Did you know the most common cause of gastroparesis is diabetes?
The most common cause of gastroparesis is diabetes. When gastroparesis, which literally means stomach paralysis, is present the stomach can't crush food or propel it into the small intestine properly. Infections, endocrine disorders and neuromuscular diseases are a few of the other causes. The effects of some medicines can mimic the condition as well. -- The American College of Gastroenterology
Top Story
GLOBAL CASES OF CELIAC DISEASE RISE SHARPLY
Studies from around the world indicate that the number of people who have been diagnosed with celiac disease increased up to fourfold during the last three decades. "This increase has affected young and old people. It suggests something has happened in a pervasive fashion from the environmental perspective," one researcher said. Medscape (free registration) (7/30)
Guide to Healthy Living
STUDY: LOSING WEIGHT IS MORE IMPORTANT THAN GETTING FIT
A U.S. study found physical fitness had less impact on blood pressure than measures of body mass index. The finding suggests that those who are trying to lower their risk for high blood pressure should work more on losing weight than getting in better shape. Reuters (7/30)
Diagnosis & Treatment
INFANTS WITH FEEDING AVERSION OFTEN HAVE ACID REFLUX
A Birmingham, Ala., mom is helping form a nonprofit group called Reflux Rebels for families of babies who have feeding aversion, which often is linked to acid reflux disease. Aaryn Holland, whose daughter struggled with the disease for nearly a year, says parents should not wait to get help so that feeding issues do not become long-term medical problems. WIAT-TV (Birmingham, Ala.) (7/29)
OTC DRUGS ARE FIRST LINE OF TREATMENT FOR ACID REFLUX
There are several levels of over-the-counter medications for acid reflux, from calcium carbonate to acid reducers and proton pump inhibitors, says Dr. Otis Brawley of the American Cancer Society. Long-term acid reflux can lead to serious conditions and even esophageal cancer, so as a last resort a surgical procedure called Nissen fundoplication can reshape the esophageal-gastric junction to reduce the tendency of fluid to reflux into the esophagus. CNN (7/28)
TNF-BLOCKERS MAY RAISE CANCER RISK IN CHILDREN
Children taking tumor necrosis factor-alpha blockers, particularly for inflammatory bowel disease rather than for rheumatic conditions, may be at higher risk of cancer, researchers said. Study data showed 48 malignancies among children and young adults taking infliximab, etanercept or adalimumab, according to the FDA. MedPage Today (free registration) (7/31)
JULY 2010 Newsletter
New Website Features!
As many of you know we have been hard at work on our website: ccamembers.com
We’ve recently added a new “Member’s Only” section filled with valuable information just for CCA members! Here is how you can login and check it out!
Your “username” is the email address you are receiving this newsletter at, and your password is “cca” followed by your member ID number. For example:
Username: dc@bestchiro.com
Password: cca76239
If you have any questions please contact the webmaster: sfvcd.cca@gmail.com
Stay tuned as we continue to upgrade and improve the CCA website.
2009 – 2010 CCA Awards - Honoring Our Own
Annually, CCA pauses to recognize and honor those among us who voluntarily invest their time, talent and energy to reinforce the positive image of the chiropractic profession. These chiropractic professionals, chiropractic supporters and CCA districts reflect the best of our professional unity as they strive to implement CCA’s mission to “Promote high standards of professionalism and patient care through education, advocacy and accountability.” The awards were bestowed on the following recipients in conjunction with the June 2010 CCA Board of Directors meeting:
CCA Statewide Awards
Congratulations! We were recently awarded the District of the Year!
Presented to the district which, as a body, has made outstanding accomplishments for the chiropractic profession and/or fulfillment of CCA programs for the year: CCA San Fernando Valley District
Additionally, we would like to recognize Dr. Brad Sullivan for his President Award. This award is given to those doctors who have meritorious achievements.
Being awarded the District of the Year is an outstanding achievement and you should consider yourself honored to be part of such an amazing district! Here are just a few things our district has accomplished over the last year:
Complete Website Overhaul
Private Member’s Only Section of the Website with Valuable Research Articles and Important News
A Brand New Marketing Flyer to Promote Active Recruitment
Weekly Newsletter Update: Keeping You Up to Date and Informed with the Latest News, Important Dates, and Medical/Legal Issues
Informative Seminars: HJ Ross hosted an informative and educational seminar.
We Sent Two Doctors to LedgeCon to Meet With Our Legislators
Bridging the Gap: The San Fernando Board of Directors Keeps In Close Contact With It’s Members To Relay Important Issues To Sacramento.
Creation of the Media and Communication Committee: Dedicated To Keeping You Digitally Connected To The CCA Via Informative Newsletters and Innovative Website
New Co-Op Advertising Program: Connecting You With Attorneys To Generate Revenue
Cancer Defense: Think Nutrition
From an article in Environmental Nutrition.
Everyone knows about the dreaded C word, and far too many have direct experience with it in one way or another. A diagnosis of cancer alone can send shock waves through an entire family, office or even a community.
And with cancer risk factors (carcinogenic foods, environmental hazards, sedentary lifestyles) on the rise, there's no better time to learn about a simple, painless step you can take to reduce your risk of developing cancer - or do your best to fight it if you've already been diagnosed. Yes, it's the power of nutrition - nature's best cancer defense.
