FIGHT FOR YOUR FUTURE!
What you and your patients can do about Insurance Complaints.
The PCA makes every effort to document provider complaints and take necessary action to help PCA members. In this case, PCA took your concerns to the PA Insurance Department Commissioner. Click here to read more! For the PA Insurance Department's patient complaint form click here.
Click logos to support & learn about our sponsors
Calendar for 2013
Saturday, Dec. 7, 2013
Â 10 AM- noon
(e-meeting on 2014 budget, likely using Go-to-Meeting)
Pennsylvania Chiropractic Association
(717) 232-5762 Fax (717) 232-8368
1335 North Front Street
Harrisburg, PA 17102
WHAT'S NEW in the
What's New Page
- PA Supreme Court Denies State Farm's Appeal In Chiropractors Delegation Case
- DEP Announces X-ray Registration Fee Amnesty Program
- ACA/TeamCME Set to Certify DCs as Transportation Industry Medical Examiners
- 2013 Auto & Workers' Compensation Fee Schedule available for download
- 2012 Medicare Fee Schedule
What your patients can do about Insurance Complaints.
PA Insurance Department's patient complaint form, click here.
The Pennsylvania Chiropractic Association (PCA) proudly welcomes:
Strategic Business Partners
Cancer Treatment Centers of America
Symmetry Medical Billing
Natural Health Remedies
Jules Zacher, Esq.
PCA PRESIDENT'S MESSAGE
Dr. Dan Schatzberg
PCA President, 2013-14
I sincerely thank all of you for being members of OUR Pennsylvania Chiropractic Association. It has been an honor to serve you, since the last convention. I appreciate the privilege and responsibility of continuing to serve as your President until our next convention in June.
We work for you!
The PCA works on a daily basis to protect Chiropractic and the rights of Chiropractors and patients. The PCA cannot do this without the help of our most valuable asset. I’m not talking about our staff or EVP, our Board of Directors, our Executive Committee and certainly not our President. I’m talking about you, our members.
You are our most valuable asset
Our members are the PCA’s most valuable asset. The PCA needs to grow its most valuable asset. The PCA needs to nurture its most valuable asset. The PCA must inform its most valuable asset. The PCA must protect its most valuable asset. You, our members, are the PCA. Thank you for being a PCA member.
One of the most contentious issues our profession has faced in years is Highmark’s much-maligned Physical Medicine Management Program (PMMP). OUR PCA has been working and fighting the PMMP since Highmark’s initial announcement of intent in June 2012. ne of the most contentious issues our profession has faced in years is Highmark’s much-maligned Physical Medicine Management Program (PMMP). OUR PCA has been working and fighting the PMMP since Highmark’s initial announcement of intent in June 2012. Read more
PCA LEGAL FUND
PCA members have risen to the call in regard to supporting our legal action fund. It is imperative that we continue to develop the resources to sustain the momentum in the fight against unfair practices by the health insurance industry in Pennsylvania.
It is vital that the Legal Fund be as broadly supported as possible- doctors, physical medicine professionals, patients, employers, unions, companies doing business with physical medicine professionals, etc. ALL can contribute and support PCAs Legal Fund.
Please continue contributing AND spreading the word about PCAs initiative to level the playing field between health care providers and insurance companies.
Thank you for your support!
NEW HIPAA-COMPLIANT FORMS EFFECTIVE SEPTEMBER 23, 2013
The 2013 Auto & Workers' Compensation Fee Schedule
is available NOW!
Go to the "Members Only" section/Insurance page.
Take Action! PID Complaint Program!
LEARN MORE ABOUT THE PRE-SERVICE BENEFIT NOTICE AND COMPLAINT SUBMISSION PROCESS!
PCA President Daniel Schatzberg, D.C., DABCO proudly announces a process for Pennsylvania Chiropractors in response to PCA member questions and concerns regarding Highmark's PMMP. The PCA was tasked with assisting its members with the development of a process for helping providers educate their patients on the PMMP including medical determinations and appeals, patient financial responsibility if services are denied by Highmark, and a procedure for helping patients voice their complaints to the Pennsylvania Insurance Department. Learn more...
