All Medicare providers and suppliers, including pharmacies, must not bill Medicare beneficiaries in the Qualified Medicare Beneficiary (QMB) eligibility group for Medicare Part A or Part B cost-sharing. This includes Medicare Part A and Part B deductibles, coinsurance, and copayments.
Starting today 11/18/2024, healthcare providers won’t have access to beneficiary eligibility information on the NGS Medicare interactive voice response (IVR) system. This includes all beneficiary eligibility information that was obtained under Option 1, Eligibility. The IVR will continue to offer the other non-eligibility transactions.
Beginning Jan. 1, 2025, the $15 copayment for the EmblemHealth-GHl portion of the Senior Care Plan will resume. Senior Care members will be required to pay a $15 copay each time they use the health services listed below. Copays are limited to one copay per provider per date of service.
Every year there are updates to the ICD-10 codes. Listed below please find the codes most relevant to the Chiropractic profession per the cms.gov website. These changes take effect 10/1/2024.
Effective August 29, 2024, Humana is requiring prior authorization of certain Medicare Advantage members for chiropractic manipulative therapy rendered on or after August 29, 2024. The NYSCA Insurance Committee (NIC) reached out to Humana over the past week to ascertain whether prior authorization was required for Humana Medicare Advantage members in New York.
The NYSCA continues to communicate with Optum regarding the implementation of the new prior authorization program for AARP and UnitedHealthcare's Medicare Advantage members. We understand many of you have been attempting to determine the impact of this requirement on your practice and the patients you serve.
On Thursday August 1st many of you received UnitedHealthcare's Provider News email. That edition of Provider News included a section titled 'Outpatient therapy and chiropractic prior authorization required starting Sept. 1'. Due to the lack of clarity in that email, the NIC reached out to several members of Optum's team Thursday morning and afternoon to obtain more specific information about the new requirement.
On March 4, 2024, the U.S. Department of Health & Human Services (HHS) through the Centers for Medicare & Medicaid Services (CMS) published a notice in the Federal Register that clarifies changes to the data elements providers must submit to the National Plan and Provider Enumeration System (NPPES) to obtain and maintain a National Provider Identifier (NPI).
According to the 2024 Medicare Physician Payment Schedule (MPFS), chiropractors are experiencing a 5.37 MPFS percent cut this year.
In mid-Summer 2021, the NYSCA issued a memorandum in response to a question about whether chiropractors as merchants could levy a surcharge on a patient who used her credit card to pay for her deductible, copayment or visit charge in order to offset the credit card companies processing fees often referred to as “swipe fees.”
On Wednesday, November 29, 2023 NGS Medicare released a statement that the calendar year (CY) 2024 Medicare Physician Fee Schedule (MPFS) is now available. You can view the new fees using the Fee Schedule Lookup tool located on NGSMedicare.com.
On October 12, 2023, the Centers for Medicare & Medicaid Services (CMS) released the 2024 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs, and the 2024 Medicare Part D income-related monthly adjustment amounts.
Enrollee benefits have changed for certain groups in The Empire Plan effective July 1, 2023. We have included information relative to massage therapy and acupuncture, for those NYSCA members who provide these services in their office. Please note: The New York State Health Insurance Program (NYSHIP) Empire Plan for NY state and local government employees is not Empire Blue Cross Blue Shield.
The ABN, Form CMS-R-131, and form instructions have been approved by the Office of Management and Budget (OMB) for renewal. The use of the renewed form with the expiration date of 01/31/2026 will be mandatory on 6/30/23. You may continue to use the ABN form with the expiration date of 6/30/23 until the renewed form (expiration date 01/31/2026) becomes mandatory on 6/30/23. The ABN form and instructions may be found below in the downloads section.
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.
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.
The U.S. Senate has introduced a bill, S. 4042, to modernize Medicare coverage and better meet the needs of today’s seniors by increasing access to services provided by doctors of chiropractic. An identical bipartisan-supported bill in the House currently has 130 cosponsors.
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:
