On February 11, 2014, the Chair of the Workers’ Compensation Board (Board) adopted amendments to the regulations governing the conduct and reporting of Independent Medical Examinations (IMEs) (12 NYCRR §300.2). The amended regulation became effective on February 26, 2014.

This Subject Number highlights the significant changes contained in the amended regulation. The complete text of the amended regulation is located on the Board’s website under Laws, Regulations and Decisions.

Notices, Provision of Information, and Requests for Information

Service of Notices by Overnight Mail: Notice of the scheduled IME may be made using overnight mail as long as the notice is received by the claimant at least seven days prior to the scheduled examination.

Provision of Information: A new requirement has been added to the regulation that requires that every record, document, or test result supplied to an IME examiner for review in connection with an IME or records review must be a part of the Board file. Any information that is not already part of the Board file must be submitted before or at the time the IME or records review is arranged. Information submitted to the Board before or at the time the IME is arranged should not be submitted to the Board as a Request for Information using an IME-3.

Note: The submitting IME examiner must list all documents, reports, and other items reviewed in the IME or records review report.

Requests for Information: An IME-3 must be submitted to the Board when the provider receives any substantive communication regarding the claimant. An IME-3 shall not include documents, records, and items that are part of the Board file.

Reports of Examinations without Physical Examination or Records Reviews

A records review conducted by a medical provider without physically examining the claimant must be completed by a medical provider authorized to treat workers’ compensation claimants or authorized to conduct IMEs, or “qualified” within the meaning of 12 NYCRR §300.2 (b)(9). A medical provider that completes a records review must adhere to the rules governing IME reports at 12 NYCRR §300.2 (d)(4) including certifying the contents of the report and listing every document, record, or item reviewed in connection with the records review. A report of a records review must be submitted to all parties and the Board at least three business days before the hearing where it will be referenced.

Videotaping of IMEs

The amended regulation clarifies that an IME examiner may not refuse to conduct an IME when a claimant appears at the IME prepared to record or videotape the IME. A party (or agent of a party) may not alter a recording or videotape, nor may a videotape be distributed beyond its use in a hearing of the Board.

Reports

The amended regulation sets forth specific criteria for the content, certification, and signing of an IME report and a records review report. The reports must list all documents, records, and items reviewed by the examiner. Any questionnaires or intake sheets completed by the claimant must be attached to the report. In addition to the parties and the Board, copies of all reports must be submitted to attending providers that have treated the claimant within the last six months. The regulation states that a treating provider who examined the claimant solely for consultation or to perform a diagnostic test does not need to receive a copy of the report. The regulation specifies that a report may not be based on a checklist or questionnaire.

Exemptions

The amended regulation clarifies that a carrier's medical professional, as that term is defined in 12 NYCRR §324.1 (c), is not an IME examiner within the meaning of WCL §137 and 12 NYCRR §300.2. In addition, an examination conducted at a clinic that is a member of an occupational health network established pursuant to WCL §151 (3) is not an IME within the meaning of WCL §137 and 12 NYCRR §300.2.

IME entities

The term IME entity is defined. Services that may be supplied by an IME entity are described. The amended regulation sets forth clear and specific rules for IME reports submitted by IME entities. The amended regulation also clarifies that the IME examiner is responsible for certifying the contents of a report and that an IME report may not be derived from an IME examiner completing a checklist or form. The process for registering an IME entity is updated.

Suspension and revocation of the authorization of IME examiners and IME entities

The amended regulation updates the process and basis for suspending and revoking the authorization of a provider to perform IMEs and records reviews. The process and basis corresponds to the process and basis for suspending and revoking the authorization of treating providers as set forth in WCL §13-d.

The amended regulation also sets forth a process for revoking the registration of an IME entity.

Robert E. Beloten
Chair

Washington, D.C.--The American Chiropractic Association's (ACA) House of Delegates (HOD) today adopted language describing the profession's approach to health care and the use of drugs by chiropractic physicians during it's annual meeting Feb. 28- March 1 in Washington, D.C.

