The Academic Consortium of Complementary and Alternative Medicine (ACCAHC) recently elected Horace Elliott to its board of directors.  The ACCAHC was formed in 2004 as part of a broad coalition of health care professionals and organizations driving public policy to ensure that all Americans have access to safe, high quality, integrated health care.
 
Elliott has been Executive Vice President of the National Board of Chiropractic Examiners (NBCE) since 1986.  Reporting to an 11-member board of directors, Elliott is responsible for the daily operations and finances of the NBCE, as well as the goals and policies of the organization.  Prior to the NBCE, Elliott held several executive management positions at companies such as the Bendix Corporation, and Price Waterhouse/Coopers in Houston. 
 
Elliott is a graduate of Lamar University in Beaumont, Texas.  He has received numerous awards including two honorary doctorate degrees, one from Texas Chiropractic College and another from the American College of Chiropractic.  Elliott is a fellow of the International College of Chiropractic.  In 2004, he received the George Arvidson Award for Meritorious Service to Chiropractic Licensure from the Federation of Chiropractic Licensing Boards.  
 
Elliott is actively involved in his hometown community of Greeley, Colorado, where he lives with his wife, Sue.  He has been an active member of the Greeley Chamber of Commerce, serving as Chamber representative to the Greeley Planning Commission, and the Greeley Rotary Club, where he previously served on the board of directors.

New York Chiropractic College received the “green light” to deliver its Master of Science in Applied Clinical Nutrition (MSACN) program completely online from the New York State Education Department.  The College plans to convert the nutrition curriculum to an online, distance-learning, Web-based format via Desire2Learn (D2L) by September 2010. 

NYCC’s MSACN program is uniquely structured to provide a comprehensive professional education that will prepare graduates for employment in a variety of settings including private practice, integrative practice with other professionals, research, and industry consulting.
NYCC Executive Vice President of Academic Affairs Michael Mestan, D.C., describes the new online initiative as “a successful team effort that significantly enhances practitioners’ skills and benefits patients.”

Designed for practicing chiropractors, current chiropractic students and all other qualified healthcare professionals (i.e., nurses, medical physicians, dentists, etc.), matriculants can complete this Masters level program entirely online in the comfort of their homes.

The online program, emphasizing an integrative and natural healthcare approach, distinguishes itself through an outstanding faculty, innovative and diverse curricula, and an emphasis on the applied use of clinical nutrition in disease prevention and management.  This sort of advanced training enables practitioners to expand existing practices, offer more comprehensive treatment, and augment their professional success through interventions that incorporate diet, exercise, nutritional supplementation, and life style modifications.

“We’re looking to teach healthcare practitioners who want to enhance their credentials and expand their practices by incorporating nutrition to address a myriad of health conditions,” explained Anna Kelles, PhD, director of the School of Applied Clinical Nutrition at NYCC, noting that nutrition is a fundamental building block in the success of all healthcare treatments.

“The most recent research (Neck Pain Task Force Report of the Bone and Joint Decade 2000-2010, a study sanctioned by the United Nations and the World Health Organization) indicates neck manipulation is a safe and effective form of health care,” according to Matt Pagano, DC, chiropractic profession spokesperson.

Respected researcher and epidemiologist J. David Cassidy, DC, PhD, DrMedSc, testified as a key witness last week at the hearings on informed consent before the Connecticut Board of Chiropractic Examiners in Hartford, Conn. Speaking as an expert witness and consultant to the International Chiropractors Association (ICA)—and with the support of all chiropractic organizations involved in the process, including the American Chiropractic Association, Association of Chiropractic Colleges, Foundation for Chiropractic Progress, Life West, New York College of Chiropractic, Parker College of Chiropractic, Palmer College of Chiropractic, and the University of Bridgeport College of Chiropractic—Dr. Cassidy addressed key facts and issues on the basis of the existing science and research record, to which he has been a significant contributor. The objective of his testimony was to bring the discussion from an emotional issue back to science and the objective research record.

