Filtered by category: Insurance News Clear Filter

ACA's Investigation of ASHN Reveals Scope of Problems


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ACA, COCSA, OtherPlaintiffs Defeat UnitedHealthcare's Motion to Dismiss Class Action Lawsuit

Profession Can Now Pursue Alleged ERISA Violations   

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HHS Bulletin Outlines Plan for Implementing Essential Health Benefits in Health Law

Opportunities Look Bright for the Chiropractic Profession
The U.S. Department of Health and Human Services (HHS) today released a bulletin outlining proposed policies that will give states more flexibility and freedom to implement certain provisions of the Patient Protection and Affordable Care Act (PPACA). 
The HHS proposal describes "an inclusive, affordable and flexible proposal and informs stakeholders about the approach that HHS intends to pursue in rulemaking to define essential health benefits. HHS is releasing this intended approach to give consumers, states, employers and issuers timely information as they work toward establishing Exchanges and making decisions for 2014." This approach was developed with significant input from the public, including ACA's comments provided during the Institute of Medicine hearings, as well as reports from the Department of Labor, and research conducted by HHS. Today's HHS proposal offers for public comment four alternative "benchmark plans" for flexible choice by the states in designing how to meet the new health care reform essential health benefit (EHB) requirements.
Although the American Chiropractic Association's (ACA) leadership has just begun to analyze the HHS proposal, its first impression is positive for the chiropractic profession. "Overall, this is one of the best outcomes we could achieve," said Keith Overland, DC, president of ACA. "Given that virtually every state has chiropractic services or some sort of insurance equality included among their existing insurance plans; this HHS proposal released today appears to be very good news."
ACA understood in 2010 that the health care reform legislation was not likely to include chiropractic services as a named essential benefit. Therefore, its strategy has been to ensure that DCs are able to provide their services under the categories of EHBs included in plans offered through the health exchanges. "We will continue to make our position crystal clear at the highest levels of HHS-that language considered at the federal and state level relative to essential benefits must include the services provided by doctors of chiropractic. Anything less would be a disservice to the millions of Americans that benefit from chiropractic care on a daily basis," said Dr. Overland.
ACA and its Chiropractic Summit partners will examine the HHS proposal and, in partnership with the state associations, work to advocate that state governments  choose benchmark plans that include chiropractic services among the EHBs.
As projected by ACA, the HHS bulletin allows for public comment before Jan. 31, 2012. It is also expected that HHS will revert to the standard regulatory process on this issue next year, where further opportunity to comment will be available before a final rule is issued.

The American Chiropractic Association (ACA), based in Arlington, Va., is the largest professional association in the United States representing doctors of chiropractic. ACA promotes the highest standards of patient care and ethics, and supports research that contributes to the health and well-being of millions of chiropractic patients. Visit

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Congress Passes Bill Delaying Medicare Cut


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New ABN form required as of Jan'12

Medicare has released a revised version of the ABN. They previously indicated that mandatory use of this version would begin on Nov. 1, 2011. Medicare has now delayed the implementation date to Jan. 1, 2012. All ABNs with the release date of March, 2008, that are issued on or after January 1, 2012 will be considered invalid.

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Daily News - New workers' compensation rules jeopardizing insurance for thousands of workers and retirees


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CBO: 30% Medicare Physician Pay Cut in 2012

According to a Congressional Budget Office (CBO) report released this week, Medicare payments to physicians will be reduced by 29.4% on Jan. 1. 2012, unless Congress takes action. 

The reduction is the result of several years of legislative action intended to either maintain or increase Medicare physician payments as those rates were scheduled to decrease according to Medicare’s Sustainable Growth Rate (SGR), a mechanism used to determine reimbursement rates.

There is general consensus that the SGR needs to be amended. Determining how best to change the formula has been the topic of numerous congressional hearings this year.  CBO's new report provides input into the costs of proposals to replace or amend the Medicare fee schedule formula. CBO reports that if Congress were to eliminate the SGR and freeze Medicare payments to physicians at current rates, the cost to the federal government would be almost $298 billion over 10 years. By contrast, providing a 2% pay increase each year until 2021 would cost $389 billion over 10 years. One of the less expensive options would be to reset the SGR by having Congress forgive all previous spending above the cumulative targets as of the end of 2010.  That solution would cost $195 billion over 10 years.

