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YOUR PCA is working for you in Harrisburg and on Capitol Hill!
What the Biden-Harris Administration Emergency Regulation Means for YOU
Yesterday, Thursday, November 4, 2021 the Biden-Harris Administration Issued Emergency Regulation Requiring COVID-19 Vaccination for Health Care Workers. Click here if you wish to read that proposed regulation or the Interim final rule with comment period.
Jason Martin, PCA General Counsel, has since reviewed the HHS/ CMS proposed language and has offered the following response:
Background: The Centers for Medicare & Medicaid Services (CMS) establishes health and safety standards, known as the Conditions of Participation, Conditions for Coverage, or Requirements for Participation for 21 types of providers and suppliers, ranging from hospitals to hospices and rural health clinics to long term care facilities (including skilled nursing facilities and nursing facilities, collectively known as nursing homes).
Most of these providers and suppliers are regulated by this interim final rule with comment period (IFC). Specifically, this IFC directly regulates the following providers and suppliers, listed in the numerical order of the relevant CFR sections being revised in this rule:
● Ambulatory Surgical Centers (ASCs) (§ 416.51)
● Hospices (§ 418.60)
● Psychiatric residential treatment facilities (PRTFs) (§ 441.151)
● Programs of All-Inclusive Care for the Elderly (PACE) (§ 460.74)
● Hospitals (acute care hospitals, psychiatric hospitals, hospital swing beds, long term care hospitals, children’s hospitals, transplant centers, cancer hospitals, and rehabilitation hospitals/inpatient rehabilitation facilities) (§ 482.42)
● Long Term Care (LTC) Facilities, including Skilled Nursing Facilities (SNFs) and Nursing Facilities (NFs), generally referred to as nursing homes (§ 483.80)
● Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs-IID) (§ 483.430)
● Home Health Agencies (HHAs) (§ 484.70)
● Comprehensive Outpatient Rehabilitation Facilities (CORFs) (§§ 485.58 and 485.70)
● Critical Access Hospitals (CAHs) (§ 485.640)
● Clinics, rehabilitation agencies, and public health agencies as providers of outpatient physical therapy and speech-language pathology services (§ 485.725)
● Community Mental Health Centers (CMHCs) (§ 485.904)
● Home Infusion Therapy (HIT) suppliers (§ 486.525)
● Rural Health Clinics (RHCs)/Federally Qualified Health Centers (FQHCs) (§ 491.8)
● End-Stage Renal Disease (ESRD) Facilities (§ 494.30)
This IFC directly applies only to the Medicare- and Medicaid-certified providers and suppliers listed above. It does not directly apply to other health care entities, such as physician offices, that are not regulated by CMS. Most states have separate licensing requirements for health care staff and health care providers that would be applicable to physician office staff and other staff in small health care entities that are not subject to vaccination requirements under this IFC
Bottom line is this does not apply to chiropractors in private practice.
2022 ICD-10-CM Updates Effective October 1, 2021
Provided as a courtesy of the PCA
The 2022 ICD-10-CM files below contain information on the ICD-10-CM updates for FY 2022. These 2022 ICD-10-CM codes are to be used for discharges occurring from October 1, 2021 through September 30, 2022 and for patient encounters occurring from October 1, 2021 through September 30, 2022.
This year's coding updates that will affect chiropractic claims are listed below:
- M54.5 Low back pain. Loin pain and Lumbago NOS have been deleted from the description
- New Code: M54.50 Low back pain, unspecified. This includes Loin pain and Lumbago NOS.
- New Code: M54.51 Vertebrogenic low back pain, Low back vertebral endplate pain
- New Code: M54.59 Other low back pain
- M54.8 Other dorsalgia. Revise low back pain (M54.5) to low back pain (M54.5-)
- G44.86 Cervicogenic cephalgia (Code also the associated cervical spine condition, if known. Cervicogenic cephalgia is a secondary code.