The statement was originally written and approved by the Chiropractic Summit, an umbrella leadership group of more than 40 prominent chiropractic organizations, during a meeting in Seattle in November.

The statement reads, in part--

As you can imagine, this statement was crafted very carefully and after long discussions by all participants of the Summit, which includes organizations and individuals from all corners of the profession and with widely varying viewpoints. When the group first approached the task, it realized that the profession could not legitimately use the word "drugless" to describe itself. Surprised? It makes sense when you consider the FDA classifies the use of certain vitamins and supplements to treat a condition a form of drug use. With so many doctors of chiropractic using nutritional therapy to help their patients, it was obvious to even the most conservative among us that "drug-free approach" more accurately describes what we all do.

Granted, there are wide variations in the scope of practice for chiropractic based on the state in which DCs practice. Some states are quite expansive in what they allow doctors of chiropractic to do; others are rather restrictive. The Summit's role is not to define scope (that is the function of the states themselves), so any statement on chiropractic practice drafted-to be accurate-needed to keep into account those who may have more tools in their toolbox.

Nevertheless, the approach that all doctors of chiropractic take, regardless of their available tools for patient care, is first and foremost drug-free. This is what unites us; we as a profession can be proud that the organizations representing the Chiropractic Summit came together and unanimously agreed on this very positive and powerful statement.

"ACA is proud to adopt the Chiropractic Summit's statement, which succinctly describes the intention behind our profession's conservative approach to health care," said ACA President Keith Overland, DC.

The HOD met in conjunction with the 2014 National Chiropractic Legislative Conference (NCLC) and Education Symposium. Be sure to visit ACA's Facebook fan page for photos, updates and videos from the conference. Twitter users can talk about the event using the hashtag #NCLC2014.

The American Chiropractic Association (ACA), based in Arlington, VA, is the largest professional association in the United States advocating for more than 130,000 doctors of chiropractic (DCs), chiropractic assistants (CAs) and chiropractic students. ACA promotes the highest standards of ethics and patient care, contributing to the health and well-being of millions of chiropractic patients. Visit us at www.acatoday.org.

Washington, D.C.—Hundreds of chiropractic physicians, students and supporters joined the American Chiropractic Association (ACA) in Washington, D.C. today to visit with lawmakers on Capitol Hill as part of the 2014 National Chiropractic Legislative Conference (NCLC) and Education Symposium.

Doctors from all walks of the profession came to Washington to tell their stories and advocate on behalf of the patients they serve. Attendees urged lawmakers to support bills that would benefit patients, expand access to chiropractic services for veterans and active-duty military personnel, and help chiropractic graduates qualify for federal programs that would enable them to practice in underserved areas in exchange for student loan debt relief.

Keynote speaker, Sen. Jerry Moran (R-Kan.)—a member of the Senate Appropriations Committee, the Banking, Housing and Urban Affairs Committee, and the Veterans’ Affairs Committee—discussed how his commitment to improving the health and quality of life of our nation’s veterans ties into his support for chiropractic.

“When we advocate for chiropractic, we are really advocating for patients, including veterans,” said Sen. Moran. “We must honor our commitment to provide for the military, including providing for their health care. Chiropractic is a way to provide for veterans and their communities.”

NCLC Plenary Speaker, Fabrizio Mancini, DC, an internationally acclaimed educator, philanthropist and president emeritus of Parker University, shared his experiences promoting whole-person wellness, and how that focus will be essential in the formed health care landscape.

“Just because our health care system has a hard time fitting us in its box doesn’t mean we can’t serve that system,” said Dr. Mancini. “Chiropractic has what the new health care system is looking for. We get more results than most, we just have to share them with the public.”

Attendees also heard from the prime sponsor of the Chiropractic Care Available to All Veterans Act, Sen. Richard Blumenthal (D-Conn.), who was part of a bipartisan coalition of senators responsible for including major portions of the bill in larger legislation that was recently sent to the full Senate for consideration; Rep. Bill Enyart (D-Ill.), a cosponsor of the Chiropractic Health Parity for Military Beneficiaries Act designed to further integrate the services provided by doctors of chiropractic in the U.S. Department of Defense (DoD) health delivery system; and Rep. Cory Gardner (R-Colo.), a member of the influential House Energy and Commerce Committee.

