2019 - Issue 5

CA SCENE

If you haven’t yet confirmed your annual CE is listed accurately per the TBCE, don’t delay – verify compliance today! As a special benefit to TN licensed participants of CE sessions at TCA/CAT seminars, TCA automatically reports hours attended to CE Broker in addition to sending CE certificates to the licensee via mail. Prior to the end of the year, simply login to your CE Broker account to ensure credits were uploaded correctly. If you at-tended a TCA event and do not see that your hours were reported to CE Broker, please be sure to report your CE using the certificate you received in the mail. The TBCE only requires licensees maintain a free CE Broker Basic account; how-ever, premium account options are available for those interested. HOW TO CREATE YOUR CE BROKER ACCOUNT:

1 Visit https://cebroker.com/tn/plans to pick your plan.

2 You will then be prompted to search for your TN license number and link it to your account.

3 Verify compliance with your annual CE requirement. If you need further assistance, you may contact CE Broker at support@cebroker.com or 1-877-434-6323.

CTAs and CXTs: Have You Confirmed YOUR 2019 CE?

2018 CE Audit Spurs Inquiries on CTA/CXT Licensee Rules

The TCA has received numerous calls since the Tennessee Board of Chiropractic Examiners (TBCE) began notifying licensees of non-compliance for 2018 CE requirements after their October 17th meeting. The TCA volunteered to send communications to help all impacted licensees respond prior to further action by the TBCE. Through this process, we have become aware that there are CTAs and CXTs who were licensed in 2018 who have been notified of non-compliance. As questions have

been received, we have provided the CTA and CXT rules which speak to the requirements for new licensees, but feel it is important to provide this information via CA Scene to further support those who may be unsure or unaware of the CE requirements for their license. Per the TN Rules Governing Chiropractic Therapy Assistants (which mirror the CXT Rules): 0260-05-.12 CONTINUING EDUCATION. (1) Basic requirements-The Board of Chiropractic Examiners requires each certificate holder registered with the board to complete six (6) clock hours of continuing education each calendar year. (2) New certification requirements

(a) A two (2) clock hour Board approved course in risk management, sexual/professional boundaries, and Tennessee statutory and regulatory chiropractic jurisprudence must be taken within twelve (12) months prior to certification or within the first (1st) calendar year that continuing education is required. If taken prior to certification, the course must be an additional course beyond the regular chiropractic therapy assistant program. If taken after certification, the course shall not constitute part of the six (6) clock hour continuing education requirement in para-graph (1) of this rule. Those who are certified as both chiropractic X-ray technologists and chiropractic therapy assistants need only take this course once. (b) New certification by examination or reciprocity – New certificate holders, whether by examination or reciprocity, shall be exempted from the continuing education requirements of 0260-05-.12(1) for the calendar year in which they are certified, but must take the two (2) hour course as described above in 0260-05-.12(2)(a).

Based on these rules, CTAs and CXTs who were initially licensed in 2018 would be exempt from the CE requirement for that calendar year. Their CE requirement is effective starting in 2019 and provides the calendar year, in its entirety, to comply. (These rules differ from DCs.)

Click Here to Check the 2018 CE Audit List. If your CTA or CXT license was issued in 2018 and you received correspondence from the TBCE, we recommend that you email them at Unit2HRB.Health@tn.gov as soon as possible to confirm with them your compliance status.

Phone Scam Targeting TN Chiropractic Licensees

Unfortunately, 'tis the season for scammers and the TCA has become aware of one particular phone scam targeting chiropractic licensees in Tennessee. This week, the TCA heard from member doctors who received calls from individuals stating that they were from the TN Board of Chiropractic Examiners (TBCE). The scammer goes on to tell the doctor that their records show they have an unpaid balance, and threaten to suspend their license, impose additional fines and even take legal action if they don’t provide a form of payment over the phone. PLEASE NOTE: The TBCE will NOT contact licensees by phone to demand payment of any license fees or fines. TCA staff has contacted the TBCE administrative team and they are alerting all Health Related Boards, as this could be impacting other professions, as well. Be on alert and notify your team. Make sure your fellow chiropractic assistants have been trained in what information cannot be provided over the phone to unverified contacts. Here are tips to avoid phone scam tactics:

• Don’t assume your caller ID is proof of whom you’re dealing with. Scammers can make it look like they’re calling from a company or number you trust.

