ACA PDR Bi-Monthly Report

[Guest guest]

Your ACA at work for you.

E Beeson DC DABCI

The Office of Professional Development and Research Bi-monthly Publication

December 16, 1999

The following is a bi-monthly report aimed at keeping you informed of the

works in progress at the American Chiropractic Association (ACA). For more

information on any of the pieces mentioned in this report, please call me at

any time.

Burroughs

Assistant Director Managed Care

American Chiropractic Association

email: bburroughs@...

Phone: 703-276-8800 X211

PDR'S YEAR IN PERSPECTIVE

The Department of Professional Development and Research restructured in

February to place more emphasis on getting doctors paid. Within a few short

months, close to sixty insurers have contacted the department to correct

reimbursement policy and to improve communications with doctors of

chiropractic.

Talks have taken place with some of the largest national insurers in the

country along with many local and regional carriers. Insurers are

responding favorably as was evidenced by their turn out at ACA's historical

Claims Solutions Work Group meeting in November (please see next article).

If you are facing claim reimbursement problems, let your state and national

association know. We want to help!

HISTORIC MEETING SETS TONE FOR COOPERATION AND CLAIM PROCESSING IMPROVEMENTS

Participants at the ACA's first ever Claims Solution Workshop held in

November gave the conference high ratings, indicating their excitement for a

brighter future between our respective professions. On a scale of 1-5,

participants rated the overall conference 4.83.

Insurers were direct and open about existing hurdles and made

problem-solving recommendations. Not surprising, some of their interests

were the same ones chiropractors express on a regular basis, but from a

different perspective. They include:

* Proper Documentation

* Medical Review Protocols

* Fraud and Abuse Avoidance

Ongoing meetings of this nature will be considered for the future, and as

Drs. Krippendorf and Gentile said in their wrap up, " we've only just begun

and have reason to believe from the professional interactions at this

seminar, that direct positive results will come to all. "

ACA GETS COMMITMENT FROM MEDICAL GUIDELINE VENDOR TO MAKE IMPROVEMENTS

, Vice President of Professional Development and Research

attended a Milliman & on Users' Conference in Arizona from December

1-3, at the request of the Ohio State Chiropractic Association.

Milliman & on offers a " Medical Management, Care Planning, " suite of

software products to managed care organizations. The product having the

most direct impact on doctors of chiropractic is " Volume 7 Workers

Compensation, " which includes a " Return to Work Component. "

Ms. addressed the following while at the meeting:

1. Member concerns with guideline limitations and evaluation of

source documentation behind the guidelines.

2. Determine M/R's interest in partnering with ACA to customize

guidelines to more accurately reflect chiropractic treatment practices.

Ms. was able to meet with high-level officials of Milliman &

on who agreed that it was important to work with the ACA to continue

to improve the guidelines.

Ms. is optimistic that ACA will have the ability to make a positive

impact on Milliman & on guidelines as a longer-term solution.

MEDICARE INFORMATION SOUGHT

The Office of Professional Development and Research, together with the ACA's

Medicare Committee, would like to know of any situations where Medicare

billing difficulties exist. We have been following trends throughout the

country where denials based on " medical necessity " are being received after

one or two visits. The Medicare Committee would like to evaluate these

situations to be in a better position to provide assistance in these

instances. Please call 800-986-4636 for assistance. You can also fax any

examples you have. Please include the bill, office notes for that date, and

the Explanation of Medicare Benefits. Be sure to blot out any

patient-specific information, such as name and identification number to

protect patient confidentiality.

INSURANCE SOLUTIONS FOR DOCTORS, STUDENTS AND CAs

The solutions you need to move you and your practice ahead in the new

millennium will be discussed during an NCLC seminar on March 4, 2000.

Staff from the ACA's Office of Professional Development and Research field

insurance questions every day. Doctors and staff face daily challenges with

coding, reimbursement, Medicare and other issues. ACA will conduct an

" Insurance Solutions " seminar to address some of the more common insurance

issues throughout the country. The seminar content will be valuable for the

insurance novice as well as the expert. Topics on the agenda include:

* General insurance knowledge, PI, worker's comp, and Medicare

* Proper use of forms

* General coding information

* Medicare utilization guideline information, including

P.A.R.T.

* Insurance follow-up techniques

* Verification of insurance

* Pre-authorizations and referrals

McClelland, chiropractic assistant and clinic manager, and Kathy

Mills, assistant director for insurance at the ACA, are presenters for the

program. Together, they have 35 years of combined chiropractic insurance

experience. McClelland has served as a CA instructor and in-office trainer

in Virginia for many years. She currently serves as the editor of the ACA

publication, CA Chronicles, and provides advice to the ACA on a variety of

issues. Mills has been a chiropractic assistant, office manager and practice

manager for various doctors of chiropractic since 1983. She has developed

and presented CA training seminars for two state associations and provided

in-office training for doctors and CAs for 10 years.

Managed care, CPT and P.A.R.T. resources will be available at the seminar at

discounted rates. For more information or to register, call ACA at

800/986-4636.