According to Drs. Richard Beliveau and Denis Gringas, authors of Foods That Fight Cancer: Preventing Cancer Through Diet, research suggests that specific food-borne bioactive molecules can do the following in terms of cancer prevention:
Decrease free-radical damage to DNA, which is known to produce cancerous mutations;
Strengthen immune system function, as various immune cells are known to destroy cancer cells (e.g., macrophages and killer-T cells);
Inhibit angiogenesis (growth of new blood vessels) of developing tumors;
Block key signal transduction pathways required for cancer cell replication;
Stimulate pathways that induce programmed cell death (known as apoptosis) of existing and emerging cancer cells;
Enhance detoxification, helping to neutralize and eliminate carcinogens in the body;
Promote cellular differentiation, which decreases the risk of healthy cells from becoming cancer cells;
Block the formation of dangerous nitrosamines (chemical compounds, some of which can cause cancer) in the body.
Here are some key anti-cancer foods for daily use as suggested by these two leading cancer researchers:
Brussels sprouts - ½ cup
Broccoli, cauliflower, cabbage - ½ cup
Garlic - 2 cloves
Onions, shallots - ½ cup
Spinach, watercress - ½ cup
Soy (edamame, dry roasted beans) - ½ cup
Freshly ground flaxseeds - 1 tablespoon
Tomato paste - 1 tablespoon
Turmeric - 1 teaspoon
Black pepper - ½ teaspoon
Blueberries, raspberries, blackberries - ½ cup
Dried cranberries - ½ cup
Grapes - ½ cup
Dark chocolate (70 percent cacao) - 40 g
Citrus juice - ½ cup
Green tea - three 250 ml servings
Red wine - 1 glass (5 ounces)
What About Supplements?
While Drs. Beliveau, Gringas and Servan-Schreiber don't recommend the use of dietary supplements to prevent cancer, or in the adjunctive nutritional management of cancer, numerous studies have appeared in peer-reviewed medical and scientific journals in recent years showing important anti-cancer properties provided by various nutritional supplements. This includes studies demonstrating their ability to help prevent cancer, reduce cancer incidence, and be used in conjunction with medical practices as an adjunctive measure to enhance the efficacy of some forms of chemotherapy and/or slow the progression of cancer and/or decrease the recurrence of cancer.
As a practitioner who is affiliated with a leading cancer treatment facility in Toronto, my patients are provided with the best that medicine, diet and supplementation have to offer, based on the total pool of peer-reviewed scientific evidence. I have published numerous review papers on subjects pertaining to the use of nutritional supplements and cancer. I am also a lecturer on this subject in the Cancer Fellowship Program for medical doctors through the American Academy of Anti-Aging Medicine. So, I can proudly state that diet, nutrition and nutritional supplementation can all play a significant role in preventing and fighting cancer. Talk to your doctor to learn more.
JUNE 2010 Newsletter
2010-2011 CCA
Executive Officers Elected
Dr. Heather Dehn, CCA Elections Committee chair, and Dr. Steve Hammer, CCA Election Committee member, counted ballots for the 2010-2011 CCA elections. These are the results of the election:
President:
Kenneth Winer, DC
President-Elect:
Vernon Englund, DC
Vice President:
Rob Walsh, DC
Chief Financial Officer:
Victor Helo, DC
Secretary:
David Paris, DC
Immediate Past President.:
Maia James, DC
California Use Tax
This fact sheet summarizes in a FAQ format what use tax is and what doctors need to do.
Our District Website Update:
Please visit our newly revamped website at: ccamembers.com
We have made additions to the website to make it a working tool for our members. So stay tuned, we are continuing to improve our website with valuable information and news for you!
Sign up for ChiroVoice.org
Comedy Night with Congressman Adam Schiff!
June 26th, 2010
Join him for the annual Comedy Night
At the Ice House…great fun and lots of laughs every year!
LedgeCon 2010
Dr. John Termini and Dr. Victor Helo recently visited the state capital to attend LedgeCon 2010. While they were there they had a chance to tour the capital as well as attend meetings with legislators to discuss regarding issues facing the Chiropractic profession.
Dr. Termini said:
“After visiting the capital I realized what happens outside the office & what happens in Sacramento affects what we do on a daily basis in the scope of practice.”
This was Dr. Termini’s first trip to LegCon and we are pleased he was there to represent our districts concerns.
Division of Workers’ Compensation
This fact sheet will help you understand workers’ compensation temporary disability benefits. Temporary disability (TD) benefits are payments you get if you lose wages because your injury prevents you from doing your usual job while recovering.
Q: Do I need to fill out the claim form (DWC 1) my employer gave me?
Q: What if my employer didn’t give me the DWC 1 claim form?
Q: What are the temporary disability benefits?
Q: How is temporary disability calculated?
Q: When does temporary disability start and stop?
Q: Do I get other benefits while receiving temporary disability?
Q: What if there is a problem with my benefits?
Would you like to see the answers to these important questions?
Please visit the FAQ section of: CCAmembers.com
10 Guidelines For Healthy Eating
From an article by Bonnie Leibman
1. Make vegetables a main course. Vegetables or fruit are going to fill up at least half of your plate at lunch and dinner.
2. Keep saturated fat and cholesterol low. That means just a small (¼ lb.) portion of lean meat or poultry per day for a 2,000-calorie diet. (It's okay to have a more generous serving of fish.) Vegetarians can substitute veggie meats, tofu, or beans. Use eggs and non-low-fat cheeses sparingly. (Egg whites are okay.)