ACA President Keith Overland, DC, in his opening address to attendees, focused on the importance of creating a level playing field for chiropractic physicians in order to improve the health and wellness of the American people and U.S. veterans. “Doctors of chiropractic offer safe approaches for helping veterans in pain, so your message to lawmakers is so important,” he said.

To complete the day, ACA will host a “Green-tie Gala” event to honor retiring Sen. Tom Harkin (D-Iowa), a long-time chiropractic champion on the Hill who is known for his penchant for wearing green ties.

Visit ACA’s website for video excerpts of the conference, and be sure to visit ACA’s Facebook fan page for photos, updates and videos from the conference. Twitter users can talk about the event using the hashtag #NCLC2014.

The American Chiropractic Association (ACA), based in Arlington, VA, is the largest professional association in the United States advocating for more than 130,000 doctors of chiropractic (DCs), chiropractic assistants (CAs) and chiropractic students. ACA promotes the highest standards of ethics and patient care, contributing to the health and well-being of millions of chiropractic patients. Visit us at www.acatoday.org.

In order to maximize the profession’s advocacy activities at the National Chiropractic Legislative Conference (NCLC 2014), the ACA is coordinating an advance online grassroots campaign in an effort to “soften the beachhead,” when the ground forces arrive in Washington for Capitol Hill visits on February 27th. Please read carefully and take the specific action requested below.

BACKGROUND: The Department of Veterans Affairs (DVA) health care system continues to discriminate against doctors of chiropractic and America’s veterans who need and deserve the essential services DCs provide. We have long argued that the DVA needs to “fully integrate” doctors of chiropractic into their healthcare system, however, chiropractic services continue to remain unavailable in nearly half of the nation’s major DVA treatment facilities. This lack of care is not only unfair to America’s veterans, but sends a very damaging signal to the consumer public, private employers, and other hospitals and healthcare systems, that the DVA does not consider the services provided by doctors of chiropractic to be important or valued enough to be made routinely available to all consumers and patients in need of our care. Gaining “full inclusion” in the DVA would send a strong signal not only to our veterans, but to all insurers, employers, medical doctors and hospitals on a nationwide basis.

There is legislation currently pending in the U.S. House of Representatives that would greatly expand our profession’s presence within the DVA health care system, HR 921, the Chiropractic Care Available to All Veterans Act. We urgently need to gain additional cosponsors and support for this bill. We simply need to generate a strong grassroots response on HR 921, in order to increase the likelihood that the legislation will be enacted into law this year.

ACTION NEEDED: Please CLICK HERE to go to the ACA’s Legislative Action Center. From this link, you will be able to send the appropriate pro-chiropractic message to your elected federal official on Capitol Hill on the issue described above.

Remember -- all of the information you need to effectively respond to this Alert Bulletin can be conveniently accessed with just a few mouse clicks -- so please respond this important request ASAP. Also please note: You can greatly increase the effectiveness of this grassroots campaign by forwarding this message to your staff members, family and patients, anyone can access the ACA Legislative Action Center and we encourage them to do so.

In order to maximize the profession’s advocacy activities at the National Chiropractic Legislative Conference (NCLC 2014), the ACA is coordinating an advance online grassroots campaign in an effort to “soften the beachhead,” when the ground forces arrive in Washington for Capitol Hill visits on February 27th.

This is the first in a series of three Legislative Alert Bulletins that requires your immediate grassroots response. Please read carefully and take the specific action requested below.

BACKGROUND: In the near future all Part B Medicare providers, including doctors of chiropractic, will face draconian reductions (over 27%) in their Medicare payment rates unless Congress takes legislative action to “fix” a flaw in the Sustainable Growth Rate (SGR) payment formula that exists under current law.