Dr. Cassidy joined an extensive list of witnesses representing the chiropractic profession, including William J. Lauretti, DC; James J. Lehman, DC, MBA; J. Clay McDonald, DC, JD, MBA; Gerard W. Clum, DC; Stephen M. Perle, DC, MS; Gina Carucci, DC, MS, DICCP, who appeared on behalf of the Connecticut Chiropractic Association (CCA); and George Curry, DC, FICA, who appeared on behalf of the Connecticut Chiropractic Council (CCC).

“The chiropractic profession unequivocally supports a patient’s right to be informed of the material benefits and risks of any type of health care treatment – not just chiropractic. Legislation or regulatory mandates governing informed consent should apply to all health care providers and all treatments in equal measure. However, a new law, regulation or mandate highlighting one specific treatment by a specific health care profession, which carries with it an extremely rare association and no causal link identified in the research, is simply not good public health policy. It would set an unnecessary precedent for all health care providers, procedures and products that would be virtually impossible to implement,” said Pagano.

The existing informed consent standards in Connecticut allow for the best opportunity for shared decision making between a patient and his or her health care provider. Further, the chiropractic organizations participating in the hearing process all believe informed consent is more than a piece of paper; it is a process. It should occur in the context of a discussion between a doctor and a patient, and it should be appropriately documented.

In a finding highly relevant to the issue before the Connecticut Board of Chiropractic Examiners, the Neck Pain Task Force study demonstrated that patients suffering from headache and neck pain are no more likely to suffer from a stroke following a visit to a chiropractor than they are after a visit to a family medical physician. This implies that there are factors involved other than the type of care provided by doctors of chiropractic.  It’s important to note that millions of patients safely benefit from chiropractic care every year—they are able to return to their normal activities and enjoy a better quality of life.

Dr. Cassidy was an investigator with the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. The work of this international task force affirms the safety and benefits of chiropractic care for people with neck pain—a condition frequently treated by doctors of chiropractic. The Task Force initiated this new population-based, case-control and case-crossover study, which appeared in the Feb. 15, 2008 edition of the journal Spine.

The study, which analyzed nine years’ worth of data from a population of 110-million person years, concluded that vertebrobasilar artery (VBA) stroke is a very rare event and that the risk of VBA stroke following a visit to a chiropractor’s office appears to be no different than the risk of VBA stroke following a visit to the office of a primary care medical physician (PCP).

The study goes on to say that any observed association between VBA stroke and chiropractic manipulation—as well as its apparent association with PCP visits—is likely due to patients with an undiagnosed vertebral artery dissection seeking care for neck pain and headache prior to their stroke.

Over the years, popular media has all too often sensationalized the association between chiropractic cervical manipulation and cerebral vascular accidents—even though the evidence would strongly indicate that this assertion is incorrect. The organizations representing the chiropractic profession believe this most recent evidence should help to dispel any myths on this issue, as well as provide more data to support the safety and effectiveness of chiropractic procedures.

As a profession, doctors of chiropractic remain committed to expanding the research and clinical understanding of VBA injuries, because even one cerebral vascular incident that could have been prevented or detected early is one too many.

The Palmer Center for Chiropractic Research (PCCR) has undertaken a collaborative clinical trial to follow up on preliminary research indicating a specific form of chiropractic treatment can be effective in lowering blood pressure in hypertensive patients. This clinical trial involves 165 patients with high blood pressure and is called Chiropractic for Hypertension in Patients, or CHiP. Palmer is collaborating with Mount Sinai Medical Center, Miami, Fla., and Trinity at Terrace Park Family Practice, Bettendorf, Iowa. Potential participants will be examined at the PCCR clinic facility and Trinity Terrace Park Family Practice Clinic to determine eligibility. If accepted into the study, participants will be randomly assigned to one of three treatment groups, each receiving care at the Palmer Research Clinic for eight weeks. Participants will have their blood pressure monitored on a regular basis during the study.

