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Daily Office Notes


General Insurance


Dr. Chris Outten

coutten1@aol.com

919-593-6198 (Cell)

919-467-3362 (Office)


Dr. Outten was the 2003-2004 President of the North Carolina Chiropractic Association. He was also named Doctor of the Year in 2004 for the NCCA.

 

Department of Insurance Complaint Form

Click Here

 

Insurance Documents and Forms


ICD-10

 

Useful Links  

ICD-10 Related Videos

ICD-10 Related Articles


Medicaid 


Request for Assistance with Medicaid Issues

To request assistance with a Medicaid Issue please submit an e-mail with all three of the following people copied on it:

 

Medicaid Managed Care Model Program

North Carolina is transitioning into a managed care model for its Medicaid program due to House Bill 372 which was passed in 2015. How the state plans on rolling out this managed care is by having 3 statewide health plans managing those beneficiaries. They will be required to enroll in 1 of the 3 state chosen health plans in order to see a doctor.

Many of you have received a call or email from Carolina Complete Health. They are bidding to be selected as 1 of the 3 managing health plans so they are trying to increase their provider network. You should review the paperwork regarding the enrollment as you would any other provider contract.

Medicaid Age Requirement
Effective March 1, 2018, all North Carolina Medicaid and NC Health Choice beneficiaries must be  12 years of age or older to receive chiropractic services . Please note that prior approval is not required. 
Beneficiaries with Medicaid for Pregnant Women coverage are eligible for chiropractic service, but prior approval is required. Click here to read more.

 

Updated Medicaid Diagnosis Codes Released

After multiple communications with NC Tracks by the NCCA over the last 7 months, they have finally released a revised list of approved diagnosis codes.  The new list of codes can be found in the revised and updated Chiropractic Policy 1F (revised July1, 2016) by clicking here.  

 

Medicaid Visit Limits 2016

Directions on the DMA website are, in the top search field type visit limits and hit enter. A list of links are included and at the very top is Annual Visit (click here go to that page) From there, you will see the following as well as more options:

  • The Code of Federal Regulations (CFR) defines the services that must be provided by each state Medicaid program. These services are mandatory services. Each state may decide which, if any, optional services, as defined by the CFR, will be covered. Optional services that are covered by the NC Medicaid Program include optometry, chiropractic services, and podiatry.
  • According to the Centers for Medicare and Medicaid Services (CMS), a visit limit may not combine both mandatory and optional services.
Mandatory Services

Annual Visit Limit Period:July 1 - June 30
Number of Visits: 22

Provider Types Included in Visit Count:

  • Physicians (except for physicians enrolled in NC Medicaid with a specialty of oncology, radiology, or nuclear medicine)
  • Nurse practitioners
  • Nurse midwives
  • Health departments
  • Rural health clinics
Federally qualified health centers
Optional Services

Annual Visit Limit Period:July 1 - June 30
Number of Visits: 8

Provider Types Included in Visit Count:

  • Chiropractors
  • Optometrists
  • Podiatrists

 

NC Tracks: Prior Approval for Chiropractic and Podiatry Services for MPW

Recipients with eligibility through Medicaid for Pregnant Women (MPW) can only receive services that are related to pregnancy such as prenatal care, delivery, childbirth classes, postpartum care and family planning. Medicaid also provides coverage of services that are medically necessary to treat conditions that may complicate a pregnancy. Some of these services require prior approval (PA) to validate the medical necessity for the service requested.

Effective December 14, 2015, NCTracks will begin accepting PA requests for the authorization of chiropractic and podiatry services for medical necessary pregnancy-related services for recipients with MPW coverage.Effective with date of service March 1, 2016, claims submitted for chiropractic or podiatry services for recipients with MPW coverage will deny if PA is not on file for the recipient.

 

Click here for more information.

 

Frequently Asked Questions

 
Question:If Medicare pays the spinal adjustment and Medicaid processes at a $0 payment for the coinsurance due to the fact that Medicare has paid more than the Medicaid allowable, is the patient responsible for the Medicare coinsurance or are we required to write it off?

Answer: Click here. 

 

Question: Does the Medicaid 8 visit annual limit apply when Medicaid is secondary to Medicare?

Answer: Medicaid Response: In response to your limitation question Clinical Policy staff indicated

that the visit limitation you reference does not currently apply to crossover claims. 

 

Validate Taxonomy for each provider record:

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Medicare

 

Ricky Sides, DC

sides@triad.rr.com

Phone:(336) 774-0209

2018 Medicare Fees

 

The 2018 Medicare fees have been published.There are now too many variations to make it feasible for the NCCA to publish the Medicare Fees.

Instead, please go to the PalmettoGBA website to determine your Medicare fees at:

http://www.palmettogba.com/palmetto/fees_front.nsf/fee_main?OpenForm

Palmetto GBA Provider Inquiries:855-696-0705 (Monday-Friday, 8 a.m. - 4:30 p.m. ET)

 

Helpful Documents and Forms

 

New Medicare Card
Medicare is transitioning to the Medicare Beneficiary Identifier (MBI) cards beginning April 1, 2018. Patients will be receiving their card by mail starting April. Beginning in October 2018, through the transition period, when providers submit a claim using a patient’s valid and active Health Insurance Claim Number (HICN), CMS will return both the HICN and the MBI on every remittance advice. Click here to read more information on new card.

 

Medicare Requiring Modifier GP on Physical Therapy Services

Medicare's MLN Matters Number: MM10176 was recently revised to identify services subject to their therapy cap. The revision became effective on January 1, 2018. There are two such caps. One cap is for PT and SLP services combined and another cap is for OT services. In order to accrue incurred expenses to the correct therapy cap; the use of one of the three therapy modifiers..." Click here to continue reading.