• If you get a phone call, email, or text from someone asking for your personal information, don’t respond. Instead, check it out using contact info you know is correct.

• Don’t trust someone just because they have personal information about you. Scammers have ways of get-ting that information.

• If you gave a scammer your information, contact your bank or credit institution immediately. You may also go to IdentityTheft.gov to learn what to do if the scammer made charges on your accounts.

Unfortunately, we all have to be on guard for these Grinch-like scammers; however, keeping these tips in mind can help you keep your season merry and bright!

TCA & BCBST Talks Push Forward

The TCA stands in strict opposition to discrimination against the chiropractic profession in any pay system. The impact of such negative practices affects the profession as a whole: individual providers and patients. Since 2016, the TCA has persistently engaged in talks with BlueCross BlueShield of TN (BCBST) leadership in an effort to address the negative impact of their contract changes which implemented a global rate pay system on chiropractic care. Additionally, the TCA has made it a priority to continue to measure the impact this change has had on our TCA members and the patients you serve.

Most recently, TCA E.D. Tiffany Stevens, TCA Immediate Past President Dr. Andrew Dixon and TCA Insurance Liaison Dr. Michael Massey met at the BCBST headquarters in Chattanooga with Dr. Andrea D. Willis, Senior Vice President & Chief Medical Officer; Marc Barclay, Vice President of Networks and Contracting; and Steve Burdette, Director of Provider Networks & Contracting. In this meeting, the TCA presented data from our ongoing surveys, including the most recently conducted profession-wide survey validating the significant effects the global rate change has had on the profession. We once again conveyed the negative impact a pay transition of this magnitude has had on practices and patients, yet it was quickly made clear that they have no plan on the horizon to return to the previous pay system. Our direction shifted to a solution-focused approach aimed at key areas highlighted in the compilation of concerns surveyed from the profession. While the meeting did not confirm any change at this time, many solutions were presented and actively debated. We ended by reaffirming recommendations to address the areas most impacting the profession, and secured a commitment to further open dialogue. We are guardedly hopeful that our concerns were met with genuine consideration. One takeaway of our ongoing efforts to be better utilized in BCBST policies to address the opioid epidemic was their preparedness to accept DCs who have met the TN Board of Chiropractic Examiners’ acupuncture requirements in their program of covered acupuncture services. Doctors should contact their provider representatives for more information on the credentialing process. The TCA will continue discussions in our effort to push for positive change. Watch for updates in future issues of the CA Scene.

Thank you for your support as a CAT Member! You give so much of yourself in time and resources to strengthen the

future of the profession, while caring for the health of your communities. We are consider it a privilege to support and serve you!

Clinical Corner

Patient Education: Migraine Headaches – Know the Facts

Migraine headaches affect 39 million adults and children in the United States. This neurological condition typically involves severe, stabbing or throbbing pain, and is known for a number of other symptoms such as: visual disturbances; nausea and/or vomiting; dizziness; extreme sensitivity to sound, light, touch, and smell; and tingling or numbness in the extremities or face. Due to this complicated array of symptoms, migraines can be so severe they can leave sufferers incapacitated for hours, even days, at a time.

The impact of migraine headaches on our nation’s health and wellbeing is enormous. researchers are taking a closer look at ways to combat the debilitating effects of migraines to reduce their negative impact.

In 2017, the European Journal of Neurology reported on the results of a 17-month migraine study comparing chiropractic treatments with “usual pharmacological management” in patient care. Overall, there was a general reduction in the duration of migraine headaches for the participants; however, for the chiropractic group, this reduction was maintained through the study follow-up period of 12 months. Additionally, the reduction in the duration of migraines was significantly more when compared to the control group that received medications only.

