Specifically, the ACA is gathering information on these and other wrongful practices: automatic downcoding or limiting physician discretion in the planning of care; CPT code bundling; improper utilization review (including refusal to recognize coding modifiers); and performance management issues, such as limiting the number of visits, X-rays and modalities.
This aggressive anti-abuse campaign stems from a March 2002 ACA House of Delegates resolution that formally outlined the association's opposition to these improper practices by chiropractic networks, and authorized the collection of data to determine the types of abuses inflicted upon chiropractors by third-party administrators. As part of this process, the ACA recently retained prestigious plaintiff law firm Milberg Weiss to assist in data collection/analysis.
Several disturbing trends have emerged in reviewing data collected over the past three years from "managed care data collection" forms completed by doctors of chiropractic. Doctors of chiropractic appear most troubled by three managed care carriers: American Chiropractic Network (ACN), American Specialty Health Plans (ASHP), and Landmark Healthcare. According to doctors who completed data collection forms, these carriers routinely deny requested treatment and reduce or deny reimbursement.
"We have heard your complaints, and we are further analyzing our options to deal with these activities," emphasized ACA President Donald Krippendorf, DC. "We need your continued support and information to protect not only your practice and profession, but also the quality of care you provide your patients."
If you have experienced problems with chiropractic managed care carriers, particularly with respect to the restriction of treatment, downcoding, bundling, and/or improper use of modifiers, the ACA urges you to complete the data collection form available on the association's Web site:
www.acatoday.com/pdf/managed_care_collection.pdf. The completed form can be submitted via fax to 703-243-2593, Attention: PDR Department. All information will be kept confidential.
Additional information regarding the ACA's data collection campaign appears online at www.acatoday.com/insurance/managed_care/
resourcesheet.shtml.
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