“This study has the potential for significant impact on the treatment of hypertension,” said Palmer’s Vice Chancellor for Research and Health Policy and CHiP Co-leader Christine Goertz, D.C., Ph.D. “More than 50 million Americans suffer from high blood pressure, and although many medical treatments for diagnosed hypertension are available, only about 30% of patients achieve blood pressure goals. Many patients report that they are unable to tolerate medication side effects and find it difficult to sustain lifestyle changes. Thus, a non-pharmacological treatment that lowers blood pressure could become an attractive option to many patients and their physicians.”

Greeley, Colo.— Paul D. Townsend, D.C., the NBCE Director of Practical Testing Research and Development , is the lead author on an article published in the January 2010 issue of the journal Teaching and Learning in Medicine.  NBCE Director of Testing and Executive Vice President Mark G. Christensen also contributed to the article.

On Wednesday, Dec. 16, as part of the FY 2010 Defense appropriations bill, the House of Representatives passed legislation that would delay the 21 percent Medicare fee cuts until March 2010.  The Senate has yet to vote on this bill.  We urge members to contact your senators today, to ask them to stop the 21 percent Medicare fee cuts for 2010.  The Senate is expected to take a vote on this bill in the next few days, so your immediate action is needed.  Please visit the ACA Legislative Action Center  where you can create an e-mail message quickly and easily to send to your senators to tell them to block the implementation of these drastic fee cuts. A template e-mail is included at the Action Center.

Many providers are receiving notices that they must complete a Fraud, Waste and Abuse (FWA) training program from Medicare Advantage Plans.  In 2007, CMS regulations mandated that Medicare Advantage (MA) programs require MA providers to take a FWA training program once a year, beginning in 2009.   However, in response to concerns from the provider community, CMS has recently proposed to revise this requirement.  In the Oct. 22 Federal Register Proposed Rule, CMS stated that individuals who were enrolled as Medicare providers should not be required to complete the FWA training because it was redundant to the Medicare requirements for enrollment.  This proposal has not become a final regulation, but will most likely become final next year.  At this point, MA providers are required to take the FWA training. Many individual MA plans are offering their own FWA training courses.  An example of an available training course can be accessed here.

At the request of several members of Congress, the Federal Trade Commission (the “FTC” or “Commission”) is extending its deferral of enforcement of the Identity Theft Red Flags Rule (“Red Flags Rule” or “the Rule”)¹ until June 1, 2010.

