The Missouri Chiropractor - November 2007

• President’s Message by Edward A. Hengel, DC
• Executive Director Report by Kathleen Wilcoxson, MPA
• Government Report by Mo McCullough
• Feature Article: Chiropractic Board of Examiners Releases Survey Results
• ACA Weighs in on National Debate by Dr. Jack Kessinger, Missouri Delegate
  
• Plan to Attend Legislative Day
• CA’S CORNER - Thank you, but I have other plans By John C. Nab, DC
• Membership Report By Michael Finley, DC
• Auxiliary Report
• Insurance Report By Margaret Freihaut, DC, Insurance Committee Chair
• District 1 Report By Michael Finley, DC
• District 2 Report By Ron Manfredi, D.C.
• News & Views
• Classified Ads
  

President's Report

by Edward A. Hengel, DC,  MSCA President

Volunteers The Backbone of MSCA

The dictionary definition of volunteer states: a person who voluntarily undertakes or expresses a willingness to undertake a service. With the exception of a handful of paid staff, the MSCA is comprised of those persons who have expressed a willingness to help manage the affairs of the chiropractic profession in Missouri. This includes DCs from every corner of the state as well as many spouses and family members.

The majority of chiropractors in our state have never attended a board meeting much less even seen our office at 220 E Dunklin in Jefferson City. What does it take to attend? Well, you have to be willing to miss birthdays, miss anniversaries, miss children’s functions and/or family gatherings. Ah, this is not an easy choice. Also, one has to be willing to close their office at different times. Hmmm, all this in order to help make our profession stronger. This definitely falls under the title of true dedication. So, to all the service-oriented volunteers who continue to make the sacrifice of their time and money to attend board meetings, district meetings, college affairs, state conventions, legislative day, etc. I APPLAUD YOU.

To those who have not yet stepped forward to take part, I look forward to meeting you. The MSCA continues to make progress on numerous health care fronts; but we still need fresh minds and bodies to support those who have carried the burden to this point in our history.

At this writing, we just hit a record 700 MSCA members. We are hopeful that this number will continue to grow. The strength of our association is a direct reflection of membership. So again, to those members, new and old, please take part in our decision-making process at district meetings and board meetings. You will be welcomed with open arms, and your input will not be scoffed at ... well, usually.

People may scoff at my writing, as my thoughts don’t always flow too well; but I do feel compelled, at this time, to mention a few individuals. While attending numerous functions, I have met a lot of Missouri DCs. Subsequently, I have gotten to know a few colleagues more thoroughly over the last number of years. So, to that, I would like to give a sincere thanks to four of the hardest working chiropractors/volunteers in my district and the state.

Quinn James, D.C.
Marty Freihaut, D.C.
Mike Finley, D.C.
Dave Dolinar, D.C.

Their personal dedication, knowledge and belief in our profession is to be praised as their work has helped us all.

In closing, the word volunteer comes right before the word voluptuous in Merriam Webster’s Collegiate Dictionary. While being a volunteer is not exactly “pleasing to every sense” it does have a certain satisfaction. Give it a try. This is for your sake and the strength of chiropractic in Missouri. Thank you.

Executive Directors Report

by Kathleen Wilcoxson, MPA

Save Money: Make a Difference

For many years now, the MSCA has offered a 10 percent savings to doctors who re-join the MSCA in advance of the upcoming membership year. This offer is only available once a year, for approximately two months. It gives a 10 percent savings to doctors who pay their MSCA membership dues, “in full,” before December 31.

In real dollars, this means you pay only $360 instead of $400 for a regular MSCA membership. If you are over the age of 65, you pay only $180 instead of the regular $200 for this level of membership; and so on for each level available.

Feel free to clip and use the coupon below; or watch for this coupon to arrive in your mailbox, through your email and on our website. We appreciate, however, if you will fill out a new membership application so we can check and update your contact information in our database. This way, you will be sure to receive all the important legal, legislative, insurance and CE messages sent to our core membership.
Please remember, if you choose not to pay your full dues up front, we provide an automatic quarterly credit card payment option as well as a monthly checking auto debit program which allows you to spread your membership payments out over the entire year. But please keep in mind, you will not be allowed to take advantage of the 10 percent discount when you choose one of these alternate payment options.

