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March 26, 2006

ACA House of Delegates

To all New Mexico Chiropractors

The ACA-HOD met in Washington today to discuss issues of vital importance to the profession and to your patients. The most pressing issue is S-1955 known as the Health Insurance Marketplace Modernization and Affordability Act. This is the alternative plan to allow associations of business and commerce to purchase fully insured health care plans that are exempt from state insurance coverage mandates. This is a crisis issue for chiropractic benefits because we all know what benefits would dropped out.

What can the doctor in the field do to demonstrate our opposition to this legislation? Call or e-mail the offices of Senator Domenici (202-224-6621, fax 202-228-3261, domenici.senate.gov) and Senator Bingaman (202-224-5521, fax 202-224-2852, Bingaman.senate.gov) and express your opposition. The points that we feel are germane to the issue include that this legislation will allow the development of insurance plans that are exempt from state coverage mandates, result in insurance that is unaffordable due to “risk selection”, the proliferation of health plans that do not cover basic and preventive services, the loss of protection from unfair claims and handling practices, significant increases of patient out of pocket costs, and that the legislation will seriously fragment the insurance market by creating one tier of younger healthier subscribers and another for all the other people that will be far more costly and fail to reduce the population of uninsured citizens that exists today.

We suggest that each doctor call and fax their opposition to each of the Senators, even though we know that Bingaman is strongly opposed to the legislation. I would recommend that the calls faxes and E-mails to Bingaman stress our appreciation for his opposition and his attempts in committee to amend the legislation to make it friendlier to the public.

We also suggest that the doctors ask, beg, and plead with patients to call Domenici’s office to express their opposition with a simple script that says “I oppose S-1955 because it allows the insurance plans to preempt state enacted consumer protections. This may cause a great deal of harm to my family and myself and may increase insurance premiums to the point that we cannot afford the same coverage that we have now”. Print this out along with the Senator’s phone # and have them call from their home. Have them hand write the statement on a blank sheet of paper including their name, address and home phone # and fax it from your office.

The next most important issue we addressed was the OIG report that concluded that an error rate of 94% existed in chiropractic claims for Medicare services (not specifically the Demonstration Project) and that the claims lacked at least 1 required item from the current Medicare rules and regulations. Examples of the items that were most often missing from the doctors documentation of treatment included: patient history, history of the recent trauma or injury, presence of absence of conditions that presented absolute or relative contraindications to spinal manipulation, acknowledgement of the discussion of treatment options, a current treatment plan, incorrectly coded procedures, goals of the current treatment plan, methods of assessing the patient’s response to care, establishment of subluxation by PART methods, the patient’s response to care and the actual reduction or correction of the subluxation by the doctor. 6% of the errors involved the lack of any documentation at all.

The findings in the OIG report make us an obvious and reasonable target for attack including the elimination of our participation in Medicare. All of the Congressional offices were aware of the report and the poor showing that the profession made. The documentation that we record in our treatment notes must improve and the task force created by the ACA, ACC, COCSA and FCLB has acted rapidly to address the issue of poor documentation throughout the profession. There will be classes developed and educators trained to teach those classes to doctors in the field quantifying what Medicare documentation is required and how it can be expressed within your notes. The college clinic directors and clinical instructors will also be trained to provide the same information and methodology to the students. The FCLB will be asked to encourage the examining boards to make these classes mandatory for re-licensure. A four hour class can be easily carved out from the 16 hours of yearly CME’s that you are now required to obtain, but the class will have to be taught by an accredited instructor trained by the coalition approved training program.

Our friends in Congress are acutely aware of the OIG report and the profession suffered a great embarrassment when our government relations personnel were called to task to explain how the profession was going to address the problem. The ACA, as a member of the coalition developed the documentation manual and will be proactive in demonstrating significant improvement by the next OIG evaluation and report. Doctors in the field must realize that the failure to document according to the requirements in the Medicare regulations is a serious deficiency in our professional responsibilities. Some of the things that the OIG report listed as errors were probably not true errors. Such as the doctor whose notes indicated that the patient had a knee problem and that the knee was adjusted but a spinal adjustment was billed to Medicare. I would consider that fraud but the OIG people, thankfully, listed that as an error in billing. The same goes for the doctor who performed massage but billed for spinal manipulation. If we do not improve our documentation it may adversely affect the great job we are doing in the Demonstration Project and can totally negate any benefit that we demonstrate in our cost effectiveness and great rates of patient satisfaction. We must improve documentation and you can expect that the next NMBCE rules hearing will address mandating documentation as a specific portion of your continuing education requirements.

The ACA web site (www.acatoday.com) has a check list that enumerates all of the Medicare requirements for proper and complete documentation of care. I urge all DC’s to access that site and see what are the specific documentation elements required by Medicare for a claim to be error free and fully payable.

The ACA has a coding manual that includes Medicare requirements and they are currently offering the Documentation guidelines at cost ($39). I encourage everyone to at least purchase these two references and use them to be proactive in correcting our short comings. All of us have these problems (Me Too) and all of us can improve.

Other issues addressed during the week and associated with the NCLC includes enhancing the unimpeded access to chiropractic services in the VA and DOD programs which should include chiropractic access at all military treatment facilities at home and abroad. Encouraging the Surgeon General in writing to commission chiropractors into the Uniformed Commissioned Corps of the Public Health Service. This would allow DC’s to serve and provide treatment at public health clinics and participate in the National Health Service Corp tuition repayment program. Generating support for the passage of HR 999 which provides access and coverage for chiropractic services with in Tricare which covers all military retirees and military dependants.

It was a pleasure to have Dr. Connie Moore (T or C) present at the conference. She is going to take on the task of Carrier Advisory Committee representative and will soon be an expert at Medicare rules and submission. She was in attendance at all the meetings and workshops during the week and helped me keep abreast of the issues completely.

The week included meeting with students from the SACA which now includes membership in excess of 50% of all the students in chiropractic colleges in North America. There were chiropractic students present and representing every chiropractic college in the US and Canada at the legislative conference. The doctors from New Mexico should all consider attending this conference next year. It is exciting, there are CME’s available and you will have an opportunity to interact with doctors and students that have helped shape the laws and policies that affect our profession.

Lastly, I hope that each of you that are not currently an ACA member will demonstrate your support for the work and time it takes to defend and protect our rights and legislation that affects us by joining the ACA on the EZ Pay plan at $50 per month. New Mexico has 68 ACA members and I think that 100 members is a reasonable goal and expectation. Please do not look away or depend on the “other” doctor to represent you. I need you and the profession needs you. I think that the income from the demonstration project far offsets the $50 monthly dues, so show me that you really do appreciate the work involved and give me acknowledgement for the work by joining the ACA. I’ll have EZ Pay membership forms at the NMCA convention.

Bill Doggett, D.C.
NM-ACA

 

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