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House Votes to Rescind 1099 Provision

The Senate and now the House of Representatives has voted 314-112 to repeal a provision in the healthcare reform law that requires all businesses, including chiropractic practices to submit a 1099 form each time they spend $600 or more. The measure now goes to President Obama for his signature.

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Legislation to Expand Patient Access to Chiropractic Care Introduced in the U.S. House of Representatives

The American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC) today announced that their work with key congressional supporters has resulted in two important pieces of pro-chiropractic legislation being introduced in the U.S. House of Representatives. These bills, if enacted into law, would increase patient access to vital health care—which includes chiropractic care—and benefit chiropractic physicians and students. 

One of the legislative initiatives, the Access to Frontline Health Care Act (H.R. 531), would establish a new program that would help chiropractic physicians and other select health care providers repay their student loans if, in exchange, the providers establish and maintain practices in medically underserved areas. The legislation, introduced Feb. 8 in the U.S. House of Representatives by Rep. Bruce Braley (D-Iowa) would designate certain types of health care providers as “frontline” providers. ACA and ACC worked closely with the sponsor of the bill to ensure that chiropractic physicians are specified in the bill as qualifying for this status.

“Many regions of our nation, particularly the rural parts of America, simply do not have sufficient numbers of qualified health care professionals to meet the needs of the local population,” said ACA President Rick McMichael, DC. “This legislation would provide vital health care to underserved patients across the country, and it would also help newly graduated chiropractic physicians establish practices and repay their student loans.”

The second piece of legislation, the Chiropractic Membership in the Public Health Service Commissioned Corps Act of 2011 (H.R. 664), introduced by Rep. Gene Green (D-Texas) on Feb. 11, would also benefit the public and the profession by requiring the inclusion of chiropractic physicians in the U.S. Public Health Service (USPHS) Commissioned Corps.

The Commissioned Corps is an elite team of more than 6,000 well-trained, highly qualified public health professionals dedicated to delivering the nation’s public health promotion and disease prevention programs and advancing public health science. Officers in the Corps provide health care services in a variety of locations and venues, including care to members of the U.S. Coast Guard and at community health centers. 

"Both of these pieces of legislation are critical to the integration of chiropractic care in every federal health care program,” said Frank J. Nicchi, DC, president of the Association of Chiropractic Colleges. "Chiropractic students and alumni will benefit immensely from the opportunity to provide care to citizens in medically underserved areas and to participate in the Commissioned Corps. We applaud Reps. Braley and Green for their leadership and support for the inclusion of chiropractic care in these important national health care initiatives.” 

The introduction of both pieces of legislation fairly early in the First Session of the current 112th Congress was intentional by ACA, ACC and the bill’s supporters. “Early introduction allows for the time necessary to build critical momentum for these pro-chiropractic initiatives,” said John Falardeau, ACA’s vice president of government relations. “Having that momentum increases the likelihood of these bills successfully advancing through the legislative process.”

To view the full text of HR 531, click

To see the full text of HR 664, click

ACA and ACC request that chiropractic physicians
contact their congressional representatives and urge them to cosponsor both of these bills.

The American Chiropractic Association (ACA), based in Arlington, Va., is the largest professional association in the United States representing doctors of chiropractic. ACA promotes the highest standards of patient care and ethics, and supports research that contributes to the health and well-being of millions of chiropractic patients. Visit

The Association of Chiropractic Colleges represents accredited chiropractic colleges in North America and seeks to advance chiropractic education, research and service.

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Congress Moves to Expand Chiropractic Services to Veterans and Military Beneficiaries

(Arlington, Va.) -- The American Chiropractic Association (ACA) and the Association of Chiropractic Colleges (ACC) today expressed support for newly introduced legislation in the U.S. House of Representatives designed to expand the availability of the services delivered by chiropractic physicians in the federal Department of Veterans Affairs (VA) and to those who utilize the military’s health care delivery system, TRICARE, run by the Department of Defense (DoD).