Click Here to Make Your PCA PAC Contribution NOW!: PAC: Fuel for the Chiropractic Revolution in Pennsylvania!
What would happen if Pennsylvania passed legislation that truly levels the playing field? between Doctors of Chiropractic and Pennsylvania's health insurers? Only PCA has taken steps to create such comprehensive reforms.
How relieved would you be if you knew that retroactive reviews, denials and recoupment requests were deemed illegal beyond a very specific time frame- 6- 24 months for retroactive reviews, rather than the current 5+ years? Only PCA has taken the steps to initiate reforms on insurers retroactive review policies.
Would your patients and practices thrive if multiple co-pays in a single office visit were outlawed by the Pennsylvania General Assembly? Only PCA has taken steps to initiate reforms that eliminate multiple co-pays in a single office visit.
What would your practice be like if you were free from misguided and heavy-handed insurer benefits? like Highmark's Physical Medicine Management Program (PMMP) disrupting your relationships with your patients? Only PCA has taken aggressive steps to challenge and fight Highmark's PMMP on your behalf as well as in the interests of your patients.
None of the above scenarios are out of the realm of possibility, thanks to YOUR Pennsylvania Chiropractic Association and the aggressive, pro-doctor, pro-patient efforts being made on your behalf EVERY day by PCA's leaders, engaged members and our top-notch, well-connected lobbying and legal teams.
On the other hand, ALL of these very positive initiatives and scenarios will be unlikely if Doctors of Chiropractic do not maintain a well-funded Political Action Committee (PAC) that supports legislators and candidates who advocate for the Chiropractic profession. For example, PCA works closely with key leaders introducing co-pay reforms, retroactive review reforms, and generally outspoken champions of Chiropractic- Republicans, Democrats and Independents.
That's why we're appealing to each of you, ALL Pennsylvania Doctors of Chiropractic, to support PCAs political, legislative and regulatory efforts to reform the health insurance playing field and rules for Doctors of Chiropractic and the patients our profession so ably serves.
On the behalf of OUR profession, we are asking YOU- each and every Doctor of Chiropractic in Pennsylvania- to personally contribute AT LEAST $100 to PCAs Political Action Committee NOW to strengthen our efforts to take back control of our profession and right the many wrongs within our current and often lamented disease management system.
Please join us in this epic battle to level the playing field and remember The World is What YOU Make It- YOUR Profession Included! Thank you in advance for your support and your generous contribution!!
Daniel Schatzberg, DC, DABCO
Eric Osterberg, DC
1st Vice President & Chair, Legislative Committee
PATIENTS AND CHIROPRACTORS!
Visit PCA's NEW INTERACTIVE MAP DIRECTORY
to find a chiropractor in your area by clicking on the logo below.
Become a member of PCA to have your practice/business listed, today!
News You Can Use
The Federal Affordable Care Act and YOU!- More than 70,000 Doctors of Chiropractic, YOURSELF included, need to make the case for full- scope of practice inclusion to your patients, employers, insurers and YOUR Congressional legislators (US Congress and US Senate) Click here to learn more...
Affordable Care Act Call Center (open 24/7): call 1-800-318-2596 or visit www.healthcare.gov Health Insurance Marketplace PowerPoint Presentation: June 15, 2013 briefing to PCA Board of Directors on Health Insurance Marketplace (formerly health insurance exchanges) implementation. Click here to download presentation
Highmark's Multiple Co-Pays Eliminated Effective 9/1/13!
After PCA's extensive and intensive advocacy over the past year to eliminate multiple co-pays, late last month Highmark announced a
simplification in spinal manipulation services via NaviNet. The major
change in policy is effective September 1, 2013 and essentially ceases all multiple co-payments for a single office visit.
Doctors of Chiropractic and their billing staffs should remain vigilant about this change and immediately report any discrepancies in the application of the policy.
Join us as we welcome DeMarco & DeMarco, PC as our newest
Strategic Business Partner.
