BC|BS Articles and Resources
News and Important Information
Effective for all commercial and Medicare Advantage Professional Claims submitted to the plan on or after Oct. 1, 2019, your Anthem Blue Cross and Blue Shield (Anthem) Provider Agreement(s) will be amended to require the submission of all commercial and Medicare Advantage professional claims within ninety (90) days of the date of service. This means all claims submitted on or after October 1, 2019 will be subject to a ninety (90) day timely filing requirement.
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Medicare: effective date of 6/1/2017 for IL, MT, NM, OK, and TX
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Medicaid: effective date of 6/1/2017 for IL and TX
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December 9th, 2019
Regence: Dental Procedures Under The BlueCard Program?
Published December 9th, 2019|
This information can be found on Regence/Blue Cross Dental procedures explaining additional benefits for dental procedures. Regence currently does not offer dental benefits, however, there are times a patient can receive treatment with a Blue Cross provider and qualify under their medical benefits. In addition, Regence informs the providers to file these claims ...
August 20th, 2019
Are You Aware of Medicare Advantage Plans Timely Filing Rules?
Published August 20th, 2019|
The Medicare Fee for Service (FFS) program (Traditional or Original Medicare) has a timely filing requirement; a clean claim for services rendered must be received within one year of the date of service or risk payment denial. As any company who has billed Medicare services can attest, the one-year timely filing ...
May 13th, 2019
Electrical Stimulation and Electromagnetic Therapy Devices
Published May 13th, 2019 - Last Review/Update May 20th, 2019|
Electrical Stimulation and Electromagnetic Therapy Devices can be used for pain, muscle atrophy, help spinal cord injuries, treat symptoms caused by other medical conditions and can be used in the treatment of wounds. This Regence BC/BS article lists codes and devices and gives guidance on coding from Medicare Advantage viewpoint.
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July 30th, 2020
Evaluation & Management Coding Rules are Changing in January - Is Your Organization Ready?
May 5th, 2020
Finally, the SOAP Note That Will Satisfy Everyone
Every regulator, every payer, and every chiropractor will tell you that they have the perfect SOAP note. But then why are they all different? In this raucous presentation Dr. Gwilliam, Clinical Director for PayDC EHR software, will finally bring all these parties together. We'll look at the requirements and elements that make up a good note and then break it down so that you can build one without suffering from a breakdown.
April 2nd, 2020
Injection Coding Changes for 2020
Injection Coding Changes for 2020
November 5th, 2019
Proving Medical Necessity and Functional Improvement
Medicare is required by law to pay for care that is medically necessary. Medicare considers functional improvement to be the primary indicator of medical necessity for chiropractic care. It is up to you, the doctor, to prove functional improvement and medical necessity with your documentation. Dr. Short will show you how to use common practice tools to document functional improvement, medical necessity and maximum medical improvement.
September 11th, 2019
Inappropriate Payments Made to Chiropractors – An OIG Review
In this webinar, Dr. Gwilliam will take you on a fun filled journey through all of the reports created by the Office of the Inspector General based on their reviews of chiropractors. If you can understand what they see, and what advice they give Medicare when dealing with chiropractors, then you will be better prepared to not become their next target. This webinar may feel a little frightening with hundreds of thousands of dollars paid back to CMS, but, by the end, you will know exactly what to do and what not to do.
July 9th, 2019
Expanding Chiropractic Coverage in Medicare
Currently Medicare only pays for the adjustment and then only when it is used to correct a subluxation. This injustice within the Social Security Act needs corrected. Dr. Ron Short will discuss the Medicare laws as they relate to chiropractic and what changes need to be made and why. ...
May 14th, 2019
Confusing Codes for Chiropractors - 97110 versus 97112 versus 97530
In this webinar, you'll get a deep dive into three therapeutic procedure codes. Dr. Gwilliam, a chiropractor and certified professional coder, will take you thorough the ins and outs of therapeutic exercises, activities, and neuromuscular reeducation. They will be compared and contrasted with examples to make sure everyone leaves with the confidence to document and bill them correctly.
March 5th, 2019
Evaluation and Management Coding
The Evaluation and Management service is an important part of an episode of care. It is the initiation of care and determines the scope and severity of the patient’s condition. Dr. Ron Short will review the levels of Evaluation and Management codes and which are appropriate in the chiropractor’s office. In this webinar you will learn: What constitutes a new patient Which Evaluation and Management codes should not be used When to use the consultation code What changes are coming to Evaluation and Management coding
January 8th, 2019
Chiropractic Manipulative Treatment and Medicare - Part 2
In this CE webinar, Dr. Gwilliam will continue his discussion from the webinar delivered Dec. 18 about chiropractic manipulative treatment. But this time, it is all about Medicare. If you don't treat Medicare beneficiaries, you should probably listen anyway. Usually whatever Medicare wants is the same thing as all the other payers. Find out the difference between acute, chronic, and maintenance, as well as when to use certain modifiers.
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August 25th, 2020
Do You Have All the Right Dental Resources Needed to Succeed in Dental Medical Billing and Coding?
Discussion with LaMont Leavitt (CEO of innoviHealth) and Christine Taxin (Adjunct professor at New York University, President of Dental Medical Billing, and Links2Success). Some of the resources and tools they discuss will help you with your dental coding/billing and education.
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