DAVENPORT, IA – (November 4, 2009) – Following what might be the most expansive search for a chiropractic college leader in the history of the profession, the Palmer College of Chiropractic Board of Trustees is pleased to announce the unanimous selection of Dennis Marchiori, D.C., Ph.D., D.A.C.B.R., as chancellor of Palmer College. His appointment will take effect December 15, 2009. Dr. Marchiori was approved by the Board of Trustees at its October 30, 2009, meeting in Daytona Beach Shores, Florida. He was recommended to the full Board after a comprehensive interview process led by a Board-appointed, seven-member ad hoc Succession Planning and Search Committee. The Committee was assisted by Diversified Search, a Philadelphia-based executive search firm, and a five-member search advisory group consisting of notable chiropractic, higher education and community leaders. “I’m very pleased with the process we followed to identify who we all believe is the most qualified person to lead Palmer College,” said Mr. Ken Koupal, chair of the Committee. “Diversified Search, the Committee and everyone involved worked as a true team to recruit and examine a strong pool of 27 internal and external candidates. In the end, we all recognized that the best candidate, Dr. Marchiori, was right here at Palmer.” “From the outset, our goal was to be thorough and committed to finding the right candidate to lead this institution,” said Trevor Ireland, D.C., chairman of the Palmer Board of Trustees. “We will never lose sight of our responsibility for doing what is best for Palmer College and we’re confident that, under Dr. Marchiori’s proven leadership, we will continue to uphold that responsibility.” “For more than a century, Palmer College has been leading the chiropractic profession and contributing to the communities surrounding our campuses,” said Dr. Marchiori. “I am honored to continue the successes of the past, including recent regional accreditation and growing extramural research grants, as we advance the College through its next phase of accomplishments. We have energized students and a dedicated team of staff, faculty and administrators to promote our educational mission. Palmer College is an exceptional organization and well-positioned for future success. I’m truly honored to have been selected chancellor.” A Palmer Product A native of western Pennsylvania, Dr. Marchiori completed his prerequisite work at Penn State University before earning his Bachelor’s of Science at Regents College in Albany, New York. He graduated with his Doctor of Chiropractic degree from Palmer College’s Davenport Campus in 1990 and went on to earn his Master of Science degree in Anatomy at Palmer in 1992. In 1995, he completed a three-year residency in radiology at Palmer College leading to Diplomate status with the American Chiropractic Board of Radiology. Dr. Marchiori received his doctorate in Policy, Planning and Leadership from the University of Iowa in 2005. He has had faculty appointments in the Research, and Diagnosis and Radiology departments. His administrative tenure includes the roles of department chair, dean, vice president of Academic Affairs for the Davenport Campus, and vice chancellor for Academics for the College system. In addition to his teaching and administrative service, he has published numerous scientific articles and two editions of a comprehensive textbook in radiology, titled “Clinical Imaging.” “With nearly 20 years invested with Palmer College, Dr. Marchiori has proven himself as a leader in chiropractic and higher education,” said Dr. Ireland. “There is a great sense of pride in watching someone like him live the American Dream, advancing through the administrative levels and excelling with each new chapter.” Passing the Baton In assuming the chancellor role, Dr. Marchiori will succeed Mr. William Wilke, a respected Quad-City area businessman and a member of the Palmer Board since 1998. In December 2008, following the departure of Chancellor Larry Patten, the Board asked Mr. Wilke to serve until a complete and thorough search could be conducted. “While we are excited about the future of Palmer College under Dr. Marchiori’s leadership, I want to express the Board’s sincere gratitude to Mr. Wilke for his service during the past year,” said Dr. Ireland. “His guidance and management expertise played a key role in so many of our accomplishments.” Dr. Marchiori lives in Bettendorf, Iowa, with his wife, Cheryl, and four children: Isabella, Sophia, Tony and Olivia. An investiture ceremony is being planned for early next year.

Greeley, Colo. – On Friday, October 16, the National Board of Chiropractic Examiners (NBCE) broke ground on a 15,000 square foot, $2.5 million dollar building. The target completion date is May 27, 2010. NBCE President Dr. Vernon Temple along with members of the NBCE Executive Committee Drs. Edwin Weathersby, Richard Cole and Ted Scott, and Daniel Saint-Germain, President of the Federation of Chiropractic Licensing Boards and Chair of the NBCE Developmental Committee, were on hand to welcome special guests, including Larry Steel, Architect. Opening remarks were made by Horace Elliott, NBCE Executive Vice President, Greeley Mayor Ed Clark, Greeley Chamber of Commerce President Sarah MacQuiddy, and Terry Drahota representing Drahota Construction of Fort Collins, Colorado. Other special guests recognized were County Commissioner Sean Conway and Greeley City Council member Maria Seacrest, Greeley City Manager Roy Otto, Bruce Biggi of the City Economic Development office, and several academic vice presidents of chiropractic colleges. According to President Temple, “The new building represents the growth and expansion necessary for the NBCE and its international component, the International Board of Chiropractic Examiners, to maintain the high standard we have set for testing in the health care community.” He continued, “In the last 46 years, this organization has set the standard in testing—not just in chiropractic, but in the general standardized testing community. NBCE has gained the recognition and confidence of the general public and state regulatory boards as well as unified the profession by providing standardized testing that assesses the ability of each doctor of chiropractic." The new building will house state-of-the-art audiovisual and teleconferencing equipment that will enhance the ability of test committee members to develop future examinations testing basic science and clinical knowledge and the demonstration of clinical competency. Each year more than 300 visitors, representing state licensing boards, chiropractic college faculty, and subject matter experts meet at the NBCE to develop standardized written and practical examinations for candidates seeking chiropractic licensure throughout the United States and in many foreign countries. The organization has been headquartered in Greeley, Colo., since 1978 and moved to its current campus in west Greeley in 1990.