3. Don't overdo grains. Even whole grains are limited to four servings a day if you're shooting for 2,000 calories.
4. Minimize added sugar. A 2,000-calorie diet allows two teaspoons (8 grams) of added sugar a day. There's no room for more empty calories.
5. Keep a lid on sodium. In a OmniHeart study, sodium was limited to 2,300 milligrams a day. That means avoiding high-sodium processed foods.
6. Eat beans and nuts. If beans seem dull, think Middle Eastern (hummus), Indian (curried lentils), French (cassoulet), Southwestern (black bean soup), or American (vegetarian chili). Or just throw some chickpeas into your salad.
7. Eat real food, not junk. Notice what's missing (or minimal) in this diet? It's not just sweets (cookies, cakes, ice cream, muffins, soda, etc.). It's also big bowls of pasta, big bagels, and big muffins. Most pizzas, panini sandwiches, wraps, and burritos are too big. Also gone are granola or energy bars, pita chips, and other junk disguised as health foods. Think of them as an occasional splurge.
8. Cut calorie density to lose weight. "People eat for weight or volume," explains Barbara Rolls of Pennsylvania State University. Her studies show that if you trim the calorie density—that is, the calories per bite—people leave the table feeling full but with fewer calories in their belly (and, eventually, with less belly). Her research team analyzed data from the Premier diet, "People who lowered their calorie density ended up eating fewer calories and losing more weight," she explains.
9. Eat veggies instead. Adding vegetables only curbs calories if you eat less of everything else. "So if your goal is to cut calorie intake, you have to substitute vegetables for other ingredients."
10. Cut liquid calories. When the Premier study began, most participants got 350 calories—nearly a fifth of their calories for the day—from soda, alcoholic beverages, juice, milk, and other drinks. Trimming those calories mattered.
CCA UPDATE BILLING TIPS:
Medical Legal Discounts are NOT allowed by MPNs
On April 28, 2010 the Division of Workers’ Compensation (DWC) issued a DWC Newsline stating
“Unless the medical-legal provider and the payor have made a specific written agreement regarding medical-legal service payment at rates different than the MLFS, a general MPN or PPO discount does not apply.”
The medical-legal fee schedule (MLFS) is a distinct and separate fee schedule from the Official Medical Fee Schedule (OMFS). The MLFS is set forth under Labor Code 5307.6 and the OMFS is set forth under Labor Code 5307.1.
Cascading Reimbursement for Procedures
The California OMFS cascades reimbursement of multiple procedures based on the VALUE of the procedure.
Per the regulations found in the Surgery section of the OMFS, multiple procedures are reimbursed for CPT codes 10040-69979 as follows:
100% for the major highest-valued procedure
50% for the second highest-valued procedure, or equivalent
25% for subsequent-valued codes
Missed Med-Legal Appointments ML100
When a med-legal appointment is scheduled, our office completes the Notice of Med-Legal Cancel Policy Template (Notice of ML Cx) which is sent to the adjuster. This notice alerts the adjuster that there will be a charge of $500 for all appointments canceled less than 48 hours prior to the appointment time.
If the patient does not show or the appointment is cancelled less than 48 hours, a claim is submitted for ML100 and the claim includes the Notice of ML Cx that was originally sent to the adjuster.
Thank You
A special thanks to Hubie Chang and HJ Ross for a wonderful and informative meeting.
Free - CCA Convention & Exposition - Save Your Seat
June 11-13, Reno, NV
Check out the schedule of sensational speakers and terrific topics. It’s FABULOUS and FREE!
Our own Dr. Eric Mumbauer, D.C. will be teaching Worker Compensation 101 classes.
So make your reservation at the Grand Sierra Resort by May 18 to get CCA’s special Summit guest room rate of $109/night. Call 800.648.5080 or 775.789.2000 and say you are with California Chiropractic Association.
Website Update
Please visit our newly revamped website at: ccamembers.com
Stay tuned, we are continuing to improve our website with valuable information and news for you!
Comedy Night with Congressman Adam Schiff!
Save the date of June 26th, 2010
For his annual Comedy Night
At the Ice House…great fun every year!
The California Chiropractic Association announces its endorsement of Mike Gatto for Assembly District 43!
Mike Gatto is a chiropractic supporter. Gatto has experienced, first hand, the tremendous impact chiropractic adjustments can have on one's immediate health and well-being. He has the strength of character and conviction to stand up for what he believes is right.
For more information on Mike Gatto, visit his webpage at: http://www.mikegatto4assembly.com.
5 Underrated Foods
From an article by Bonnie Liebman and Jayne Hurley
Sunflower Seeds
A quarter cup of sunflower seeds has 3 grams of fiber and 6 grams of protein plus 25 to 75 percent of a day’s copper, vitamin E, selenium, and manganese and roughly 10 percent of a day’s zinc, magnesium, and vitamin B-6.
For a snack, buy sunflower seeds in the shell (it will slow down your munching). For tossing on salads or yogurt, buy them raw, unsalted, and shell-free. (You can easily roast them in a toaster oven for richer flavor.) There’s only one catch: every ¼ cup contains 180 calories...and it’s tough to stop there.
