deadlines which have impacted how you interface with payers.  The NYSCA Insurance Committee (The NIC) has been inundated with calls, especially with the new Workers' Compensation requirements and the new MVP program effective 1/1/23. This article will address questions related to the New MVP program. Workers’ Compensation will be addressed in a separate piece.

As you prepare for your holiday weekend, the NYSCA Insurance Committee (the NIC) would like to provide you with the following reminders and updates which encompasses three topics: Workers' Compensation, MVP, and Highpoint BlueCross Blue Shield of Western New York. More detailed information and news related to other insurance issues will be disseminated in the next several weeks.

Welcome to Spring!  The NYSCA Insurance Committee (The NIC) would like to provide this summary update of recent insurance-related issues which may impact your practice.  This edition is dedicated to Workers’ Compensation, and in particular the continuing rollout of the NYS Workers’ Compensation OnBoard Initiative and submission requirements. 

The Chair has determined that the solicitation or receipt of payments from a third party for chiropractic or other health care treatment and services (including so-called "fitting fees" or "service fees") are prohibited by the Workers' Compensation Law, the Rules of the Board of Regents governing the professions, and the New York State Education Law governing the practice of medicine. The Chair has taken, and will continue to take, administrative action against any provider found violating the law.

Every year there are updates to the ICD-10 codes. These codes take effect 10/1/2021. This year's coding updates that will affect chiropractic claims are listed below:

As previously reported, the NYS WCB continues to develop and refine their CMS-1500 and OnBoard electronic communication initiatives. These initiatives are designed to submit claims and related documentation, enhance communication, and will allow access to information in a transparent, streamlined manner.

As you may have heard, The New York State Workers’ Compensation Board is in the process of developing a new business information system, OnBoard. OnBoard will be a Better System for a Better Board – providing an intuitive, user-friendly system, increased accuracy and quality, and paperless transactions to our system participants.

NYSCA has previously communicated that the revised January 1, 2020 New York Workers' Compensation Fee Schedule included reference to an updated Durable Medical Equipment (DME) Fee Schedule.

For many years, the NYSCA in conjunction with our lobbyist have been working tirelessly to gain Chiropractic parity in reimbursement with other health care providers.

As some of you are aware, the availability of telemedicine services for New York's injured workers was set to expire on July 20th.  The NYSCA workers' compensation committee contacted the WCB to ensure telemedicine would remain available for those injured workers who could not seek chiropractic care as a result of COVID-19.

The NYSCA recently hosted a live webinar with Carisk Clearinghouse on Thursday, June 25, 2020 at 8pm: "Workers' Compensation and Auto/No-Fault Made Easy: How to get paid faster."

Your office may have received a notice from American Specialty Health (ASH) titled REMOVAL FROM PARTICIPATION FOR SPECIFIC CLIENT SOURCES. The letter indicates that your office has been terminated from participation in Medicare specific Client Summaries as allowed in your ASH Practitioner Services Agreement.

As many of you are aware, we will be required to submit our workers' compensation claims and clinical documentation in an electronic format.  Most (if not all) clearinghouses who work with commercial carriers and Medicare do not accept No Fault and Workers' Compensation Claims. 

UnitedHealthcare recently published an update relative to COVID-19.  Noted in the introductory paragraph of this notice: