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.
PCA Strategic
Business Partners
Click logos to support & learn about our sponsors
PCA Meeting
Calendar for 2013
Saturday, June 15, 2013
8 AM- 4 PM
(Harrisburg; location to be announced later)
Sunday, October 6, 2013
8 AM- noon
(Pittsburgh, during Annual Convention; bylaws-required Board re-org meeting)
Saturday, Dec. 7, 2013
10 AM- noon
(e-meeting on 2014 budget, likely using Go-to-Meeting)
District Meetings
Pennsylvania Chiropractic Association
(717) 232-5762 Fax (717) 232-8368
WHAT'S NEW in the
Members-Only Section
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
Insurance Page
- 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.
ANNOUNCEMENTS!
The Pennsylvania Chiropractic Association (PCA) proudly welcomes:
Strategic Business Partners
AXA Advisors
Cancer Treatment Centers of America
Symmetry Medical Billing
Natural Health Remedies
Jules Zacher, Esq.
PCA PRESIDENT'S MESSAGE
SPRING 2013
Are You an Engaged Participant in Your Profession or a
Passive Bystander?
Dr. Dan Schatzberg
PCA President, 2012-2013
PCA is a professional association, composed of licensed Doctors of Chiropractic in the Commonwealth of Pennsylvania. With that said up front, several provocative questions follow, and I encourage each reader to give thought to my message to you:
Are we all in this together, or just some of us? Do we all love and care about our profession, or just some of us, some of the time? Is the fight against programs like Highmark’s Physical Medicine Management Program (PMMP) important to all Doctors of Chiropractic, or just some? Is passing legislation like the Fairness in Copayment Act important to just a few Chiropractors or all Chiropractors in Pennsylvania? Is passing a bill limiting the time frame that insurance companies can retroactively recover money from Chiropractors important to all Chiropractors, or just some? Is having an association in Pennsylvania that stands up every day, protecting and fighting for Chiropractors and their patients, important to all Chiropractors, or just a few?
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 PCA’s Legal Fund.
Please continue contributing AND spreading the word about this critical initiative to STOP HIGHMARK’S PMMP.
Thank you for your support!
Thank you for your support!
“I am personally convinced that one person can be a change catalyst, a ‘transformer’ in any situation, any organization. Such an individual is yeast that can leaven an entire loaf. It requires vision, initiative, patience, respect, persistence, courage, and faith to be a transforming leader.”
-
Stephen R. Covey, author and speaker
Stephen R. Covey, author and speakerThe 7 Habits of Highly Effective People
Principle-Centered Leadership
The Speed of Trust
The 3rd Alternative
The 2013 Auto & Workers' Compensation Fee Schedule is available NOW! Go to the "Members Only" section/Insurance page.
Take Action! PID Complaint Program!
PCA LAUNCHES PRE-SERVICE BENEFIT NOTICE AND COMPLAINT SUBMISSION PROCESS FOR HIGHMARK’S PMMP
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. Read more!
PMMP General Assembly Memorandum and PCA Rebuttal
On December 27, 2012, Michael G. Warfel, Highmark Vice President of Governmental Affairs, sent a memorandum to the Pennsylvania General Assembly, advising them of the third extension of the PMMP “soft implementation” to April 30. 2013. Read more!
ACA Files Class Action Lawsuit Challenging ASHN's, CIGNA's
Improper Practices
Affected Providers Can Submit Complaints Via ACA’s Website
In response to the January 7 ACA announcement of its class action suit against CIGNA and ASHN, PCA President Dan Schatzberg, D.C., commented:
"Pennsylvania Doctors of Chiropractic and their patients are heartened at the class action suit filed by the ACA this week. PCA members appreciate the importance of such legal interventions. I want to reinforce to Pennsylvania's Chiropractors and their patients the importance of responding to the ACA's initiative, per the next to last paragraph in their release.
Also, remember that as a result of PCA's advocacy efforts, the PA Insurance Department very recently opened up their complaint-handling procedures to now include "Actionable" complaints from both patients AND providers. In addition to complying with the ACA's requests in the release, also make sure that you and your patients file complaints with the PA Insurance Department through the included link."