Garbanzo Beans
All beans are good beans. They’re rich in protein, fiber, iron, magnesium, potassium, and zinc. Garbanzos (chickpeas) stand out because they’re so versatile. Just drain, rinse, and toss a handful on your green salad. If you have an extra few minutes, dress them up with chopped scallions, olive oil, and lemon juice. Or coat with olive oil, balsamic vinegar, and fresh chopped garlic and serve as is or roast (stirring occasionally) until they’re crunchy.
You can also throw garbanzo beans into vegetable stews, curries, and soups; mix them with brown rice, whole wheat couscous, bulgur, or other whole grains; stir them into your chili; or add them to a pot of simmering greens.
Unsweetened Yogurt
Unsweetened yogurt has a pleasant tartness that’s a perfect foil for the natural sweetness of strawberries, bananas, or peaches, or for your favorite breakfast cereal. Greek yogurts (by companies like Fage, Dannon, Yoplait, and Chobani) add a creaminess that makes even the fat-free versions seem luxurious.
And plain yogurt has more protein, potassium, calcium, zinc, and vitamins B-6 and B-12 because it doesn’t have to share a container with the sugary fruit preserves or the sugar that’s in many flavored yogurts.
Watermelon
Contrary to what most people think, watermelon is no lightweight in the nutrient department. A standard serving (about 2 cups) has 38 percent of a day’s vitamin C, 32 percent of a day’s vitamin A, and 7 percent of a day’s potassium for only 85 fat-free, salt-free calories. You won’t find two cups of many foods that go that easy on your waistline.
Watermelon is one of the “Clean 15,” the fruits and vegetables with the fewest pesticide residues, according to the Environmental Working Group. (That’s partly because the thick rind keeps out both bugs and pesticides.) And when they’re in season, watermelons are often locally grown, which means they may have a smaller carbon footprint than some other fruits.
Leafy Greens
Yes, you’ve heard that leafy greens are nutritional superstars. But if you’re a typical American, the only greens in your grocery cart are likely to be lettuce and (maybe) spinach. Nothing wrong with that, except that you’re missing out on powerhouse greens like kale, collards, turnip greens, mustard greens, and Swiss chard.
Leafy greens are jam-packed with vitamins A, C, and K, folate, magnesium, potassium, calcium, iron, lutein, and fiber. And people who eat them have a lower risk of diabetes, stroke, colon cancer, cataracts, bone loss, and memory loss. (Though it’s also possible that healthy people are more likely to eat greens.)
Either way, you’ve got a delicious new side dish that’s cheap, even if you buy it pre-cut in a bag. Don’t pass greens by.
CCA Update
Comedy Night with Congressman Adam Schiff!
Save the date of June 26th, 2010
For his annual Comedy Night
At the Ice House…great fun every year!
Alzheimer's and Diet: Good for Heart May Be Good for Brain
From an article by Todd Neale
A diet rich in fruits and vegetables as well as omega-3 fatty acids may not only be good for your heart -- it may also reduce the risk of developing Alzheimer's disease.
Looking at more than 2,000 dementia-free adults ages 65 and older, researchers revealed that persons who consumed a Mediterranean-type diet regularly were 38 percent less likely to develop Alzheimer's disease over the next four years, according to Dr. Nikolaos Scarmeas of Columbia University in New York and colleagues.
The findings were published online in the journal Archives of Neurology.
The dietary pattern is characterized by eating more salad dressing, nuts, tomatoes, fish, poultry, cruciferous vegetables, fruits, and dark and green leafy vegetables and lesser quantities of red meat, organ meat, butter, and high-fat dairy products.
News From ASHLink
Adjunctive Therapy/Modality Approval Process Change
Due to changing marketplace conditions and client expectations effective June 1, 2010 ASH will begin to verify the medical necessity of any submitted adjunctive therapy/modality service on a “per date of service” as well as “per treatment plan” basis.
ASH will continue the current process of approving, as medically necessary, a maximum number of adjunctive therapies/modalities for a specific date of service within the approved treatment plan. Those approved numbers will be included on the ASH Response From and linked to Claims for payment on a “per date of service” level.
For example, if submitting for verification of medical necessity eight (8) dates of service with manipulation and sixteen (16) adjunctive therapy services, ASH may respond with an approval of medical necessity eight (8) dates of service with manipulation and (16) adjunctive therapy services with no more than three adjunctive therapy services deemed medically necessary and eligible for reimbursement per each date of service.
Adjunctive therapies will continue to be reimbursed according to the applicable Payor Summary and Fee Schedule for a health plan as well as count towards approved therapies on your “Clinical Treatment From”.
Kaiser Permanete of California Program Clarification for CalPERS Members
In the ASH Annual Year End mailing sent in September 2009 it was announced that CalPERS, a group sponsor covered under the Kaiser Permanete of California benefit plan administered by ASH Plans, elected to discontinue their chiropractic coverage effective January 1, 2010.
To clarify that announcement, the discontinuation of coverage only applies to the CalPERS commercial population. CalPERS membership through Kaiser’s Medicare programs are still eligible for coverage.
CalPERS Kaiser Senior Advantage members are not affected by this change and are still currently eligible for chiropractic coverage.
All CalPERS Kaiser Senior Advantage members have a subluxation benefit however; those members also have an additional benefit which covers non-subluxation services. Both of these benefits were inadvertently terminated causing denials in authorization requests as well as claim denials for eligible members.