MSCA NEWS: 700 Members!
Friday, October 12, 2007, the MSCA reached it's record-breaking 700 members!
 
Please join me in welcoming all our new members, and thanking all those who helped bring each and every one on board. Dr. Ness was responsible for referring member number 699, Dr. Jeffrey Burbank of Union.
 
Our 700th member received membership information at the MSCA Insurance Seminar and made the decision to become a member of the MSCA. Welcome Dr. Coe Ann Hardwick of Kirksville.

THE GOVERNMENT REPORT

Working at the Capitol for You

By Mo McCullough, Government Affairs Director

I was asked yesterday, for the hundredth time, “how’s your summer been?” My reply, “what summer?” Is it just me or does it feel like time is flying by at an ever accelerating rate? Don’t look now but here comes winter.

From a legislative standpoint, there are basically two distinct “seasons.” The period of January through mid-May is the legislative session. It is during this time the Capitol in Jefferson City is buzzing with activity. Members of the General Assembly are all on site, and the legislative process is in full swing.

Then comes the “off-season,” and the focus shifts from the Capitol to the local legislative districts. The senators and representatives go home to reconnect with their families, get back in the groove of the real world and meet with constituents. However, don’t think for a minute that the “off-season” has any correlation to “time off.” If anything, life in the legislative arena gets even busier. This is the time of year when interim committee hearings are held across the state. Add to that the special session, the veto session, bill signings and the ever important political fundraisers; and, yes, time flies by at an ever accelerating rate.

So far, since the end of the 2007 legislative session on May 18, while representing the MSCA PAC and the MSCA, I have traveled over 3,000 miles, attended more than 30 legislative functions, and spoken with countless legislators and statewide elected officials. And 2007 is not even an election year.

“So,” you ask, “what’s your point?” “Everyone is busy!” Yes, that’s true; but I can help ease your burden. I know that deep down every licensed DC in Missouri wants to help the cause but just doesn’t have the time. Well, you can help more than you know by simply becoming a dues-paying, card-carrying member of the MSCA PAC, as well as the MSCA, and let the staff and lobbyists do the leg work. If you have time to get involved, that’s great. If not, your financial support will help keep us a viable player in a very tough arena.

2007 is not an election year, but 2008 is. It’s going to be fast and furious, and you can help.

Feature Article: Chiropractic Board of Examiners Releases Survey Results

(printed per request) Below are the results of a survey sent to 2,174 licensees by the Missouri State Board of Chiropractic Examiners during the most recent renewal cycle.

Comments in italics were submitted by survey respondents. Comments with brackets and a number indicate the comment was received more than once.

Do you participate with any third party providers? If yes, please list the top 3 third party providers? Yes 341 No 80
Anthem, Blue Cross Blue Shield, United Health Care, Aetna, GHP, and Medicare

Have you ever participated with any third party providers? If yes, please list top 3 third providers. Yes 293 No 62
Anthem Blue Cross Blue Shield, United Health Care, Aetna, GHP, Medicare

Have you ever been placed on probation by a third party provider? If yes, please list date? Yes 23 No 399
Two more than seven visits
One month after put on probation, was told stats. were fine.
Moved from tier 1 to tier 2; not referred to probation.
Called “Performance Improvement”
ACN required too much paper work before processing a claim. You know before starting it would not be worth the headaches.
Company didn’t notify when Dr. was off probation until five months later
Not yet

Have you been terminated from participation by a third party provider? Yes 32 No 389
UHC, ACN, GHP, Almost by ACN
Not yet
UHC terminated me because I take X-Rays! Also said my technique (CBP) wasn’t research bases, when it is.
Medicaid-They insisted I moved my office and closed my account/provider #. I called them & told them I have never moved. I was not reinstated.
Following a merger. 2 complaints.
They decided to only use the Spinal Care Group and I did not belong to that group.
United Health Care claimed to have lost documentation.