PPCA’s DeMarco & DeMarco Offers DCs Counter-Offensive Weapon to Fight Excesses of Insurers & Big Business
PCA President Dan Schatzberg, DC, DABCO and Membership Chair Case Phillips, DC announced a new weapon for PCA members only: a counter-offensive resource to the legislative and regulatory assaults against Doctors of Chiropractic and physical medicine professionals in general: PCA Strategic Business Partner DeMarco & DeMarco, P.C. a firm which brings 20+ years of specialized legal experience in workers comp and auto legal advocacy.
Dr. Schatzberg commented, “We are delighted to have a partner like DeMarco & DeMarco, which adds yet another critical offensive arrow to the PCA’s and PCA member’s quiver. In prior legislative sessions of the Pennsylvania General Assembly, the legislature attempted to modify the PA Workers Compensation Act and Motor Vehicle Financial Responsibility Law by targeting the worker and driver. Now, we know such efforts are also directed at the health professionals, in our case, Doctors of Chiropractic. Last year, the PA Chamber of Commerce boldly advertised on its website that the current method of ‘Utilization Review’ is ineffective, and 90 days of employer-managed care is not long enough; the period must be extended to 180 days. The Chamber also wants to create a CCO -- Coordinated Care Organization- that would be in place though the life of the claim, to curtail ‘doctor shopping,’ i.e., further restrict patient access to the provider of their choice. This was unacceptable to PCA in 2012, and it remains as unacceptable in 2013.”
Dr. Phillips stated, “In motor vehicle cases, the peer review system is so skewed against health care professionals that it is known as a Defense Exam in the legal community. Whereas initially, this system may have been installed to curtail a select few inappropriate doctors who over-treat, we now know that this system has been distorted against all doctors, merely as an unjustified and unsubstantiated insurance cost-savings measure. In some instances, it can be so extreme that the first visit for care has been denied. DCs cannot allow such abuse of power to stand and we plan to fight this every step of the legislative process.
In summarizing the situation and the role of DeMarco & DeMarco in helping PCA and DCs fight these excesses, principal Larry DeMarco, LLM., said “There are on-going legislative, regulatory, insurance, economic, and legal attacks against the chiropractic community. In order to insure that you receive the amount to which you are entitled for your work, sometimes you need the protection of a lawyer. With the uncertainty of the new health care law coming into play, it is more important than ever to have both offense and defense ready to procure your just and appropriate payments. As professionals, it is extremely necessary to put up a united front to ensure that the future holds promise so you can continue to practice the trade that you studied, love, and enjoy as independent businesses, rather than pawns of an over-reaching and blatantly abusive managed care system.”
DeMarco continued, “Now, what can I do for you? I can be your first line of defense and your best offensive weapon. I can provide you with the greatest hope - reimbursement of all expenses that are due you. I have the education and experience -- 20+ years of workers’ compensation and automobile law experience, including trial advocacy, and the passion to see that today’s doctors are here for tomorrow’s patients. I can collect your bills for you, so you can practice chiropractic in a worry-free environment with the knowledge that any trouble from the insurance industry will only be temporary in nature and endurance.
I encourage every Doctor of Chiropractic who reads this article to never write off another bill merely because it is ‘too much trouble to collect.’ If you do that, you are playing into the insurance industry’s hand and moving one step closer to obsolescence through such abusive excesses. Unless you receive your due compensation for each patient possible, you are surrendering to an insurance industry scheme to gradually take away your livelihood and your patients’ access to and choice of providers.
CALL TODAY FOR A FREE CONSULTATION:
DeMarco & DeMarco, PC
1333 Race St, Suite 205
G. Lawrence DeMarco, LLC / Partner
PA Healthcare Update
Welcome to the first edition of PA Healthcare Update, an e-newsletter designed to keep you informed of the latest healthcare news from Governor Tom Corbett and the Departments of Aging, Drug & Alcohol Programs, Health, Insurance and Public Welfare.
