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EVP Update

ACA Position on CCGPP Low Back Pain Draft
The ACA Board of Governors has viewed with dismay the recent exchange of attacks and counterattacks surrounding the Low Back Pain draft and those who have commented on it. Many unkind, unnecessary and questionable statements have been made, on both sides, and the attention given to these salvos threatens to distract the profession from the substantive matter at hand -- the creation of a representative and accurate report of effective treatments for low back pain.

Like many associations, ACA formed a committee to review the Low Back Pain draft, and we encouraged our members to read the document and offer their own opinions to the CCGPP. Upon its approval by our Executive Committee, we sent our response directly to CCGPP on June 28. When asked, we have shared it with other individuals and associations. However, we chose not to disseminate our statement widely, so as to allow members of the profession the opportunity to draw their own conclusions without ACA’s undue influence. This desire may have been naïve, and it certainly has been overtaken by the tenor of the current debate. For this reason, we are publicly sharing our review committee’s report and our public statement.

The most important point to take from our position statement is that this draft is still a work in progress. It is the first draft of the first chapter of a seven chapter document. Taken in this context, one can see that while the precedents set by this draft will determine the processes followed in the future, it is important to note that the CCGPP panel is still determining the most effective way to communicate its findings to the profession. There will be a learning curve, and constructive criticism can help move the panel along this curve.

ACA’s statement points out that the document lacked sufficient input from doctors in the field, and offers a number of recommendations to encourage more participation. Furthermore, we agree with many who have expressed concern about the transparency of the review, revision and consensus-building processes to be followed from this point forward.

We note that CCGPP has recently added text to its Web site describing the review process; this text is a good first step but in our opinion does not provide sufficient detail. We call on CCGPP to provide more information and to open the lines of communication that have been damaged by the exchanges of the past two weeks.

It is to be expected that a process with as much potential impact on individual doctors and the profession as a whole would generate strong feelings; had the process been met with apathy, it would have signified almost certain failure. However, for decades we’ve been told that a lack of research and documentation has been a root cause of our struggles with third party payers. Now that CCGPP has begun to assemble that documentation, we should allow the review and comment period, and subsequent revisions, to proceed so a fair and accurate document can be created. Calls for withdrawal of the draft at this time will undermine the review process.

ACA and ANJC Combat Inequitable Reimbursement
ACA has been working closely with the Association of New Jersey Chiropractors (ANJC) to oppose Horizon Blue Cross Blue Shield’s unfair reimbursement policies. This case was first filed with the New Jersey Department of Banking and Insurance (“DOBI”) in March 2004, and was referred to the New Jersey Office of Administrative Law for determination of fact. A hearing was held last month; ACA/ANJC were represented by Dr. Craig Little and Dr. Frank Stiso and by our legal counsel Tom Daly, who worked closely with ANJC counsel Jeffrey Randolph.

By all accounts, ACA’s and ANJC’s witnesses did an outstanding job of supporting our position, describing examples of Horizon paying other providers for services denied to DCs and of explaining the details aspects of CMT codes which are at the heart of this case. During the preliminary questions for his testimony, Dr. Little was asked if he was being paid for his testimony; he indicated that he was not but he had hoped to be reimbursed for his travel costs. This caused Horizon’s lawyer to offer to “personally pay for your expenses to return to California, if you leave right now.”

Because of the nature of administrative hearings, ACA and ANJC were able to introduce into evidence a number of documents which would not have been admissible in a different setting. At this time, we await the judge’s decision, and are hopeful that a positive decision in this case will set a precedent and have a cascading effect in other states and with other managed care organizations.

We anticipate a ruling on this matter in late October, and will keep you apprised of the outcome, as well as any interim developments.

Sports Nirvana
September may be the best sports month of the year -- baseball’s pennant races are heating up, the football season has just started, golf and NASCAR are both going strong, and basketball season is just weeks away. The only thing that could make this better would be a brand new HDTV to watch it all on.

The ACA-PAC is raffling a beautiful 42” Panasonic Plasma HDTV to one lucky individual. The drawing will be held on Sept. 9, during the House of Delegates meeting in Scottsdale. Not going to Scottsdale? No problem; you can buy your tickets online.

Please be sure to scroll down to the PAC Report from Andrew Dentamaro, which has all the details, and the link for online purchases.