More recently, a 2019 meta-analysis of 5 randomized clinical trails showed a reduction in both duration as well as pain/intensity for patients who received chiropractic care. These study results show the importance of ensuring migraine patients understand their options for relief. For those who have tried various treatment options, it may be enlightening to learn that in comparison to pharmaceutical treatments, these researchers concluded that conservative care such as chiropractic treatments can often work as well or better.

As these studies show, chiropractic care can have a positive impact in relieving symptoms for migraine patients. Additionally, it provides a treatment method that does not involve medications which may have unwanted side effects such as the “medicine hangover” effects which can come from some. Chiropractic care should be considered as a treatment option to improve the quality of life for migraine patients.

TCA Prepares for 2019 Legislative Session

The TCA is preparing for the second session of the 111th TN General Assembly which experienced a major overhaul due to a high number of transitions in both the Senate and House this past year. While many relationships have been fostered through grassroots efforts of TCA and CAT members in 2019, TCA leadership have been taking a close look at how these factors may impact our legislative agenda. Powered by our members, the TCA and CAT have several big priority items on the agenda for

2020—including both proactive and defensive measures such as ongoing efforts to exhaust all avenues to address the negative impact of discriminatory practices by insurers on chiropractic physicians and their patients.

Furthering Opportunities in 2020 – Giving CTAs and CXTs a Voice! As part of our extensive advocacy efforts, one item which remains on our agenda is to propose a Practice Act caption (or place-holder) bill that, among its benefits, would offer an opportunity for an actively licensed CTA or CXT in good standing to be appointed to the TN Chiropractic Board of Examiners as a voice of their profession. We will need your help to make this endeavor successful. Watch your CA Scene for updates and calls to action!

SAVE THE DATE: CHIROPRACTIC Day on “the Hill” — Tuesday, March 3, 2020 Chiropractic Assistants are in a position to see first hand how laws and regulations directly impact not only the chiropractic office, but their patients as well. Your unique perspective is invaluable! Help us make sure chiropractic has a strong voice on “the Hill” by keeping the TCA informed of any legislative contacts you may have in your district and planning to participate in the 2020 Chiropractic Day on “the Hill”! Get involved for your profession! Mark your calendar now!

Billing and Coding News

Order Your 2020 Coding Resources and Save!

The TCA is participating in the ChiroCode Institute's Association Program to offer their resources at a discounted rate to our members AND support pro-chiropractic efforts. TCA members may order both the 2020 ChiroCode DeskBook, the 2020 ICD-10 Coding for Chiropractic and the 2020 HIPAA Compliance Guide at the member rate. Click here for more information on these resources and to download the TCA Order Form.

Medicare/Palmetto GBA Reminders and Updates

2020 Participation - Enrollment Period Now Open

Every year you have the opportunity to become a participating provider with Medicare. The open enrollment period begins November 14, and ends on December 31, 2019. A participating provider enters into an agreement to accept the Medicare-approved amount as full payment for services and supplies covered under Part B. A participating provider receives five percent more reimbursement than a non-participating provider. The participation agreement will automatically renew each year. However, if there is a name or EIN (tax identification number) change, you will need to complete a new participation agreement. Click here for more information.

Get paid! Use Medicare Beneficiary Identifiers (MBIs) now. CMS has released information stating that if you do not use MBIs on claims (with a few exceptions) after January 1, you will get:

• Electronic claims reject codes: Claims Status Category Code of A7 (acknowledgment rejected for invalid information), a Claims Status Code of 164 (entity’s contract/member number), and an Entity Code of IL (subscriber

• Paper claims notices: Claim Adjustment Reason Code (CARC) 16 “Claim/service lacks information or has submis-sion/billing error(s)” and Remittance Advice Remark Code (RARC) N382 “Missing/incomplete/invalid patient identifier”

See the MLN Matters Article for answers to your questions on using MBIs.