Specifically, Congress needs to enact new legislation to prevent the imposition of these prior to March 31 of this year. As a “solution” to this problem, the American Chiropractic Association favors the enactment of legislation, which would provide a long-term “fix” to the SGR problem. While the legislation currently under consideration does not address all problems and limitations that DCs have with the Medicare program, it does include a new Merit-Based Incentive Payment System (MIPS) and DCs are specifically made eligible to qualify for this component.

ACTION NEEDED: Please CLICK HERE to go to the ACA’s Legislative Action Center. From this link, you will be able to send the appropriate pro-chiropractic message to your elected federal official on Capitol Hill on the issue described above.

Remember -- all of the information you need to effectively respond to this Alert Bulletin can be conveniently accessed with just a few mouse clicks -- so please respond to this important request ASAP. Also please note: You can greatly increase the effectiveness of this grassroots campaign by forwarding this message to your staff members, family and patients, anyone can access the ACA Legislative Action Center and we encourage them to do so.

CMS is extending the deadline for eligible professionals to attest to meaningful use for the Medicare EHR Incentive Program 2013 reporting year from 11:59 pm ET on February 28, 2014 to 11:59 pm ET March 31, 2014.

This extension will allow more time for providers to submit their meaningful use data and receive an incentive payment for the 2013 program year, as well as avoid the 2015 payment adjustment.

This extension does not impact the deadlines for the Medicaid EHR Incentive Program or any other CMS program, including the electronic submission for the Physician Quality Reporting System EHR Incentive Program Pilot.

How to attest?

If you are an eligible professional, you may use the registration and attestation system to submit your attestation for meaningful use for the 2013 reporting year. You must attest prior by 11:59 pm ET on March 31, 2014 to meet the new 2013 program deadline.

Resources

If you are an eligible professional working on your attestation for the 2013 reporting period, there are resources available to help you with the registration and attestation process.

• Stage 1 Meaningful Use Calculator
• Registration and Attestation User Guides
• EHR Incentive Program Website

The EHR Information Center is open to assist you with all of your registration and attestation system inquiries. Please call, 1-888-734-6433 (primary number) or 888-734-6563 (TTY number). The EHR Information Center is open Monday through Friday from 7:30 a.m. – 6:30 p.m. (Central Time), except federal holidays.

Tips

In addition, there are some simple steps you can take which will help to make the process easier for you:

• Ensure that your payment assignment and other relevant information is up to date in the Medicare payment system PECOS
• Make sure to include a valid email address in your EHR program registration
• Consider logging on to use the attestation system during non-peak hours such as evenings and weekends
• Log on to the registration and attestation system now and ensure that your information is up to date and begin entering your 2013 data
• If you experience attestation problems, call the EHR Incentive Program Help Desk and report the problem
• If your organization has more than 1,000 providers assigned to a proxy user, use the PECOS system to designate additional proxies to facilitate attestation.

"For possibly the first time since this "great compromise" between workers and employers was reached in 1914, the whole system is under review, not only by the Board but be representatives of all system participants. Never before has the Board taken the opportunity to work in conjunction with stakeholders and other major participants to examine the entire scheme and to seek to address the issues within it and to build into the system methods and mechanisms for making it self-correcting in the future."

BPR As-Is Assessment Report

NYSCA recognizes the currently challenges of NY's Workers Compensation system. As such we have been and will continue to be part of this review process. We will be meeting with the WCB again next week to continue to advocate for the needs of the injured workers of New York and our members.

The National Board of Chiropractic Examiners (NBCE) has just begun mailing surveys to more than 10,000 randomly selected chiropractic practitioners throughout the United States. The survey procedures have been reviewed and approved by the Institutional Review Board of Palmer College of Chiropractic. Results from the survey will be used to produce the Practice Analysis of Chiropractic 2015. This reference volume is the fifth edition of a document that was first published in 1993 and called the Job Analysis of Chiropractic.

The Practice Analysis is the only publication of its kind to focus on the role of a typical full-time doctor of chiropractic, presenting reliable statistics about demographics and practice patterns, as well as a review of recent research about chiropractic. Results of the completed project will be shared with educators, insurance companies, legislators, libraries, state licensing boards and others who need a reference concerning the profession.