Humana Agrees to Proposed Settlement with Chiropractors, Non-MD Providers for $3.5 Million
(Arlington, Va. - Aug. 16, 2006) Humana has agreed to a class action settlement resolving claims on behalf of chiropractors and other health care providers in Solomon v. Anthem, et. al., pending before Judge Frederico Moreno of the U.S. District Court for the Southern District of Florida. The ACA participated, through its counsel, in the settlement discussions and is a signatory to the proposed class action settlement agreement. If approved by the Court, Humana will pay $3.5 million to fund payments to class member chiropractors and other health care providers as well as fees and costs advanced by class counsel.

Plaintiffs in the Solomon action recently filed a motion seeking to add the ACA as a named plaintiff in the Solomon case and requesting that ACN Group, Inc. and United Healthcare Services, Inc. be added as defendants. The case against ACN, United Healthcare Services and all remaining defendants is still pending.

In addition to the cash fund described above, terms of the proposed settlement agreement with Humana include:

*Changes in Humana’s business practices, intended to make its claims editing process more transparent and reduce confusion and disagreement over payments.

*Online information provided by Humana to help providers understand its payment decisions.

*More options for chiropractors and other health care providers to challenge Humana payment decisions in the future, if necessary.

*Independent external reviews to resolve billing disputes.

*The appointment of an ACA representative to a newly formed Humana health care provider advisory committee, which will provide a means of direct communication on issues and concerns.

“We are extremely pleased that Humana has agreed to compensate chiropractors and other non-MD providers for claims that were previously and wrongly denied,” commented ACA President Richard Brassard, DC. “More importantly, however, we are heartened that Humana has committed to improving its business practices in the future and are hopeful that other networks and insurance companies will follow suit. Doing so can only benefit the nation’s health care consumers, who also deserve fair treatment and reimbursement.”

As part of the settlement, doctors of chiropractic will be permitted to assign their portion of the recovery to the ACA, if they wish to do so.

For a copy of the settlement agreement, click here. Once the Court approves the settlement, ACA will provide more details on how individual DCs can recover damages. For more information on ACA's managed care initiatives, visit ACA’s Chiropractic Networks Action Center.

Kevin Corcoran, Executive Vice President
kcorcoran@acatoday.org

Government Relations
LAST CALL! Citizens' Health Care Working Group Needs To Hear From You
As featured in previous installments of the EVP Report and ACA News, The Citizens’ Health Care Working Group, created by legislation in the 2003 Medicare Modernization Act, is charged with engaging Americans across the country in a discussion on health care services, financing, and trade-offs, before making final recommendations to the President and Congress.

The Working Group has heard from more than 25,000 people around the country, including many doctors of chiropractic and chiropractic patients, before formulating an interim set of recommendations for how to improve health care in the United States. The ACA will soon submit comments on how chiropractic is integral to the health care delivery system in this country. In addition, the Working Group wants individual comments as they continue to refine these recommendations before sending them to the President and Congress.

The opportunity to comment ends Aug. 31. Please follow the links below to read the Working Group’s interim recommendations and learn how to comment:

Read the Working Group Recommendations
PDF
HTML

Tell the Working Group What You Think
Online
By Mail print and mail to us

Ask Others to Comment

Learn more about the Working Group by clicking here.

Remember, you have until Aug. 31 to comment. Let the Working Group, Congress, and the President know the value you bring to this nation’s health care delivery system.

John Falardeau, Vice President, Government Relations
jfalardeau@acatoday.org

Enter to Win a Panasonic 42” Plasma HDTV!!
ACA-PAC will raffle off a Panasonic 42” Plasma TV (Model TH-42PD60U) at the upcoming House of Delegates meeting in Scottsdale, Arizona (Sept. 5-9). Help support the only PAC committed to supporting pro-chiropractic candidates for the U.S. House of Representatives, the U.S. Senate, and the White House. Your contributions will help counter the millions of dollars spent by organized medicine, the physical therapy lobby and other groups with anti- chiropractic agendas and add to our “political muscle” in Washington. Enter now for your chance to win!!

Tickets are $20 each or 7 for $100, and the winner does not need to be present at the time of the drawing. ACA-PAC will ship the TV at no cost to the winner. Per FEC regulations this raffle is open to ACA and SACA members ONLY. Entries from non-members will be returned.

 

Tickets may be purchased online, or by check or money order.

Please send payment to:

ACA-PAC
1701 Clarendon Blvd.
Arlington, VA 22209
Attn: Andrew Dentamaro, ACA-PAC Manager

Please indicate on the check/money order that the payment is for the raffle.

