WELCOME TO THE PENNSYLVANIA CHIROPRACTIC ASSOCIATION!
YOUR PCA is working for you in Harrisburg and on Capitol Hill!
How the COVID-19 pandemic created a "perfect storm" for opioid addiction
sent by Keith Miller, PCA Vice-President
The PCA working group for UPMC HP recently met with top representatives of UPMC HP and had a very productive call addressing the following important topics:
- E/M denials- You may send appeals to HPtempproviderappeal@upmc.edu.
- Pre-auths for children under 13
- TMJ/ Fibromyalgia coverage
- 98940-98942 billing on the same day as 98943
- Routine Care definition
- Tiering
- Billing
- Appeal times-FYI UPMC has 60 BUSINESS days to respond to appeals.
UPMC HP relayed some encouraging information to the working group, but final decisions have not been reached at this time. PCA continues to address these matters with UPMC HP and expects developments soon.
Dr. Justin Miller, a member of PCA’s UPMC HP Working Group summarized the discussion nicely: "This is a great example of your PCA dues making a positive difference. Thank you to all involved with your countless hours researching and organizing to make a difference for our profession!"
If PCA members have questions or want more information, email PCA's UPMC HP working group chair, Dr. Darcie Anselment: acdarcie@gmail.com.
###
Medicare FFS Claims: 2% Payment Adjustment (Sequestration) Suspended Through December
The Coronavirus Aid, Relief, and Economic Security (CARES) Act suspended the sequestration payment adjustment percentage of 2% applied to all Medicare Fee-for-Service (FFS) claims from May 1 through December 31, 2020. The Consolidated Appropriations Act, 2021, extended the suspension period to March 31, 2021. An Act to Prevent Across-the-Board Direct Spending Cuts, and for Other Purposes, signed into law on April 14, 2021, extends the suspension period to December 31, 2021.
Medicare Administrative Contractors will:
· Release any previously held claims with dates of service on or after April 1
· Reprocess any claims paid with the reduction applied
You don’t need to take any action
https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2021-04-16-mlnc
– Sent to PCA courtesy of Dr. Victor Rizzo
###
The Bureau of Occupational Affairs has learned of an increase in scams targeting health related licensees.
Interested in Getting Involved?
PCA 2021- 2022 PRIORITY LEGISLATION:
House Bill 171 of 2021: An Act limiting restrictive covenants in health care practitioner employment agreements.
House Bill 173 of 2021: An Act amending Title 40 (Insurance) of the Pennsylvania Consolidated Statutes, in special provisions relating to particular classes of insurers, providing for nondiscrimination by payers in health care benefit plans.
House Bill 225 of 2021: An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in quality health care accountability and protection, further providing for definitions, for responsibilities of managed care plans, providing for preauthorization standards and for preauthorization costs, and providing for preauthorization and adverse determinations, for appeals, for uniform preauthorization form, for preauthorization exemptions.
House Bill 325 of 2021: Advisory Opinions from Licensing Boards
House Bill 916 of 2021: An Act amending the act of May 17, 1921 (P.L.682, No.284), known as The Insurance Company Law of 1921, in casualty insurance, providing for coverage for nonopioid pain management care.
-
Delegation of Therapeutic Exercise to Unlicensed Personnel (no bill # yet)
-
Parity in Insurer Reimbursements (no bill # yet)
-
PID Direct Oversight and Enforcement Authority of Health Insurers’ Contracted Third Party Administrators (no bill # yet)
Working Groups are Formed! Join YOUR Colleagues! #PCAStrong
The staff at the home office has never been better. Our executive vice president is cordial, respectful, and a true leader who has years of experience which has helped the association greatly over the past number of years.
I'm thankful for the PCA and what we as an association have accomplished to protect the rights of chiropractors to practice as well as protecting the health of individuals throughout our state."
Ed Kropf, DC - Pittsburgh, PA
"As a PCA member over 31 years I have been a distant observer of Chiropractic in our state as well as the several factions of philosophy practiced here. As so far as the PCA is viewed, I feel the current system in place is providing the best communication with it's members. PCA has put into place several terrific members and administration that take on the problems from many fronts, report and attempt to correct/improve the position for the future of Chiropractic in our state.
Good job, you all are doing things so very much better, keep it up!!!"
The level of responsiveness from any direct inquires to the Execs or affiliates(legal, political) has always been unparalleled with Ed Nielson as Executive Director. Whether you are a member or not, you have benefited from battles won by the PCA that may have never crossed your front steps.
The PCA has been a major contributor to my success in practicing in Pennsylvania. I am grateful to serve and more grateful to have such selfless colleagues that freely donate hours and hours of their time for our benefit as Pennsylvania DCs!"
“I am a retired doctor, who was hit with a $17,000 recoupment request from a Pennsylvania health insurer, TWO years after I retired. As a retired-status member, I immediately contacted the Pennsylvania Chiropractic Association. PCA’s staff were responsive and very helpful, including referring me to Mr. Jason Martin, PCA’s General Counsel, for a free legal consultation.
After talking at some length with Mr. Martin, he assisted me with the audit and provided very solid advice. I followed his advice and I was able to resolve the audit with the health insurer without any payment on my part. I am thrilled with the supportI was given by PCA staff and General Counsel Martin’s legal advice.
Thanks to my membership in PCA, I received very responsive and immediate support for my problem. Most importantly, my membership in PCA saved me $17,000of my hard-earned money! Thank you, PCA!”
Lori Kalie, DC - Lancaster, PA
"I actually sold my practice. About two hours after you posted the ad, I got a call from a doctor who was interested. He officially took over today. I received quite a number of calls about the practice since the ad was up. The service you provide is valuable, and I just wanted to thank you and the PCA for offering this service."
Brian Meenan, DC - Pittsburgh, PA
"I just started my own practice a couple of months ago. $600 is a bit steep but it is worth it! Charge me monthly, that’d be great."
Strategic Business Partner Spotlight
Pittsburgh Property & Casualty, Inc.
Experience ~ Trust ~ Strength ~ Choice
Since 1984 Pittsburgh Property and Casualty, an insurance brokerage firm specializing in healthcare professional liability coverage, has been protecting the assets and professional reputations of healthcare providers. With our experience and expertise we are able to analyze the individual needs of our insureds, explain coverage options and provide sound insurance advice to protect their practice.