A report, prepared by a global leader for trusted human resources and related financial advice, products and services, finds that the addition of chiropractic care for the treatment of low back and neck pain will likely increase value-for-dollar in US employer-sponsored health benefit plans. Authored by Niteesh Choudhry, MD, PhD, and Arnold Milstein, MD, the report can be fully downloaded at: (Full Report) Executive Summary: Low back and neck pain are extremely common conditions that consume large amounts of health care resources. Chiropractic care, including spinal manipulation and mobilization, are used by almost half of US patients with persistent back-pain seeking out this modality of treatment. The peer-reviewed scientific literature evaluating the effectiveness of US chiropractic treatment for patients with back and neck pain suggests that these treatments are at least as effective as other widely used treatments. However, US cost-effectiveness studies have methodological limitations. High quality randomized cost-effectiveness studies have to date only been performed in the EU. To model the EU study findings for US populations, researchers applied US insurer-payable unit price data from a large database of employer-sponsored health plans. The findings rest on the assumption that the relative difference in the cost-effectiveness of low back and neck pain treatment with and without chiropractic services are similar in the US and the EU. The results of the researchers’ analysis are as follows: Effectiveness: Chiropractic care is more effective than other modalities for treating low back and neck pain. Total cost of care per year: -For low back pain, chiropractic physician care increases total annual per patient spending by $75 compared to medical physician care. -For neck pain, chiropractic physician care reduces total annual per patient spending by $302 compared to medical physician care. Cost-effectiveness: When considering effectiveness and cost together, chiropractic physician care for low back and neck pain is highly cost-effective, represents a good value in comparison to medical physician care and to widely accepted cost-effectiveness thresholds. These findings, in combination with existing US studies published in peer-reviewed scientific journals, suggest that chiropractic care for the treatment of low back and neck pain is likely to achieve equal or better health outcomes at a cost that compares very favorable to most therapies that are routinely covered in US health benefits plans. As a result, the addition of chiropractic coverage for the treatment of low back and neck pain at prices typically payable in US employer-sponsored health benefit plans will likely increase value-for-dollar by improving clinical outcomes and either reducing total spending (neck pain) or increasing total spending (low back pain) by a smaller percentage than clinical outcomes improve. Accordingly, this report was commissioned by the Foundation for Chiropractic Progress (www.f4cp.com) to summarize the existing economic studies of chiropractic care published in peer-reviewed scientific literature, and to use the most robust of these studies to estimate the cost-effectiveness of providing chiropractic insurance coverage in the US. Gerard Clum, DC, spokesperson for the Foundation for Chiropractic Progress and president of Life Chiropractic College West, says, “While some studies reflect cost efficiencies and others clinical efficiencies, these findings strongly support both for chiropractic care of neck pain and low back pain.” About F4CP A not-for-profit organization, the Foundation for Chiropractic Progress (F4CP) embraces a singular mission to promote positive press for the profession in national, regional and local media. Through effective and ongoing initiatives, the Foundation’s goal is to raise awareness to the many benefits provided by doctors of chiropractic. The F4CP relies upon strategic marketing campaigns that span prominent spokespersons, monthly press releases, public service announcements, and advertisements in high-profile media outlets. To learn more about the Foundation, please visit us on the web at www.foundation4cp.com or call 866-901-f4cp.