**ALL ENTRIES MUST BE RECEIVED BY FRIDAY, SEPT. 1, 2006. ENTRIES RECEIVED AFTER THIS DEADLINE WILL BE RETURNED**

Andrew Dentamaro, ACA-PAC Manager, Government Relations
adentamaro@acatoday.org

Insurance Relations
ACA Reaffirms its Policy on Zero-Tolerance
We have mentioned our efforts against fraud in a recent installment of the EVP Report, and would like to give you an update on the progress of those efforts. We our gearing up for the first semi-annual teleconference on Sept. 28. Additionally, Insurance Relations will staff a booth at the International Association of Special Investigative Unit's (IASIU) Annual Seminar & Expo on Sept. 11-12, where we hope to interest new participants. We have already heard from several companies who want to participate and we have asked the IASIU to publicize the teleconference to their members. And finally, we are also working with the Federation of Chiropractic Licensing Boards to learn more about the use of their licensure database CINBAD.

Fraud is certainly not a new issue, either to our field or others. Patients do not stop going to MDs when they are sick because they have heard of cases involving dishonest doctors. Yet oddly, the few cases of fraud in chiropractic seem to sway the thinking of insurers and the general public to an all or nothing attitude. Even though the majority of doctors would never engage in dishonest practices, the few cases of those who do seem to be made all too visible. The ACA is working to rectify this misperception by engaging those who work in special investigation units (SIU) to educate them regarding what is appropriate practice and what is not.

Our zero-tolerance policy means that if a doctor is convicted of fraud and loses his/her license, they also lose their ACA membership. If they are sanctioned in any way, their case is reviewed by ACA's Ethics Committee and the Board of Governors to determine the appropriate action which can include reprimand, suspension and if necessary, termination. Such policies assure that your membership with the ACA is a visible mark of excellence and an indication of your devotion to integrity within the profession. For questions regarding our SIU efforts please e-mail Laurie Douglass at ldouglass@acatoday.org.

Laurie Douglass, Vice President, Insurance Relations
ldouglass@acatoday.org

Communications and Marketing
The Smart Choice – Two Must-Have Resources from ACA

Chances are, as a doctor of chiropractic, you’ve had to spend more time on insurance paperwork and less time seeing patients. Make it easier with these two products – exclusively from ACA.

2006 Chiropractic Coding Solutions Manual

The only chiropractic coding manual developed by doctors of chiropractic for doctors of chiropractic. ACA’s 2006 Chiropractic Coding Solutions Manual supplies you with the most reliable, up-to-date coding and insurance related information. And with the 6x9 desktop reference size and color-coded tabs it is a must-have for any chiropractic office. Take a look at this year’s features and highlights:

New for 2006! Fraud and Abuse

• Evaluation & Management
• CPT®
• ICD-9-CM
• Medicare
• HCPCS
• HIPAA

Plus Insurance Template Letters, Talking Points and CD-ROM

Order Item CPT06
ACA member price: $79.95
ACA non-member price: $119.00

Clinical Documentation Manual

Ensure accurate and complete clinical documentation, and help combat criticism of the documentation practices in the chiropractic profession. The Clinical Documentation Manual features 32 easy-to-use recommendations, including clinical examples. It was developed in consultation with insurers, licensing boards, colleges and other outside groups to help doctors of chiropractic better document their services and improve reimbursement rates while ensuring quality of patient care.

Order Item CDM05
Price: *$39.95 for ACA members and non- members

Order today by calling 1-800-368-3083 or shop online.

*This price will only be available until Dec. 31, 2006

Heidi Cifelli, Marketing Manager, Communications and Marketing
hcifelli@acatoday.org

Membership and Business Development
Okabashi.com Offers Heightened Interactive Experience and Shopping-Friendly Features

Tickle Okabashi’s feet, learn about reflexology, or pick up a pair of flip flops. Do that and a whole lot more when you check out the new Okabashi Web site (from Okabashi Brands, Inc.), the number one brand in massaging footwear.

To help customers celebrate the warm weather of summer and the launch of their new Web site Okabashi is introducing a special promotion that will run through Sept. 1. Customers that order $35 or more will receive free shipping. You can also save more when they shop online during Okabashi.com’s "Get Active Sale," with reduced prices on three great styles: Women’s Resort Thong, Women’s Resort Slide and Men’s Milan. For more information on Okabashi's "Get Active Sale," click here.

An ACA-endorsed partner, Okabashi is the number one brand in massaging footwear, having sold more than 25 million pairs in the U.S., customers will find both men’s and women’s shoes in a variety of styles and colors. Shoe collections include thongs, casual slides, mid-heel sandals and clogs. To learn more about special pricing for doctors of chiropractic please contact Art Serrano at Okabashi via e-mail at arts@okabashi.com.

Ray Chattman, Vice President, Member Services and Business Development
rchattman@acatoday.org

 

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