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Orange County Chiropractic District
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Memorandum to: ACA Members, ACA Board of Governors, ACA
House of Delegates and Other Interested Parties This week's report includes the following items: 1 McAndrews, Daly (ACA) VS TRIGON ROUND 4 2 VA LEGISLATION UPDATE 3 ONE MORE WORD ABOUT THE VETERANS ADMINISTRATION 4 CLAIMS SOLUTIONS WORK GROUP A BIG SUCCESS 5 ACA NEWS RELEASES CONTINUE TO GENERATE MAJOR INTERVIEWS 6 X-RAY ORDERING MEDICARE: DO YOU HAVE A PROBLEM? 7 FORMER CHAIRMAN DEBATES ICA PRESIDENT 8 PEDIATRIC COUNCIL 9 OUTCOMES ASSESSMENT 10CPT 2001 BLOWOUT SALE MCANDREWS, DALY (ACA) VS TRIGON ROUND 4 The federal Court in Abingdon Virginia has ruled on the recent ACA and Trigon motions concerning Trigon's failure to specifically answer ACA's allegations that Trigon and the national Blue Cross Blue Shield Association had conspired to wrongfully discriminate against chiropractors. The Court in noting that Trigon had issued a general denial but nevertheless failed to specifically respond to the allegations ordered that Trigon file an amended answer addressing the conspiracy allegations within 20 days. The Court also stated for the record that, "The plaintiffs have now made it clear that they do intend to pursue those [wrongful conspiracy] claims." This eliminates a possible approach that Trigon could later have used to maintain that documents relating to communications with the national group are not germane to the current litigation and therefore not subject to discovery by the plaintiffs. This was Mr. McAdrews primary concern in this exchange of pleadings. The Court also denied Trigon's request for sanctions against ACA and VCA attorneys and ACA's request for partial summary judgment on the conspiracy allegations. VA LEGISLATION UPDATE As of today, the issue of the chiropractic benefit in the VA bill is still in doubt. The House continues to support our general provisions, while Senator Rockefeller, a key player on the Senate side, continues to advocate for demonstration projects. Senate Majority, Leader Tom Daschle, continues to push Rockefeller on the issue supporting the compromise language that we are advocating. We urge you to contact your Senator and ask him/her to contact Senators Jay Rockefeller and Arlen Spector urging that they support the compromise language on the chiropractic provision being advocated by the House. If we are unsuccessful this year, we intend to bring this issue up next year. Since it has passed the House of Representatives, we can focus our attention on the Senate. ONE MORE WORD ABOUT THE VETERANS ADMINISTRATION Regardless of the outcome in the Senate, the one thing we can crow about is that we prevailed over the bureaucrats of the Department of Veterans Administration who attempted to keep the House from considering and passing a measure to expand chiropractic in the Veterans Administration health plan. This was no easy task, as the bureaucrats were politically savvy. Here's a little history: In 1999, we forced through legislation that required the department to establish a policy in implementing chiropractic into the VA. The legislation also included the provision that they had to get input from chiropractic groups in order to put this together. We felt pretty good about this provision and thought that the department would work with groups that were responsible for getting the legislation passed, i.e. ACA and ACC, as has been the practice in the past. In March of last year, the VA started the process. But as an early sign of their intentions, rather than inviting the major chiropractic groups, they invited nearly every chiropractic group that had the word "national" in its title. They had clearly done their homework, realizing that the more groups from the profession involved in the discussion, including the fringes, the more likely the results would be chaos. This would provide the VA with the argument to go back to Congress saying that they tried but the chiropractors can't get their act together. At first they were very successful, but once all the groups (except for the National Association of Chiropractic Medicine) came together and presented a unified front, the VA had to change tactics. The VA started to include osteopaths and physical therapists in the meeting. With the exception of NACM, the major chiropractic organizations boycotted these meetings as it was clear that the VA was going against the intent of Congress. It doesn't take a rocket scientist to figure out why NACM was such a player at these meetings. Despite the fact that they are considered by reasonable groups within the profession to be outsiders, they were given major visibility by the VA at the meetings. I under that after the first meeting, representatives of the VA referred to Dr. Charles DuVall as "Chuck" rather than doctor. Clearly a relationship had been developed. The question that comes to mind is, were the representatives of the NACM treated this way because they were players or pawns? I will let you make that determination. CLAIMS SOLUTIONS WORK GROUP A BIG SUCCESS Despite the fear of flying by some and the restrictions imposed on travel by others, representatives from eight major insurance carriers met with ACA representatives for a two-day meeting in October with a focus was on chiropractic education. Representing the industry were the following companies: AAA, BC/BS Federal, BC/BS SCarolina, Metropolitan, NAII, State Farm, WC Fund, Farm Bureau and AIG. Representing ACA were Drs. Krippendorf, Gentile and Spoto.and Pat Jackson. On Thursday, the group gathered at the National