Ranking member of the House Veterans Affairs Committee, Rep. Bob Filner (D-Calif.), has again introduced the Chiropractic Care to All Veterans Act (H.R. 329), a bill similar to legislation that was overwhelmingly passed by the entire House in 2010 but was not considered in the Senate. H.R. 329 would require the VA to have a chiropractic physician on staff at all major VA medical facilities by 2014. It would also amend the current statute, the Department of Veterans Affairs Health Care Programs Enhancement Act of 2001, ensuring that chiropractic benefits are included in the U.S. Code of Federal Regulations and therefore, cannot be denied.

“Our nation’s veterans and active-duty military, along with their family members, have sacrificed so much for our country. They deserve the best health care available, and that includes chiropractic care,” said ACA President Rick McMichael, DC. “It makes me proud to see the chiropractic profession working with our congressional allies in support of this important legislation.”

Through previous congressional action, chiropractic care is now available at 36 VA facilities across the country; however, in the more than 100 major VA medical facilities without a chiropractic physician on staff, the chiropractic care benefit Congress authorized for America’s veterans remains virtually nonexistent. Detroit, Denver, and Chicago are a few of the major metropolitan areas still without a chiropractic physician at the local VA medical facility.

The ACA and ACC believe that integrating chiropractic care into the VA health care system would not only be cost-effective, it would also speed the recovery of many of the veterans returning from current operations overseas.  A 2010 report from the Veterans Health Administration indicates that over half of all veterans returning from the Middle East and Southwest Asia who have sought VA health care were treated for symptoms associated with musculoskeletal ailments – the top complaint of those tracked for the report.

In addition, Rep. Mike Rogers (R-Ala.) has re-introduced another piece of legislation in the House that would extend chiropractic care to U.S. military retirees, dependents and survivors as part of the TRICARE program. H.R. 409, the Chiropractic Health Parity for Military Beneficiaries Act, would require the Secretary of Defense to develop a plan to allow any beneficiary covered under TRICARE to select and have direct access to a chiropractic physician. The plan deadline is Aug. 31, 2011. Currently, only active duty members are afforded the chiropractic benefit.
“I am pleased that Congress has taken these two important steps that, when taken together, facilitate access by our veterans, active military and their families to fundamental health care benefits such as chiropractic care,” said ACC President Dr. Frank Nicchi, “Chiropractic continues to enjoy high levels of satisfaction among our servicemen and women.”

H.R. 409 defines “chiropractic services” as diagnosis (including X-ray and tests), evaluation and management, and therapeutic services for the treatment of neuromusculoskeletal health conditions. The legislation specifically notes that chiropractic services may only be provided by a chiropractic physician. Rep. Rogers introduced nearly identical legislation in the past two sessions of Congress.
To view the full text of H.R. 329, click

To see the full text of H.R. 409, click

ACA and ACC request that chiropractic physicians
contacttheir congressional representatives and urge them to cosponsor both of these bills.

The American Chiropractic Association (ACA), based in Arlington, Va., is the largest professional association in the United States representing doctors of chiropractic. ACA promotes the highest standards of patient care and ethics, and supports research that contributes to the health and well-being of millions of chiropractic patients. Visit

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Palladian Audit Extension


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President Signs Sustainable Growth Rate (SGR) Fix Bill

President Obama signed into law legislation that delays for one year the scheduled 25% cut in Medicare payment to doctors.

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NYSCA IN ACTION...Membership Update

Medicare - Some good news for a change:

The Red Flags Rule requires creditors and certain businesses to develop and implement written identity theft prevention programs to help identify, detect and respond to patterns, practices or specific activities that could indicate identity theft.  The applicability of the rule to health care providers has been debated over the past several months.  On Tuesday, November 30, 2010, the Senate passed legislation (S3987) that clarifies the definition of a creditor and in effect would exempt health care providers from the Red Flags Rule.  On December 7, 2010, the House of Representatives passed S3987 and sent the bill to President Obama.  The President is expected to sign the bill before the Red Flags Rule goes into effect on January 1, 2011.

Thanks to the efforts of the ACA along with other healthcare provider groups whose efforts were instrumental in removing this additional administrative burden for doctors of chiropractic and other health care providers.

And more good news for a change:

The Senate has passed a $15 billion bill that would block the impending 25% cut in the Medicare payment rate to physicians and instead keeps rates steady through 2011. The cut was scheduled to take effect on January 1, 2011. It is likely that the House would pass the bill – it would by the fifth and longest extension of Medicare physican payment rates enacted this year and puts us back in the “yearly extension cycle” that we have all become familiar with. Unfortunately, the bill does not fix the sustainable growth rate (SGR) problem and doctors would be subject to a cut of more than 25% for treating Medicare patients in 2012 unless Congress figures out a long term solution in the meantime.