For the PA Insurance Department’s patient complaint form, click here.
January 7, 2013 -The American Chiropractic Association (ACA) has filed a class action lawsuit against American Specialty Health Inc. and American Specialty Health Networks Inc. (collectively, "ASHN"), and CIGNA Corporation and Connecticut General Life Insurance Company (collectively, "CIGNA"). The litigation alleges a litany of problems with the defendants, including arbitrary reductions of care, lack of communication to providers and patients resulting in coverage and payment errors, and interference with doctors' duty to exercise professional clinical judgment in managing patients' treatment plans.
Filed on Dec. 28, 2012, ACA's litigation--which is being handled by the law firm Pomerantz Grossman Hufford Dahlstrom & Gross LLP--represents a nationwide class of health care providers and subscribers who were subjected to ASHN and CIGNA's improper coverage and reimbursement practices.
Furthermore, CIGNA allegedly failed to comply with terms and conditions of its plan to afford its subscribers or their health care providers an opportunity to obtain a "full and fair review" of denied or reduced reimbursement, and to make appropriate and non-misleading disclosures to subscribers or their health care providers--an alleged violation of the Employee Retirement Income Security Act of 1974 (ERISA), the federal law governing private employee benefit plans.
Additionally, the litigation outlines various allegations, including:
•Use of false and misleading Explanations of Benefits relating to chiropractic claims (required under ERISA for informing subscribers of how their claims have been processed), which interferes with the doctor-patient relationship
Use of false and misleading Explanations of Benefits relating to chiropractic claims (required under ERISA for informing subscribers of how their claims have been processed), which interferes with the doctor-patient relationship•Manipulating charge and payment data, allowing ASHN and CIGNA to pass on excessive costs to subscribers, while distorting the amounts providers actually receive in benefit payments
Manipulating charge and payment data, allowing ASHN and CIGNA to pass on excessive costs to subscribers, while distorting the amounts providers actually receive in benefit payments•ASHN's restrictions of care via the pre-authorization process and provider contract provisions that prevent patients from having access to the full breadth of their benefits and in contradiction to their certificates of coverage--a violation of ERISA
ASHN's restrictions of care via the pre-authorization process and provider contract provisions that prevent patients from having access to the full breadth of their benefits and in contradiction to their certificates of coverage--a violation of ERISA•ASHN and CIGNA's imposition of excessive co-pay requirements on subscribers, another ERISA violation
ASHN and CIGNA's imposition of excessive co-pay requirements on subscribers, another ERISA violation •CIGNA's improper prevention of doctors of chiropractic (DCs) from providing services that fall within their scope of practice, in violation of state provider non-discrimination laws
CIGNA's improper prevention of doctors of chiropractic (DCs) from providing services that fall within their scope of practice, in violation of state provider non-discrimination laws •ASHN and CIGNA's violation of various state prompt payment laws
ASHN and CIGNA's violation of various state prompt payment lawsACA's suit requests the court to award injunctive, declaratory and other equitable relief to ensure ASHN and CIGNA's compliance with ERISA as well as other state and federal laws and regulations.
"ACA was compelled to take this action against ASHN and CIGNA because their egregious practices are undermining patient care and doctor-patient relationships. DCs feel they have to choose between acting in the best interest of the patient, and adhering to the requirements imposed by ASHN and payers they work with," said ACA President Keith Overland, DC. "Since 2002 we have worked to try and improve these issues. It is now time for action and we will not rest until patients across the nation receive all the care they need and have paid for through their insurance premiums."
Providers who believe they and/or their patients have been affected by ASHN and/or CIGNA's improper practices can visit the Chiropractic Networks Action Center where they will find instructions and forms that can be used to submit a complaint to ACA.
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 www.acatoday.org.
Highmark’s PMMP Delayed Again! Now Set for May 1, 2013
Highmark has agreed to delay implementation of the PMMP once again.
