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District Meeting 6.6.12 @ 7p 

 

Mark your calendars, our summer meeting is just around the corner.  This meeting will take place on Wednesday June 6^th, 2012 at 7:00 pm. This is a great opportunity to gain some valuable knowledge, as well as network with other doctors in the Valley.  The district meeting will be held at our regular meeting location, The Orange Grove Bistro on the campus of Cal State Northridge at 18111 Nordhoff St., Northridge, CA 91330-8271.  This meeting is sponsored by HJ Ross and will help you clean up your billing and coding with the "ABC's of Chiropractic Billing".  

You can RSVP for this meeting by simply responding to the monthly email or faxing this form to Dr. Mumbauer, 818.365.6533.

URGENT SB924

HELP STOP SB 924: Patient Direct Access to Physical Therapists and Provider Corporations' Ability to Hire Physical Therapists 
 
Senate Bill 924 authored by Senator Curren Price, Senate President pro Tem Darrell Steinberg and Senator Mimi Walters, would permit physical therapists direct access to patients without a diagnosis or referral from a medical doctor, doctor of osteopathy, or doctor of chiropractic. Allowing physical therapists to treat without a thorough diagnosis puts patients at risk.
 
Additionally, this measure authorizes only medical corporations and podiatric medical corporations to employ physical therapists; we are troubled that chiropractic corporations are not included in the provision.
 
CCA is very concerned that not including chiropractic corporations in the authorization for employing physical therapists puts patient access to care at risk as we move through this transition period with healthcare reform.  
 
While we agree the provision is necessary to clarify existing law to allow physical therapists to be employed by medical corporations and podiatric corporations to preserve the employment relationships that currently exist, for over twenty years, chiropractic corporations have been able to employ physical therapists until the authority was inadvertently eliminated in statute through SB 907 by Senator John Burton, chaptered in 2003.
 
SB 924 passed out of the Senate without being heard in a policy committee. The measure will be heard next in the Assembly Business, Professions, and Consumer Protections Committee.
CCA will meet with Assembly Member Mary Hayashi, chairwoman of the committee and other stakeholders to discuss our concerns.
 
We need your help! Contact your assembly representative AND express your individual opposition to SB 924. And get your patients involved too!  We've written a template so that you can easily contact your legislators.  Download the letter and customize with your personal information.

Important points to think about regarding SB924

Physical therapists should not treat patients without a referral from a doctor trained in complete diagnosis.
*Only health care providers who are trained in the complete diagnosis of all conditions that affect the human body can provide adequate patient safety.
 *Currently, a patient is examined by a provider educated in diagnosis who can rule out potentially serious or life threatening conditions PRIOR to being referred to a physical therapist for evaluation and treatment. 
 *Our concern lies in the fact that a so-called simple problemmay actually mask a much more serious condition such as heart failure, diabetes, cancer or other disorder.
 *Physical therapists are not trained to diagnose potentially life-threatening conditions. Additionally, they are not trained to order or interpret diagnostic tests such as (laboratory, x-ray, MRI etc.) to make a complete diagnosis.
 *Without the skills to diagnose potentially serious conditions, appropriate treatment could be delayed and patients may be harmed.
 
Chiropractic corporations should be added to the list of providers who may employ physical therapists.
 *The continued ability of healthcare provider corporations to employ physical therapists will enhance the coordination of patient care between providers.
 *Chiropractic corporations should be added to the list of provider corporations that may employ physical therapists.
 *For over twenty years, chiropractic corporations have been able to employ physical therapists. 

 

AB2109

Assembly Member Richard Pan has introduced AB 2109, which would require parents to obtain the signature of a “health care practitioner” for a personal beliefs/religious exemption from his/her child’s school immunization requirement. MD’s, nurse practitioners, and physician’s assistants can sign the form. The “health care practitioner” is also required to provide information regarding benefits and risks of the immunization.  Stay tuned for more information on this issue, and you can view the official bill language here.