ASSISTANT DIRECTOR OF MANAGED CARE ATTENDS InterQual Criteria Products

Seminar

Assistant Director of Managed Care Burroughs, attended a seminar

hosted by InterQual in Washington DC in November.

InterQual has been a key player in the health care industry in the

development of utilization management resources for the last twenty years.

InterQual claims that its 'Clinical Decision Support Criteria' " are

essential tools that assist healthcare organizations in balancing cost and

quality across the continuum of care " . Several case studies were presented

to demonstrate the utility features of InterQual's

Intensity/Severity/Discharge Criteria (ISD) for acute, sub-acute,

rehabilitation and home care, a decision support tool for clinical

management.

Chiropractic was added to InterQual's product line this summer. Its

'Indications for Rehabilitation and Chiropractic Care' (IRC), reviews

appropriateness of care modalities for physical therapy, occupational

therapy and chiropractic.

ACA plans to pursue dialog with InterQual by January to address its sources

of data on chiropractic used in its software and to discuss ways in which

the ACA can help InterQual update its database with current information on

chiropractic.

QVS/CAGA MEETING

A meeting was held recently with the Credential Assurance Group of America

(CAGA) to discuss the Quality Verification System (QVS) credentialing

program. CAGA administers the QVS program on ACA's behalf.

QVS is designed to facilitate the individual chiropractor's participation as

a Managed Care Network panel provider with health plans and carriers. QVS

is a credentials information verification system and clearinghouse for the

information health plans need in order to contract with doctors of

chiropractic. QVS aids in simplifying the administrative burden on

professional health care practioners by allowing a single credentials

application which will be verified from the appropriate primary sources.

CAGA recently relocated to new offices and is in the process of upgrading

its operations. This will allow it to adequately handle increased capacity

and improve its overall response times.

Look for additional information in ACA Today on QVS and how the program can

help you!

SEASON'S GREETINGS TO EVERYONE!!!

[Guest guest]

FYI

E Beeson DC DABCI

The Office of Professional Development and Research Bi-monthly Publication

January 21, 2000

The following is a bi-monthly update from ACA's Department of Professional

Development and Research (PDR), aimed at keeping you informed of the works

in progress at the American Chiropractic Association (ACA). For more

information on any of the pieces mentioned in this report, please call me at

any time.

Burroughs

Assistant Director for Managed Care

American Chiropractic Association

email: bburroughs@...

Phone: 703-276-8800 X211

ACA MEETS WITH AAHCC/URAC

Assistant Director of Managed Care, Burroughs and Vice President of

Professional Development and Research, Pat , recently met with the

American Accreditation Health Care Commission/URAC at URAC's office in

Washington DC.

The purpose of the meeting was to discuss the process around managed care

accreditation oversight and formal investigations, share ACA's goals on

credentialing with URAC and to establish a working relationship with URAC

that would provide opportunities for ACA leadership to promote the

chiropractic profession for direct access into managed care plans.

Representing URAC were Vice President of Accreditation Ms. Lori

-s and CVO/Accreditation manager Ms. Lesley Manus. URAC's

President and CEO Carneal and Vice President of Business Development

Taney Hill met briefly with the ACA representatives.

The meeting was hailed a success, as ACA was able to develop a better

understanding of the accreditation and credentialing process and both URAC

and ACA agreed to maintain a working relationship. Discussions are taking

place on each association's president addressing the other's board and ACA

was invited to participate on a new URAC committee on improving claims

review.

PDR KEEPS CHANNELS OF COMMUNICATION WITH INSURERS OPEN

PDR continues to communicate with insurers via the telephone and in writing

to correct inappropriate reimbursement policies toward chiropractic and to

provide information requested by insurers.

The following are some of the issues PDR has recently discussed with

insurers:

1) State Farm Insurance has contacted the ACA to work on a joint research

project. A meeting is scheduled to take place on January 27, 2000.

2) The National Blue Cross/Blue Shield organization asked the ACA to review

guidelines developed for low back pain before they were implemented. Dr.

Gentile, Chairman of the Insurance and Managed Care committee, reviewed

the guidelines and corresponded with their Medical Director.

3) The ACA contacted Aetna/US Healthcare about the exclusion of

chiropractic information in their low back pain guidelines. Our

intervention prompted the insurer to rewrite their guidelines, which now

include spinal manipulation. Communication and recovery continues with

their medical and chiropractic directors on other issues (Medigap, codes,

etc).

PRESTIGIOUS UK UNIVERSITY REQUEST INFORMATION ON SPINAL MANIPULATION

PDR recently received a request for information on spinal

manipulation/adjustment from Professor E. Ernst of the Department of

Complementary Medicine School of Postgraduate Medicine and Health Sciences

of the University of Exeter in the United Kingdom.

Professor Ernst was sent a copy of ACA's recently published Spinal

Manipulation Policy Statement which demonstrates low risk and high quality

for this procedure when done by an expertly trained and experienced doctor

of chiropractic.

