United Healthcare Disbands Financial Recovery Program
At the urging of the American Chiropractic Association (ACA), United Healthcare has disbanded its financial recovery program for claims involving spinal and extraspinal CMT. United Healthcare is also reassessing the edit that reduced the extraspinal CMT procedure by half. The edit in question was not developed by the ACA, as United Healthcare originally claimed.
The ACA was informed in November 2004 that various United Healthcare Explanation of Benefits (EOB) forms indicated: "American Chiropractic Association Coding Policy designated Procedure Code 98943 as a reducible service by 50 percent when used on the same day with another CMT code." Citing this as an ACA policy, United Healthcare initiated a national campaign to reclaim money from chiropractors already paid for the extraspinal CMT.
On Nov. 10, 2004, ACA Chairman of the Board George McClelland, DC, sent a letter to United Healthcare (excerpted as follows):
Please be advised that the ACA has not established or otherwise maintained such a policy. The ACA does make reference to the policy of Medicare RBRVS on page 12 of the ACA 2004 Chiropractic Coding Solutions Manual as follows:
"It is appropriate to use code 98943 to describe CMT to one or more extraspinal regions, regardless of how many individual extraspinal manipulations are actually performed. The extraspinal CMT code 98943 can be used either by itself or in conjunction with a spinal CMT code. In those cases when 98943 is used in conjunction with a spinal CMT code, it is necessary to add a "-51" modifier (98943-51). Addition of the "-51" modifier reduces the total RVU of 98943 by 50% under the Medicare payment system." [ACA emphasis added]
Following this and other correspondence with the ACA, United Healthcare made the decision not to pursue the collection of money from chiropractors for the extraspinal CMT. In letters addressed to network DCs, United Healthcare stated that it is currently reviewing its reimbursement policy and regrets any inconvenience the policy may have caused.
"ACA has questioned the appropriateness of United Healthcare's attempt to recover payments from DCs who correctly used the -51 modifier," said ACA President Donald Krippendorf, DC. "We are pleased that United has recognized its error and is taking the necessary action steps to correct the situation."
As we go to press, the ACA and United Healthcare are arranging a meeting to discuss other code bundling situations and medial review practices. The ACA has already met with five different insurance vendors - the latest being Mitchell Medical, one of the largest developers of insurance-specific software in the U.S. The association met with Mitchell Medical to discuss chiropractic-specific coding policies and to ensure that Mitchell's software edits are consistent with ACA policy. According to the ACA, the software company is interested in "fairly representing chiropractic in its coding policies."
Mitchell Medical develops decision support software tools for the property and casualty insurance industry. Many of the top insurance companies in North America, as well as the majority of auto collision repair shops, use Mitchell products. Mitchell products are used throughout the entire claims and repair cycle.
Dr. James Giordano Awarded Visiting Scholarship at Georgetown
James Giordano, PhD, a professor of pathology and the director of research at Texas Chiropractic College (TCC), was recently named a visiting scholar at the Center for Clinical Bioethics at Georgetown University in Washington, D.C.
From April 15-May 6, Dr. Giordano will be studying "the philosophical basis of the use of integrative (Complementary and Alternative Medicine - CAM) approaches to fulfill the obligations of therapeutic agency in the act of medical professionalism and the ethics of integrative therapeutics in acknowledgement of patient-centered needs in palliative care." He will also be granted scholar privilege in the National Reference Center and Library for Bioethics Literature, and will participate in the Kennedy Center for Bioethics symposia. Dr. Giordano will be working under the direct mentorship of Professor Edmund Pelligrino, MD, PhD, chair of the Department of Medical Philosophy and Ethics and Center for Clinical Bioethics and professor emeritus of medicine at the Georgetown University School of Medicine.
In other TCC news, Sandra N. Mooney, CPA, the college's chief fiscal officer, has been elected to the Executive Committee of the Board of Directors of the Council on Chiropractic Education (CCE). Ms. Mooney was elected during the CCE's annual meeting, held in January 2005 in Scottsdale, Ariz. Ms. Mooney will serve as the secretary/treasurer of the CCE for a two-year term.
Ms. Mooney joined the TCC staff in 1993. She currently oversees the multimillion-dollar budget of the college, as well as the fiscal operation of its 18,000 sq. ft. outpatient clinic, the Moody Health Center.
