We thank the PCA Insurance Committee and General Counsel, Jason B. Martin, Esq., who spend valuable time each week to review and answer PCA members’ questions and concerns. They go above and beyond to help in any way they can.
Below you will find a few answered questions that PCA thought would be helpful to Pennsylvania DCs.
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How can my patients file a complain to the PA Insurance Department (PID)?
PCA has no authority over DC licensure, so any complaint against a DC can only be handled by the PA State Board of Chiropractic. THIS COMPLAINT FORM should be used by patients or providers who wish to file a complaint or discuss concerns regarding a PA-licensed Doctor of Chiropractic. You may also file a complain online here.
Any further issues or questions can be directed to:
Professional Compliance Office
P.O. Box 69522
Harrisburg, PA 17106-9522
PCA members should be prepared to give their patients instructions and forms for filing complaints with the Insurance Department (link to PID patient complaint form, click here). When patients are expected to be financially responsible for services that may be denied by health insurers and/or their intermediaries, they will most certainly want to complain to someone. PCA President Raymond Benedetto, DC, commented, “The PA Insurance Department has clearly requested PCA to direct patients and their complaints to the PA Insurance Department, so that’s what PCA members should do. Our members are currently serving as the voice for many of their patients, so it is extremely important that members direct their patients to the PA Department of Insurance.”
Click here to file a complain online
How long do I need to keep records and how should I destroy them when it is time to destroy them?
There are two main laws that affect this, a state and a federal law. The state law requires a minimum of 7 years but a federal law that says 10 years, trumps that. Patient files can be so entwined in the records and health insurance coverage in the state of Pennsylvania that we recommend the minimum of 10 years for all records so you are meeting the minimum of state plus the federal regulation.
Then there is also a caveat if you are treating children in your practice. The state requires you to keep a child’s record for the legal age of majority plus a minimum of 1 year. We like to say 2 years to be on the safe side. For example, if you are treating a 4-year-old patient, the legal age of majority is 18 so that would be 14 years plus an additional 2 years. Therefore, you would actually be keeping the records of a child who was 4 years old in your office for 16 years to be safe before you destroy them.
If a patient is returning every once in a while, maybe every couple of years, that restarts that counter for the number of years you should keep the file. Therefore, you may have files that go back 20 or 30 years depending on how long you have been in practice and it may be correct to keep all of that information in most cases until the patient has not been in your office for that minimum amount of time.
Federal Law – for Medicare and other federal health care programs = must keep records for 10 years.
PA Law – For everything besides Medicare and other federal health care programs = must keep record for 7 years.
For children: must follow the above but may have to keep the records even longer since the requirement is that they must be kept until the child reaches the age of majority (18) plus 1 year. For example, if a child is 4 years old, records must be kept for 15 years (14 + 1).
Source: PCA General Counsel Jason B. Martin, Esq.
How long do I need to keep X-rays?
The x-rays are treated the same as medical records. They need to be kept for the same period of time as medical records depending on the age of the patient.
If the patient is deceased, most offices keep the records for a minimum of 2 years because after 2 years the time frame for filing a lawsuit on behalf of the patient is over. You should probably keep them closer to a 3 year time frame because if they file right at the deadline it might take 60 days for a request to come to you for records. So it would be best to keep the records for about 3 years after the patient is deceased in case a court case would be filed and they are looking for medical evidence to fight it.
The records then, if they are paper, should be shredded and you should keep a log of what you are shredding (i.e. which file, which patient, which sheets, and maybe how they were destroyed.) If it is an electronic record, the recommendation is that you also have some type of file where you have shown what you have deleted and why.
What are the X-Ray Requirements in PA?
The PA State Department of Environmental Protection(DEP) Bureau of Radiation Protection(BRP) requires all x-ray operators to demonstrate four units of continuing education every four years. For example, if you completed a radiation safety course or study on 5-1-18, then the latest date that you would need to take your next radiation safety course must be on or before 5-1-2022.
Lisa Funk, RT (R)(M), Radiation Protection Program Supervisor with the DEP Bureau of Radiation Protection confirms: ”The 4 year time frame is based on the date the individual first received radiation safety training. It has nothing to do with the date the facility had a state inspection. This is why there are varying dates of compliance.”
