2021 E/M Guidelines Take Effect

by Mario Fucinari DC, CIC, CPCO, CPPM

Since the initial evaluation and management (E/M) guidelines were released in 1995 and again in 1997, there has been controversy. The American Medical Association and the Centers for Medicare and Medicaid Services have joined together to arrive at a consensus that will reshape evaluation and management (E/M) guidelines for years to come.
In the outpatient evaluation and management codes' reorganization, the framers had a common goal; to reduce documentation and coding burden. The committees hope that the necessity for audits will be reduced by adding more detail to the CPT codes. The E/M coding will be consistent, thus decreasing ambiguity, errors, and needless future revisions.

Denial of Re-Exams or Established Patient Care

Many Chiropractic Physicians across Missouri have been contacting the MCPA about insurance companies denying re-exams or established patient exams. The MCPA Insurance Committee met with Anthem last week to discuss the issue.

If your exams are denied, we recommend sending in your records to the insurance company to prove that a separate and identifiable service was performed. The insurance companies are reviewing these records and paying on them after the records are sent showing that the service was done.

New Medicare Card: MBI Transition Ends in Less Than 10 Weeks

The 21 month Medicare Beneficiary Identifier (MBI) transition period ends on December 31, 2019. Are you ready?

Starting January 1, 2020, you must use the MBI when billing Medicare regardless of the date of service:

Unanimous Support from Missouri Representatives on Non-Opioid Options for TRICARE Recipients

The Missouri Chiropractic Physicians Association (MCPA) would like to thank our Missouri Representatives for their support with U.S. House Bill 344 and US Senate Bill 30. Currently, all eight of our Congressmen and women from Missouri are co-sponsors on this legislation: Reps. Lacy Clay, Jr., Emanuel Cleaver II, Sam Graves, Vicky Hartzler, Billy Long, Blaine Luetkemeyer, Jason Smith, and Ann Wagner.

U.S. House Bill 344 is a bipartisan bill introduced by Reps. Mike Rogers (R-AL) and Dave Loebsack (D-IA) that would provide career military retirees in TRICARE with access to Chiropractic Physicians and services to address pain management, musculoskeletal disorders, and related ailments. The Senate companion bill is Senate Bill 30 introduced by Sens. Tammy Baldwin (D-WI) and Jerry Moran (R-KS).

Missouri Leads the Way on Non-Opioid Options for TRICARE Recipients

U.S. House Bill 344 is a bipartisan bill introduced by Reps. Mike Rogers (R-AL) and Dave Loebsack (D-IA) that would provide career military retirees in TRICARE with access to Chiropractic Physicians and services to address pain management, musculoskeletal disorders, and related ailments. The Senate companion bill is Senate Bill 30 introduced by Sens. Tammy Baldwin (D-WI) and Jerry Moran (R-KS).

Currently active duty military has access to cost-effective, Non-Opioid treatment options; however, once they retire or “medically retire” from service, this treatment option is no longer available. The chiropractic profession is working with elected officials on a national level to fix this issue.

Missouri HealthNet Update

Representatives from the Missouri Chiropractic Physicians Association Legal Committee, along with our Bill Sponsor Rep. John Wiemann and MCPA Lobbyist Lynne Schlosser, met with MO HealthNet last month to discuss the progress of our the implementation of the HB 1516 that became law the end of August. This new law allows MO HealthNet patients to see a chiropractic physician practicing within their scope for up to 20 visits per year.

Although this law is currently in effect, unfortunately, that does not mean that the state is currently ready for this to occur. We were told that they are working on getting their computer program set up to allow chiropractic physicians to enroll and set a fee schedule for codes that chiropractors bill. They expect to have this done by sometime in January, but no later than February. MO HealthNet will send out an announcement when enrollment is open. Since they do not currently have chiropractic physicians in their database, you are encouraged to go to their website and sign up to receive notices. Go to https://dss.mo.gov/mhd/ and sign up for email updates located on the right side. Once enrollment opens, you will first need to apply to be a MO HealthNet provider with the State of Missouri. Following that, you will be able to sign up with MCO's that cover MO HealthNet recipients. Currently, there are three MCO's: Home State Health Plan, Wellcare, and UHC Community Plan.