If you’ve received a denial for an authorization request or claim reimbursement for services for a CalPERS Kaiser Senior Advantage member for dates of service in the months of January and/or February 2010, please be aware that ASH is automatically reprocessing those Clinical Treatment Forms and claims.
You do not have to resubmit Clinical Treatment Forms or claims for affected dates of services.
Continue to refer commercial CalPERS members to Kaiser Permanente of California directly for further information on benefited chiropractic care as of January 1, 2010. Please note however that these commercial members will continue to be eligible for the ASH Plans ChooseHealthy Affinity Discount Program.
If you have any questions regarding the contents of this notice please contact ASHLink.
CHECK YOUR ASHLINK INBOX REGULARLY
Once registered on ASHLink all Provider Notices from ASH Networks regarding health plan changes & announcements, ASH Networks news & information and other ASH Networks changes will be sent to your ASHLink Inbox. It is important to check your ASHLink Inbox on a weekly basis to ensure you are aware of any changes that apply to you or new patients that may be accessing your services.
Fee Bill
The BCE’s relicensure fee bill, AB 1996 (Hill), was further amended in Assembly Business and Professions committee today. The amendment allows the BCE to increase relicensure fees up to $250 on January 1, 2011. The current fee is $150.
The original bill would have increases fees to $200 immediately, and allow the BCE to further raise fees by regulation up to $350. CCA opposed the $350 cap because it represented a 133 percent fee increase during a recession and was more money than the BCE needed to operate. The bill was heard by the Assembly Business and Professions Committee on March 22 and the committee chair told the bill author he had to work out CCA’s concerns before the bill could move forward. The author amended the bill on April 7 to reduce the cap to $295 in an attempt to address CCA’s concerns. The April 7 amendment also included statutory gradual fee increases to $245 by 2012. CCA’s Board agreed to a neutral position on this version but CCA’s executive committee instructed CCA lobbyists to try and further reduce the cap to $250.
At today’s committee hearing, the BCE, ICAC and Southern California University of Health Sciences all testified in support of the bill as amended on April 7. CCA sent a letter to the legislative committee explaining our neutral position but the letter arrived late. The committee chair forced an amendment to the bill that reduced the cap further to $250. After the amendment, the bill passed this first committee with bipartisan support.
The BCE will be forced to go back to the Legislature if they want to raise fees more than $250 per year. It’s safe to say, without CCA’s intervention, the annual relicensure fee would probably been increased much higher. Just another example of how your membership in CCA makes it possible for us to protect and promote the practice of chiropractic on a daily basis.
CCA Elections – Your Vote Counts
Election materials will be mailed to eligible CCA members on April 26. Ballots must be postmarked by May 11 to be counted. Vote on executive committee officers, PAC trustees and bylaw revisions.
California Use Tax: How It Works and What to Do
Many CCA members recently received a letter from the state Board of Equalization (BOE) stating that they are a "qualified purchaser" and may owe state use tax. This fact sheet summarizes in a FAQ format what prompted the letter, what use tax is and what doctors need to do in response to the letter. The fact sheet is also included in the April 2010 edition of CCA Advantage.
CCA UPDATE
Leg Con to the Max - May 11!
Register now for this year’s CCA Legislative Conference, Tuesday, May 11 at Sacramento’s Esquire IMAX Theatre. Not only is the location convenient to the Capitol, but the BIG SCREEN rocks!
FREE CE for CCA Members
• March 20-21, San Jose
• April 17-18, Sacramento
Register early – seats are limited.
• March 20-21, San Jose
100 Year Lifestyle Certification doctors get 12 hours of certification credit. (Additional fee required.)
Special Thanks
Congressman Adam Schiff
The CCA would like to extend a special thanks to the Honorable Congressman Adam Schiff for sending a letter to Speaker Pelosi regarding upcoming changes in our Nation’s Health Care Plan the protection of a patient’s right to choose their doctor. We commend Congressman Adam Schiff’s efforts, and appreciate his willingness to go to bat for chiropractors across this State.
Save the date of June 6,2010 for his annual Comedy Night at the Ice House…great fun every year !
CCA Fights Big Insurance –
In the Ring with Anthem Blue Cross
Anthem Blue Cross is under intense scrutiny and criticism in the wake of its recently proposed 39 percent premium hike which alone would impact a reported 800,000 California policyholders. The hearings and accusations fall on the heals of two lawsuits filed against Anthem and its parent company, Wellpoint in which CCA is a plaintiff, for alleged illegal provider reimbursement practices.
A recap of the recent turn of events and CCA’s actions follow:
February 22: the California Department of Insurance (DOI) announced that an investigation of consumer complaints filed between 2006 and 2009 against Anthem Blue Cross' claims handling practices uncovered more than 700 violations of state law.
The DOI’s investigation of Anthem, which was triggered by consumer complaints, underscores the need for doctors of chiropractic and their patients to file complaints with state officials to get action. Visit CCA’s Web page for a step-by step-guide to making complaints to the appropriate regulatory agencies.
February 23: the Assembly Health Committee hearing examined Anthem’s proposed 39 percent premium increase for California policyholders. In answer to a question posed by committee chair Assembly Member Dave Jones, D-Sacramento, the president of California’s largest for-profit health insurer said the company had no interest in profits beyond what she said were slim margins of 2 to 5 percent.