Have you ever felt pressure to alter treatment protocol to comply with the need to reduce a statistical profile?
Yes 251 No 167
Are you kidding! ACN is Horrible! Now that BC/BS reimburses below Medicare I’ve been tempted to use different codes.
Absolutely.
Yes, but I didn’t do so.
I received a call from Dr. Gary Baker, D.C. from United Healthcare telling me that my average tx time was too long.
We get harassed from ACN.
Don’t care-I do what the patient needs.
However, I still stuck with my recommendations.
I did not do it. I treat as to the pt needs.
Once when Briggs& Stratton had health link I was non par however in order to pay a percent was necessary and patient was only able to come certain # of times in a certain period of time.
ACN Group alters it automatically
I am not a participating D.C., but the patients feel the pressure to stop based on the insurance co. letters.
With United Health Care wanting a reduction on fees.
I base my treatment protocol on patient need w/o regards to any insurance profile.
I was contacted by UHC to review my profile b/c it was higher than average and they suggested ways to reduce.
I treat a patient needs, sometimes I report in terms insurance companies prefer.
I perform fill-in service and I have been directed not to perform unneeded service.
Some companies will only pay for certain number of visits-regardless of patient.
UHC and ACN pressures doctors to limit care of risk being dropped as a provider.
50% of time both in and out of network

Have you or your staff ever found it necessary to assist patients in filling out a patient questionnaire that is sent to chiropractic review agencies? Yes 277 No 142
UHC thinks it is ridiculous & non-clinical
Only to explain questions.
UHC Forms, nightmare.
Patients don’t like to fill out extra forms.
Those policies that require patient questionnaires for ACN have been complicated for patients and staff.
Some patients find extra paperwork annoying and unnecessary.
Questions are asked in such a manner that does not allow complete explanation of conditions.

Do you sometimes not bill for services rendered in order to lower your utilization statistics? 194 219
All the time (2)
My attitude is why bother.
But do not bill because I know it is not going to be paid. Want patient to get better.
We have had to write things off.
Don’t bill for Medicare for any therapies b/c they don’t pay.
I bill for what I do.
Always
That’s why I was on probation
Only when patient agrees to pay in full out of pocket.
Have felt pressure to do so.
We still don’t get paid for it.
I list everything performed knowing I will only receive a flat fee.
Pressure from ACN to move from tier 2 to tier 1.
Report 98940, but deliver 98941
Easier to manage accounts receivable instead of write – offs.

Over the past year, have you noticed any substantial decrease in the number of treatments permitted for the same disease process/diagnosis?
Yes 275 No 125
BCBS in particular
Just reimbursing amount decreasing greatly.
Mostly 26 a year.
BC/BS for federal employees went from 50 visits per year to 10 visits per year.
As well as dollar amount.
DX doesn’t matter; disc problem treated same as sprain.
The treatment duration is usually unreasonable.
Number of treatments permitted doesn’t correlate with patient need.
It seems that all treatment plans are pre determined; no matter the diagnosis.
739 codes

Over the past year, have you noticed any substantial decrease in the permitted modes of treatment for the same disease process/ diagnosis? (therapies/modalities) Yes 286 No 120
Absolutely-What does it matter? Being capped at a value less than my adjustments, no therapies are paid.
Allow more types, but cap the reimbursement.
Hot packs and Ultrasound
I only do spinal adjustments
United Healthcare allows me to do adjustments and therapies, but will not compensate for over $44.00/ day and not allowed me to collect from patient the difference in cost.
Bundling issues
No exam w/adjustment
More of a decrease in the reimbursement for those therapies.
Flat rate fees make modality denials annoying, irrelevant.
UHC allows less than one modify per visit for all areas diagnosed.