 

 

Important

Dear CCA,

It has been brought to my attention that Anchor General Insurance of San Diego has a written exclusion in their policy not covering chiropractic or acupuncture services.  It is extremely important that your staff not only verifies Med-Pay coverage, but that it verifies there are no exclusions for chiropractic care.  As a member of both CCA's and ACA's Dept of Insurance, I will be attempting to contact Anchor General and see why they are placing this restriction with the hope of modifying it. I will keep you posted as to the results.  

Best, 

Brad Sullivan, D.C.

Chair, CCA Dept of Ins. 

 

February District Meeting Photos

A special thanks to all those who came out our February District Meetings.  It was great to see DC's visiting from CCA districts across Southern California!  Also, a special thanks to Dr. Brad Glowaki who gave a wonderful presentation.  We've put a few photos from the meeting in our blog section of the website which you can access here.

Department of Insurance Report

·         Health Plans are now regulated under multiple authorities. In some instances, they are regulated by two or more authorities.

·         Union Plans are regulated under Taft Hartley regulations which allow them to operate however it wants with union member consent. State insurance laws do not apply to Union Plans in general.

·         True insurance products are sold and regulated by the California Department of Insurance.  The same carriers that operate under this license group may also sell plans that are licensed under the Department of Managed Health Care.  The rules are different for each and you should know which authority the carrier operates under.

·         Erisa Benefits and its regulatory authority supersede state laws with the exception of government, school or religious employers. It is very important for each provider to research and understand this complex regulation.  Erisa patients may assign all of their benefits to the provider. This is not limited to just payment, but the right to file a complaint, the right to sue etc.

·         When verifying coverage, your staff must ask sufficient questions to determine the source and type of coverage as well as what regulatory agency licenses the plan.

·         The CCA Department of Insurance will help you, but please realize that the answer will be different depending upon the source and type of coverage.

·         United Health Care sells some plans with a limit on the number of CMT visits and the number of PT visits.  Providers on the east coast are reporting that United Health Care is denying payment for modalities and procedures to DCs after the CMT benefit is exhausted, despite the fact that the patient has more PT coverage available.

·         The January 1, 2012, deadline for 5010 billing implementation has been pushed back to March 31, 2012.  Make sure if you are doing electronic claims submission that your software or clearinghouse are compliant by that date.

·         ICD-10 continues to be scheduled to replace the ICD-9 codes in October 2013. These codes are much more specific and will provide the carriers a more detailed understanding of each patient and their co-morbidities.

To see the full report, please sign into the research section here.

Department of Industrial Relations Summary

CCA Workers’ Compensation Committee

• CCA Workers’ Compensation Committee is preparing for the expected introduction of workers’ compensation reforms in either 2012 or 2013.
• Labor has been interested in restoring permanent disability benefits; however, its resources and focus may be on pension reform and ballot initiative 1487, which restricts union political fundraising by prohibiting use of payroll-deducted funds for political purposes.

New Workers’ Compensation Legislation Signed into Law

• AB 378: requires compound medications to be billed at the ingredient level and be reimbursed at the Medi-Cal rate for each ingredient as identified by its national drug code (NDC). Ingredients, without the NDC, are not reimbursable under this measure.

• AB 459: authorizes the Labor and Workforce Development Agency, upon finding a person or employer willfully misclassified an employee as an independent contractor, to impose civil fines of $5,000 to $15,000 for each violation. If the development agency or a court finds a pattern of willful misclassification, the civil penalty created by the bill is between $10,000 and $25,000 for each violation.

• SB 684: requires insurers to provide written disclosure to California employers if the carrier includes in the employer’s policy a provision that requires disputes to be arbitrated or resolved in courts outside of the state.

• AB 228: allows the State Compensation Insurance Fund to write policies covering the out-of-state employees of companies who have the majority of their workers located in California.

• AB 335: requires the administrative director of the Division of Workers’ Compensation to work with the Commission on Health and Safety and Workers’ Compensation (CHSWC) to develop regulations regarding notices to injured workers that explain the claims process in plain language. It also requires workers’ compensation notices posted by employers include the website address and contact information for the nearest DWC information and assistance officer so workers can get additional information.

• AB 436: establishes the State Public Workers Enforcement Fund to pay for efforts to monitor prevailing wage issues on public works projects.

