Action Steps
Resources Available to Assist You
Questions?
The American Chiropractic Association is urging doctors of chiropractic nationwide to take immediate action to provide documentation pertaining to, what we view as discriminatory practices of chiropractic networks. The Congress of Chiropractic State Associations (COCSA) has recently joined with ACA in this important call for action. The investigation of these matters is becoming an issue of national interest and we want to supply regulatory authorities with the information they need to stop these discriminatory practices.
“Doctors across the country have the information that regulatory authorities need to address the serious problems posed by managed care organizations,” announced ACA President Dr. Glenn Manceaux. “Many doctors have assisted us over the past three years in this long battle, but now more than ever, it is time for all doctors of chiropractic to take action and stand together to protect our patients and our profession. We have a real opportunity, one that we may not have again, to address the problems of these networks – and we cannot do it without help. We must all do our part now, to put an end to the discriminatory practices of some managed care panels.”
ACA has been in communication with several state Departments of Insurance and Attorneys General regarding tactics employed by managed care networks that, in ACA’s view, limit reasonable and necessary treatment, placing effective patient care at risk. So far, in 20 states, the preliminary evidence gathered by ACA has been used to petition regulators to open investigations. Some of these regulators are already collaborating with other state regulatory agencies regarding our concerns.
“The only way that state authorities will act is if they have the ‘ammunition’ to take on the powerful and wealthy managed care companies,” added Dr. Manceaux. “That ammunition is your patients’ records, which contain hard evidence on how managed care decisions have limited access to medically necessary chiropractic care that is provided for under plan descriptions and/or state law.”
Please do your part to move this historic effort forward. Help us give regulatory authorities the information they need to investigate and correct these discriminatory practices of managed care panels. To get started, see Action Steps.
Thank you for your help with this important initiative. Together, we can accomplish great things.
ACTION STEPS
Managed Care Data Collection Initiative
1. Identify patients whose care has been compromised by inappropriate policies, procedures or coverage decisions of managed care networks.
2. Complete a Summary Patient Information Form for each of your patients identified.
3. Copy all the following that apply to each patient’s case.
a. Patient intake forms - case history, chief complaint(s), etc.
b. Diagnostic reports – x-ray report, exam, test results, etc.
c. Chart notes – treatment plan, progress notes, re-exam(s), outcomes, etc.
d. All communications, letters, forms that show a complete chronology of the interaction with the managed care organization
3. Sanitize the copies of the patient file(s) to be submitted. Be sure to retain all originals in the charts.
If you decide to submit un-sanitized patient files, then you must first obtain a HIPAA Authorization: You should appropriately explain HIPAA rights to the patient – a brochure can be found here in case you are unsure if your office documentation covers all aspects of HIPAA regulations. Once you are sure the patient clearly understands the reason for this initiative, and they indicate they would like to participate, have them sign the HIPAA Authorization, found here which has been pre-completed for your convenience.
4. Mail the copies of your sanitized patient file(s) to ACA with the completed Summary Patient Information Form attached to the front of each file submitted.
American Chiropractic Association
Attention: Insurance Relations/Records
1701 Clarendon Blvd.
Arlington, VA 22209
If you decide to send un-sanitized patient files, then you must include signed HIPAA Authorizations.
For ease of future submission of un-sanitized charts, you may choose to sign a Business Associate Agreement which will allow submission of files without authorizations.
Resources Available to Assist You
Questions?
For questions about this initiative, please e-mail insinfo@acatoday.org or call (703)812-0225. Your assistance with this unprecedented data collection is critical to this collaborative effort and very much appreciated.
Together we can bring managed care abuses to light and share this information with those who have the power to stop inappropriate policies and practices of managed care networks.
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