Memorandum
To: ACA Members, House of Delegates, Board of
Governors and Other Interested Parties
From: Garrett Cuneo
Re: ACA EVP Weekly Report
Date: January 5, 2004
Happy New Year! The following is a list of items included in this week's report:
1. LMRPs CAN MEAN HEADACHES UNDER MEDICARE
2. SPECIAL CONFERENCE SCHEDULED FOR CAC REPRESENTATIVES AT NCLC
3. NCLAF SUPPORTERS: SEE YOU AT PARKER
4. WELLNESS YEAR-END REPORT
5. CHIROPRACTIC MANAGED CARE INDEX - ISSUE #4: TERMS FOR DOCTORS OF CHIROPRACTIC - INSURANCE, MANAGED CARE, CLAIMS PROCESSING
6. HUNDREDS OF RADIO STATIONS NATIONWIDE AIR SPINAL HEALTH MONTH AUDIO NEWS RELEASE
7. THE MEDICARE BILL CONTAINED OTHER BENEFICIAL PROVISIONS
8. NEW ACE LIST SERVE NOW LIVE!
9. CAN’T ACCESS THESE LINKS?
1. LMRPs CAN MEAN HEADACHES UNDER MEDICARE
Did you realize that a slight deviation in the local medical review policy (LMRP) can mean headaches and LOST dollars to our doctors in Medicare? By CMS regulations, LMRPs are not to be in conflict with CMS National Policy on chiropractic. Yet, as Ms. Susan McClelland pointed out to a number of state associations and their Chiropractic Advisory Committee (CAC) representatives in December during a conference call, many of their local policies were in conflict in substantive ways. For example, the National Policy requires that for care to be covered "some improvement" must be shown in the patient. One LMRP, however, used the _expression "significant improvement." Another indicated "Significant Long Term Improvement." Needless to say, the doctors in these states had a stricter standard to meet than the national standard.
This conference call was the second in a series that we have held with state assoc! iations and their CAC representatives. It brought home to me not only the important role that a CAC representative can play in assuring that chiropractic doctors are properly reimbursed under Medicare, but also the importance of knowing what your LMRPs state. The following state associations participated: Kentucky, Pennsylvania, South Carolina, New York, Puerto Rico, Alabama and Nebraska.
The next CAC call is scheduled for January 22nd at 1:00 pm Eastern. On that call we will focus on the LMRPs for the following carriers: Administar Federal, Inc; BlueCross BlueShield of Montana; BlueCross BlueShield of Rhode Island; Empire Medicare Services; First Coast Service Options, Inc; Group Health Inc. (GHI Medicare); HealthNow of Upstate New York; Medicare Northwest; National Heritage Insurance Company; and Wisconsin Physician Services. Those CAC representatives who were unable to attend the last two calls will also have an opportunity! to hear a review of their individual LMRPs if time permits.
The role of the CAC representative in each state has grown in importance. His/her action (or inaction) can influence the implementation of Medicare policies by local carriers. We will be putting on a program at NCLC for CAC representatives reviewing the LMRP and -- equally important - will be discussing ways to alter those policies that need to be changed. It would be a good investment for each state association to send its CAC representative to the meeting.
2. SPECIAL CONFERENCE SCHEDULED FOR CAC REPRESENTATIVES AT NCLC
The ACA Medicare Committee has scheduled a special CAC conference in conjunction with NCLC. The meeting is scheduled for Friday, March 5th beginning at 8:00 am. State associations are urged to support their representatives in attendance at this meeting. The meeting will cover the importance and the duties of a CAC representative, and how ACA can be of assistance. It will include a presentation by Ms. Susan McClelland regarding Local Medical Review Policies, how they compare to the National Policies -- and most important -- suggestions on how to make local policies more consistent with national policies. In the afternoon there will be a panel discussion on how to hold the local carriers’ feet to the fire. Representatives from CMS will also be invited to participate in the conference. Contact Mary Brown at the ACA office (800-986-4636;
mbrown@amerchiro.org to register or to obtain a more detailed agenda.
3. NCLAF SUPPORTERS: SEE YOU AT PARKER
If you are a monthly contributor to the National Chiropractic Legal Action Fund (NCLAF), I encourage you join us at the Parker Seminar in Las Vegas, January 15 to 17. Your board of governors, along with a number of NCLAF volunteers, will be operating three NCLAF booths and promoting the lawsuits at the opportunities Dr. Mancini Fabrizio Mancini has provided. Look for Lt. Col. Mark Losack, DC, at one of the NCLAF booths. He will be there in uniform signing autographs and taking pictures. As a NCLAF monthly contributor you will be given a copy of a photo of Dr. Losack adjusting a soldier in front of one of Saddam's palaces in Iraq. You can also have a picture taken with Dr. Losack. Additionally, you will be given a NCLAF contributor ribbon that will proclaim your support for the lawsuits. We also hope to recognize you when we ad! dress the attendees during the Thursday evening and Saturday events.
