ACA - The American Chiropractic Association (ACA) - Representing doctors of chiropractic (chiropractors)-

Managed Care Data Collection

Part 1

Resolution

The American Chiropractic Association (ACA) has long been concerned over the harmful and discriminatory practices of managed care organizations, particularly chiropractic networks and third-party administrators affecting proper patient care and the practice of chiropractic. We vehemently oppose these harmful and discriminatory practices, including but not limited to: limiting full scope of practice, inappropriate CPT applications and reimbursement policies, use of discount/affinity programs, restrictive limits of care, and improper utilization review.

To determine the scope and impacts of managed care on the chiropractic profession, ACA staff is collecting data to identify abuses and develop an implementation plan to halt these unfair practices.

Part 2

Data Collection

You can be an important part of creating change in the managed care industry by providing data on your managed care experiences. Be assured we will not release your name to any managed care network. Please complete the following:

* Network/MCO:

* Insurer:

* Location/State:

Issues (Please check all that apply and provide specific comments below as necessary):

Coding E/M CMT X-Rays Modalities Modifiers Downcoding/ Bundling* Other	Reimbursement Fee decrease Untimely payments Documentation Per diems/ Global fees Other	Performance Overtreatment Lack of authorization Other	Contract/Network Termination/ Non-acceptance Plan limitation/Caps Other	Treatment Limitations Requested care denied Requested care restricted
* The ACA is currently particularly interested in receiving more information on downcoding/bundling issues.

Comments:

Part 3

Documentation

Are you able to provide documentation on the above complaints? Yes No

If patient information is provided, please remove or otherwise expunge any patient identification information and/or confidential patient information from the documentation provided to us and fax to ACA Data Collection: 703-243-2593

Part 4

Contact Information

Submitting data on your experiences with networks and managed care organizations will assist ACA in working on your behalf. Please note that the information provided on this form and on our website is the most current information/advice we have available at this time.

In the event ACA needs to contact you, please provide the following:

* Name:
Address:
* City:
* State:
Zip Code:
* Telephone:
Fax:
Email:

Thank you for your cooperation so managed care improvements
can be made for the chiropractic profession.