Foundation for Chiropractic Progress Welcomes
Support of Pennsylvania Chiropractic Association
The Foundation for Chiropractic Progress (F4CP), a not-for-profit organization dedicated to raising awareness about the value of chiropractic care, is pleased to announce the financial support of the non-profit Pennsylvania Chiropractic Association (PCA), he Foundation for Chiropractic Progress (F4CP), a not-for-profit organization dedicated to raising awareness about the value of chiropractic care, is pleased to announce the financial support of the non-profit Pennsylvania Chiropractic Association (PCA) Read More
PCA Members Lobby State Legislators
Members of PCA lobbied over a dozen state Senators and Representatives this week in Harrisburg. PCA advocated passage of Senate Bill #594, the Co-Pay Bill, and Senate Bill #998, the Retroactive Review Bill, as well as urging action against the Highmark PMMP. PCA's doctor-lobbyists were joined by State Senator David Argall at a Noon press conference in the Capitol Rotunda.
Organized by PCA's government affairs representatives with the Winter Group, member-doctors were able to meet with over a dozen legislators and their staffs. Many co-sponsors of PCA's legislative initiatives were added and key allies were developed in the House of Representatives and the Senate.
PCA wishes to thank Doctors Aukerman, Schatzberg, Osterberg, Novatnak, Brown, Giles, Green and Harcourt for giving up time away from their practices to meet with our legislative leaders. Thank you!
Be a Squeaky Wheel for Your Patients!
An Important Announcement
Regarding the Highmark PMMP
The PA Chiropractic Association (PCA) has received a large number of complaints and concerns regarding Highmark’s Physical Medicine Management Program (PMMP ). The PCA has taken these complaints to the Pennsylvania Insurance Department (PID) and the Pennsylvania Attorney General’s Office (AG) who have both requested that providers and their patients submit complaints to them when patient care is negatively affected by Highmark’s Physical Medicine Management Program (PMMP).
PHYSICAL MEDICINE PROVIDERS NEED YOUR HELP!
The PID and the AG are aware of the concerns; however, they want to hear from you as the provider and your patient. If you have patients who are adversely impacted by the PMMP, please take action by way of submitting written complaints to the PID and the AG.
We urge you to visit our website at www.pennchiro.org to learn more about the complaint submission process. You will be able to download complaint forms and find links to the PID and the AG office for easy submission of the complaint. If you want the PID and the AG to hear your patient’s complaints, please help your patient submit a complaint form today.
You can download the complaint form from the PA Insurance Department here or visit their website to learn more. You can download the complaint form for the PA Office of Attorney General here.
A patient may complain about a number of issues related to the Highmark PMMP such as multiple co-payments, denial of care, and an unreasonable and burdensome appeal process. Here is an example of how a patient might phrase their complaint: "I was denied insurance coverage by Highmark for chiropractic treatments under the PMMP because ........ My complaint is ……………………”
We suggest you help your patients who want to file complaints. You can discuss the complaint process with your patient and help them file the complaint on-line directly to the PID or AG.
You can teach an appropriate staff member to assist the patient in properly completing and filing the complaint forms.
Be sure to make copies of the complaint forms that are filed with the PID or AG. The PCA asks that you can send copies to the PCA after removing or redacting any private or protected health information under HIPAA.
The PCA will use the information to assess how the PMMP is affecting chiropractors and patients throughout the Commonwealth and in its efforts to stop the PMMP.
Aetna Clarifies 97140 Policy Language
In response to reports that doctors of chiropractic were continuing to experience difficulties when submitting claims for manual therapy (CPT code 97140) billed with CMT (CPT codes 98940 - 98943),
2013 Convention: PCA’s 2013 Annual Convention in Pittsburgh Reignites Chiropractic
Daniel McCann, DC
Annual Convention Committee
PCA’s 2013 annual convention is now history, but the energy and commitment to the Chiropractic profession that the event generated continues to inspire those who were able to join their colleagues at the Sheraton Station Square Hotel in Pittsburgh on October 5 and 6. From the big view on the “state of Chiropractic” to superior educational offerings to the latest in exhibitor offerings, there was something for every interest at one of the most outstanding conventions of the past decade.
