In case you hadn't heard the news, Regence Blue Cross Blue Shield is recommending pre-authorization for Acupuncture services for all members starting November 1, 2013 in Oregon, Washington, Idaho and Utah.  Starting February 1st, 2014 this will be a requirement, not just a recommendation.

The full details of this change can be found HERE on the Regence Oregon website.

It looks like the process will be pretty easy and handled by an organization called CoreCare National, LLC.  You will have to register your credentials with them and can either call or go online to obtain a pre-authorization for the specific diagnosis code and CPT codes you want to bill for.

A complete list of all the CPT codes required to get pre-authorization for is on the Regence site linked above, or HERE if you want to go direct.

Its been clear for the past year that Regecen has really been buttoning down on Acupuncture.  Regence used to have some of the best reimbursement rates in my practice and now it is one of the lower eschelon to be sure.  This move does not have me hopeful of a strong reimbursement rate in the future as the Affordable Care Act gets into full swing, but we'll just have to take it step by step and see what happens in the coming years.

For now, if you are a preferred provider with Regence in Oregon, Washington, Idaho or Utah its time to get signed up with CCN and start familiarizing yourself with the pre-authorization process.  Regence is offering several webinars about it this month.  They are free and you can sign up through the Regence page linked above.

Good luck all you Acu-Stars out there, lets keep fighting the good fight!
~Rebecca Hurwood, LAc

Its here!  The Affordable Care Act has gone into effect despite all the brouhaha in DC and the traffic on the exchange websites is high enough to cause glitches here and there is a good sign I think.

In Washington State, a minimum of 12 Acupuncture treatments per plan year is included in the essential benefits list, so ALL Washington State plans will include Acupuncture coverage starting in 2014.  How cool is that?

While I don't have time to review the plans online in every state, I did take the liberty of scanning all the Individual and Family plans in Oregon and compiled the best list I could of which plans include Acupuncture coverage:

• Bridge Span Health Plans - no Acupuncture coverage under any individual plans
• Family Health Care - Medicare and Medicaid Oregon Health Plans only. NOTE that Medicare does not cover Acupuncture at this time.  The OHP Plus plan does include Acupuncture services though the exact benefit is not listed on the OHP site.
• Health Republic Insurance Company - NEW!  Health Care Co-Op option.  All plans cover 40 combined Acupuncture + Chiropractic Visits
• Health Net - does not currently list acupuncture benefits in any of their individual & family plans but it looks like a glitch - they have traditionally covered Acupuncture and Chiropractic under all plans.  I talked to Provider Relations and they indicated Health Net was not dropping Acupuncture coverage but couldn't give me specific plan details.  They referred me to their Affordable Care Act information line but I have been unable to get through.  Group health insurance will most likely continue to cover acupuncture.  Confirm  benefits with a sales person if you are considering these plans.
• Kaiser Permanente - Plan details are not listed online at this time.  Traditionally all Kaiser patients (aside from Medicare only coverage through Kaiser) have access to Acupuncture through referral whether they have a "self refer" benefit or not.  Expect this benefit to continue, but speak to a sales representative to confirm if considering a KP plan.
• Lifewise - Acupuncture included in the Gold and Broze VA plans
• MODA Health - Acupuncture included in the Gold-Be Protected, Silver - Be Prepared and Silver - Be Smart plans.
• Oregon's Health Co-Op - another NEW health care co-op insurance agency!  Acupuncture included in SiMPLE Silver, Bronze and Gold plans as well as all Group plans
• PacificSource - Acupuncture included in the Balance Bronze 6350, Silver 2500 & Silver 1500 plans
• Providence - no Acupuncture coverage evident in any of the Individual & Family plans.
• Regence Blue Cross Blue Shield - Acupuncture is not currently listed as a covered OR an excluded benefit in their individual plan brochure so I cannot confirm or deny coverage, but traditionally BCBS has been good at providing alternative care benefits to members.
• Trilium - like Family Health Care, provides Medicare/Medicaid/OHP plans only.  As with Family Health, Medicare does not cover Acupuncture but the OHP plan does though again - the exact benefit isn't listed.

Since Group plans are subject to employer approval I did not review all of them, and I highly recommend working with a broker to compare plans and determine which one is right for your business if you are selecting something new or considering doing so.  The health care exchanges generally have qualified brokers who can help you review and compare group and individual plans - you can get referrals to them through your state's health exchange website.

If you are self-employed there may be some new benefits available to you as well.  Check out THIS PAGE on the Healthcare.gov site for an FAQ.  It isn't comprehensive in any way, it really just directs you to go to your state exchange, but it is still nice that the government addressed and highlighted this issue.

Lastly, I wrote a patient-centered blog post about this on my clinic website today and if you need a place to start for your patients to answer questions about ACA and Acupuncture, feel free to point them there or lift information and post it on your site or ezine.  All I ask is that if you reproduce something from my blog you link back to me as the source of information.