University of Health Sciences. Dr. Winterstein and his department chairs provided a tour of the campus and a five-hour program covering every aspect of chiropractic education. You might recall that I brought a HCFA medical director to National five years ago for a similar experience, and it opened his eyes to chiropractic education, and we had friend at the agency. The next day, the group went to the offices of the National Association of Independent Insurers, where they met in the chairman's boardroom. Dr. Spoto presented an excellent program discussing the various research documents and materials available about chiropractic that might be useful to claims adjusters. The group focused on 10 issues to expand upon. A subcommittee was formed including ACA and insurance to further develop the material. The plan is to develop a comprehensive binder that can be made available to claims adjusters throughout the country. In addition, NAII, the largest professional trade organization for casualty, representing over 700 insurance companies, suggested ACA officials present information about the important work CSWG is doing with their 150-member executive claims committee. Staff will follow up with NAII about the timing and details. ACA NEWS RELEASES CONTINUE TO GENERATE MAJOR INTERVIEWS As a direct result of three recent news releases, the ACA has enjoyed a string of interviews with high-profile publications. ACA's media relations staff has traditionally used informative news releases as a vehicle for securing such prominent interviews, ensuring that the chiropractic message is received by millions of people. In response to ACA's feature titled, "Get in Shape to Tackle Your Yard This Fall," prominent health periodical Self magazine called and interviewed Dr. Jerome McAndrews, ACA's national spokesperson. Next, the Detroit Free Press interviewed Dr. McAndrews after reading ACA's "Good Sleeping Habits Just as Important to Your Health as Good Nutrition." Finally, after ACA heralded the recent Veterans Affairs victory in its news story titled "ACA Hails Key House Committee Approval of New Chiropractic Benefit for Veterans," the New York Times and American Medical News each responded by interviewing Dr. McAndrews. ACA's media relations staff expects these interviews to develop into articles with the ACA as a leading source for information. X-RAY ORDERING MEDICARE: DO YOU HAVE A PROBLEM? The ACA continues to work with CMS (formerly HCFA) and its regional offices to ensure that chiropractic referrals for x-rays under Medicare are recognized. The ACA has received numerous reports from doctors that hospital radiology departments are refusing to recognize a referral from a doctor of chiropractic. Currently the ACA is working with CMS to ensure that the carrier in New Jersey is accepting chiropractic referrals for X-rays. According to CMS policy, a doctor of chiropractic can refer, not order, other services. The confusion arises when the doctor of chiropractic is listed as the referring doctor on Line 17 of the CMS-1500 form (formerly known as the HCFA 1500). Line 17 permits physicians submitting the claim to report either the ordering or the referring physician on the CMS 1500 form. Because of the current system, computer systems reviewing the claims unfortunately will automatically deny the claim because it cannot distinguish between ordering and referring. If a referral by a doctor of chiropractic is being denied by the carrier or radiology department, the doctor of chiropractic should contact the regional CMS office. ACA members are urged to contact Ingrid Lusis at the ACA office for further information including a copy of the letter from CMS that supports our position. FORMER CHAIRMAN DEBATES ICA PRESIDENT Last weekend, Dr. Mike Flynn flew to Cleveland College in Kansas City to participate in a discussion with Dr. D.D. Humber, president of the ICA. The discussion was chaired by Dr. Carl Cleveland and was attended by the entire student body of Cleveland College. You can guess who I would indicate was the winner, so if you get an opportunity, ask a student or faculty member from Cleveland for a more objective opinion. I think I can predict the response. PEDIATRIC COUNCIL If you have an interest in helping to form an ACA Pediatric Council, look to the November ACA Today for information and an application. OUTCOMES ASSESSMENT In today's managed care landscape, outcomes assessments are paramount to documentation of patient care. Outcome assessments quantify the patient's problem and demonstrate patient progress. "The Outcomes Assessment 2001 CD has given me back the time to be the doctor again, and not the statistician." - DrLinda Zange, ACA Governor, District 2. Order today: www.lighthousemarket.net/acastore/product.asp?dept%5Fid=2&pf%5Fid=8 ACA members can order the Outcomes Assessment CD and the Clinical Application of Outcomes Assessment book and take 10% off. For details, call 1-800-368-3083. CPT 2001 BLOWOUT SALE Get the reimbursement you deserve. Order ACA's Official Coding Solutions 2002 by Dec 15, 2001 and get ACA's Coding Solutions 2001 for only $11.95 to start your desktop coding solutions series. That's more than 65% off! Both the 2001 and 2002 booklets will be delivered directly to your office in January 2002. Accept no substitutes - ACA's Official Coding Solutions books are the only coding references on the market approved by ACA's Coding and Reimbursement team of experts, including two doctors who participate in the American Medical Association CPT committee process. For more information and to reserve your copies now, call 1-800-368-3083. |
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