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 Educate primary care physicians, employers, and mid-level providers about the benefits of chiropractic care with these informative brochures:
Chiropractic Professionals: Part of Your Managed Care Team
Doctors of Chiropractic: Part of Your Team - A Guide for Employers
Chiropractic Professionals: Part of the Managed Care Team
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 Chiropractic Managed Care Index - New!
This new series of educational articles for ACA members informs doctors of chiropractic on insurance and managed care issues that can effect their business.
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The emerging dominance of managed care in the 1990s made obtaining contracts from managed care organizations not only a priority, but a necessity for doctors of chiropractic. In this section you'll find what you need to know about federal managed care programs, general information on managed care, and resources you can use from ACA's managed care experts to assist you in working with managed care organizations and plans. |
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| Federal Employees Health Benefits Program: Medically Underserved Areas for 2005 |
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Each year the Office of Personnel Management (OPM) is asked to determine, for the purpose of the Federal Employees Health Benefit Program (FEHBP), which states are considered Medically Underserved Areas (MUA). MUAs, designated by the Department of Health and Human Services (HHS), are determined to be states where 25% or more of the population lives in an area with a primary medical care manpower shortage.
From a practitioner's perspective this means, effective January 1, 2005, covered federal employees in the FEHBP not in an HMO and subject to their benefit contract terms, are reimbursed for covered services obtained from any licensed provider in these MUA states (under the basic option, the practitioner must be a Preferred Provider with the plan). In specific relation to chiropractors, if a service is considered a covered service and is within the scope of practice, under the statute those services can be reimbursed if the patient is not part of an HMO plan.
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| Blue Cross/Blue Shield Federal Employee Plan: What You Need to Know |
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The ACA has received confirmation from both the Federal Office of Personnel Management (OPM) and the Blue Cross/Blue Shield Federal Employee Program (FEP) that doctors of chiropractic may now be reimbursed for physical therapy (PT) services under the FEP plan. This PT benefit is in addition to the manipulation benefit in place since January 1, 2002 under the Basic Option of the FEP plan.
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| Federal Worker's Compensation: What You Need to Know |
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Although the Federal Worker's Compensation Act (FECA) authorizes medical services for treatment of any condition causally related to factors of Federal employment, many doctors of chiropractic have found difficulty in getting their chiropractic claims paid. The reasons for this difficulty are quite varied, as noted in ACA's 2004 Chiropractic Coding Solutions Manual.
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| Managed Care and Chiropractic |
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With the emergence of managed care in the 1990?s, the ACA initially took an educational role in alerting doctors to pre-contract issues to consider. As more and more DCs enrolled in managed care plans, a different picture emerged: DCs were not getting referrals from gatekeepers and some were not getting contracts renewed. More recently, restrictive global fees are emerging as a financial threat.
In response, the ACA Legal, Government Relations and Professional Development and Research areas joined forces and developed an anti-discrimination, non-exclusion, direct access non-referral, patient quality of care legislative model for state chiropractic associations to use in state lobbying. There are many added features that protect doctors and patients in the medical review and appeal process.
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| ACA/Managed Care Professional Responsibilities |
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The American Chiropractic Association (ACA) and chiropractic networks have common interests in finding ways to cooperate with one another. Those interests center on the value in selecting chiropractic care and the patient's ability to obtain direct access to a doctor of chiropractic and quality care within payer plans. To further the market value initiative, a forum has been established for the ACA and chiropractic networks to discuss issues of common interest and seek the greatest good for the patient. The following matrix identifies major priorities and serves as a roadmap to an improved business relationship to benefit the chiropractic patient and the advancement of chiropractic in insurance paid plans.
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| Managed Care Data Collection |
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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. While we have developed excellent working relationships with certain managed care networks, others will be compelled to respond given factual information on their practices that you provide. You can be an important part of creating change in the managed care industry by providing data on your managed care experiences.
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