10/23/2017

REMINDER: eviCore Implementation Delayed

Reminder: eviCore Implementation Delayed Until At Least July 1, 2018

Representatives of the MAC Legal Affairs Committee, including Executive Director Kristine Dowell and MAC attorney Greg Nowakowski, recently met with Blue Cross to continue our discussions on a number of outstanding reimbursement and coverage issues. Included among them was the implementation of Blue Cross’ upcoming contract with eviCore to provide utilization management for chiropractors, which we have been monitoring closely. As a result of our efforts, Blue Cross has now delayed the implementation date until JULY 1, 2018.

We are waiting on the Blues to provide answers to the comprehensive set of questions we submitted earlier this year.

We will continue our strong efforts to ensure that any utilization process that Blue Cross ultimately adopts will be in the best interest of our members and their patients, and we have not ruled out any tool at our disposal to ensure this is the case.

Blue Cross Policy Regarding Delegation of Massage has been Clarified in TheRecord

As you well know, in August 2015, the MAC entered into a lawsuit settlement with Blue Cross and Blue Care Network. Coverage of medically necessary massage was included as a newly covered service in the settlement agreement. Several months after the settlement was reached, the MAC was made aware of a Blue Cross “payment policy” that states that massage may only be provided by MDs, DOs, PTs, and DCs, and may NOT be delegated to someone educated and trained to provide it.

As soon as we became aware of this payment policy, our legal team began an investigation with Blue Cross to determine if the policy was discriminatory, or violated any laws. While our discussions were taking place, we were told that audits for delegating massage would not be undertaken.

Shortly after our lawyers determined the policy did not violate the settlement or other laws, our talks ended. Blue Cross then confirmed the policy in the September 2017 Record: “No provider type can supervise therapeutic massage (procedure code 97124) or delegate therapeutic massage to any individual not eligible to perform therapeutic massage.”

As a result, only an MD, DO, PT, or DC will be eligible for reimbursement for this service.

It’s important to remember, this policy does not apply to MESSA, or to some other plans that are administered by Blue Cross. Doctors are advised to have their staff check on patient coverage to be sure what is allowed under the different policies.

If you have any questions about this policy, or have been contacted by Blue Cross regarding it, please contact Kristine Dowell at the MAC at (517) 367-2225 or info@chiromi.com.