We look forward to seeing you at Parker. If you need more information regarding the excellent speakers at the Parker program, please visit:
http://www.parkerseminars.com/seminar/seminardetail.asp?locationid=29
4. WELLNESS YEAR-END REPORT
The ACA Wellness Committee has grown wings in the year of 2003. The committee began by completing a survey of students and chief academic officers at all of the accredited chiropractic colleges regarding wellness education. The results of this survey are being used in many facets of the campaign, most notably to suggest where changes might be considered within the curriculum. Additionally, the committee held two face-to-face meetings earlier this year and set up its implementation plan. Since that time, the committee has established two subcommittees to tackle two very different and impo! rtant aspects of this campaign. To learn more about these subcommittees and the work they are doing, please click on the following link:
http://www.acatoday.com/insurance/initiatives
5. CHIROPRACTIC MANAGED CARE INDEX - ISSUE #4: TERMS FOR DOCTORS OF CHIROPRACTIC - INSURANCE, MANAGED CARE, CLAIMS PROCESSING
The ACA is pleased to announce the fourth issue in a series of education articles designed to inform doctors of chiropractic on insurance and managed care issues. Chiropractic Managed Care Index (CMCI) focuses on issues faced by new graduates, including network evaluation and provider agreement review, but includes information for experienced DCs as well.
CMCI, developed under the direction of the ACA's Insurance and Managed Care Committee, is distributed six times per year, and is available to ACA members only via the ACA Web site. The fourth issue -- Terms for Doctors of Chiropractic -- is available at:
http://www.acatoday.com/membersonly/frameset.cfm?
FIND=insurance/mc_index/terms_for_dcs.pdf
Should you have any comments on CMCI, please forward these to David Page! - Manager, Insurance and Managed Care, at:
dpage@amerchiro.org.
6. HUNDREDS OF RADIO STATIONS NATIONWIDE AIR SPINAL HEALTH MONTH AUDIO NEWS RELEASE
More than 550 radio stations across the country aired ACA's Spinal Health Month audio news release this past October - according to a final report we recently received from the firm that produced the release for us. From stations in top markets like WHLI-AM in New York and KMPC-AM in Los Angeles to small stations like WYNU-FM in Jackson, TN -- an estimated 1.4 million listeners tuned in to hear the one-minute newscast. The audio news release featured ACA President Dr. Donald Krippendorf promoting the results of a study in the medical journal Spine showing that spinal manipulation offers better short-term relief of chronic back pain than medication. The piece also encouraged listeners to visit ACA's Web site to find an ACA member doctor-like you-in their community. To hear ACA's Spinal Health Month audio news release, click here:
http://www.acatoday.com/media/releases/spinal_health_month_release.mp3
7. THE MEDICARE BILL CONTAINED OTHER BENEFICIAL PROVISIONS
The recently signed Medicare Bill, which included the chiropractic demonstration project, contained other provisions that were beneficial to the profession. In previous reports I indicated that all health care practitioners would face a 4.5% decrease unless legislative remedies were by passed Congress. The ACA worked with the AMA and other health care organizations in persuading the Congress to include a provision that--instead of a 4.5% decrease--would guarantee a 1.5% increase. Additionally, there are provisions that require the carriers to be more responsive to providers and patients, as well as the introduction of Health Savings Accounts under Medicare. We will be doing a more detailed analysis. Look to this report for further information.
One rumor that has been floa! ting around the profession is that there was a strong movement within Congress to remove the CPT system from Medicare. We watched this bill very closely, and that option was never given any serious consideration.
8.NEW ACA LIST SERVE NOW LIVE!
Do you have a topic on the "business of chiropractic" you would like to discuss with other ACA members? ACABizDoc, the new practice management list serve, is now LIVE and open for participation from both experienced and new practitioners. This latest ACA member benefit is YOUR free electronic chiropractic networking forum, and will include a special section on the ACA website dedicated to the business of chiropractic later this month.
Use ACABizDoc to participate in conversations among other ACA members looking for answers to questions on insurance reimbursement, regulatory issues such as HIPPA and ERISA, and more. Find out what has worked for others or share what you have learned on successfully managing the small but important details of everyday chiropractic business and specific practice management challenges. You MUST formally register for the ACABizDoc list serve in order to participate on it. Sign up to! day and post your topic at
http://ww3.chirolists.com/mailman/listinfo/acabizdoc.
9. CAN'T ACCESS THESE LINKS?
Some of you have been unable to download my PDF links. To view these file types,
you need Adobe's Acrobat Reader. This is a free utility available at www.adobe.com. If you need further assistance
viewing anything referred to in this report, please e-mail me at gcuneo@amerchiro.org.
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