Legislative News

Hello Doctor and Staff!

I hope this eNews finds you well and well on your way to achieving your 2019 goals!

For you Game of Thrones fans (yours truly), we started to watch the beginning of the end, but I believe each 
day is a chance for new beginnings and opportunities, and for us it starts with desire and being well-informed. 
So, let's not think "game of groans", but 'game of milestones', with regards to getting your practice life in order,
and let's get rolling!

1. AvMed, et al - notes requests are a warning!
2. ASHN/BCBS response to verification issues
3. DWC-25 - Worker's Comp carriers may be tightening this requirement
4. Availity - check, check, check
5. GP Modifier - request verification
6. Florida PIP update - be at the ready!

1. AvMed, et al - notes requests are a warning!
I've mentioned in previous eNewsletters that when a health insurer requires notes to be sent with claims it's 
a pretty fair certainty that an audit is being performed. Recently, I've noticed that companies such as AvMed,
Ambetter and Cigna do exactly that, which I was able to confirm after calling and speaking with them
directly. 
Triggers to audits could be from such things as prolonged billing with the same diagnosis codes (never updating
to an improved status), or prolonged billing with the same CPT codes (how about graduating from acute care
procedures, to attended or rehab-type procedures, to MMI and out the door!), or a treatment plan that doesn't 
spell out an endgame, pre-game, half-time, or over-time, if necessary [hey, NBA and NHL playoffs are happening -
I'm in the mode].
Be aware, too, that some insurers may have specific procedures for submitting notes when requested with claims - 
as I learned with AvMed. AvMed has a specific form [found online, Providers > Forms > Request for Claim Review/
Appeal] that should be filled out and sent with notes. These actually end up in a completely different department
than claims, Audit Services, and reviewed by an auditor/reviewer therein. Other insurers may have similar
requirements, so, it's important that you call them immediately when you get notification that notes will be
required when claims are sent, to find out the proper protocols for sending such requests.

2. ASHN/BCBS response to verification issues
iCollect clients and DCs at large have been complaining about difficulties getting verification details for ASHN 
patients. For BCBS patients, when first calling BCBS offices have been told to call ASHN, then at times ASHN 
may say to call BCBS. 
To get clarity on the situation, I called ASHN directly and spoke with Tonia Holland, Manager, Clinical Customer
Service Department, who apologized for the confusion and "poor direction" and said that most verification 
answers can be found on the Ashlink website. Under the Resources tab look under Client Summary, and 
information such as covered CPTs, rates, and reimbursements are supposedly listed. Check it out and if
not there let them and me know!

3. DWC-25 - Worker's Comp carriers may be tightening this requirement
Recently, we've been noticing some Work Comp carriers here in Florida delaying or denying payment until a
"proper state required patient status update form is received". The form that they are referencing is the 
DWC25 form [Google 'Florida DWC25 form"], which is a medical treatment/status report form. There has 
been an uptick in the request for this form, and I was told by one adjuster that she believed after some
years of Work Comp insurance carriers being lax on requesting such updates from providers, that the
State has gotten stricter in gathering such data from insurers. Apparently, the State has not been able
to keep current data on Work Comp injuries because they haven't been receiving this information with
regularity from the carriers. 
Download this form, familiarize yourself with it, and be prepared to provide it should delays/denials of
the sort I've mentioned begin to materialize, if they haven't already. 

4. Availity - check, check, check

Availity has been sending out email notifications warning that Payors are removing unverified providers
from the Availity rolls. This could prevent or delay your ability to utilize Availity for all the resources it
provides for those specific payors that have removed you! So, make sure to visit the Availity website
immediately and check your status to ensure everything is up-to-date! Aside from such notifications
appearing on the website landing page (once you sign-in), make sure to check your "messages" section
as well.

5. GP Modifier - request verification

Most of you (I hope) should know that insurers such as Medicare, Medicare Advantage/HMO plans, and
some other State and federal plans require the use of the -GP modifier when billing physical therapy codes.
There has been growing scuttlebutt that some other insurers may start requiring the use of this modifier
as well. I, personally, think it would be a good idea to add this question, "to use, or not to use, the -GP
modifier" when verifying insurance. It may save you a lot of time, money and grief to know up-front 
whether therapy codes would only be considered with the -GP modifier present. Remember, if the primary
insurer doesn't cover the therapy codes, a secondary or supplemental insurance just might!

6. Florida PIP update - be at the ready!
Rumors have been spreading that the battle to end No-Fault PIP here in Florida have failed to make it
through all the necessary committees, and therefore, no changes will occur.
FCA Government Relations chief, Jack Hebert, has warned that although the discussion was tabled by
one of the House committees it must make its way through, it is not dead until the final day of this
legislative session has come and gone. Bizarre events, including backroom deals, have been made in
final days sending once thought dead bills to the floor for a vote in the final moments. Another non-
matching BI bill has made it through 2 of 3 Senate committee so far, which has more than caused
its fair share of worry and heartburn among the majority of our colleagues. 
Bottom line, remain diligent in watching and listening for breaking news, and only get it from a valid
and reliable source. We may be asked to make telephone calls last minute to a select group of legislators,
so make sure your phone service is paid up to date, and be equally prepared to rally the troops, ie,
colleagues and patients, to make the calls as well. If necessary, scripts will be provided. 

I hope you found the information I've presented helpful, and as always, please reach out with any questions.Should you be thinking about engaging help with your billing and collection needs give me a call and I'd be happy to answer any questions you might have!

*Feel free to share or re-post this eNewsletter as long as it remains intact, as is, and unaltered.

All the best,

Dr. LeVine







Dr. Arthur I. LeVine
CEO & Founder, iCollect Medical Billing Services, LLC
Chairman, SecureCare of Florida IPA Board of Directors,
Past President, Florida Chiropractic Assn.,
Board of Directors, Florida Chiropractic Assn.,
Chairman, Insurance Relations Committee, Florida Chiropractic Assn.,
Co-Chairman, Government Relations Committee, Florida Chiropractic Assn.,
Florida Representative, Congress of Chiropractic State Assns.,
Past Florida Contractor Advisory Council (CAC) Representative
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