b'CODING Update ComplianceLEGAL NUTRITIONCouncilANJC Leadership LEGAL EASE NUTRITION REHAB Council Executive Directors Update LEGAL Q&A CHIROASSISTINSURANCE Update INSURANCE Update Legislative Update NewJerseyBecomes the 12th State with Its By Jon BombardieriTECHNIQUE CouncilANJC Government Affairs Counsel Own Health ExchangeGov. Phil Murphy signed legislation incare.gov, which has been used by Newits new individual market system with MedicareQ&AMedicare Update Jersey and nearly three dozen states. online enrollment for Medicaid, which July that requires New Jersey to create its own individual health insuranceLawmakers have said that, with theOUR HEALTHnow covers some 1.8 million residents marketplace, or exchange, so it candecreased open enrollment windowof New Jersey. Sponsors of the take over a process now run by theand fewer navigators, New Jersey is notlegislation say the goal is for the state Trump administration. Eleven othergetting a fair return on this investment.to create a single, integrated online states and Washington, D.C., nowplatform with the individual market operate their own individual markets,The goal of the state exchange is toand Medicaid that helps all insurance but New Jersey is the first to make thisprovide an opportunity to gain betterconsumers not covered through their change since the current system wascontrol over open enrollment andjobs find the right product.established. In New Jersey, these plansstabilize the insurance market. The sponsors and Gov. Murphy stated benefit some 300,000 residents whoThe law also provides that thethat the overall objective of the earn too much to qualify for MedicaidDepartment of Banking and Insurancelegislation is to make sure more New and are not offered coverage through(DOBI) coordinate the operations ofJerseyans have healthcare coverage. their work. the exchange with the operations ofOne of the main focuses of Gov. Based on legislation sponsored bythe State Medicaid program and theMurphys campaign platform was to Assemblyman Herb Conaway and Sen.NJ FamilyCare Program to determineinsure more New Jerseyans, along Nellie Pou, this law allows the state toeligibility for the programs as soonwith this legislation and legislation that collect a fee of 3.5 percent on plansas practicable. The commissioner ofwas signed into law in May 2018 that sold through this marketplace, whichHuman Services, in consultation withrequires those without health coverage enables the state to raise more thanthe commissioner of the DOBI, willto pay a tax penalty starting next year. $50 million annually to fund the system.submit a proposal for available federal The federal government currentlyfinancial participation funds to CMS for collects this money, now assessed atthe Medicaid eligibility platform andJon Bombardieri and his firm, CLB the same 3.5 percent, to pay for thethe exchange to be integrated. Partners, serve as the Government Affairs national sales platform, www.health- The state is directed to coordinateCounsel to the ANJC.[ CODING FROM PREVIOUS PAGE ] one-on-one component.should always be careful to check all contact. However, any actual time theAs with all procedures, yourapplicable state laws and regulations documentation must substantiateas well as individual payer policies to therapist uses to attend one-on-one to aensure proper coding and compliance.patient receiving a supervised modalitythe medical necessity of the service, cannot be counted for any other servicebe dated and signed, and support provided by the therapist. the diagnosis and services billed. ADavid Klein, CPC, CPMA, CHC, an ANJC thorough and well-drafted treatmentcoding and compliance consultant, is the It should be noted that this advisoryplan in the patients record willco-founder of PayDC (www.paydc.com), only pertains to supervised modalitiessignificantly help and is required bya web-based EHR/Practice Management and not constant attendanceMedicare and most, if not all, payerssystem that focuses on documentation, modalities. Constant attendanceand state boards. Providers shouldcompliance and reimbursement. He modalities also require one-on-onealso be aware of Medicares Correctis a certified professional coder and contact and therefore cannot be billedCoding Initiative (NCCI). NCCI edits areauditor through the American Academy at the same time as a therapeuticapplied to CPT codes and may prohibitof Professional Coders (AAPC), and is procedure (they can however becertain codes being billed together orcertified in healthcare compliance through billed with supervised modalities).require that the services are distinct orthe Health Care Compliance Board (HCCB). He is the founder and president Additionally, more than one constantindependent from each other whenof DK Coding & Compliance, Inc. a attendance modality cannot be billed atbilled on the same day. This advisoryhealthcare consulting firm that focuses on the same time (e.g. combination stim/ is designed to serve as an overviewaudit defense, education, compliance and ultrasound units) as they both have aof certain coding scenarios. Providersreimbursement issues.www.njchiropractors.com I 9'