In order to address problems that have been created by abusive IMEs, the Missouri governor has signed into law a very important piece of legislation. The chiropractors of Missouri, faced with the same IME-related problems as the rest of the profession in the United States, developed legislation that would solve most of their problems:
Problem -- Out of state "hired guns" reviewing claims in Missouri.
Solution -- All claims reviewers are required to "be licensed and practicing as a chiropractor in the state of Missouri. ..."
Problem -- Some chiropractors currently reviewing insurance claims are simply not trained sufficiently for the task. They lack the adequate experience and/or education to allow them to perform a review fairly.
Solution -- All DCs who wish to conduct claims reviews must have:
"Successfully completed at least 100 hours of postgraduate training in insurance claims consulting. This training must have been presented by a college of chiropractic having status with the council on chiropractic education; or
"Successfully completed at least one hundred hours training in insurance claims consulting in the course of study approved by the Missouri Board of Chiropractic Examiners. ..."
Problem -- Some chiropractors become full-time claims reviewers. This creates a potential problem whereby the reviewer can lose perspective.
Solution -- A reviewer must "have received at least one-half of his earned income from the practice of chiropractic."
Problem -- Some insurance companies offer a "commission" or percentage of the amount of the claim as payment to the reviewer.
Solution -- "The compensation of such consultant shall not be based on a percentage of the amount by which a claim is reduced for payment."
While this new law will not eliminate all abuse problems, it should make most problems manageable. If you would like a copy of this legislation in its entirety, please phone the Missouri State Chiropractors Association (314) 636-2553.
Kenneth Osia, D.C.
(314) 351 6308
Editor's Note:
Dr. Osia has worked very diligently for the past two years in an effort to bring this legislation through the political process and into law. The Missouri State Chiropractors Association has awarded those efforts by honoring Dr. Osia as their 1990 Chiropractor of the Year. The efforts of Dr. Osia and the other members of the profession who have worked so hard in Missouri will benefit the chiropractic profession and its patients for years to come.
Some state boards and colleges are working very hard to implement consultant certification programs. Call your college or state association to find out when it will be offering this program in your area.