In order to comply with statistical profile expectations, have you had to release a patient from care before their problem was fully resolved? Yes 186 No 210
I just stop sending in the insurance and accept the patients co-pay as payment in full-nice huh?
Patients often leave TX due to insurance not paying.
I would not do this.
I have not released patient only explained to patient insurance will no longer pay for the needed treatment.
Release from insurance coverage, NOT from care.
Then just quit paying.
Continue treatment if patient so desires.
No, but they were denied care from their insurance before MMI was reached.
I did not release, however pt discontinued AMA.
United Healthcare
Yes, but I won’t.
We take care of them anyway.
I would not release the patient, but some have discontinued care.
I know many doctors who have.
Medicare patients discontinue care prematurely many times, because of reimbursement.
But patient stopped care due to letters sent to her by ACN before problem was fully resolved.
I wouldn’t release them, but patients won’t come if insurance won’t pay.
Insurance carriers of plans have limited the number of visits they will allow or cover.
It was expected, but didn’t for patient’s welfare.
We just discontinue care.
Patient had to pay out of pocket.
I instruct the patient for the continued need for care and they have a choice to payout of pocket or stop care.
I have had to treat the patient at no cost.
Workman’s comp. esp.
I should have and wouldn’t have been terminated.

Have you converted a patient to a cash basis in order to lower your utilization statistics?
Yes 134 No 272
Have been converted to CAPH to continue treatments.
No, but probably should.
PT must be billed when insurance fails to pay.
Co-pays are as high as our office visit so practice is just like cash anyway!
Have always had a cash practice. (3)
No, But we have converted to cash if benefits run out.
Not for lower stats but b/c co-pay of $30 is equal to or higher than cash pay amount.
Not to lower statistics, but due to high co-pay.
All patients are cash.
Trying to become a non provider for ACN as patients feel hassled.
I didn’t know we could do that!
But we do when we run out of approval visits.
To continue care we have.
But that is what ACN wants you to do.
All are cash, they get reimbursed.
UHC maximum $44.00/visit patient co-pay $40.00, HMO PCP, referrals needed with limited visits
Patients are very upset that the insurance they pay for is not covered.
Not to lower stats, but to remove paperwork as an obstacle between pt and treatment.

Have you lowered your CMT Level to lower your statistical profile? Yes 164 No 252
Only with ACN/UHC.
I bill for what I do.
There for I am not tier I
ACN has told me they would not cover and 98941, only the 98940.
I do what the patient needs, but I do sometimes not bill for the level of care given.
Always bill 98940
To avoid hassle
Actually, ACN did it for me.
It was suggested that I do so.

ACA Weighs in on National Debate

By Dr. Jack Kessinger, Missouri Delegate

The following is a summary of what the ACA is doing. At the recent ACA convention we spent considerable time creating strategies for our involvement in the debate on National Health Care Reform and full scope Medicare issues. These are two topics you will be hearing a lot about in the coming months. The ACA also hosted a Chiropractic Summit. There were about 15 organizations present. At the end of the day it was determined that unified actions between our organizations focusing on specific issues was the best way for our profession to successfully navigate the greatest challenges that lie ahead. Please keep your eye out for further communication on this historic meeting.
 
ACA Files Comments Opposing CMS X-ray Proposal
Late last week, ACA filed comments with the Centers for Medicare and Medicaid Services (CMS) in opposition to a proposal eliminating patient reimbursement for X-rays taken by a “non-treating physician,” such as a radiologist, and used by a doctor of chiropractic.  ACA thanks all DCs and other interested parties who "answered the call" and filed similar statements in opposition. 

Confused about Federal Workers Compensation?
ACA has produced an overview of what you need to know when treating a Federal Workers Compensation beneficiary. In the coming months, ACA will release dditional information pertaining to insurance issues, such as the use of re-pricing companies, developing a thorough benefits verification process, and HIPAA.

Have Coding Questions?  ACA Can Help
At the beginning of 2007, ACA launched its new online Coding Resource Center.  The Coding Resource Center is a searchable database that includes code definitions, official ACA policy statements on commonly asked coding questions, ACA official coding clarifications, and template letters for appealing denials based on coding.  ACA encourages members to use the Coding Resource Center when questions arise in your practice.

Medicare Providers to US Senate:  Implement Positive Reimbursement
ACA was among the many Medicare provider organizations that co-signed a letter recently to Senate Majority Leader Harry Reid (D-Nev.) urging the Senate to ensure funding for positive Medicare physician payment updates over the next two years. 