ACA evaluates DHHS Regulations

The Department of Professional Development and Research, along with

Government Relations and ACA's Legal Department, is currently examining

draft standards on Culturally and Linguistically Appropriate Health Care and

Privacy Standards issued by the Department of Health and Human Services.

The CLAS (culturally and linguistically appropriate health services)

proposed standards seek to address the demographic changes in the US to

ensure equal access to quality health care by the diverse population base.

The standards include access to bilingual staff or interpretation services,

ongoing education/training of staff in CLAS services, signage and

educational material in the predominant language group and distribution of

annual reports on the organization's performance in implementing CLAS.

ACA is also reviewing proposed Privacy standards from the Department of

Health and Human Services. These proposed standards are expected to

establish policies that protect the privacy and confidentiality of health

records particularly on the Internet. The new rules seek to address the

lack of uniform laws and regulation pertaining to the widespread use of

information technology in the transmission of data to and from providers,

insurers and other third parties

ACA expects to comment on the implications of these proposed standards on

doctors of chiropractic.

UPDATE ON HCFA X-RAY REQUIREMENTS

Earlier this fall, ACA obtained a written policy from HCFA about an upcoming

change in x-ray requirements. This statement implicitly states, " You are

correct as to the current policy that x-rays must be taken within one year

prior to, or 3 months after, the initiation of chiropractic treatment. As

the x-ray requirement is not required after January 1, 2000, it will not be

necessary for a patient beginning treatment in November to provide an x-ray

to document subluxation. " High-level officials at HCFA, who have long been

associated with ACA in Lewin Studies, PART Documentation and other

pro-chiropractic initiatives, developed this policy.

ACA let members know about this change in early November. Some state

Medicare carriers refused to acknowledge the transition x-ray policy that

prompted the ACA to meet with HCFA on December 10, 1999. HCFA reaffirmed

their policy with no reservations. Unfortunately, just prior to the

Christmas holidays we learned HCFA is withdrawing this policy on x-rays for

the last 3 months of the year. We are working with HCFA on a remedy for

doctors of chiropractic, who in good faith, relied on HCFA's policy and did

not perform an x-ray during the last three months of 1999.

ACA is very disappointed with this turn of events. We are talking with HCFA

on a daily basis to determine the exact nature of this withdrawal and to

promote a protective remedy. Our efforts are now focused on making sure

doctors of chiropractic will not be financially harmed with the forthcoming

HCFA remedy. We expect to have a final outcome to share with you very soon.

Watch the ACA website at www.amerchiro.org for updates.

Insurance Solutions for Doctors, Students and CAs

Just a reminder! The solutions you need to move you and your practice ahead

in the new millennium will be discussed during an NCLC seminar on March 4.

Doctors and staff face daily challenges with coding, reimbursement, Medicare

and other issues so ACA will conduct an " Insurance Solutions " seminar to

address some of the more common insurance issues throughout the country.

Topics that will be covered include:

* General insurance knowledge, like general health insurance,

PI, worker's comp, and Medicare

* Proper use of forms

* General coding information

* Medicare utilization guideline information, including

P.A.R.T.

* Insurance follow-up techniques

* Verification of insurance

* Pre-authorizations and referrals

Managed care, CPT and P.A.R.T. resources will be available at the seminar

at discounted rates. For more information or to register, call ACA at

800/986-4636.

ACA TO PARTICIPATE IN NMHCC IN ATLANTA

For the third consecutive year, ACA will be participating in the annual

National Managed Health Care Conference (NMHCC), to be held in Atlanta

Georgia at the Georgia World Congress Center from April 16-19. The NMHCC is

the world's largest managed health care exhibition and features an extensive

array of products, programs and services from over 500 industry leaders in

the health care industry.

ACA hopes to advertise the benefits of chiropractic to the over 18,000

conference attendees, and will distribute valuable information on

chiropractic to managed care organizers, lay persons and the media.

We are inviting you to pass by our booth, particularly our members in

Georgia!

More information on the conference can be obtained from NMHCC or through its

website at www.nmhcc.org.

STATE ASSOCIATION ACTIVITY

Twenty-seven states have requested assistance from ACA's Office of

Professional Development and Research on a total of 70 different projects

since May of 1999. These projects range from providing information to

states on insurance policy language to providing intervention with insurance

adjusters and executives.

PDR will continue in its efforts to assist state associations on national

insurance issues that affect members on a national basis.

BRISK SALES FOR CPT 2000 MANUAL

The CPT 2000 manuals are hot off the press and already, orders are

proceeding briskly with well over one thousand orders being placed even

before the printing process was completed.

The CPT 2000 contains valuable information on coding and is vital to every

DC's practice. This year's book provides user-friendly solutions to

problems, not just data and is a valuable resource not only for DCs but

Chiropractic Assistants as well. This edition, the latest in a series of

annual CPT references from the ACA, is expanded to include more

comprehensive coding and modifier sections, a separate Medicare section,

relative value units and geographic practice cost indices, and important

updates since the release of CPT '99.

Call ACA on 1 800 368-3083 to place your order.