Below is great news! For any Money Tree PT & OT providers you no longer need to report the G codes in the billing database. Starting January 1st please stop adding the G codes as charges in your system.
The ONLY time you NEED to still add these codes is if you are doing MIPS reporting. Below is the guidelines for MIPS but most of our Money Tree Providers are NOT required to report for MIPS due to the low volume threshold indicated below. IF you think you may still fall under MIPS and need to report for MIPS, please contact us to discuss this in further detail.
Beginning in January 2019, functional reporting will no longer be required for reimbursement by Medicare. PTs, OTs, and SLPs will not be required to report HCPCS codes G8978-G8999 or G9158-G9186. Also, severity modifiers CH through CN will not be required. The codes are still going to be valid for a little while to allow providers and insurers time to update their billing systems and policies (and thus, avoid claim rejections due to inadvertent non-payable code submission).
If you want, you can continue to report the codes, they just aren’t required for payment. It should be noted that even though they aren’t required for payment, they may be used by MIPS-eligible PTs, OTs, and SLPs for MIPS quality reporting in 2019.

Low Volume Threshold & MIPS Participation

Low volume thresholds for MIPS participation were also revised. Beginning in 2019, if one of the following statements holds true for a MIPS-eligible clinician or group, they will not be required to participate in MIPS:
  • The provider or group did not charge more than $90,000 for covered professional services.
  • The provider or group treated 200 or fewer Part B-enrolled individuals.
  • The provider or group provided 200 or fewer professional services to Part B-enrolled individuals.
Even if you are not required to participate, you can choose to either opt-in to MIPS or voluntarily report. Clinicians and groups have the opportunity to opt in to MIPS if they only meet one or two of the three low-volume thresholds listed above. If you meet all three, then you may NOT opt in but you could still participate voluntarily and obtain feedback about your reporting. Those who voluntarily report quality data will experience no MIPS payment adjustments. Those who decide to opt in for 2019 will experience payment adjustments (positive, neutral or negative) in the 2021 payment year.
In order to opt in or voluntarily report, you MUST log into the Quality Payment Program portal and select the applicable option.

The Minnesota Court of Appeals case, Western National v. Nguyen, held that all medical providers who DO NOT submit bills electronically to the “responsible” insurance vendors within six-months will be barred from recovering payment from ANYONE, pursuant to Minn. Stat. 62Q.75.  Based on this, the case denied payment of a large No-Fault arbitration award because the medical provider had not electronically billed a No-Fault company following the denial of benefits.


MN Doc’s, what does this mean for you?


First, remember that in Minnesota you are required to bill all claims electronically if the provider has the means to receive electronic claims.  This holds true for all insurance, including auto and work comp carriers.


Secondly, once No-Fault denies, many providers will hold claims until arbitration or decide to discontinue billing No-Fault and bill the private insurance as primary instead.  This means you need to stop, or you run the risk of not getting paid on any services provided after the No-Fault denies.


Once the No-Fault denies, you must continue to bill the No-Fault as primary until the case has settled, or the patient has reached MMI (Maximum Medical Improvement) status.  As the No-Fault denies payment on each claim, you should then bill the patient’s personal insurance as secondary.


You should also bill their private insurance, even if there is a large deductible and/or a provider reduction, as this protects you and the patient from the effects of this case.  In many states, if you are an in-network provider for their private insurance, this is an obligation not an option.


Lastly, this statute also defines a six-month timely filing limit.  Meaning, not only do you need to continue to bill to the No-Fault carrier, you also need to follow-up and make sure the claims are on file and responded to within 6 months of the treatment date.


Unfortunately, as a Minnesota Chiropractor, this means the extra step of billing two insurances and the possibility of additional paperwork, however, this is the only way to ensure your best chances of getting paid for the services you have provided.


Note:  Money Tree Clients, this has always been our recommendation and we have sent out a couple of blasts previously discussing this topic and showing exactly how to set it up in your software.  Please email if you would like another copy.

As our billing processes continue to become more and more electronic in nature, insurance carriers and provider portals are looking for ways to consolidate and/or link information to streamline and simplify processes for all of us.  Availity is the provider website (portal) for several insurance carriers, varying by location. Because Federal regulations now require payers to verify provider directory information every 90-days, Availity has updated their portal so that providers can update their information using pre-populated forms containing most of your current information on file.  Once you correct any errors and verify that all your information is correct, Availity will update all participating payers they are linked to for you. They also allow you the option to download your verified information to use in order to notify other payers of your current information.


To take advantage of this option, you will need to log into your Availity account.  Every 90-days you will see a notification alert reminding you to please review, update & verify your information.


More information can be found on the Availity website here.