Did You Code Your Patients' Co-Morbidities Today?
Sounds simple, but one would be surprised at how many CMS 1500 forms lack the vital codes that describe patients’ co-morbidities.  Providers often struggle to obtain reimbursement for longer or complex treatment plans simply because they have not given the insurer the most clear description of patients’ conditions and treatment needs.  When claims are filed electronically, notes often cannot be attached.  By coding co-morbidities on the CMS form, the insurer understands from the outset of the claims process the information they need to perform appropriate utilization review.  It also gives the provider the opportunity to note additional factors that may affect

the patient’s progress and to ‘explain’ the choice of care for the patient.  As an example, in 2006 obesity rates increased in 31 states.  In addition to obesity, rates of diabetes and hypertension are also increasing in the U.S.  Co-morbidities such as these should be shown, when possible, not only on the CMS 1500 form, but should be clearly described and accounted for in the treatment plan.

ACA Requests Presidential Candidates to Comment Specifically on Chiropractic
Last week, presidential candidate Sen. Hillary Rodham Clinton (D-NY) announced a wide-sweeping plan for health care reform in America.  Earlier this summer, ACA sent a questionaire to all presidential hopefuls to gauge their support for chiropractic and chiropractic patients.  Thus far, Sen. Barrack Obama (D-IL) and Sen. Chris Dodd (D-CT) have submitted statements regarding support for chiropractic.
In October, ACA will launch a web page dedicated to the 2008 campaign where DCs and patients can quickly go to see each candidate’s statements on health care, their views on chiropractic, and other interesting and helpful information.  Please stay tuned to ACA’s Week in Review for an official announcement on the launch of this web page.

ACA Attends IASIU Conference—Educates Investigators
For some healthcare providers, having a discussion with a special investigator might not be a comfortable experience.  However, ACA representatives were fortunate to have the opportunity to have numerous collegial conversations with special investigators from around the world at the annual International Association of Special Investigation Units (IASIU) conference in early September.  ACA’s presence at the IASIU conference provided a unique opportunity to educate special investigators about chiropractic.  Staff distributed an "Investigator Field Guide" which provides an overview of chiropractic care and helpful resources for claims adjudicators, as well as a brochure about ACA's zero tolerance stance toward fraud and abuse. Additionally, brochures from FCLB regarding their CIN-BAD databank (a comprehensive database of Board actions useful to investigators) were also on hand.  ACA’s presence at the IASIU conference reaffirms its stand as an association that sets the highest ethical bar where quality patient care is the foremost concern. 

Also held in conjunction with this year’s annual meeting was an ACA-sponsored Chiropractic Summit, where representatives of leading chiropractic organizations met to discuss top-level issues of concern among today’s doctors of chiropractic and develop an action plan to address solutions.

Plan to Attend Legislative Day

by Paul W. Foster, DC, PAC President

Mark your calendar! Tuesday, February 12, 2008, from 10:30 am to 3:00 pm.  This is one of the most important fundraisers of the year for PAC .  It is also a great opportunity to become part of the political process and meet face-to-face with your legislator to promote chiro-practic issues.
 
Future fun events
MSCA PAC's first annual "PAC's Great Golf Event" will be held in St. Louis in the fall of 2008.  This will become an annual event and will move around the state.  Details will follow as soon as plans are finalized.

According to PAC by-laws, a PAC membership meeting and reception will be held at the MSCA summer convention for PAC members only.  Again, details will follow when plans are finalized. Watch the MSCA journal and your email news for other PAC events.
 
What is MSCA PAC?
PAC's function is to help keep chiropractic issues in the forefront of the political process.  PAC does not fund political entertainment, trips or non-fundraising activities.
 
Your PAC dollars do go directly to support the campaigns of those members of the general assembly, as well as new candidates, who are friends of chiropractic.  Over the past several years, our success percentage in supporting winners has been over 95 percent, thanks to Mo and Sam's leadership.  This is one of the most important parts of the entire political process, and we must have a strong PAC to survive.

FREQUENTLY ASKED QUESTIONS
Q. What is Legislative Day at the Capitol?
A. It is the biggest fundraiser of the year for MSCA PAC, and a great opportunity to support your profession.
Q. Can I support the MSCA PAC even if I cannot attend?
A. YES! You can donate for two Back-Saver Wallets, one for your senator and one for your representative, and be recognized for doing so even if you are unable to attend.
Q. Should I purchase Back-Saver Wallets for my legislators even if I attend Legislative Day?
A. YES! These high-quality wallets have the MSCA logo proudly printed on them; and the proceeds go to the MSCA PAC.
Q. Is it important for me to join my colleagues in Jefferson City for Legislative Day?
A. YES! If at all possible! This is your best opportunity to get personally involved in the political process and make a difference.