 

Are Ready for MIPS? Will You Participate?

MIPS is the Merit Based Incentive Program which is essentially the combination of the old PQRS, Value Modifier, and EHR Meaningful Use programs.  You may be able to opt out of the program if your Medicare volume is low enough.  If not, your MIPS reporting in 2017 will impact your reimbursements in 2019 by up to 4%. Click here for more information.


Medicare Diagnosis Codes and Billing Guidance 

CMS Publishes New Series of Chiropractic Resources

(This information is reprinted Courtesy of the ACA)

 

The Centers for Medicare and Medicaid Services (CMS) recently published a series of three Special Edition educational articles for DCs submitting claims for services provided to Medicare beneficiaries. MLN Matters® articles SE1601SE1602 and SE1603 provide guidance on improving billing and documentation of chiropractic services, increasing compliance with Medicare regulations and reducing the profession's claims error rate. 

 

Medicare / Medicaid Crossover Claims

As explained in a previous announcement, as of November 1, 2015, the "lesser of" logic is being applied to services covered by both Medicare and Medicaid that are rendered to Qualified Medicare Beneficiaries (QMBs.) Specifically, claims for Medicare-covered services that are also covered in the Medicaid state plan are paid at the lesser of the Medicare cost-share (which is the sum of co-insurance, deductible and co-pay) or the difference between the amount paid by Medicare and the Medicaid state plan rate (if any). For services not covered under the North Carolina Medicaid plan, the claims are paid the Medicare cost share amount. This applies to crossovers as well as secondary filed claims for Q class recipients. This methodology results in the provider receiving the Medicare or Medicaid allowable and the QMB recipient not being responsible for any additional monies for services covered by Medicaid and/or Medicare.

 

 

Frequently Asked Questions

Question: If Medicare pays the spinal adjustment and Medicaid processes at a $0 payment for the coinsurance due to the fact that Medicare has paid more than the Medicaid allowable, is the patient responsible for the Medicare coinsurance or are we required to write it off?

Answer: Click here. 

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Personal Injury

 

 

Dr. Chad Robertson

drchad@queencitychiro.com

 

Dr. Robertson is the chair of the NCCA’s Personal Injury committee and prior to that position, he was the South Central District president from 2008-2012. He really enjoys serving our association as a member support specialist because he has the opportunity to meet and assist his colleagues, answer questions, or provide advice when challenges in their practice arise.

David E. Vtipil, Attorney

(919) 661-9000 Call me

David E. Vtipil is originally from Prince George, Virginia. He attended college at Wake Forest University where he graduated in 1989 cum laude with Honors in History. . David focuses his practice on personal injury and workers’ compensation claims. David E. Vtipil has received an AV rating by Martindale Hubbell – a rating given to lawyers who achieve the highest level of professional excellence as judged by his peers. He is also a Board Certified Specialist in Workers’ Compensation Law.

 

Important Documents and Forms 

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Veterans Administration

 

Veterans Administration Guidelines

Click here for VA guidelines

 

Veterans Choice- Episode of Care Extended to One Year

Click here for the announcement from Health Net Federal Services.


Information on Treating Veterans 

Many of our members reported difficulty navigating the issues of treating veterans and getting paid. For a summary of the information gained from NCCA research, CLICK HERE.  If you find errors or have additional information that would be helpful to our members, please provide it for future updates on this information.

 

VA Patients Require Medicare Codes

Some time in 2014, a regional administrator took over the Veterans Administration of claims for services rendered off-site from the actual VA facilities. 


The VA is administering this program under Medicare guidelines. You must file the claim as if it were a Medicare claim and you will only be reimbursed for services as if it were a Medicare patient.  This means you must use Medicare codes and modifiers.
 
The NCCA has received several complaints about VA claims that originated with a referral from the VA but are not being paid. The source of the problem is that the VA makes the referral with no information about what will be reimbursed.  Reimbursement is coming from another entity after treatment has already been rendered.
 
The NCCA is recommending that you try to get resolution of your claims by contacting either the VA or Health Net Federal Services.  If you cannot receive satisfaction, then we recommend you contact your congressman or one of our two senators and register a complaint.  The NCCA has not been able to affect change in this system however, some claims have been paid after we contacted a congressman or senator.

 

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Workers Compensation

 

Charles Hecht, DC

drcharleshecht@yahoo.com

(919) 933-8633

Dr. Charles Hecht is the NCCA Member Support Specialist for questions related to workers' compensation.

David E. Vtipil, Attorney

(919) 661-9000

David focuses his practice on personal injury and workers’ compensation claims. David E. Vtipil has received an AV rating by Martindale Hubbell – a rating given to lawyers who achieve the highest level of professional excellence as judged by his peers. He is also a Board Certified Specialist in Workers’ Compensation Law.

 

 

Helpful Documents and Forms

 

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Contact Us

NCCA State Office
8412 Falls of Neuse Road,
Suite 106
Raleigh, NC 27615

919-832-0611
E-mail

 

 

 



The North Carolina Chiropractic Association (NCCA), based in Raleigh, NC. is the only professional association in the state of North Carolina representing doctors of chiropractic. NCCA provides a unified voice for all its members and is dedicated to promoting chiropractic through public awareness, quality post-graduate education, legislative efforts and securing equality in the health care arena. These collective efforts assure continued growth of the profession, ultimately improving the overall well-being of North Carolina citizens through chiropractic.

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