ACN, ASHP and Landmark Receive Most Complaints in ACA Managed Care Data Collection Campaign

ACA Asks Doctors Nationwide for More Data into Problems Affecting Patient Care and Reimbursement (Arlington, Va) The American Chiropractic Association (ACA), as part of its ongoing aggressive campaign to correct the wrongful practices of certain chiropractic managed care networks, is asking doctors of chiropractic nationwide to provide additional information that will assist in putting an end to these practices. Among the wrongful practices that the ACA is gathering information about are the following: • Automatic downcoding or limiting physician discretion in the planning of care: The doctor submits the network's forms after examining the patient and is advised of the frequency, duration and type of care that will be covered. Requested treatment is often reduced or denied. Claims are downcoded without the doctor of chiropractic being provided the opportunity to provide any documentation supporting the claim as submitted. • Bundling: The submitted CPT code is incorporated into another submitted CPT code. • Improper utilization review including refusal to recognize coding modifiers: Managed care organizations sometimes refuse to recognize "modifiers" that chiropractors append to CPT codes to report a service or procedure that has been performed and which has been altered by some specific circumstance. • Performance management issues: Managed care networks often disregard the doctor's discretion to diagnose and treat, and limit the number of visits, x-rays and modalities. Doctors say they are reprimanded and threatened with the loss of their contract when the care they prescribe is outside the managed care organization's set standards. "For too long, there has been a misguided perception within the profession that ACA somehow condones the unfair practices of certain chiropractic networks," explained ACA President Donald Krippendorf, DC. "In reality, the ACA strongly denounces these practices and needs your support and information to put an end to what we view as unconscionable activity by these groups." The latest campaign to correct these harmful practices is an outgrowth of a resolution passed by the ACA House of Delegates in March 2002 formally outlining ACA's opposition to the improper practices of chiropractic networks and authorizing ACA staff to collect data identifying the types of abuses doctors of chiropractic experience at the hands of third-party administrators. As part of this effort, ACA recently retained the services of Milberg Weiss, one of the nation's largest class action law firms, to assist in the collection and analysis of this information. Over the past three years, hundreds of doctors of chiropractic have contacted ACA and completed "managed care data collection" forms detailing their troubling experiences with chiropractic networks - and the names of several specific organizations and trends have emerged. According to the data collected by ACA, doctors of chiropractic are most troubled by the actions of American Chiropractic Network (ACN), American Specialty Health Plans (ASHP) and Landmark Healthcare. These carriers routinely deny requested treatment and improperly reduce and deny reimbursement, putting patients and quality of care at risk, according to doctors who contacted ACA. ACA's data collection efforts have uncovered an array of serious concerns with these carriers, but more information is needed regarding particular problem areas. "We have heard your complaints, and we are further analyzing our options to deal with these activities," added Dr. Krippendorf. "We need your continued support and information to protect not only your practice and profession, but also the quality of care you provide your patients." In addition to canvassing the chiropractic profession for more data into specific problem areas, the ACA is also contacting certain chiropractic networks and demanding that they cease the misleading use of ACA's name and trademark in their communications and treatment forms. In a May 13, 2005, letter to ASHP President George DeVries, ACA Executive Vice President Garrett F. Cuneo demands that ASHP remove the "unauthorized and misleading reference and use of the ACA name" in the company's "Clinical Treatment Form." "Please be advised that the ACA views this unauthorized use of its name in connection with the misleading representation contained in your form as defamatory, a violation of its trademark and a continuing unfair trade practice that has resulted and continues to result in damage to the association," Cuneo wrote. The full letter can be found on ACA's Web site at: letter to American Specialty Health (ASHP). The ACA is requesting that doctors of chiropractic who have experienced problems with ACN, ASHP, and Landmark in the areas of restriction of treatment, downcoding, bundling and improper use of modifiers fill out the data collection form found on ACA's website at: CARE DATA COLLECTION FORM. Please fax the completed form to (703) 243-2593, Attention: PDR Department. Your information will be kept in strict confidence and your name will not be released to any managed care network. You will also find additional information and resources regarding ACA's data collection campaign and what you can do to assist in this effort on ACA's Web site at: Are You Having Problems with Chiropractic Networks and Managed Care Organizations? For more information: Felicity Feather Clancy Vice President, Communications [email protected] phone: (703) 276-8800, ext. 241 or Angela Kargus Communications and Public Relations Manager [email protected] phone: (703) 276-8800. ext 240