Update on NYS Workers Compensation fee schedule:

As you know, 97140 was not included in the chiropractic fee schedule. Carriers will be notified that the 97139 code (unlisted therapeutic procedures) will be used instead with the descriptor being the procedure that was performed.  This code usually requires a report for the service, but that will not be necessary. The 97940 omission will be addressed in the future.

Effective December 1, 2010 the “new” C4 family of forms must be used. The exception is in the physician shortage are in Rochester where the forms go into effect Jan 1, 2011. These are the 4 page new patient C4 and the 2 page C4.2. The forms can be found on the NYS WCB website (click on the link below):

And a reminder: Any condition that is resultant from a work related injury is compensable by workers compensation insurance. Under no circumstances, can the doctor charge the patient for any treatment related to a workers compensation injury (even if a variance is denied).

The New York State Chiropractic Association is committed to the advancement of the chiropractic profession in New York State. Our officers, directors, delegates and district officers are working diligently on your behalf to protect your right to practice and to provide the highest quality services to the patients we serve.

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U.S. Department of Health & Human Services Granted a Total of 733 Waivers to the New Federal Health Reform Law.

Many plans have limits on how much can be paid out in coverage, limits which would be phased out under the new health reform law.

The feds though have granted waivers from that law, amid worry that certain Unions and Big Companies
would drop their health insurance programs entirely. Those waivers are good for one year, and can be considered for renewal.

The list of the 222 733 Unions and Big Companies
waivers are available by clicking on the link below.


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Congress Passes Medicare Payment Bill and Legislation Exempting DCs from Onerous Red Flags Rule

Both measures expected to receive quick White House approval

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Medicare Signature Requirements for Patient Records

Medicare requires that services provided to a patient are authenticated in the patient health record. Hand written or electronic signatures are acceptable. A handwritten signature is a mark or sign by an individual on a document to signify knowledge, approval, acceptance or obligation. Signature must comply with the following:

Stamp signatures are not acceptable.
You must be familiar with your Local Coverage Determination (LCD) policy on authenticating records as these policies will take precedence over the guidelines below.
If, in the course of a patient health record review, a signature is found to be illegible, Medicare contractors will look for a signature log or attestation statement to determine the identity of the provider.
A signature log includes a list of the typed or printed name(s) of the author(s) of the associated initials or illegible signature(s).
The signature log can be included on the page where the initials or signature are present, or may be in a separate document.
Although a reviewer may encourage providers to list their credentials in the signature log, a claim should be not denied if the log is missing a provider’s credentials.
All signature logs should be considered regardless of the date the log was created.

Attesting to a Signature’s Validity

Providers can include an attestation statement in the documentation they submit. Only the author of the medical record can attest to the record in question.

Attestations will be accepted by reviewers regardless of the date of the attestation, except in those cases where the regulations or policy indicate that a signature must be in place prior to a given event or a given date. For example, if a policy states the physician must sign the plan of care before therapy begins, an attestation can be used to clarify the identity associated with an illegible signature but cannot be used to “backdate” the plan of care.

CMS recommends that, rather than backdating a patient health record, providers should use the signature authentication process explained below. In some situations, a provider may be contacted by a contractor and asked to submit an attestation statement or signature log. Providers will have 20 calendar days from the date of the contractor’s call, or the date that the request letter is received by the post office, to provide the information. To be valid for Medicare medical review purposes, the attestation statement must be signed and dated and contain sufficient information to identify the beneficiary. An example is included below:

“I, _____[print full name of the physician/practitioner]___, hereby attest that the medical record entry for _____[date of service]___ accurately reflects signatures/notations that I made in my capacity as _____[insert provider credentials, e.g., DC]___ when I treated/diagnosed the above listed Medicare beneficiary. I do hearby attest that this information is true, accurate and complete to the best of my knowledge and I understand that any falsification, omission, or concealment of material fact may subject me to administrative, civil, or criminal liability.”