December 27, 2012-Since Highmark announced its Physical Medicine Management Program (PMMP) this past June, the PCA Board of Directors and the Highmark Working Group have tirelessly worked to stop or delay Highmark’s implementation of the PMMP. Once again, PCA’s efforts have paid off, with the active involvement of the Pennsylvania Physical Therapy Association (PPTA) and others. Highmark’s new target “hard” implementation date is May 1, 2013.
The PCA has worked closely with the PPTA and identified numerous legal and administrative issues and problems directly related to the PMMP. Also, PCA has met with Highmark and senior staff from the Pennsylvania Insurance Department (PID) to address the legal concerns, the administrative problems associated with the “soft” implementation, and the potential harm to patients and providers. Through persistent advocacy and education, regulators now clearly understand the inherent flaws in the PMMP and most significantly, have agreed to accept complaints filed by patients AND providers through the procedures outlined in this notice.
But we need your help.
We urge you to file complaints with PID every time a problem occurs with PMMP compliance. It is better that these complaints come from patients rather than just providers, but you can file complaints on behalf of your patients, so long as you have their approval to do so and include their pertinent information on the complaint. PID will accept complaints based upon:
Process problems affecting providers
- Difficulties in sending or receiving information on patient determinations, inaccurate program information being provided, delays in processing, etc.
- Benefit design and “vanishing benefit” problems
- Whether there is sufficient clarity in the Highmark insurance policies and Highmark subscriber contracts under which a patient may get a single encounter and have that count as two or more visits when they may receive multiple types of services in a single visit.
- Multiple co-payment problems
- Whether the imposition of multiple co-payments renders their physical medicine benefit “illusory” – if the patient has two, three or more copayments imposed on a single visit, the provider gets nothing and the patient has to pay for the entire cost.
PID has also provided us with this useful information about filing complaints regarding Highmark’s PMMP:
- Providers should file complaints using the Department’s consumer portal from the Department’s website at www.insurance.pa.gov, or by using the link below.
- Providers can attach supporting documentation (i.e. HIPAA-compliant screen prints and/or EOBs)
- Providers should review the “Frequently Asked Questions” if there is a problem registering or entering the complaint information. If this document does not address the problem, Carolyn or Leslie at PID can be contacted using the information below:
Carolyn Morris – 717-783-9862, camorris@pa.gov
Leslie Pierce – 717-705-4395, lepierce@pa.gov
- Providers should include as many specifics as possible about their problem, WITH supporting documentation. Any system or process problems must have occurred on, or after December 21, 2012, so that we can monitor the progress of the system/process going forward.
It is important that we flood PID with complaints from patients and providers about PMMP. The more complaints they receive, the greater PID’s leverage will be in forcing Highmark to satisfy those complaints. So too will it assist our legislators in their fight against PMMP on our behalf. If you have questions or comments please direct them to either the complaint information listed above, or contact the PCA offices. We’ll be happy to assist you.
REGISTER TODAY!
June 22-23, 2013
CAMP HILL, PA
Saturday 9 AM - 6 PM;
Sunday 8 AM - 1 PM
CAMP HILL, PA
Fibromyalgia, Muscle Pain & Dysfunction
Presented by
Michael Schneider, DC, PhD
Speaker provided by NCMIC
Refreshments provided by Designs for Health
12 CE hours
DC CE approved in PA;
PT CE approval pending
Attend this NCMIC approved seminar and receive a 5% discount on each policy renewal premium for the next three (3) years, beginning on your policy renewal following the seminar. Part-time premium policyholders receive half the discount.
2013 PCA Convention
October 5 & 6, 2013
Sheraton Station Square Hotel
Pittsburgh, PA
Dinner Cruise:
October 5, 2013
On the Gateway Clipper
(The dinner cruise has limited seating and is expect to sell out.)
ONLY $25
locks in your registration and Dinner Cruise ticket
$324./PCA Member
and
$424./non-members
Balance due by
August 1, 2013 to receive
your dinner tickets.
March 6, 2013
PAC: Fuel for the Chiropractic Revolution in Pennsylvania!
Dear Doctor:
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 PCA’s 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 PCA’s 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!!