Within the NBCE, the Practice Analysis is the foundation of the Part III and Part IV clinical and practical skills assessments administered by the NBCE. Its use ensures that the content of these examinations directly pertains to the practice of chiropractic. In short, the new edition will benefit every aspect of the profession, including the general public.

The accuracy of the Practice Analysis is largely dependent upon the response of a large number of practitioners. It is critical that those who receive the survey complete and return it as quickly as possible, either by mail or online. The submitted data will be compiled and analyzed, with the results being added to the chapters that are already in progress.

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Headquartered in Greeley, Colo., the NBCE is the international testing organization for the chiropractic profession. Established in 1963, the NBCE develops, administers and scores legally defensible, standardized written and practical examinations for candidates seeking chiropractic licensure throughout the United States and in many foreign countries.

Abstract

Objective To model the effect on UK vascular mortality of all adults over 50 years old being prescribed either a statin or an apple a day.

Design Comparative proverb assessment modelling study.

Setting United Kingdom.

Population Adults aged over 50 years.

Intervention Either a statin a day for people not already taking a statin or an apple a day for everyone, assuming 70% compliance and no change in calorie consumption. The modelling used routinely available UK population datasets; parameters describing the relations between statins, apples, and health were derived from meta-analyses.

Main outcome measure Mortality due to vascular disease.

Results The estimated annual reduction in deaths from vascular disease of a statin a day, assuming 70% compliance and a reduction in vascular mortality of 12% (95% confidence interval 9% to 16%) per 1.0 mmol/L reduction in low density lipoprotein cholesterol, is 9400 (7000 to 12 500). The equivalent reduction from an apple a day, modelled using the PRIME model (assuming an apple weighs 100 g and that overall calorie consumption remains constant) is 8500 (95% credible interval 6200 to 10 800).

Conclusions Both nutritional and pharmaceutical approaches to the prevention of vascular disease may have the potential to reduce UK mortality significantly. With similar reductions in mortality, a 150 year old health promotion message is able to match modern medicine and is likely to have fewer side effects.

Following our release of the fee schedule increase for Medicare codes 98940,-41 and -42 there seemed to be some disappointment in the overall results. While we all acknowledge that the most commonly used code, 98940 (thanks to Medicare audits), had the lowest percentage increase, the implicates can have far reaching impact as other carriers look to the RVU that Medicare sets. In addition, the ACA Medicare Carrier Advisory Committee and executives of the ACA have been diligently meeting the CMS and HHS to get us full scope coverage to include E & M codes as well as active and passive modalities. Unfortunately, as we know just from our dealings in NY that major changes take time. In the interim, a 2% increase in 98940 is better than another decrease, and as we draw closer to paying off the 2% reduction due to the overage of the demonstration project (thanks to some of our colleagues in part of Chicago), that decrease is anticipated to be lowered in the coming year.

For further information on the efforts of the ACA, please check out the following links:

• ACA Responds to Joint Congressional Discussion Draft on Medicare Physician Payment Reform (Nov 2013) 
• ACA RUC Advisors Comment to CMS on DCs Billing for Evaluation & Management (E/M) Services 
• ACAtoday.org Medicare Advocacy 

Respectfully submitted,
Mariangela Penna, DC
NY CAC Representative

I.C. System, a family-owned accounts receivable management firm, recently launched a new chiropractor debt collection website highlighting the company’s 40+ years of chiropractic collection experience and industry expertise.

With the onset of increased premiums and decreased coverage for beneficiaries along with diminishing reimbursements for health care providers, many financial experts are speculating that America is currently formulating a health care bubble. Having the potential to burst, similar to the housing bubble that caused the 2008 recession, it is imperative to have processes in place so that you and your practice will be sheltered. In essence, that is exactly what a chiropractic debt service agency does for you. It shelters you in the storm and helps ensure that your bottom line is not affected, regardless of the economy.