Planning is underway for next year’s convention, slated for June 20-22, 2014 at the Penn Stater Convention Center in State College. Next year’s convention also coincides with Pennsylvania’s biennial re-licensure period, which includes demonstrating attainment of DCs state-required 24 hours of Continuing Education – so attendance will be high and early registrations are encouraged. The committee has created a $50 savings for early bird registrants, so make sure you take advantage of registering early for the 2014 PCA convention!.
While the plaudits are many for those who worked tirelessly “behind the scenes,” the 2013 Annual Convention Committee, comprised of Dr. Roy Love-Co-Chairman, Dr. Daniel McCann-Co-Chairman, Dr. Shaun Kavanaugh, Dr. Victor Rizzo, and Dr. Nancy Shaler, deserve special acknowledgement. Over a year in the making, planning for the smooth-running event took many hundreds of hours of work by these dedicated committee members. The success of this year’s convention was due in no small part to the committee’s long-range planning and attention to details. Every member of PCA owes these doctors a debt of gratitude.
So, too, does PCA’s Executive Committee and the Board of Directors deserve special thanks for their many contributions that helped produce, promote and direct an excellent event. No event would succeed without the support and involvement of the PCA staff, headed by EVP Ed Nielsen, Executive Assistant Mary Firestone (everybody really knows it was Mary who made the event run so smoothly!), Kelly Cook, Secretary/ Receptionist, Henry Benton, Membership & Accounts Receivable, and Sherry Gehman, Bookkeeper.
Most importantly on the post-convention appreciation roster are the many outstanding sponsors supporting various functions at this year’s convention. Anabolic Laboratories and NCMIC provided much-needed support for our many continuing education classes, with PayDC, ChiroAbility and the Palmer College of Chiropractic also deserving special acknowledgements. Noteworthy throughout the convention was Palmer College and its Chancellor, Dr. Dennis Marchiori, DC, PhD. for what was, by all accounts, the most compelling signature presentation of the convention. Palmer also generously sponsored the Saturday evening social dinner cruise enjoyed by over a hundred convention attendees.
PCA’s continuing education classes were informative and well-attended, and PCA extends its gratitude to the cadre of excellent instructors and presenters for their good efforts. Saturday’s sessions on soft tissue treatment, taught by Dr. Thomas E. Hyde, DC, DACBSP, and patient evaluations, taught by Dr. K. Jeffrey Miller, DC, DABCO, attracted scores of doctors in day-long sessions. Other presentations included medical coding, by David Klein, CPC, CHC, and insurance billing, by J.T. Toner of ChiroAbility.
PCA’s bylaws-required Annual Meeting of Members drew over one hundred attendees, with Dr. Dan Schatzberg - President, Dr. Vince Morreale- Western Director and Jerry Halloran- Eastern Director elected to terms that run through next year’s June convention. Very provocative and engaging briefings were also provided by Dr. Michael Simone, Board Chair, American Chiropractic Association; Dr. Ronald Farabaugh, Council on Chiropractic Guidelines and Practice Parameters; Mr. Gary Cuneo, the Foundation for Chiropractic Progress; and Dr. Kathleen McConnell, chairwoman of the Pennsylvania State Board of Chiropractic Examiners.
Dozens of exhibitors also attended this year’s convention, ranging from the latest in treatment technologies to nutritional supplements, insurers, and much more. Special appreciation is extended to Mutual of Omaha and New York Chiropractic College, which co-sponsored the Saturday evening reception in the Exhibit Hall.
Saturday’s festivities wrapped up with a delightful dinner cruise aboard the Gateway Princess, with special thanks extended to the Palmer College of Chiropractic for sponsoring the two-hour cruise.
Sunday’s activities included continuing education presentations by Dr. Thomas Hyde (Soft Tissue Disorders); Anna Allen, MSN, RN, CPHT, CPEHR (Understanding Professional Boundaries, Patients Who Are Victims of Abuse); and Dr. Dan Reyes, DC, CCSP, DACRB (5 Factors of Healing). Dr. Victor Rizzo also provided the latest information on radiation safety for practitioners utilizing x-ray equipment in their offices.