All information regarding X-Rays, including the official DEP Medical X-Ray Procedures Operator Training Guide, can be found on the PA State DEP website here. At the bottom of that page is the information you will need to maintain certification:
After reviewing both, take the quiz at the end of the PowerPoint. Upon successful completion of that quiz, you will receive confirmation of completion, meeting DEP’s regulatory requirements for Continuing Education.* Just print out the confirmation webpage and retain in your records for DEP inspections. That’s it – you’re good for the next 4 years!
* Please note that this is only the DEP requirements for licensure. If you bill any health insurance companies, you will need to check your contract to see if there are any policies pertaining x-ray billing. Example: Highmark requires all personnel who take x-rays be ACRRT certified (DCs included) in order to bill. It is up to you to maintain CE requirements to keep this certification up to date.
If you have any further questions regarding X-ray safety or continuing education, please feel free to contact PCA, or contact the DEP/BRP Radiation Control Division at 717-787-3720.
Can a Chiropractor adjust employees of a company at their company instead of at the DCs office?
If it is a wellness program, meaning there are no insurance benefits, then it can be done pretty easily. If any of the treatment is for a covered service by insurance, the DC would need to know how to report the location of the services, and the DC would need to make sure the documentation of the injury, services, etc. is very good. They also need to make sure that there professional liability insurance is aware of the chiropractic services performed outside of the DC’s office.
Act 6 (Auto) and Act 44 (Worker’s Comp) - How can I file a fee review?
WC must pay within 30 days of receipt of the clean claim/bill. If they do not, you can file a fee review for timeliness. Auto carriers are supposed to pay within 30 days also but there is no recourse other than to cite Act 6 when you call the carrier.
Act 31 – Child Abuse Recognition and Reporting Requirements
Does PCA offer any Act 31 courses?
Yes, we have different dates and locations for in-person Act 31 courses in every even year, consistent with CE renewal. Act 31 will also be offered at Convention every even year: 2020, 2022, etc.
Am I correct in thinking that after our initial 3 hour Act 31 training last renewal period, we still need to do 2 hrs for each future renewal? If so, do these 2 hours count towards our 24?
Yes only 2 hrs are required for renewal, and yes if the provider has been approved as a CE provider the two hours will count for CE. Be careful of free online options, as they may not be approved for CE.
How do I determine if a child abuse recognition and reporting course has been approved?
As courses are approved by the Department of Human Services and/or the Department of State/Board, these courses will be listed on the respective Board website. Unless a course is listed as approved by one or both of these agencies, the course will not be considered acceptable to meet the requirements for initial licensure or renewal.
In the practice of my profession, I do not come into contact with children. Do I need to complete this training to obtain a license, reactivate or renew my license?
Yes. The new law applies to all health-related licensees and funeral directors, regardless of whether they feel that they come into contact with children in their profession or not. Applicants and licensees must still complete the requirements under Act 31. Requests for this type of exemption will not be considered a valid reason for exemption.
CLICK HERE for the State Board of Chiropractic’s FAQs on Act 31 Requirements.
ACA FAQs Regarding Participating vs. Non-Participating Medicare Status
ACA receives a multitude of questions regarding Medicare and the physician fee schedule. Following are answers to some of the most frequently asked questions:
Q: Can I just ignore the fee schedule? I’m non-participating anyway.
Q: Who do I contact for the latest information on the fee schedule? It’s always so confusing at the end of the year.
Q: Could you provide a complete explanation of par fee allowance, non-par fee allowance and limiting charge?
Q: Can I change my Medicare Participating status?
CLICK HERE to read the whole article!
What is ERISA and why can ERISA plans do things that other plans can’t?
- ERISA: Employee Retirement Income Security Act of 1974- a federal law that sets minimum standards for mostly voluntarily established pension and health plans in Private Industry to provide protection for individuals in these plans.
- For more information you can go to: https://www.dol.gov/general/topic/health-pla/erisa
- Private Companies may fund their own health care for their employees but hire insurance companies, like Highmark or CBC, to process claims and manage the But the plan is not written by the insurance company, it is written by the employer. Therefore, there are exceptions to the rules of insurance since it is private pay. They can add or eliminate services that are normally covered by that insurance company.
- When you have trouble with one of these plans, we suggest you get the patient involved, go to their HR department at work to complain and try and find a solution with them.