• AB 1416: amends the California Insurance Code Section 11691 to allow workers’ compensation insurance and reinsurance companies to file mandatory deposits with banks domiciled in California, as well as national banks with a trust office located in the state.

• AB 1426: eliminates the court administrator position at the Division of Workers’ Compensation.  

To see the full report, please sign into the research section here.

IMPORTANT ALERT!!!

Bills Signed Into Law By Gov. Brown

This is important because it may very well apply to advertising by manufacturers in regards to laser, weight loss products etc, and certainly applies to doctors in dealing with the public, and addresses testimonials, and before and after images, the use of a "model", before and after X-rays, claims of superiority, photos and other claims which need scientific evidence to substantiate.. please forward to members and non-memebers and to vendors of products and services.  

 

SB 540 modifies B & P code 651 SECTION 1. Section 651 of the Business and Professions Code is amended to read: 651. (a) It is unlawful for any person licensed under this  division or under any initiative act referred to in this division to disseminate or cause to be disseminated any form of public communication containing a false, fraudulent, misleading, or  deceptive statement, claim, or image for the purpose of or likely to induce, directly or indirectly, the rendering of professional  services or furnishing of products in connection with the  professional practice or business for which he or she is licensed. A "public communication" as used in this section includes, but is not limited to, communication by means of mail, television, radio, motion picture, newspaper, book, list or directory of healing arts practitioners, Internet, or other electronic communication. (b) A false, fraudulent, misleading, or deceptive statement, claim, or image includes a statement or claim that does any of the following: (1) Contains a misrepresentation of fact. (2) Is likely to mislead or deceive because of a failure to disclose material facts. (3) (A) Is intended or is likely to create false or unjustified expectations of favorable results, including the use of any photograph or other image that does not accurately depict the results of the procedure being advertised or that has been altered in any manner from the image of the actual subject depicted in the photograph or image. (B) Use of any photograph or other image of a model without clearly stating in a prominent location in easily readable type the fact that the photograph or image is of a model is a violation of subdivision (a). For purposes of this paragraph, a model is anyone other than an actual patient, who has undergone the procedure being advertised, of the licensee who is advertising for his or her services. (C) Use of any photograph or other image of an actual patient that depicts or purports to depict the results of any procedure, or presents "before" and "after" views of a patient, without specifying in a prominent location in easily readable type size what procedures were performed on that patient is a violation of subdivision (a). Any "before" and "after" views (i) shall be comparable in presentation so that the results are not distorted by favorable poses, lighting, or other features of presentation, and (ii) shall contain a statement that the same "before" and "after" results may not occur for all patients. (4) Relates to fees, other than a standard consultation fee or a range of fees for specific types of services, without fully and specifically disclosing all variables and other material factors. (5) Contains other representations or implications that in reasonable probability will cause an ordinarily prudent person to misunderstand or be deceived. (6) Makes a claim either of professional superiority or of performing services in a superior manner, unless that claim is relevant to the service being performed and can be substantiated with objective scientific evidence. (7) Makes a scientific claim that cannot be substantiated by reliable, peer reviewed, published scientific studies. (8) Includes any statement, endorsement, or testimonial that is likely to mislead or deceive because of a failure to disclose material facts.

 

 

Our CE meetings were a hit!  Thank you to all in attendance, and check out the photos here.

 

 

CALIFORNIA CHIROPRACTIC BOARD ADOPTS INFORMED CONSENT REQUIREMENT FOR CHIROPRACTORS

 

With the recent adoption of new informed consent requirements for California chiropractors, the California Board of Chiropractic Examiners has joined the ranks of only a few chiropractic regulatory agencies in the nation to require its licensees to inform patients of potential risks of their treatment.  The new law, which goes into effect on October 7, 2011, requires chiropractors to obtain patient consent prior to providing any treatment that could pose a risk of harm to the patient.  Specifically, this regulation will:

 

·         Require all licensees to inform each patient, verbally and in writing, of the material risks of proposed care.

·         Define “material” as a procedure inherently involving known risk of serious bodily harm.  Require the licensee to obtain the patient’s written informed consent prior to initiating clinical care.

·         Provide that the signed written consent shall become part of the patient’s record.