CA’S CORNER

Thank you, but I have other plans

By John C. Nab, DC

Are your plans taking you in the right direction? Be honest with yourself. Do you begin each day with a clear understanding of your desired direction and destination? Are you able to stick to your plan? We all know how easy it is to get caught up in the busy-ness of the day. Many times we find ourselves achieving menial tasks that are empty. Empty because they came at the expense of things that were far more valuable.

You’ve heard it before: failing to plan is planning to fail. Planning is a major component of success. Most of us say we have well-thought-out plans. If I asked you what your vision or mission statement was, could you tell me with a passion and purpose. What about your competitive advantage? What initiatives are you working on to generate another 10 new patients this month?

Let’s admit it. Planning is difficult. There is no immediate value. But if you think of operating your business in the same way you might think about climbing Pike’s Peak, the purpose and advantages of planning become clear. What considerations should you plan for: sudden change in weather, equipment malfunction, incomplete maps, an injury? Planning for these eventualities will allow you to deal with them and still reach your goal. On the other hand, lack of planning can spell disaster. The more careful the planning the more likely problems will be anticipated and not allowed to interfere with your ultimate business plan.

My challenge to you: Review your plan. An effective plan for your business should have a razor sharp focus, passion and help guide you in your daily planning and choices. At a minimum, your plan should include these seven pieces:

• Mission Statement: Defines your core purpose. Why does your business exist?
• Vision Statement: What does your business look like in 5 or 10 years? Where are you headed?
• Core Values: What do you stand for and believe in?
• Competitive Advantage: What do you do better than anyone else?
• Goals with Action Plans: Goals clearly state what, when, how, who and are specifically measurable.
• Financial Assessment: What is your financial health, and what are the trends of your business? Are you maximizing the financial potential of your day?
• Business Continuity/Disaster Recovery: Define what you would do if a fire, flood or tornado wiped out your facility? What about a computer virus? What would happen if you became disabled?

Take all the time necessary to complete a well-thought-out and passionate plan. Then, when someone asks you to do something that is not consistent with your plan, say “Thank you, but I have other plans.”

John C. Nab, DC is Director of Professional Development and Alumni Services at Cleveland Chiropractic College.

MEMBERSHIP REPORT

By Michael Finley, DC
Membership Committee Chair

What do the numbers represent? Many things! They represent membership in the MSCA over the last five years with steady continued growth. Where are all the new members coming from? Almost entirely from doc’s who have graduated just recently and embrace the importance of working together as a team. Recently, we have seen something interesting. Doc’s who have dropped out of the MSCA in the past are coming back. Why? Let’s look at a few possible reasons.

Legislation
The Practice Act was just passed a few months ago. Our profession was arguing for over 15 years to update it. New energy and leadership forged a consensus and it passed. The new practice act gives our Missouri doc’s control of their future. House Bill 121 mandates chiropractic coverage to many Missourians. The “lien law” enforces our right to be paid! All of these occurred in just over the last six years. That’s a piece of legislation being passed every two years. That’s never happened in the past.
Leadership
We are seeing many new doc’s step up for leadership positions. New people often bring in new energy and ideas. This is the key to see a continued growth in our organization. Are you one of those doc’s who’s been thinking about becoming involved? There are numerous activities, and your level of involvement is up to you.

Money
A strong financial base is very important. The MSCA, for years, had a very tight budget, and it handcuffed the organization from some basic decisions. The MSCA’s stronger financial base allowed the organization to hire an additional lobbyist who played a critical role in helping to get the “new practice act” passed.

These are just a few of the things that greater “numbers” allow the MSCA to accomplish. Now, just imagine 1000. Wow!! If you’re a member, stay a member, and tell a friend to join. If you are not a member, “What are you waiting for?” Goals are achieved when we work together and not from standing on the sidelines.