CCA joined as a plaintiff in two cases currently pending at trial court level challenging Anthem Blue Cross, and its parent Wellpoint, Inc., with engaging in illegal reimbursement practices:
1) A federal class action against Wellpoint and Blue Shield of California alleging illegal demands for repayment by doctors of chiropractic of alleged overpayments and the repayment of reimbursements made for services rendered by DCs that were subsequently determined to not be covered benefits, and 2) a lawsuit against WellPoint/Anthem Blue Cross of California alleging the insurance giant illegally reduced reimbursements to out-of-network doctors of chiropractic.
February 24: the Subcommittee on Oversight and Investigations of the U.S. House Energy and Commerce Committee, chaired by North Hollywood Congressman Henry Waxman, held a hearing on "Premium Increases by Anthem Blue Cross in the Individual Health Insurance Market." During the hearing, Rep. Waxman questioned proposed increases in premium rates by Anthem in California’s individual health insurance market and noted WellPoint said its rate increases had nothing to do with increasing company profits, but an internal company e-mail uncovered stated the increase would “return CA to target profit of 7 percent.” He further revealed that WellPoint paid 39 senior executives over $1 million each in 2008 and spent $27 million on 103 executive retreats during 2007 and 2008.
To support CCA’s actions for the chiropractic cause, donate to the CCA Legal Reserve Fund; call (916.648.2727, ext. 0) or e-mail (cca@calchiro.org) your credit card authorization or mail your check to 1451 River Park Drive, #230, Sacramento, CA 95815.
ASH & Blue Cross - The Blue Cross Medicare PPO, Advantage Blue Cross Self Insured School Districts and PG&E have contracted with ASH to administer the chiropractic benefit under those plans. CCA is doing more research, including discussions with ACA, to determine our legal and legislative options for fighting this.
Blue Shield CMT, Manual Therapy on Same Day - CCA has become aware that Blue Shield is in some cases not reimbursing manual therapies when performed on the same day as CMT, but on a separate anatomical region. As you know, the Correct Coding Initiative allows reimbursement for manual therapies code 97140 on the same date as CMT 98940-41 when modifier -59 is used and chart notes demonstrate it is performed in a different anatomical region. If you have followed the Correct Coding Initiative and have been denied reimbursement from Blue Shield, contact Kristine Shultz at kshultz@calchiro.org or by mail at 1451 River Park Drive, Suite 230, Sacramento, CA 95815. Kristine will need a copy of your files on these cases, including the chart notes and EOBs with the names and other personally identifiable information blacked out.
Personal Injury Committee
As has been posted on CCA's Facebook page and Twitter account, a proposed settlement of a class action lawsuit is pending concerning Allstate's alleged improper failure to pay medical expense benefits under the Medical Payments or Personal Injury Protection coverage for automobile and homeowner insurance policies. Doctors who submitted claims to Allstate during the period October 26, 1989, through July 16, 2009, under PIP or Med Pay coverage had until February 8, 2010, to file a claim for monies deemed owed. Subject to applicable policy limits, doctors who submit a valid claim could potentially receive 60 percent of the difference between the amount of the bills submitted and the amount previously paid by Allstate.
Link to fact sheet: http://www.calchiro.org/documents/StrasenvAllstateClassActionInformationKit_001.pdf
CCA Takes Blues to Court
CCA joined a federal class action lawsuit against Blue Shield of California and WellPoint, Inc., parent of Anthem Blue Cross, alleging violations of ERISA and RICO in a scheme to improperly and illegally steal millions of dollars from doctors of chiropractic in post-treatment payment recoupments. CCA is represented by the New York City-based firm of Whatley Drake & Kallas, LLC, one of the largest plaintiffs’ law firms in the country that has earned a national reputation for being bold and fearless in taking on large corporations, including managed care companies. CCA alleges that these managed care companies have illegally demanded the repayment by doctors of chiropractic of alleged overpayments and the repayment of reimbursements made for services rendered by DCs that were subsequently determined by the companies to not be covered benefits.
Through the class action lawsuit, CCA seeks to halt the companies’ practices of seeking restitution from providers in the alleged illegal fashion and to compel them to repay providers for the amounts they were coerced to pay as a result of the defendants’ improper actions. In addition, the suit seeks 1) payment of treble damages for violations of RICO; and 2) declaratory relief (a) that the managed care companies’ recoupments constitute adverse benefit determinations under ERISA, (b) that these companies made adverse benefits determinations in violation of ERISA requirements; and (c) to compel the defendants to find that the chiropractic and other health care services provided by doctors of chiropractic are covered services under their health care plans. Read more in the December 2009/January 2010 CCA Advantage.
Reminder: CCA Dues Changed January 1st
A reminder that there has been a modest dues investment increase for Active Members that took effect January 1, 2010. For dues paid in advance, the dues investment change will not take effect until payment is due. CCA offers one month free dues to Full-Active, 3rd Year and 2nd Year members who pay 11 months of dues in advance: Full Active $869, 3rd Year $660, 2nd Year $412.50.
See The Latest
It is the position of the American Dietetic Association that appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases.
A vegetarian diet is defined as one that does not include meat (including fowl) or seafood, or products containing those foods.
The lacto-ovovegetarian eating pattern is based on grains, vegetables, fruits, legumes, seeds, nuts, dairy products, and eggs. The lacto-vegetarian excludes eggs as well as meat, fish, and fowl. The vegan, or total vegetarian, eating pattern excludes eggs, dairy, and other animal products.