Sincerely,
Daniel Schatzberg, DC, DABCO
President, 2012-2013
Eric Osterberg, DC
1st Vice President & Chair, Legislative Committee
Jules Zacher, PC
URGENT ALERT!
PENNSYLVANIA CORPORATIONS SOLICITATION SCAM
Important Consumer Alert
Corporate Compliance Company
and Corporate Records Service Scam
April 18, 2013
The Pennsylvania Department of State has been made aware of solicitations that are being mailed to Pennsylvania businesses from two companies: Pennsylvania Corporate Compliance Company and Corporate Records Service. These solicitations are titled "Annual Meeting Disclosure Statement" and "2013 - Annual Minutes Form ." These mailings urge business corporations and limited liability companies to file information and send payment in the amount of $125.00 by a certain date in order to maintain proper records.
These solicitations include a citation to the Pennsylvania Business Corporation Law regarding corporate records. At first glance, these solicitations may look official; however, none of the information being requested is required to be filed with the Department of State or the Secretary of the Commonwealth. Pennsylvania corporations and limited liability companies are not required to file corporate minutes with the Department of State or with a private company such as Pennsylvania Corporate Compliance Company or Corporate Records Service . The Department is alerting all Pennsylvania business entities of this deceptive solicitation to prevent Pennsylvania businesses from completing the form and sending payment to a mailing center post office box address by the deadline on the form.
Despite the suggestive language on the mailing, the "Annual Meeting Disclosure Statement" and the "2013 - Annual Minutes Form" are not required to be completed. These formal-looking letters did not originate from any governmental office, nor are the Pennsylvania Corporate Compliance Company and Corporate Records Service affiliated or associated with Pennsylvania state government in any way. Similar scams have been reported in other states. This "Annual Meeting Disclosure Statement" and "2013 - Annual Minutes Form" documents should be disregarded by all companies which receive them.
Additionally, please keep in mind that any official notices sent to businesses by the Pennsylvania Department of State or the Secretary of the Commonwealth’s office will contain the letterhead and/or contact information for the Bureau of Corporations and Charitable Organizations. Please contact the Bureau at (717) 787-1057 or ra-corps@pa.gov should you have any questions or concerns regarding these solicitations.
If you received this solicitation, likely via USPS, the PA State Department asks that you make a copy the envelope and the contents for your records and mail the original to the PA Department of State, per the below notice:
PA Department of State
Bureau of Corporations
401 North Street, Room 208
Harrisburg, PA 17120
717-787-1057
888-659-9962
Highmark PMMP Implementation Delayed Until June 1
In the face of increasing complaints from Pennsylvania’s physical medicine providers and patients alike, Highmark announced the fourth extension of the troubled Physical Medicine Management Program (PMMP) through May 31, 2013. Read more!
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!
ACA Clarifies Aetna Policy on Manual Therapy for the Profession
The American Chiropractic Association held a meeting with Aetna representatives on May 16th which culminated after an exchange of correspondence to ascertain the rationale for their new national policy regarding manual therapy. The policy, effective March 1st, states that Manual Therapy (CPT code 97140) is not recommended for separate payment when submitted with Chiropractic Manipulative Treatment (CMT). Modifiers -59 and -25 do not override this policy. As is commonly known, AMA CPT's guidance for use of 97140 with CMT provides for occasions when a patient may present with a need for manual therapy in a region other than the region in which manipulation occurred. Modifier -59 is used to indicate this situation and the chart is to be thoroughly documented that the therapy occurred in a separate region and why.
Discussions with Aetna revealed that their investigative audits found that 90 percent of the time that modifier -59 was used, manual therapy was performed in the same region as the CMT. They also found very poor or lack of documentation. Aetna's need to make such a strong policy change was due to what they considered to be excessive and improper use of modifier -59.
While Aetna's policy is to deny all 97140 services when billed on the same date of service as CMT, if medical necessity and separate regions are established in the medical record, Aetna has agreed to allow providers to appeal and submit documentation to request payment. Appeals are permitted retroactive to 3/1/2013 when the policy became effective.