AUXILIARY REPORT

The theme for the 2008 convention is "Expanding Your Mind." In conjunction with this theme, it was suggested that we might decorate/display old/antique chiropractic equipment from years past -- create a bit of a museum. Several at the meeting mentioned having items in their possession which might be brought and displayed. Wanda Munson further suggested Cleveland and Logan has some items that may be used, as well.

Another idea was for the Auxiliary to collect old pictures some of the docs (20-, 30-, 40-year-old pictures), possibly from when they went through chiropractic college, and see how many of their friends in practice recognize them or can name them -- this could be a contest (or not). Your input is greatly appreciated.
 
The next meeting will be held on Saturday, January 26, 2008.

INSURANCE REPORT

By Margaret Freihaut, DC, Insurance Committee Chair

United Healthcare raised a tremendous ruckus in the chiropractic community this month when they released their United Healthcare Bulletin, (Volume 21, September 2007) stating, “United Healthcare had previously concluded that certain services provided as a part of chiropractic care were unproven. A recent review of the clinical evidence in published peer-reviewed medical literature leads to further conclude that chiropractic services for treatment of children and adolescents is unproven and services for treatment of headaches is unproven.”

This new policy has caused all the major chiropractic organizations to ban together in opposition to this new policy. The groups that co-signed a letter to United Healthcare were the American Chiropractic Association, Association of Chiropractic Colleges, Congress of Chiropractic State Associations, Council on Chiropractic Guidelines and Parameters, Foundation for Chiropractic Education and Research, and the International Chiropractic Association. The MSCA is preparing a letter to send concerning this action that they feel will hurt rather than help the health of the enrollees of United Healthcare.

ACN clarified that this does not involve ACN providers but only those contracted directly with UHC. It is my understanding that this would include out-of-network providers in Missouri.

As reported in the last journal, there have been network terminations by ACN for doing spinal decompression and for advertising free or discounted services. Reports have come in from several states where this has happened. The MSCA is very concerned about these actions and how it will affect our doctors and their patients.

I continue to have complaints about the high error rates on claims submitted to UHC and the great difficulty in getting them resolved even after calls and appeals. The Insurance Committee would ask for any documentation that you may have concerning this issue. I would also recommend to all doctors to train your staff to document all calls and make sure to get reference numbers from the employee of UHC you talk with. It is very helpful in documenting to the Division of Insurance. They need to know about these types of problems.

Great-West
Great West is administered by ACN. I have had reports from doctors with upset patients because Great West sends an EOB to the patient that does not match the EOB that they send to the doctor. On the patient’s EOB it shows a higher reimbursement than the doctors are actually getting, and it appears the difference is the administrative fee that ACN collects. It is a very confusing to the patients, and it appears that the policy limits are being based on the higher Great West reimbursements. We are looking for documentation showing these differences and ask that you send them to the insurance committee (especially on fully funded plans).

HMO co-pay lawsuits have been filed on behalf of patients against six different HMOs in Missouri. There has been one case that has settled out of court, and the rest are pending.

Some companies are refunding patients on the backend of care, while others are adjusting EOBs to reflect the lower amounts. Regardless of how they try to compensate for not charging the correct co-pay in the beginning, it discourages our patients from getting the care that they need.

The MSCA Legal Action Fund continues to ask for your support because it needs to be able to fight for our patient’s rights to receive chiropractic care. United we stand. We ask everyone to give a little, give a lot, but give something, because it affects us all.

Documentation from the profession is requested to build a data bank to prove the unfair practices that happen in our offices everyday.

MSCA INURANCE COMMITTEE WELCOMES YOUR QUESTIONS AND YOUR CONCERNS. THANK YOU FOR YOUR CONTINUED WATCHFUL EYE THAT HELPS TO KEEP US INFORMED IN THIS TIME OF MUCH CHANGE IN OUR PROFESSION.

SEND CORRESPONDENCE TO: MSCA INSURANCE COMMITTEE, 500 MAE COURT, FENTON, MO 63026, EMAIL freihaut@ruralcom.net.