In 2006, based on a nationwide poll, approximately 2.3% of the US adult population (4.9 million people) consistently followed a vegetarian diet, stating that they never ate meat, fish, or poultry.
Features of a vegetarian diet that may reduce risk of chronic disease include lower intakes of saturated fat and cholesterol and higher intakes of fruits, vegetables, whole grains, nuts, soy products, fiber, and phytochemicals.
Wellness Tips
From an article by Dr. John H. Maher
Back away from the doughnut! Essentially, it is your kryptonite. This type of food contains a low amount of fiber, high amounts of sugar and a guaranteed crash after insulin surges into the blood. Insulin does such a great job of clearing out the sugar in the blood it results in low blood sugar and then you are right back to where you started: hungry, tired, and grumpy.
Long term, continued over-eating of sweets and low fiber carbohydrates can eventually “burn out” the insulin receptors on the cells that assist in getting sugar from the blood into the cells. This is quickened by a lack of exercise. In an effort to overcome this, our bodies may make more insulin. This constant disruption of blood sugar levels is called “Metabolic Syndrome.” This is often a precursor to heart disease and diabetes. Common finding are blood pressure above 130/90 (either number), high triglycerides, a suboptimal good (HDL)/bad (LDL) cholesterol ratio, and central adiposity. Central adiposity is when your waist size is more than half your height.
A little known fact is that fenugreek seeds help to control cholesterol and regulate blood glucose. These seeds lower overall serum cholesterol and reduce triglycerides. In one human study, 2.5g of fenugreek per day for 3 months significantly reduces these cardiac risk factors. Spice cinnamon may also help lower insulin resistance in doses as little as one gram. Finally, the best sweetener for blood sugar balance is stevia. Stevia has proven to support healthy blood sugar and blood pressure.
CCA CALENDAR OF EVENTS
Teleseminars
Marketing Chiropractic to Medical Practices, Wed., Mar.10
For information or to register, call CCA at 916.648.2727, ext. 120.
CCA Conventions & Seminars
Marketing Chiropractic to Medical Practices Teleseminar
• March 10
CCA’s Right in Your Back Yard Seminar – Free to CCA Members
• March 20-21, San Jose
• April 17-18, Sacramento
Save My Seat!
Don’t miss out on a great opportunity to have fun as well as get some continuing education credits. The CCA will be holding its 2010 Annual Conference in Reno, NV on June 11-13. This conference is free for members! Simply put down an $81 deposit and you can join the many other professionals who will be at this exciting event! Please see the attached application and sign up today!
Next Meeting
Our next district meeting is Wednesday March 24th and will be presented by HJ Ross regarding 2010 Billing Codes.
The HJ Ross Company is a medical management consultant firm that has been involved with the health care industry for approximately 30 years. It has streamlined insurance operations for thousands of doctors, dentists, hospitals and clinics.
Meeting Location:
Cal State Northridge, University Club
18111 Nordhoff St., Northridge, CA 91330
For questions and RSVP please contact Dr. Fernandez.
California Jam
California Jam III is scheduled for March 12th, 13th & 14th, 2010 at the most exquisite and beautiful Orange County Performing Arts Center in Costa Mesa, California.
For more information visit:
http://www.californiajam.org/
Reminders
Continuing education requirements will be increased to 24 hours and courses accredited by the AMA will be accepted.
CCA Update
ASH & Blue Cross - The Blue Cross Medicare PPO, Advantage Blue Cross Self Insured School Districts and PG&E have contracted with ASH to administer the chiropractic benefit under those plans. CCA is doing more research, including discussions with ACA, to determine our legal and legislative options for fighting this.
Blue Shield CMT, Manual Therapy on Same Day - CCA has become aware that Blue Shield is in some cases not reimbursing manual therapies when performed on the same day as CMT, but on a separate anatomical region. As you know, the Correct Coding Initiative allows reimbursement for manual therapies code 97140 on the same date as CMT 98940-41 when modifier -59 is used and chart notes demonstrate it is performed in a different anatomical region. If you have followed the Correct Coding Initiative and have been denied reimbursement from Blue Shield, contact Kristine Shultz at kshultz@calchiro.org or by mail at 1451 River Park Drive, Suite 230, Sacramento, CA 95815. Kristine will need a copy of your files on these cases, including the chart notes and EOBs with the names and other personally identifiable information blacked out.
Personal Injury Committee
REMINDER: FEBRUARY 8 DEADLINE TO FILE CLAIM IN ALLSTATE SETTLEMENT
As has been posted on CCA's Facebook page and Twitter account, a proposed settlement of a class action lawsuit is pending concerning Allstate's alleged improper failure to pay medical expense benefits under the Medical Payments or Personal Injury Protection coverage for automobile and homeowner insurance policies. Doctors who submitted claims to Allstate during the period October 26, 1989, through July 16, 2009, under PIP or Med Pay coverage have until February 8, 2010, to file a claim for monies deemed owed. Subject to applicable policy limits, doctors who submit a valid claim could potentially receive 60 percent of the difference between the amount of the bills submitted and the amount previously paid by Allstate.