Your PCA Board of Directors also met in a morning-long session to chart the future for the organization, with various legal, legislative, political and operational briefings held, as well as strategies and directions established. Highlighting the agenda was the board’s discussion and consideration of the Council on Chiropractic Guidelines and Practice Parameters (CCGPP), which are national guidelines for care and treatment that have been determined by chiropractic professionals, rather than the medical community. The PCA Board will consider endorsing the CCGPP in the near future.
In closing this report on the 2013 convention, we are excited to have the 2014 convention hosted in State College next June 21-22. While our planning is already well underway, we challenge our colleagues (and their office staffs) to send in their requests for speakers and programs to the PCA office as soon as possible. Likewise, we challenge our members, including exhibitors and sponsors to work closely with the committee to envision, create and achieve an even larger convention in 2014 that delivers value in programs, resources and return on your educational investment.
After all, this is YOUR Pennsylvania Chiropractic Association!
The following consumer alert has been issued from Governor Corbett and the Pennsylvania Insurance Department:
Now that the federal health exchange is online and has experienced well-publicized issues, scammers may pose as insurance agents or representatives of the federal government and try sell to fraudulent policies or obtain sensitive, confidential information.
Neither the federal government nor the state insurance department will be contacting individual consumers to sell them insurance. Do not give any sensitive information to anyone who claims to be with the federal government, your state insurance department or a navigator for the exchange.
Beware of unsolicited calls from scammers who claim to have your new “Obamacare” or Medicare insurance card and need personal information in order to send it. You are not required to obtain a new insurance or Medicare card under the Affordable Care Act. A legitimate representative will already have that information.
Here are some scenarios where healthcare scams could occur:
Not using the appropriate website for the federal exchange. The federal exchange website is www.healthcare.gov. Don’t trust any other website that asks you to enter personal data such as a Social Security Number, bank account number or credit card information.
Callers posing as navigators or certified application counselors trying to “sell” you an exchange policy. A navigator or a certified application counselor can be an individual or an organization trained to help you learn about the available choices and guide you through the application process once open enrollment begins. These parties cannot sell you a policy, nor can they recommend a specific insurance plan to you. Navigators are certified and trained by the federal government.
Lastly, do not be misled or tricked into believing everything you hear. Here are some “lies” to watch out for:
“Premium offer only good for a limited time.” Enrollment in the exchanges will be open from Oct. 1 to March 31, and rates for plans in the exchanges will have been approved for the entire enrollment period.
“You could go to jail for not having health insurance.” Starting in 2014, all Americans will be required to have health insurance. You will not face jail time if you do not purchase health insurance. However, those who remain uninsured and do not qualify for any exemptions will face a penalty of $95 (for each adult) or 1 percent of family income, whichever is greater. In 2015, the penalty will increase to $325 per adult or 2 percent of family income, and in 2016 and beyond, the penalty will be $695 per adult or 2.5 percent of family income.
The Insurance Department has an educational website, www.pahealthoptions.com, which focuses on health insurance questions and all coverage options.
Consumers wishing to shop on the new federal exchange should use www.healthcare.gov.
Insurance consumers with questions, comments or concerns can visit the department’s website at www.insurance.pa.gov to check licensed entities and file complaints. They can also use the department’s toll-free consumer services number at 1-877-881-6388.
HHS Announces OIG’s 2014-2018 Strategic Plan- Fighting Fraud, Waste, Abuse Top Goal
The US Department of Health and Human Services Office of Inspector General (OIG) released its strategic plan for the next five years (through 2018), and fighting fraud, waste and abuse is at the top of their list of goals. To read the entire strategic plan for the HHS OIG, click here
PCA Fall Direct now available!
PCA's quarterly newsletter, PCA Direct, is now available online and in your in-boxes. This Fall 2013 edition marks our inaugural attempt to digitize Direct and its distribution, thus reducing the number of printed and mailed copies and saving thousands a year in production costs.
More improvements for Direct as well as our website will be made in future months as your PCA works to better meet the needs of the Chiropractic profession in Pennsylvania.