New Medicare Card: Claim Reject Codes After Jan 1

2020 Medicare Fee Schedule Posted Online

The 2020 CMS Physician Fee Schedule is now online through the Palmetto website palmettogba.com. The annual deductible for all Medicare Part B beneficiaries is $198 in 2020, an increase of $13 from the annual deductible of $185 in 2019. The format of the Medicare Fee Schedule established additional columns to display the limiting charge amount after applying the EHR and/or PQRS negative adjustment(s). This is due to the fact that Non-Par providers have the ability to choose either to accept or not accept assignment on Medicare claims on a case-by-case/claim-by-claim basis. When a Non-Par provider chooses not to accept assignment, they are required to abide by the appropriate limiting charge restriction.

CODE PAR Non-Par Limiting Charge

98940 $27.24 $25.88 $29.76

98941 $39.37 $37.40 $43.01

98942 $51.36 $48.79 $56.11

You may have heard about a pain management pilot program to waive out of pocket costs for the first three visits for consumers seeking musculoskeletal care for low back pain from an Optum® physical medicine provider. This program was piloted for UnitedHealthcare® large group members in selected states beginning July 1, 2019. In an email notice sent October 18, 2019, Optum announced that beginning January 1, 2020, this pilot will expand to include select small groups in the following states: Alabama; Arkansas (UnitedHealthcare of the River Valley); Florida; Georgia; Louisiana (UnitedHealthcare and UnitedHealthcare of the River Valley); Mississippi; North Carolina; South Carolina; Tennessee (UnitedHealthcare of the River Valley) and Virginia (UnitedHealthcare of the River Valley). Optum stated the intent of the pilot is to "encourage consumers with low back pain to seek conservative care from a physi-cal therapist or chiropractor first, as an alternative to injections, imaging, and opioids." Providers should have access to the newsletter on the Optum provider portal. The newsletter also stated that UnitedHealthcare will be contacting consumers and providers in the expansion states in the coming months.

Optum Pilot Expansion

An Association Group Health Plan - At Last! Spiraling health insurance costs represent an enormous challenge to the profitability of chiropractors. That’s why the TCA, in conjunction with Insurance Planning and Service Company, LLC (IPSCO), are pleased to offer the TDCBT group health plan as a benefit for TCA members and their employees– rates could be as much as 40% less than what you’re paying today! Highlights of what this exclusive Member benefit offers:

• Seven different plans with deductible options ranging from $500 to $5,000, including Health Savings Account (HSA) eligible plans.

• The plans utilize the MultiPlan PHCS Network. To view the provider directory, visit http://www.multiplan.com/search/search-2.cfm?originator=84451.

• Plans include full prescription coverage

• Medically underwritten health benefit plan

Don’t delay! Contact IPSCO for a quote at 1.800.347.1109

or go to: www.IPSCOAgency.com/TCA.

Hectic Schedule? One-Click Shareable Benefits to the Rescue!

Working as part of a chiropractic practice team means your schedule is always busy. Let TCA help! We have active accounts on Facebook, Twitter and Instagram with shareable posts and images! From research articles, to chiropractic memes, and information on topics like holiday stress or fun healthy snacks, we’ve got your back. Our 4th year of our Realign Your Thinking

® campaign saw

over 60 shareable chiropractic-related articles added to tnchiro.com and over 60 memes and infographics created for TCA members to share! How do you get started? Like and follow our pages! Then, find a TCA post to fit your needs and click “Share” to update your practice page. You can personalize it to your practice, while knowing the content is promoting chiropractic in a positive way. Plus, it’s quick and easy so you can get on with your day. Let the TCA’s one-click shareable benefits, like the TCA memes below, help you stay current on your socials and support your awareness efforts!

Connect with us online:

Outfit Your Team in “Powered by Chiropractic” gear

“Powered by Chiropractic” T-Shirts & Sweatshirts are available for purchase from the TCA!

