ON JUNE 23, ACA HOSTED A PRESSCAST via live teleconference for members of the chiropractic press and state association representatives to provide them with an update on the association’s recent advocacy efforts. Led by ACA government relations staff who lobbied successfully for improvements to the Protecting the Integrity of Medicare Act (PIMA) and ACA leadership who have met with the Department of Health and Human Services (HHS) numerous times on the issue of parity for chiropractic services in Medicare, the press-cast focused on the following key areas:
ACA’S EFFORTS TO IMPROVE CHIROPRACTIC DOCUMENTATION IN MEDICARE
The chiropractic profession’s Medicare documentation error rate is the highest among any provider group and has been so for quite some time. Data from 2014 show that 54 percent of chiropractic Medicare claims were improperly paid, with more than 92 percent of the errors attributed to insufficient documentation.
“From the Office of Inspector General [OIG] reports to annual Comprehensive Error Rate Testing [CERT] reviews, the chiropractic profession has carried a target on its back when federal policymakers come looking for areas where they can trim the budget,” said John Falardeau, ACA’s senior vice president of public policy and advocacy.
PIMA is part of an ongoing federal effort to reduce Medicare claim error rates. Working for nearly a year with its allies in Congress, ACA successfully fended off a provision in the legislation that would have subjected all chiropractic claims in Medicare to a program of “ preauthorization” review, substantially disrupting beneficiary access to chiropractic services.
Through its strategic intervention, ACA succeeded in overhauling the proposed chiropractic preauthorization requirement under PIMA in a very dramatic and positive way.
“We quickly went into action,” Falardeau recalled. “We hired an outside lobbying firm, we held regular negotiations with staff, and we talked to virtually every member of the committee. We basically said this provision, in its original form, was completely unacceptable and would harm patient access.”
Once the PIMA bill was formally introduced, ACA was able to include a provision directing HHS to develop an education program to help improve documentation in chiropractic Medicare claims. The provision stipulates that the program would be created in consultation with ACA and Medicare Administrative Contractors (MACs) and implemented by Jan. 1, 2016. Under the provision, DCs whose claim denial rates are out of line with the rest of the profession could be subject to preauthorization standards established by HHS. DCs with a good record of claims based on proper documentation and those who avail themselves of the education program will avoid preauthorization requirements that non-compliant providers could face.
ACA is developing an online education course in Medicare documentation that should be available later this year. ACA is also in some cases partnering with state associations to bring its Medicare coding experts in for an intense one-day, in-person training session that includes participation by the local MAC.
ACA’s public policy and advocacy department has created a web page to serve as a clearinghouse for all PIMA-related information: www.acatoday.org/PIMA.
ACA’S ONGOING CAMPAIGN TO CURB DISCRIMINATION AGAINST THE CHIROPRACTIC PROFESSION
During the press-cast, ACA noted that many of the new health plans created as a result of the health care reform law include the essential services provided by DCs, including the BCBS Federal Employee Plan (FEP), which modified its benefit language in 2014 to account for Section 2706 of the Patient Protection and Affordable Care Act (PPACA).
“We’ve found that some — but by no means all — of the smaller Blues plans have followed suit and adopted similar language to FEP,” said Falardeau. “However, we still view the federal and, in many cases, the states’ disregard for Section 2706 of PPACA to be a serious threat and one that we are working to rectify. Unfortunately, there are many examples of plans that continue to ignore and/or selectively interpret the protections afforded by 2706(a), and we’re gathering examples of discrimination against DCs and actively advocating for the profession.”
ACA is nonetheless encouraged because, at its urging, CMS recently clarified a section of PPACA that led some states to improperly limit patient access to chiropractic physicians and other qualified non-MD/DO health care providers. On May 26, CMS withdrew and replaced a Frequently Asked Questions (FAQs) document on Section 2706(a) with one containing a more realistic approach to the issue of provider non-discrimination. The new FAQs establish a more reasonable standard for Section 2706(a) enforcement and are more in line with ACA’s understanding of the issue.
“This new guidance is a direct result of ACA’s work to ensure the provision is implemented correctly,” noted Falardeau. “We took this fight to Congress and even to the White House.”
Falardeau emphasized that ACA continues to monitor payer activity and engages with insurers to ensure compliance with Section 2706(a). His team has come across insurers that pay DCs less than other providers for the same services and do not allow DCs to perform procedures that are within their state’s scope of practice. In those instances, ACA’s payment policy team has written letters to insurers throughout the country and ACA’s legal team has closely monitored the situation.
Staff will overhaul the existing Section 2706 information page on the ACA website (www.acatoday.org/2706) to reflect even more resources for states, payers and policy makers over the coming months.
ACA SEEKS TO REFORM FEDERAL STATUTES LIMITING MEDICARE COVERAGE FOR CHIROPRACTIC SERVICES
ACA concluded the press-cast by providing an update on Medicare parity, a top legislative and regulatory priority for the association. Chiropractic inclusion in the Medicare program was established in 1972 and has seen little change since then, other than elimination of the X-ray requirement in 1997.
According to Falardeau, ACA continues to emphasize to Congress the importance of allowing chiropractic physicians to practice and be reimbursed for the fullest extent of their licensure, training and competencies.
“What we’re asking for is not any new benefit in Medicare,” said Falardeau. “What is feasible, in our view, is to allow a DC to perform to his or her education, scope and licensure within federal regulatory parameters.”
Falardeau and his staff have been working with Congress to pass legislation to change the current statute and ensure chiropractic parity. They have met with senior leaders of committees of jurisdiction, have targeted members of those committees and have had detailed discussions with staff on Capitol Hill. They are currently putting together a grassroots program, scheduled to launch later this year, which will bring more attention to the issue among DCs and their patients.
While progress has been made, Falardeau noted that more work remains to be done.
“It will take the work of ACA’s leadership, members and staff to ensure that chiropractic parity in Medicare happens,” said Falardeau. “It will also take the profession’s support and cooperation, as this campaign will undoubtedly need resources beyond just ACA.”
ACA plans to host additional press-casts over the coming months to further educate and engage the chiropractic media and state associations on advocacy efforts related to the most vital issues affecting the chiropractic profession.
If you are interested in participating in future press-casts, please email ACA’s communications department email@example.com.
Nicole Racadag is ACA’s public and media relations manager.