·         Specify that a violation of the above requirements constitutes unprofessional conduct and may subject the licensee to disciplinary action.

 

"The BCE has been working diligently to improve the standards of care in the chiropractic profession in California,” said Fred N. Lerner, D.C., Chair of the BCE.  “The BCE’s primary mission is consumer protection, and these new regulations are part of the Board’s ongoing effort to ensure patient safety.  Informed consent is considered a standard of care in the chiropractic profession and this regulation reinforces that standard.  The informed consent process ensures that the patient’s right to self-determination regarding health care is paramount.” 

 

The BCE continues to work with stakeholders on other regulations to improve patient safety and consumer protection. 

 

Please visit the BCE’s website www.chiro.ca.gov for information regarding existing and proposed regulations. To receive timely information concerning upcoming meetings and new and proposed laws.  Join the Board’s E-mail List at the following link: http://www.chiro.ca.gov/onlineservices_subscribe.htm

 

 

 

New CCA Group Health and Dental Insurance Program Unveiled

 

CCA is excited to announce the endorsement of a group health and dental insurance program brokered by longtime CCA broker of endorsed workers’ compensation, business and personal lines of insurance, Warren G. Bender Co. Now, CCA members can potentially improve their coverage and reduce their premiums health and dental insurance.

 

This CCA member exclusive and unique group health and dental insurance programs offer:

 

·         Unlike individual coverage, group health insurance cannot be denied for pre-existing conditions

·         Coverage available for groups as small as two (and in some regions even one participant is sufficient)

·         With one phone call, you'll have access to dozens of group plans, ranging from very broad to high deductible programs

·         Bender will scour the marketplace for the group health and dental plan that meets your needs and budget, including Aetna. Blue Cross, Blue Shield, Ameritas, Colonial, Delta, HealthNet, Kaiser, MES, Met-Life, Premier Access, Principal, UnitedHealthcare, Western Health Advantage and more

·         Bender proactively alerts you to changes with the carriers and keeps you informed regarding the benefit plans with the best value.

·         Bonus: CCA members who purchase the CCA-endorsed group health insurance will have access to a comprehensive on-line resource to California employment and labor law tailored to small businesses for $4 per month (retail value at $1,100  for the first year).  For groups of 5 or more, this HR resource will be absolutely free!   

 

Learn more about all of the lines of CCA-endorsed insurance products brokered by Warren G. Bender – workers’ compensation, businessowner’s, disability, office liability, and home and auto by visiting Bender’s booth at the free CCA Annual Convention & Exposition, June 10-12, in Reno, or call 877-WGBENDER (942-3633).

 

Return on Dues Investment: Based on actual policies written for CCA members, members can save from 50 to more than 100 percent of their annual dues investment on individual coverage for home, automobile, and business coverage for workers’ compensation, disability or office liability and group health products endorsed by CCA and brokered by Warren G. Bender Co.

 

 

Do you know all the requirements to keep your chiropractic license up to date?  Check out this flyer for all the details on how many CE hours are required for license renewal.

 

 

ACA Aggressively Pursues Concerns with ASHN

The American Chiropractic Association (ACA) continues to aggressively pursue its advocacy efforts on behalf of doctors of chiropractic against certain chiropractic managed care networks. Based on concerns received from many states across the nation since fall 2010, American Specialty Health Network (ASHN) is one of the most frequently identified offenders. According to reports, ASHN has created chaos for providers and patients by not thoroughly vetting its business arrangements through state Departments of Insurance and by implementing egregious practices such as those that would impose in-network type management upon out-of-network providers. In some states, employers were reportedly not notified that ASHN would be managing their employees’ chiropractic benefits. In others, the insurer, even after the agreement to bring on ASHN, was unaware of the policies under which providers would be managed. The overall confusion from these practices has caused patients, providers and employers to become very concerned.

To date, the ACA has received complaints of the following:

• lack of clear communication to providers, patients and employers resulting in coverage and payment errors;
• unwillingness to resolve confusion of patients and providers by coordinating services with payers;
• restriction of treatment not in keeping with standard chiropractic practice;
• disregard of state statutes;
• interfering with doctors’ duty to exercise professional clinical judgment in managing patients’ treatment plans;
• lack of appropriate, evidence-based clinical rationale for denial of treatment;
• untimely payment of claims.