Click Here for Full Document Downloads from CMS
*Be sure to send out all your billing up to September 30 due to the updated ICD10 codes above that go into effect on October 1*
Medicare ABN Changes
Get a POSTER for your office to promote HR2654 for Medicare
There is QR code to have patients click the link and then send a message to their Reps in seconds. WANT FULL MEDICARE ACCESS to exams x-rays therapies and to be able to help your Medicare fixed income patients to not have the out of pocket expenses or have to get their x-ray elsewhere? Well this is how you do it! Sample of 1 of 6 versions of the poster is shown, pick the one that "speaks" to you.
PCA 2021- 2022 PRIORITY LEGISLATION:
House Bill 171 of 2021: An Act limiting restrictive covenants in health care practitioner employment agreements.
House Bill 173 of 2021: An Act amending Title 40 (Insurance) of the Pennsylvania Consolidated Statutes, in special provisions relating to particular classes of insurers, providing for nondiscrimination by payers in health care benefit plans.
House Bill 225 of 2021: An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in quality health care accountability and protection, further providing for definitions, for responsibilities of managed care plans, providing for preauthorization standards and for preauthorization costs, and providing for preauthorization and adverse determinations, for appeals, for uniform preauthorization form, for preauthorization exemptions.
House Bill 325 of 2021: Advisory Opinions from Licensing Boards
House Bill 916 of 2021: An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in casualty insurance, providing for coverage for nonopioid pain management care.
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Delegation of Therapeutic Exercise to Unlicensed Personnel (no bill # yet)
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Parity in Insurer Reimbursements (no bill # yet)
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PID Direct Oversight and Enforcement Authority of Health Insurers’ Contracted Third Party Administrators (no bill # yet)
Working Groups are Formed! Join YOUR Colleagues! #PCAStrong
The staff at the home office has never been better. Our executive vice president is cordial, respectful, and a true leader who has years of experience which has helped the association greatly over the past number of years.
I'm thankful for the PCA and what we as an association have accomplished to protect the rights of chiropractors to practice as well as protecting the health of individuals throughout our state."
Ed Kropf, DC - Pittsburgh, PA
"As a PCA member over 31 years I have been a distant observer of Chiropractic in our state as well as the several factions of philosophy practiced here. As so far as the PCA is viewed, I feel the current system in place is providing the best communication with it's members. PCA has put into place several terrific members and administration that take on the problems from many fronts, report and attempt to correct/improve the position for the future of Chiropractic in our state.
Good job, you all are doing things so very much better, keep it up!!!"
The level of responsiveness from any direct inquires to the Execs or affiliates(legal, political) has always been unparalleled with Ed Nielson as Executive Director. Whether you are a member or not, you have benefited from battles won by the PCA that may have never crossed your front steps.
The PCA has been a major contributor to my success in practicing in Pennsylvania. I am grateful to serve and more grateful to have such selfless colleagues that freely donate hours and hours of their time for our benefit as Pennsylvania DCs!"
“I am a retired doctor, who was hit with a $17,000 recoupment request from a Pennsylvania health insurer, TWO years after I retired. As a retired-status member, I immediately contacted the Pennsylvania Chiropractic Association. PCA’s staff were responsive and very helpful, including referring me to Mr. Jason Martin, PCA’s General Counsel, for a free legal consultation.
After talking at some length with Mr. Martin, he assisted me with the audit and provided very solid advice. I followed his advice and I was able to resolve the audit with the health insurer without any payment on my part. I am thrilled with the supportI was given by PCA staff and General Counsel Martin’s legal advice.
Thanks to my membership in PCA, I received very responsive and immediate support for my problem. Most importantly, my membership in PCA saved me $17,000of my hard-earned money! Thank you, PCA!”
Lori Kalie, DC - Lancaster, PA
"I actually sold my practice. About two hours after you posted the ad, I got a call from a doctor who was interested. He officially took over today. I received quite a number of calls about the practice since the ad was up. The service you provide is valuable, and I just wanted to thank you and the PCA for offering this service."
Brian Meenan, DC - Pittsburgh, PA
"I just started my own practice a couple of months ago. $600 is a bit steep but it is worth it! Charge me monthly, that’d be great."
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