DISTRICT 1 REPORT

By Michael Finley, DC

Continuing education seminars for District 1 for 2007!
December 14-16 total 24 hours and January 19 of 2008 for 12 hours. So mark your calendars. There are additional dates for 2008. For a list of speakers and times, contact Dr. Dave Dolinar at 314-355-4050.

Remember 100% of the proceeds go to the MSCA, which in turn supports YOU!

Also check your email for District 1 meetings to get the latest information concerning our profession.

If you are not receiving the emails from the MSCA, contact our director, Kathleen. Her number is in the front of this journal, or go to mscainfo.com to get on the list.

DISTRICT 2 REPORT

By Ron Manfredi, D.C.

Member chiropractors in Kansas City and its nine surrounding counties of Benton, Cass, Clay, Henry, Jackson, Johnson, Lafayette, Platte, and Ray are strong and well and united in their support of the chiropractic profession. This unity was evident at the recent board meeting (which is usually held on the first Thursday of every month at the Ararat Shrine Temple, located at “exit 65” on I-435 in KCMO). The board members are all on the same page when it comes to their efforts to increase membership by endeavoring to provide a better product. That better product being the board’s production of an increasingly more popular and more interesting continuing education seminar series each seminar season. Amazingly, in just the last three years, the board has worked together and has been blessed with good weather, great location, and excellent speakers with focused timely topics. Last year, our two seminars attracted over 300 area chiropractors and other docs from as far away as Medicine Bow, Wyoming. I am proud to announce that the overwhelming attendance has resulted in a historical record-high MSCA District 2 membership. But we are not stopping there. We expect over 200 attendees at our upcoming 36-hour Holiday Extravaganza Seminar, December 7-9, 2007, at the Holiday Inn Northeast in Kansas City. A similar number is expected for our 36-hour Early Bird Seminar Series, held at the same location February 7 through 10, 2008.

This season’s Holiday Extravaganza Seminar series kicks-off on Thursday December 6 with our annual holiday banquet dinner dance. We will enjoy dinner and a magic show with dancing and music provided by The Chuck Eddy Band. All chiropractors and adult family members and their guests are welcome. The 36 hours of continuing education starts the next day and runs for three days: Friday, Saturday and Sunday, December 7, 8, and 9. Twelve continuing- education hours are available each of the three days.

For registration and seminar attendance, please call Dr. Russ Matthias in Blue Springs at 816-228-5113. If you need vender booth information, please call Dr. Linda Buckmiller in Smithville at 816-532-8966 for an application form and information. Some restrictions will apply, and space is limited.

News & Views

OUM’S WELLNESS WORKS PROGRAM AWARDS FOUR SCHOLARSHIPS

The OUM Chiropractor Program, a national provider of chiropractic malpractice insurance since 1983, recently awarded four Wellness Works Scholarships to chiropractic students across the United States. The scholarship funds were raised through the generous financial support of Biofreeze, Chiropractic Economics, Chiropractic Products, Dynamic Chiropractic and Today’s Chiropractic Lifestyle, five prominent companies dedicated to the advancement of the chiropractic profession.

These scholarships were awarded to Jeremy Hozjan, Charlene Lohmueller, Eric Timperley and Nam Tran for their exceptional essays.

If you are a vendor interested in participating in the Wellness Works Program or a student interested in applying for the scholarship, please call 800-423-1504 or log onto www.oumchiropractor.com.

PREVENTIVE SERVICES BROCHURES FOR HEALTH CARE PROFESSIONALS NOW AVAILABLE TO ORDER

The following preventive services brochures from the Centers for Medicare & Medicaid Services (CMS), for health care professionals, have been updated and are now available in print and PDF format:
Expanded Benefits
Diabetes-Related Services
Cancer Screenings
Adult Immunizations
Bone Mass Measurements
Glaucoma Screenings
Smoking and Tobacco-Use Cessation Counseling Services.

To download and view online, please visit the MLN Publications web page located at http://www.cms.hhs.gov/MLNProducts/MPUB/list.asp and select the title of the brochure from the list. To order copies of these brochures, please visit the MLN Product Ordering Page located at http://cms.meridianksi.com/kc/main/kc_frame.asp?kc0001&loc=5 on the CMS website.

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