Enjoy Fall, everyone, and lets hope the government gets its act together and starts functioning again soon.  Hey, any LAc's in DC?  Can you go do some group treatments for Congress?

Until next time,
~Rebecca

If you're looking for a good comprehensive ICD-10 code list, I've got a great resource for you - HIPPASpace.  Its a resource I'd used before to get NPI numbers for referring physicians, but hadn't used in a while until this week.  When I went to the site they had this magical incredible FREE ICD-10 lookup and its just too cool not to share.

You can enter a diagnosis like "fibromyalgia" or a simple category such as "pain" and get a full list of current ICD-10 codes.  Once you get the list you can choose a "mapping" option which will compare the chosen ICD-10 codes to current ICD-9 codes as well to help you understand if you've translated the code appropriately.

ICD-10 codes are much more complicated than ICD-9.  In physical medicine, for instance, the 7 digit codes include not only coding for the affected body part and type of pain/injury but also whether it is an initial treatment or follow up treatment for the injury so it is important to understand the coding language and sequence enough to choose correctly.

Still, for a quick way to just get the numbers and start translating what you have in ICD-9 to an initial subset of ICD-10 codes, this is a great free resource.

AAC's AcuCode 2014 - a comprehensive list of ICD codes for acupuncturists specifically - is now ready and available for purchase after being out for several months.  This year, they've taken their coding manual digital, so the annual fee includes instant access to their online database as well as a physical copy of the book which will print and ship beginning in October.

If you want a pared down set of codes specific to your profession, this is a good resource and still a comprehensive list.

The new CMS 1500 form, version 02/12, is now available and will be in use starting January 2014.  Mandatory use of version 02/12, however, has bee pushed back from October this year to April 2014 so we all have a little more time to review and implement this new claim form.

CMS holds regular informational calls and webinars through MLN Connects which is part of the Medicare Learning Network.  They are geared towards medical doctors and medicare billers, but they have great information for all providers who bill insurance of any sort.

Upcoming is a special ICD-10 Basics session on August 22nd that will walk through the basic differences between ICD-9 and ICD-10.  Continuing education credit may be available with proper documentation as well.

Undoubtedly, there will be much on this call that does not pertain to complementary and alternative medicine - especially for Acupuncturists since Medicare still does not cover Acupuncture - but with the extensive nature of the ICD-10 changes, more information is always a good thing.

If you haven't signed up for the MLN Connects Provider eNews I highly recommend it - its a simple way to stay on top of what is "coming down the pipeline" direct from CMS.  It is certainly a source I rely on for accurate insurance billing information and updates.

I hope you're looking forward to a wonderful week!  

Here's to your Insurance Billing and Practice Building Success,
~Rebecca

Its only taken me 3 years, but voila!  Website update which was a long time coming!  Poke around and check it out - new look, new blog, new affiliate site, pretty sweet!

That's right, it is on its way slowly but surely so hold on tight and keep up the prep work.  Currently, ICD-10 isn't required until October 1, 2014 so we still have a long time to complete our coding changes, test our systems and prepare.  But the key is PREPARATION - don't wait until the last minute!  Start compiling your code sets now so that when October 1st 2014 rolls around you are well tested and ready.

I promise I will have a book update out by then too, so stay tuned!  I will include the basic codes necessary for Acupuncturists as I did in my first edition.  You can also peruse codes at the official CMS ICD-10 website but it is rather unwieldy to search through them all.

A great code set that's been parsed down for Acupuncturists is available from the American Acupuncture Council for about $50, but it is currently sold out!  I will endeavor to post when they are available again, or you can contact AAC direct and ask if they can notify you.

Okay, guys, this one is a biggie - beginning October 1st 2013 a NEW HCFA/CMS 1500 form called version 0212 will be required for insurance billing.  You can see a PDF version HERE and you can read more on the NUCC website HERE.  Undoubtedly, your clearinghouses are already testing this new form and will be prepared to process it.  I haven't heard or seen anything about availability at stores like Office Depot or the like for purchasing pre-printed blocks of these, as you can with the current CMS 1500, but we can only assume that is coming too since its kind of a necessity for compliance.

The only CAM friendly database system that I know is assured to have the new CMS 1500 0212 built into the system is ClientTracker by Ginkgo Software.  So if you're thinking of investing in a new system for your practice, I highly recommend this one - it is what I use and I wouldn't be without it.  They have a multi-user cloud system on its way that can be accessed using both your computer and your tablet devices which is pretty sweet.

Them's the haps, people.  Stay tuned for more insurance billing, practice building and Insurance Billing Made Easy updates - I promise there will be more to come!

Oh, and have you signed up for my ezine?  If not, you should! Free tips delivered to your inbox and not spammy, I promise!