The New York State Insurance Fund today announced a state-of-the-art online medical bill inquiry service with the expansion of its electronic Explanation of Benefits (EOB) for doctors treating workers’ compensation injuries covered by NYSIF. In making the announcement, NYSIF Chief Deputy Executive Director Francine James said the upgrades are part of NYSIF’s electronic medical billing and inquiry system available to all medical providers treating NYSIF claimants. “We are pleased with the upgrades we’ve made to our electronic EOB system and we anticipate that medical providers will be, too,” Ms. James said. “This system is a real time saver for doctors, their billing staffs and for our own personnel – and by including more information on screen NYSIF is introducing a state-of-the-art system for workers’ compensation medical bill inquiries.” The new EOB service gives providers a more detailed explanation of medical bill payments made by NYSIF, alerts them to bills that have not been received, or reasons why a bill hasn’t been paid. NYSIF introduced its online EOB for workers’ compensation medical providers in 2007, an Oracle based system built in-house by NYSIF system developers. The Fund followed soon thereafter with giving providers the option to submit medical bills electronically to NYSIF. The EOB upgrades are based on the most frequently asked questions received from doctors’ billing offices. The system has been a value added service, saving time and money by providing convenience for medical administrative staffs transacting business with NYSIF. According to NYSIF medical claims team, some of the more common reasons for non-payment of workers’ compensation medical bills submitted to NYSIF include pending claim status, claim disallowance, claim settlement, invalid jurisdiction, lack of proper medical records, and duplicate billing of paid procedures. All of this information is now accessible to medical providers and their staffs 24/7/365 days a year, spelled out clearly in one location for all medical bills submitted on every claim. NYSIF’s expanded electronic EOB offers an express means by which to cut wait time on billing errors, avoid payment delays and eliminate the time and resources NYSIF and doctors’ staffs devote to billing questions. Medical bill inquiries made online at nysif.com provide users with NYSIF’s claim number, the claimant’s name, date of injury, complete contact information for the NYSIF case manager and office assigned to the case, the NYSIF assigned bill number, bill date, date received and bill status for every claim on record. As an insurance carrier, NYSIF assigns its own claim number to workers’ compensation claims. The New York Workers’ Compensation Board assigns a different number to the claim. NYSIF lists both numbers in the summary to avoid potential confusion for administrative personnel not familiar with the state workers’ compensation system. The summary includes billing codes, total charges and amounts paid, along with a reason why only partial payment may have been made for certain billed procedures. A short narrative summarizes the check number, amount paid, date issued and mailing address on record. Users have the option to click on the check number to see a complete explanation of payments included in the check and to print the complete EOB. The service is free to any medical provider doing business with NYSIF. Medical providers may only access the EOB for the bills they submit. By leading to less time spent on billing questions, either on the phone or exchanging e-mail, NYSIF believes the new features will further increase productivity and efficiency for medical office personnel using the system and for NYSIF staff. NYSIF, a non-profit organization of the state of New York created as part of the Workers' Compensation Law of 1914, is New York’s largest workers’ compensation insurance carrier. By law, NYSIF is a competitive insurance carrier that sells workers' compensation and disability benefits insurance to any employer doing business in New York State. Approximately 185,000 employers hold NYSIF workers' compensation insurance policies, constituting about 41 percent of the market.

(Arlington, Va.) -- The American Chiropractic Association (ACA) has joined with other provider groups to support legislation, S. 1776, introduced in Congress on Oct. 13 by Sen. Debbie Stabenow (R-Mich.) that would permanently repeal the “flawed” formula that determines Medicare reimbursement rates. Current federal law mandates that Medicare payments to physicians be modified annually using the Sustainable Growth Rate (SGR) formula. The SGR formula ties payments to the national gross domestic product, and many in health care have expressed concerns that this system is neither accurate nor appropriate. Acknowledging problems associated with tying payments to the SGR, Congress for the past seven years has voted to overturn proposed fee cuts based on the formula. On Oct. 16, ACA joined other health care provider organizations in the Patients’ Access to Responsible Care Alliance (PARCA) to voice its strong support of ending the system that has for too long proposed unfair reimbursement rates. By joining with other providers, ACA underscores its belief that the current system is unacceptable for any health care professional. To read the PARCA letter to Sen. Stabenow, click here. “ACA is committed to supporting S. 1776, and any other legislation that addresses problems associated with the flawed SGR formula,” said ACA President Rick McMichael, DC. “Health care services to our nation’s Medicare beneficiaries should not be undervalued.” Look for updates on S. 1776, and ACA’s efforts to address the Medicare payment system, in upcoming ACA publications and on ACA’s Web site:

With health care reform activities accelerating in Congress, the American Chiropractic Association (ACA) has launched the Chiropractic Health Advocacy and Mobilization Project (CHAMP), a one-year campaign to raise funds in support of strategic lobbying activities intended to boost chiropractic’s profile on Capitol Hill.