State of the Union
According to ACA International, The Association of Credit and Collection Professionals, “An estimated 48 million people were paying off medical debt in 2012, up from 44 million in 2010 and 37 million in 2005.” In addition, 75 million Americans reported that they experienced difficulties paying off healthcare-related expenses in 2012. Currently, 50 million Americans don’t have health insurance and, according to Ernest & Young, “Healthcare-related debt is the leading category of debt collection among survey respondents, accounting for more than half of all debt collected in the industry.”

Role of ObamaCare
The Affordable Care Act (popularly referred to as “ObamaCare”) only mentions “chiropractic” three times in the entire 2,407-page text. This can be interpreted in two different ways: With prevention being one of the underlying focuses of the entire document, some experts understand this to mean that chiropractic services – specifically asymptomatic, “wellness care” – will be covered to a greater degree than most insurance companies do now because it epitomizes preventative medicine. Other experts, however, fear that the language is too scant to properly define how chiropractic services will be covered.

In essence, the verbiage is such that the government can change their perspective on chiropractic care and services as ObamaCare progresses, thereby providing chiropractors little security in the future health care model. Consequently, the role of fee-for-service and chiropractic debt collections will greatly determine your financial bottom line as you manage co-pays and deductibles or conform to a non-insurance dependent cash model.

Helping stabilize the economy
The data presented by Ernest & Young depicts the vital role chiropractic debt collection agencies and others play in curbing the ubiquitous debt load that is affecting unsheltered healthcare professionals nationwide:

• Total debt collected in 2010: $54.9 billion.
• Total debts that were returned to creditors and health care professionals: $44.6 billion.
• “Early out debt” collected (receivables aged 90 days or less): 30 percent.
• “Bad debt” collected (receivables aged 90 days or more): 70 percent.

As consumers continue to struggle paying their bills, chiropractic debt collection agencies and others like them are becoming the backbone of our economy. This is particularly true as out-of-pocket health care expenses skyrocket and government-funded insurance companies continue to cut coverage.

Securing your future
Whether your chiro practice has suffered the fi nancial consequences of delinquent debts or not, take time today and secure your future by working with an agency that specializes in chiropractic debt collections.

Some tips to consider:

1. Be proactive. No one knows which patient will fall behind on their fi nancial responsibilities and when. By establishing a relationship with a chiropractic debt collection agency today, you won’t be scrambling for help when you need it most.
2. Be encouraged. The fate of your offi ce’s balance sheet is not sealed because you serve in an area that has been hit hard economically. Time-tested, proven collection processes and approaches ensure that your fi nancial needs can be met by the right chiropractic debt collection agency.
3. Saving face. Make sure you choose a collection agency that will not only recover your lost funds, but will also make sure your professional and personal reputation remains positive.
4. It’s never too late. Don’t give up! The data from Ernest & Young’s report is quite telling and encouraging for any chiropractor who is struggling with long-term past due accounts. Relinquish the burden and watch your P & L soar!
5. Find someone who understands. We can’t emphasize this enough: Make sure you partner with a collection agency that understands your business model, your patient base and your profession!

As you work toward stabilizing your practice in a troubled economy, it’s important to understand that chiropractic debt collection agencies can help mitigate the fi nancial risks associated with providing healthcare. In an effort to maintain your energy on what you do best, leave the stress of collecting your debts to devoted professionals! Once the burden is lifted off of your shoulders, you and your staff will be free to focus on what will bring you future success without having to worry about past due accounts!

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IC System Quick Facts

• For more than 40 years, Chiro Collect, Powered by I.C. System, has worked with hundreds of Chiropractic Practices nationwide, collecting millions of dollars on their behalf. I.C. System is a BBB Accredited Business with an A+ Rating.
• We are among just a few dozen agencies worldwide to be ”certified” for Best Practices through ACA International, The Association of Credit and Collection Professionals, Professional Practices Management System (PPMS) program.
• We leverage comprehensive skip-tracing efforts to find “missing” patients.
• We offer Chiropractor Clients Online Tools to easily submit debts, view our work effort (number of letters mailed, number of calls made, etc.) on debts, report payments, and generate reports.

See more at: http://chirocollect.com/