Proceeds support the TCA Foundation for Chiropractic Research and Education

Popular at the 2019 Southern Chiropractic Conference, the TCA is now selling these comfy chiropractic threads in a variety

of sizes, sleeve-lengths and colors, including children's sizes. Contact TCA for details and order options.

Fun Way to Look Good & Promote Chiropractic in Your Practice and Community

Keep watching CA Scene for exciting announcements we have planned for 2020!

CAT member questions, comments or updates may be directed to tca@tnchiro.com or 615-383-6231.

This issue of the CA Scene is being sent as a member benefit. Thank you for your membership. To be removed from our email or fax list, please email tca@tnchiro.com with the subject “Opt Out from Email/Fax” or contact our office at (615) 383-6231.

CAT Calendar Get the latest event & registration information at https://www.tnchiro.com/events/

TCA West Seminar January 25-26, 2020 Memphis Marriott East (Memphis, TN) Sat., 8am-3pm CT—CTA 6 Hour CE Seminar (shared session with DCs) Sat., 3pm-5pm CT—CTA/CXT 2 Hour New Licensee Course

TCA Upper East Seminar February 22-23, 2020 Holiday Inn Johnson City (Johnson City, TN Sat., 8am-3pm ET—CTA 6 Hour CE Seminar Sat., 3pm-5pm ET—CTA/CXT 2 Hour New Licensee Course

TCA Spring Seminar April 4-5, 2020 Pigeon Forge, TN Available sessions will include: CTA 6 Hour CE, CXT 6 Hour CE & CTA/CXT 2 Hour New Licensee Course DATES ANNOUNCED! CXT Training Course—Spring 2020 March 14-15 & March 28-29, 2020 Nashville, TN

CAT Membership Annual Renewal

Watch for your 2020 CAT Membership Renewal reminder in the mail and respond quickly to ensure no interruption in your CAT benefits! Has your contact information changed

recently? Please follow up with the TCA office to update your information and ensure you receive timely updates in 2020!

SAVE THE DATE

August 20-23, 2020 Embassy Suites

Hotel & Conference Center

Murfreesboro, TN www.southernchiropracticconference.com

From supplies, equipment and x-ray to banking and website design, TCA Corporate Members help meet chiropractic practice needs across the state! Browse these great companies, and if they are your vendor, thank them for being members of the TCA!

In return for their support, TCA Corporate Members receive advertising and exhibiting benefits, including exhibit space at the Southern Chiropractic Conference.

View Your TCA Corporate Member directory online now!

Back Businesses that Back Chiropractic!

The HIPAA Security Rule (45 C.F.R. § 164.308 (a)(5)(ii)(B) requires that all software used by Covered Entities and Business Associates be kept current and up to date with updates from the software vendor. If a vendor no longer supports a software program, it cannot be used. On January 14, 2020, Microsoft will end all support for Windows 7 and Windows Server 2008/R2 post January 2020. Extended support for Windows 7 will end and no new updates will be available from Microsoft. Microsoft has been extending notifications to their users throughout 2019 with recommended actions; however, as a further support, here are some steps you can follow to migrate over to Microsoft Windows 10 and remain in HIPAA compliance. First, perform a thorough risk assessment of your practice to determine all computers that are running Windows 7. Assess whether your current computers will be able to handle Windows 10, and if not, research and purchase new computers. If your computers are able, upgrade to Windows 10. Properly dispose of old Windows 7 computers, as they will still have Pro-tected Health Information on them. The hard drives need to be wiped with a secure wipe method before you dispose of them. If you engage an outside service, make sure they provide you with a certification of destruction to add to your own HIPAA documentation. This will validate that you performed your due diligence to destroy the PHI that may have been on the old hard drives. HELPFUL HIPAA RESOURCE - A revised HIPAA Basics for Providers: Privacy, Security, and Breach Notification Rules Fact Sheet is available from the Centers for Medicare and Medicaid Services (CMS). This resource covers: Who must comply with HIPAA rules; Covered entities; and Enforcement. Click here to view this resource online.

Timely Windows 7 HIPAA Compliance Reminder