The ACA recommends that providers contact their state Department of Insurance to make the voices heard on behalf of their patients. Resources to help providers can be found at the ACA Chiropractic Networks Action Center here:  www.acatoday.org/cnac.*
All providers are strongly encouraged to contact and/or send documentation to the ACA explaining the problems being encountered by calling (703) 812-0225 or by emailing insinfo@acatoday.org.

The ACA is committed to advocating on behalf of providers and patients, and to halting the abuses that impede appropriate patient care, and fair, equitable and timely provider reimbursement. 

*Check the CNAC webpage often as this page is frequently updated. 

New law increases the annual license renewal fee from $150 to $250. New BCE regulations require licensees who have either not previously submitted fingerprints to the BCE, or who were initially licensed prior to January 1, 1997, or for whom a record of an electronic submission of fingerprints no longer exists,  to submit fingerprints electronically. Licensees are required to comply by the licensee’s renewal date that occurs on or after June 1, 2011.

It was been an honor having Dr. Dale Fernandez serve as president of the board for the San Fernando Valley District.  Dr. Fernandez has served on the board for the past two years and was recently awarded “The 2011 Doctor of the Year.”  Since Dr. Fernandez has been in office he has overseen some great accomplishments.  A significant update to the San Fernando Valley District website now includes a research library and very efficient means of distributing information to the district.  Additionally, a shift in the presentation and delivery of the monthly newsletters has taken place.    Dr. Fernandez, has also led and organized many district meetings.

We will still have Dr. Fernandez serving the district on the CE committee.  This new committee will be charged to bring a CE courses directly to the district.  (Please visit CCAmembers.com to find out more information about the upcoming CE course).  Dr Fernandez will also continue to treat patients at his Valley Village practice.

Thank you Dr. Fernandez!

A Response From Congressman Adam Schiff

We recently sent you a very important news item regarding our Veterans (see below).  A bill was introduced by Bob Filner called “Chiropractic Care to All Veterans Act” (H.R. 329) that would require the VA to staff their hospitals with DC at all major Veterans Hospitals by 2014. 
 
Eric and Pat Mumbauer got in contact with the Honorable Congressman Adam Schiff, who is a long time supporter of the CCA and friend to the San Fernando Valley District.  Congressman Schiff responded with the following letter:

Hey Pat,
Thanks so much for your email. I would be proud to cosponsor H.R. 329 (Chiropractic Care Available to All Veterans Act) which will amend the VA Health Care Programs Enhancement Act of 2001 to require a program under which the VA provides chiropractic care and services to veterans through VA medical centers and clinics.  The bill also includes chiropractic examinations and services within required VA medical, rehabilitative, and preventive health care services.  I have asked my staff to add me to the bill. 
 
I also want to let you know that I am co-sponsoring HR 409 (Chiropractic Health Parity for Military Beneficiaries Act) that directs the DoD, no later than August 31, 2011, to complete development of a plan to provide chiropractic health care services and benefits, as a permanent part of the TRICARE program (a DoD managed health care program), for covered beneficiaries. Please give Eric my best, and thanks for the heads up!
 
My best,
Adam

You are the CCA!  We stand together and work toward a common goal.  Bills like H.R. 329 help ensure the future of our practice as well as get treatment to our honored Veterans.  With the CCA we have the power to reach out and work with our elected officials.  Thank you for your continued membership with the CCA.

Help Advocate for Expanded Access to Chiropractic for Our Veterans

Rep. Bob Filner (D-Calif.), recently introduced the Chiropractic Care to All Veterans Act (H.R. 329), a bill similar to legislation that was overwhelmingly passed by the House in 2010, but was not considered in the Senate. H.R. 329 would require the VA to have a chiropractic physician on staff at all major VA medical facilities by 2014. You too can help ensure chiropractic care is available to the brave men and women who have served our country. H.R. 329 needs cosponsors to increase the likelihood of this effort's success. Simply click here to urge your legislator to cosponsor H.R. 329!

 

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