New President of the American Black Chiropractic Association
Fadairo Afolabi-Rowland, DC, was inducted as the new president of the American Black Chiropractic Association (ABCA) during a ceremony at the association's recent national convention in Las Vegas.
Dr. Afolabi-Rowland is a holistic chiropractic physician practicing in New Jersey. Known fondly as "Dr. Fa" by her patients, she was the first African American woman to graduate from the University of Bridgeport College of Chiropractic, in December 1995. Dr. Afolabi-Rowland is an advisory board member at UBCC, as well as an advisory board member at Bloomfield College's pre-chiropractic program in Bloomfield, N.J. In addition, she is an active member of the Caribbean Medical Mission, a group consisting of multidisciplinary doctors who travel to Caribbean countries and volunteer their services.
Dr. Afolabi-Rowland has written numerous articles on the benefits of chiropractic and has lectured all over the country, helping minorities understand the role they play in their own well-being. "The uniqueness of chiropractic is that it offers a natural approach to health and healing; an approach that we once had, we lost, and now need to reclaim."
New Position for Dr. John Downes at Life University
John Downes, DC, was recently named the alumni and continuing education director at Life University. Dr. Downes will work directly with Life President Guy Riekeman, DC, assisting him in rebuilding the college's field support. Dr. Downes will continue to function as dean of the chiropractic college until a new dean is selected.
"Dr. Downes has been a critical player in Life University's renaissance. At the helm of the college of chiropractic he was part of the team that steered us through our accreditation process with the CCE," said Provost Brian McAulay, DC, PhD. "And while he has been responsible for the education of 750 students, he will now be responsible for 12,000 alumni and supporting them in their efforts. He now becomes our voice to our graduates."
Steel City Chiropractic
One reason the Pittsburgh Steelers may have been so successful this past season (they went an NFL-best 15-1 and made it to the AFC Championship Game) was the play of their quarterback, Ben Roethlisberger, who was named the NFL's Offensive Rookie of the Year for 2004. Another reason, however, may have been the work of Drs. Joel Smooke and Jeff Cohen, a pair of chiropractors from the Steel City.
Dr. Cohen has been treating NFL players since the late 1970s. Since then, Steelers players have been visiting his office regularly - Dr. Cohen has even traveled with the team, treating them in hotel rooms.
Pro Football Hall of Fame finalist L.C. Greenwood, who played for the Steelers from 1969-81, first saw Dr. Cohen in 1977. In an interview with the Pittsburgh Tribune-Review,1 Greenwood credited Dr. Cohen with helping him get through some of his games:
"Chiropractic was taboo at that time, so we were sneaking off to go see him," said Greenwood. "He's partly responsible for a lot of us being able to play during the time we were in the Super Bowl."
Dr. Smooke, a lifelong Steelers fan, has been practicing in the Pittsburgh area for 15 years. The first Steelers player he treated was running back Chris Fuamatu-Ma'Afala, five years ago. (Chris now plays for the Jacksonville Jaguars.) Dr. Smooke currently treats about a dozen members of the Steelers team.
"In this game you have to take care of your body," said Steelers wide receiver Hines Ward in an interview with Pittsburgh's Post-Gazette.2 "Over the course of a game your body just feels wrecked. Every Monday it hurts to get out of bed. I told Smooke, 'I want to feel good in the morning.' A lot of my credit goes to him for keeping me healthy."
References
Many relevant diagnostic signs are not performed deliberately by the examiner or by the patient at the examiner’s direction. They are observed as the patient reacts to their condition. Fortin’s finger sign, Minor’s sign, and Vanzetti’s sign are three examples of this principle.
On Feb. 1, 2024, two more legislators – John R. Carter (R-Texas) and Robert “Bob” Good (R-Va.) – co-sponsored the Chiropractic Medicare Coverage Modernization Act of 2023, bringing the co-sponsor total to 155, two more than the total achieved over the entire two-year congressional cycle in which identical legislation last appeared (2021-22).
While working at the Lovelace Medical Center in Albuquerque, N.M., one of the primary care physicians stated that imaging every patient prior to receiving chiropractic was not medically necessary. It was at that point I reconsidered the need for the imaging of every patient to avoid malpractice.