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Medicare Audit Alert

The current requests for audits by Medicare are not an unusual review.  In New York, there is currently a special services pre payment audit request for 98941 services as of October, 2010 and for 98942 services as of November 2009. Also, Medicare does ongoing CERT reviews on Chiropractic claims in which they will review records for proper documentation to support the claim and diagnosis that has been billed.
With the prepayment audit review, they seem to be sending a request letter for each patient and they are only asking for 3 months of records. A special services CERT request letter is usually 3-4 pages long, and they may ask for multiple patients or multiple dates of service, listed in chart form and they usually request 6 months of previous records.
According to Dr. Ritch Miller, ACA Medicare Committee chairman, you should and must comply. If for some reason you speak with anyone from the carrier/contractor, log the persons name, ID #, station number or whatever and write word for word what you are told. Normally we recommend not speaking with the contractor. KEEP TRACK OF EVERYTHING, and make 2 copies of everything you send to them.
Doctors are encouraged to review the Local Coverage Determination (LCD) for Chiropractic Services (L27350). LCDs can be accessed from the Medical Policy Center on the web site; enter keyword L27350 in the Medical Policy Center search form field to access the Chiropractic Services policy. There is a detailed description on what you documentation should include for the initial visit and subsequent visits.
We also suggest before you start working on the audit, go to the ACA Medicare Webpage and read the links on audits/appeals. You and your staff should take the free 2 hour ACA Medicare documentation webinar. Then, we recommend that you read everything else on the webpage. You need to know everything you can about Medicare, now. So even if you think you know everything there is to know about Medicare, you need to read everything once again. In particular, some of the things (but not all) they are looking for include the diagnosis with a subluxation to correlate with the service code that is billed (98940, 98941, 98942). There should be a treatment plan for the condition. You should note the level of the subluxation adjusted. A PART exam should be done on the onset date of the condition treated with subsequent periodic re-exams and function assessments. Finally, every visit should be signed in full by the provider of the service.  If you have not signed your notes attaché an attestation page with the visits. This can be found at key word signature.
Other suggestions from Dr. Miller include the following. With regard to what documentation to send, we recommend you send everything in from the BOX 14 (CMS 1500) date on, even if it is a month or two longer than the 3 months, if that date is less than the 3 months then we suggest you send in 3 months documentation if the patient was treated at that time. Make sure you send all supporting documentation even if it is several years old, like the patients original intake forms if that has historical information on it, if this information is found in no other place in the records.
Many doctors’ first react with anger and frustration when they start to get these audits. That is not helpful and in past cases has made things a whole lot worse. Be as pleasant as you can be with anyone you speak with. 
Only send in patient records, do not send in any explanatory letters or anything that is not an "official" patient record, since it can be used against you and since it is not official it cannot be used in your favor.
If you get denied on any of the claim(s), you we recommend that you consider an appeal, if the documentation supports the service billed, even if you are asked to return only $20. It is a temptation to not go further, but that may be seen as admission of guilt and they more than likely will continue with future audits.
Hopefully this won't turn into the battle that many other states are going through across the country, but you must prepare for the worst and expect the best. There are doctors across the country, (and again hopefully you are not one of them), that have been carrying on this battle for over two years. So you must take this very, very seriously.
The ACA is working on this with CMS and hopefully we can turn this around. Unfortunately, with the executive branch and administration's increased and well publicized focus on fraud and abuse, don't plan on that.
If you have any questions, please first go to the ACA webpage and see if you can find the answer there. If not please contact Dr. Lupinacci or Dr. Penna. If you have any questions specific to this notice, please feel free to contact either of us also.
Dr. Louis Lupinacci, DC
NY Medicare Chiropractic CAC Rep
Dr. Mariangel Penna, DC
NY Alternate Medicare CAC Rep

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Workers’ Compensation Program

WC changes are here as of Dec 1, 2010. Learn how to treat your patients and get paid under the new system.

Chiropractic Services have been Unbundled!

Learn how to correctly bill modalities and avoid costly mistakes.

The forms, the treatment, get the information you need now by clicking on the link below!

Workers’ Compensation Program

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House Passes One-Month Extension Patch

The House of Representatives has passed legislation temporarily stoping the 23% cut in physician payments under Medicare scheduled to take effect on Dec. 1. The same measure has already passed the Senate.

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Major Change in the Manner Medical Care is Provided to Injured Workers


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