The following is a summary of the key provisions relevant to chiropractic within the new Insurance Omnibus Law. Section 3, 19 & 32 Prohibits an insurer or HMO from implementing an adverse reimbursement change to a contract with a health care provider unless insurer or HMO gives health care professional 90 days written notice of the change and allows health care professional 30 days to terminate his/her contract with insurer or HMO. Effective date is January 1, 2010. Section 4 & 17 Insurers offering comprehensive policies establish grievance procedures and provide access to care consistent with insurance law. The effective date is January 1, 2011. Section 6 Requires insurers and HMOs to pay claims submitted electronically within 30 days and expands the provision of the PROMPT PAYMENT LAW to self-insured municipal cooperative health plans. This is effective January 1, 2010. Section 7 Prohibits insurers and HMOs from denying a claim on the basis that they are coordinating benefits – unless insurer or HMO has reasonable basis to believe enrollee has other insurance which is primary. Effective January 1, 2010. Section 8 If prompt payment violation is determined, an insurer or HMO shall not be subject to penalty if insurer or HMO has processed at least 98% of claims submitted within the calendar year. In the past, the insurer would pay claims to avoid penalties, but then implemented retrospective audits. This is effective January 1, 2010. Section 9 Health care claims must be submitted by health care professional within 120 days after date of service. Allows health care professionals to request reconsideration of a claim that is denied as untimely. If health care professional demonstrates untimely claim was a result of an unusual occurrence and health care professional has pattern of timely claim submission. HMO/insurer may reduce untimely claim by 25%. Effective April 1, 2010. Section 10 This portion contains most of the NYSCA drafted language on retrospective audits for the benefit of all title VIII health care professionals. Limits of look back period of time payers can go when making routine retrospective audits to 24 months. In addition, before payer can commence a recovery effort, payers must give providers written notice at least 30 days in advance of any recovery effort providing the practitioner with vital information concerning the claim and a reasonably specific explanation of any proposed adjustment as well as an opportunity to challenge the overpayment recovery effort. No time limit exists in situations where the payer holds a reasonable belief of fraud, intentional misconduct or abuse of billing. Effective January 1, 2010. Section 12, 13, 14 & 31 Inhibits insurers and HMOs from treating a hospital that participates within a network as a nonparticipating provider solely because the health care provider admitting or rendering services to the insured/enrollee is a nonparticipating provider. These sections also prohibit insurers and HMOs from treating a health care provider that participates within a network as a nonparticipating provider solely because services are rendered in a nonparticipating hospital. This is an important change, particularly for chiropractors and/or hospital based chiropractic practices. Effective date is January 1, 2010. Section 20 & 33 These provisions allow a newly licensed professional and providers relocating to NY to join the group practice of credentialed par providers participating in a HMO/MCO, a nonprofit indemnity or medical service plan to be provisionally credentialed by the health care plan until such time as the plan makes its final determination regarding the provider’s application. Effective date is October 1, 2009. Section 27 & 40 This requires an external appeal agent to notify a provider when appropriate of an external appeal determination. Effective date is January 1, 2010

Arlington, Va. -- The American Chiropractic Association (ACA) has retained Gephardt Government Affairs, headed by former U.S. House Majority Leader Dick Gephardt, to reinforce its efforts to ensure that any national health care reform legislation passed by Congress includes the services of doctors of chiropractic on par with other physician services in respect to access, reimbursement and scope of practice.

The debate concerning National Healthcare Reform is set to resume in Washington D.C. Your voice is needed to make your Senators and Congressmen know that chiropractic care is an integral part in any Healthcare Reform Legislation. Click on the link below. URGENT! CALL TO ACTION: FEDERAL HEALTHCARE REFORM