While having to take the extra step to appeal is unfortunate, these statistics are as well. Aetna indicated they are willing to work with ACA and stated that "Just as we put the policy in place, it can just as quickly be removed if this situation improves." ACA extends its thanks to Aetna for its willingness to work with ACA and the profession as we reach out and remind providers and graduating students about proper coding, billing, and documentation of these services. ACA calls to its many supportive partner organizations and state associations to likewise reach out and remind doctors regarding both Aetna's present policy and proper coding and documentation of these services.
ACA has long educated the profession in regard to this policy, as demonstrated in our policy written in 1999, and now has a new template appeal letter* for doctors to use specifically when appealing Aetna denials of manual therapy when performed on the same day as CMT to a separate region. The policy may be found here and the new appeal letter may be found here.
*ACA members may view and download a generic 97140/CMT appeal letter, for use with other insurers, and many other template appeal letters, by visiting our Appealing Claims Denials webpage here.
For more information, please contact ACA's Insurance Relations Department by emailing insinfo@acatoday.org.
______________________________________________________________
Posted: 05-24-2013
Dear PCA Colleagues:
On your behalf and in the interest of keeping you fully informed of what PCA is doing to address the many inherent problems for patients and providers alike in Highmark’s PMMP, attached are two letters recently sent to Governor Corbett and to select members of the Pennsylvania Senate and House of Representatives. You will note that both letters have been co-signed by the presidents of PCA and the Pennsylvania Physical Therapy Association.
The letter to Governor Corbett requests his intervention on the PMMP, “to facilitate bringing this poorly designed program to a close.” The second letter to select members of the legislature, requests members of the PA General Assembly to “urge the Governor’s Office and the Pennsylvania Insurance Department to intervene and stop Highmark’s PMMP.”
Here’s what you need to do:
1.Providers with complaints about the PMMP should direct their concerns to their state senators and representatives. PCA has urged legislators to contact the Governor's office to intervene and stop implementation of the PMMP. You can find your senator or representative by clicking here. The state legislature must understand your concerns about how the PMMP can adversely impact your practice and the care you provide to your patients.
Providers with complaints about the PMMP should direct their concerns to their state senators and representatives. PCA has urged legislators to contact the Governor's office to intervene and stop implementation of the PMMP. You can find your senator or representative by clicking here. The state legislature must understand your concerns about how the PMMP can adversely impact your practice and the care you provide to your patients.2.Continue sending the PA Insurance Department valid patient and/or provider complaints (click on this link to the PID). The PID has repeatedly advised PCA that problems with PMMP must be quantified and there is no better source than the treating doctors and their patients.
Continue sending the PA Insurance Department valid patient and/or provider complaints (click on this link to the PID). The PID has repeatedly advised PCA that problems with PMMP must be quantified and there is no better source than the treating doctors and their patients.3.Check the PCA web site regularly for other pertinent updates on the PMMP. The collective efforts of PPTA and PCA have contributed to the PMMP implementation delays and both Associations continue to work tirelessly on behalf of chiropractors and physical medicine providers to put a stop to this harmful program.
Check the PCA web site regularly for other pertinent updates on the PMMP. The collective efforts of PPTA and PCA have contributed to the PMMP implementation delays and both Associations continue to work tirelessly on behalf of chiropractors and physical medicine providers to put a stop to this harmful program.4.Get your fellow DCs to join PCA. PCA’s political strength is only as good as the strength of its membership and YOUR PROFESSION needs every Doctor of Chiropractic to join PCA so we can engage in this and other similar fights for the foreseeable future (click here to dowload the PCA membership application).
Get your fellow DCs to join PCA. PCA’s political strength is only as good as the strength of its membership and YOUR PROFESSION needs every Doctor of Chiropractic to join PCA so we can engage in this and other similar fights for the foreseeable future (click here to dowload the PCA membership application). Thank you for fighting the good fight for your patients and profession! Should you have any questions or concerns, please contact the PCA office or either of us at your convenience. With best wishes to you for this important Memorial Day holiday, we remain
Sincerely Yours,
Daniel Schatzberg, DC, DABCO
President
Eric Osterberg, DC
1st Vice President
Chairman, PCA Highmark PMMP Work Group
