14 I Spring 2018 www.anjc.info Insurance Update MEDICARE Q&A Legislative U Medicaid 21st Century Cures Act Providers have been receiving letters from Medicaid managed care carriers advising that due to a provision in the 21st Century Cures Act, as of January 1st of this year all managed care providers must enroll in the state Medicaid panel in order to continue participating. However, there has been a moratorium on DCs being admitted to the state Medicaid panel since 2006. Therefore, we fear any chiropractors who were not on the state panel when the moratorium went into effect will no longer be able to participate in the managed care Medicaid plans. The ANJC has contacted the director of the Division of Medical Assistance and Health Services (DMAHS), Meghan Davey, on this issue. At the January 24th quarterly public Medicaid meeting, Davey advised that the department is aware of the situation and is working on a solution. She also noted that the National Association of Medicaid Directors has sent a letter to CMS advising that many states need more time to address issues with implemen- tation of provisions of the 21st Century Cures Act. The director definitively stated that no current managed care Medicaid panelists would cease to receive payments due to this legislation before a solution to the moratorium issue was devised. I inquired again at the April 18th public Medicaid meeting. While Davey was not in attendance, the deputy director of DMAHS and the deputy commissioner of the Depart- ment of Human Services both advised that the issue was still being worked on and a resolution was near. We will continue to update membership on this matter. Medicare Audits Audits of all kinds have been expanding in both frequency and depth. The ANJC is seeking to under- stand what is being sought in these audits and how doctors can best pass them. We are currently focusing on the wide variety of Medicare audits. In order to understand and help prepare members for such audits, we need information from doctors who have gone through them. If you have undergone any form of a Medicare audit (CERT, Strategic Health, ZPIC/ UPIC, Safeguard, etc.), please reach out to me at matt@anjc.info or at HQ at 908-722-5678. We look forward to and appreciate your help in this matter. Horizon Medicaid Horizon NJ Health, Horizon’s Medicaid managed care subsidiary, has announced that it will no longer reimburse CPT code 98943, extra-spinal manipulation, as of April 1, 2018. Further, the announcement states that the only services rendered by a chiropractor that will be reimbursed are “manual manipulation of sublux- ation of the spine billed under CPT codes 98940, 98941 and 98942.” Despite this assertion, the Horizon NJ Health Provider Manual (chiropractic coverage on page 3-13) does declare that an initial evaluation billed under codes 99201-99205 is eligible for payment when billed on the initial visit with appropriate PCP referral. Horizon 98943 Over the last few months the ANJC has heard from many members that CPT code 98943 is being denied on various (but not all) Horizon plans. The denial reason code has been U702: “This service is not paid. This denial occurred because the procedure code has a status indicator of N, I, P, M, R or C. Refer to the Medicare Physician Fee Schedule to determine CMS Guidelines for reimbursement.” We have spoken to Horizon manage- ment to alert them of these denials. Horizon advised that these denials are erroneous. They believe the issue is related to a recent upload of new claim edits based on Medicare policy. They anticipated the issue with the edits would be fixed by April 22nd. In the meantime, they turned off all the edits that had been uploaded and caused this issue. As such, there should be no more 98943 denials on claims going forward. When we reached out to Horizon to address the issue, Horizon said that once the claim edit issue is resolved, they will reprocess and issue payment for the previously denied 98943 claims. They did not have an estimated time frame for this, but will advise once the claim edit issue is resolved. By Matt Minnella ANJC Director of Insurance & Regulatory Affairs 2018 SPRING INSURANCE UPDATE