government is deciding the "minimum" benefits of a health plan.
services are in danger of being left out.
Congress passed national healthcare legislation in March, they gave the
Secretary of Health and Human Services (HHS) the authority to determine the
categories of services which must be included in future health plans. The
initial categories do not include "neuromusculoskeletal care" which is the core
of what is treated by chiropractors. Unless neuromusculoskeletal care is added
as an essential benefit category, the chiropractic profession risks being left
out of national healthcare.
purpose of the Chiropractic Essential Benefit
Campaign is to bring pressure on the HHS to make sure your patients
have access to you. If the federal government decides that chiropractic services
do not have to be covered, states around the country are almost certain to adopt
this standard for workers compensation, and personal injury.
profession, your income, and the health of your patients is all at
risk - We must ALL be proactive to save chiropractic. Visit www.chirobenefit.org TODAY.
Medicare Fee Cuts Delayed Until December
June 25, 2010, President Obama signed into law the "Preservation of
Access to Care for Medicare Beneficiaries and Pension Relief Act of 2010." This
law establishes a 2.2 percent update to the Medicare
Physician Fee Schedule (MPFS) payment rates retroactive from June 1 through
November 30, 2010.
here for updated 2010 Colorado Medicare Fees for
January 1 to May 31 AND June
1 to November 30
Contact CCA Insurance Committee Chair Dr. Greg Crawford at
- or 970-493-8386
Implications of SB79 Standard Contract Bill
SB 79 will reduce
associated with processing multiple payer contracts, all of which have
different language and conditions. It
ensures that all contracts are drafted in plain language and use set of
terms. The bill requires payers to notify
providers of changes and updates to their contracts.
Previously, payers might make changes which
providers might to be aware of, and those added conditions had a
impact. If someone from the office did
not regularly check a payer’s web site, they would be unaware of
changes to their contract. After January
1, 2008, providers are no longer obligated to accept unilateral changes
the plans during the term of their contract. This
will bring transparency to the contracting
eliminates “contracts of
adhesion” that all doctors are required to sign when they join a
network. The law will eliminate “phantom” networks, stop
contract changes, require that a copy of the fee schedule be attached
contract, and provide other helpful contractual provisions that will
allow you to
evaluate whether to sign the contract or get out of the network.
SB 79, as set forth in the
entity contracting with a health care provider on or after
January 1, 2008, to use
a standard form contract . Requires each contract to include a summary
disclosure form that contains:
- Compensation and payment
terms that are sufficient for the health care provider to identify the
compensation for health care that is provided that shall include a fee
- The duration of the
contract and reasonable termination terms;
- The identity of the
- Dispute resolution terms;
- The subject and order of
an addenda, if applicable.
Requires the person or
entity to identify a program
used to review, monitor, evaluate, or assess the health care services
Exempts a person or entity from providing a fee schedule to a provider
fee schedule is for dental services whose providers include licensed
and the fee schedule is based on fees filed by the dental provider and
Requires the person or
entity to state how a
completed claim was adjudicated and any outstanding balance owed.
payment and compensation terms to be disclosed in writing when a
proposed by the person or entity. Allows
a material change to a contract only if the change is provided in
days prior to the change. Allows a contract to be terminated by either
there is written objection to the change, unless the objection is to an
addition of a new category of coverage. Prohibits a person or entity
assigning, allowing access to, selling, renting, or giving the rights
provider's services unless specific conditions are met. Prohibits a
from requiring a waiver of the provider's legal rights as a condition
entering into the contract. Allows a
health care provider to decline services to new patients upon 60 days'
Allows for termination of a contract without cause
by either party if the
contract is for less than 2
years, otherwise requires the termination without cause terms to be
in the contract. Exempts certain entities from the requirement of using
contract. Allows a contract to include
an agreement for binding arbitration.
Requires the availability
of private rights of
action, equitable relief, reasonable attorney fees when the provider is
prevailing party in an action, and the option to introduce prior
awards regarding a violation.
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or 800-829-0339 | Fax: 303-755-1010
Colorado chiropractic since 1917.