Link to fact sheet: http://www.calchiro.org/documents/StrasenvAllstateClassActionInformationKit_001.pdf
CCA Takes Blues to Court
CCA joined a federal class action lawsuit against Blue Shield of California and WellPoint, Inc., parent of Anthem Blue Cross, alleging violations of ERISA and RICO in a scheme to improperly and illegally steal millions of dollars from doctors of chiropractic in post-treatment payment recoupments. CCA is represented by the New York City-based firm of Whatley Drake & Kallas, LLC, one of the largest plaintiffs’ law firms in the country that has earned a national reputation for being bold and fearless in taking on large corporations, including managed care companies. CCA alleges that these managed care companies have illegally demanded the repayment by doctors of chiropractic of alleged overpayments and the repayment of reimbursements made for services rendered by DCs that were subsequently determined by the companies to not be covered benefits.
Through the class action lawsuit, CCA seeks to halt the companies’ practices of seeking restitution from providers in the alleged illegal fashion and to compel them to repay providers for the amounts they were coerced to pay as a result of the defendants’ improper actions. In addition, the suit seeks 1) payment of treble damages for violations of RICO; and 2) declaratory relief (a) that the managed care companies’ recoupments constitute adverse benefit determinations under ERISA, (b) that these companies made adverse benefits determinations in violation of ERISA requirements; and (c) to compel the defendants to find that the chiropractic and other health care services provided by doctors of chiropractic are covered services under their health care plans. Read more in the December 2009/January 2010 CCA Advantage.
Special Thanks
The CCA would like to extend a special thanks to the Honorable Congressman Adam Schiff for sending a letter to Speaker Pelosi regarding upcoming changes in our Nation’s Health Care Plan the protection of a patient’s right to choose their doctor. We commend Congressman Adam Schiff’s efforts, and appreciate his willingness to go to bat for chiropractors across this State.
Flu Reminder
It is still Flu season and here are some tips to prevent antibiotic resistance:
•Boost your immunity by eating a quality diet, exercising, reducing stress. During the cold and flu season, take vitamin C and zinc.
•If a medical doctor does prescribe antibiotics, stick to the schedule and take the entire dosage, even if you are feeling better.
•Don’t save any antibiotics for the next time you get sick.
Here are some tips to protect you from Staph and MRSA:
•Wash your hands before eating and after using the restroom or touching potentially contaminated items
•Avoid sharing and encourage children not to share personal items such as clothes, towels, soap, and razors.
•Promptly change wet and sweaty clothes, for example, after going to the gym.
CCA Patient Testimonial Video Contest
Create video patient testimonials for lawmakers and submit them to CCA. We will post the best videos to Facebook, Twitter and other social networking sites. Many lawmakers personally check these sites on a regular basis. If your video is chosen, your practice will get free publicity and lawmakers will get barraged with video clips of the real people (constituents) that chiropractic has helped on a daily basis. CCA will award an iPod Nano 8GB to the best video submitted before January 22, 2010. Visit CCA’s Web site for submission guidelines and winners to be announced soon.
* The conference committee might include up to three California members of the U.S. House: House Speaker Nancy Pelosi, D-San Francisco, Reps. Howard Berman, D-N. Hollywood; and George Miller, D-Martinez. If you know any of these, contact Kristine Shultz immediately.
CCA Dues Change January 1st
A modest dues investment increase for Active Members takes effect January 1, 2010. For dues paid in advance, the dues investment change will not take effect until payment is due. CCA offers one month free dues to Full-Active, 3rd Year and 2nd Year members who pay 11 months of dues in advance: Full Active $869, 3rd Year $660, 2nd Year $412.50.
See The Latest
It is the position of the American Dietetic Association that appropriately planned vegetarian diets, including total vegetarian or vegan diets, are healthful, nutritionally adequate, and may provide health benefits in the prevention and treatment of certain diseases.
A vegetarian diet is defined as one that does not include meat (including fowl) or seafood, or products containing those foods.
The lacto-ovovegetarian eating pattern is based on grains, vegetables, fruits, legumes, seeds, nuts, dairy products, and eggs. The lacto-vegetarian excludes eggs as well as meat, fish, and fowl. The vegan, or total vegetarian, eating pattern excludes eggs, dairy, and other animal products.
In 2006, based on a nationwide poll, approximately 2.3% of the US adult population (4.9 million people) consistently followed a vegetarian diet, stating that they never ate meat, fish, or poultry.
Features of a vegetarian diet that may reduce risk of chronic disease include lower intakes of saturated fat and cholesterol and higher intakes of fruits, vegetables, whole grains, nuts, soy products, fiber, and phytochemicals.
Wellness Tips
From an article by Dr. John H. Maher
Back away from the doughnut! Essentially, it is your kryptonite. This type of food contains a low amount of fiber, high amounts of sugar and a guaranteed crash after insulin surges into the blood. Insulin does such a great job of clearing out the sugar in the blood it results in low blood sugar and then you are right back to where you started: hungry, tired, and grumpy.
Long term, continued over-eating of sweets and low fiber carbohydrates can eventually “burn out” the insulin receptors on the cells that assist in getting sugar from the blood into the cells. This is quickened by a lack of exercise. In an effort to overcome this, our bodies may make more insulin. This constant disruption of blood sugar levels is called “Metabolic Syndrome.” This is often a precursor to heart disease and diabetes. Common finding are blood pressure above 130/90 (either number), high triglycerides, a suboptimal good (HDL)/bad (LDL) cholesterol ratio, and central adiposity. Central adiposity is when your waist size is more than half your height.
A little known fact is that fenugreek seeds help to control cholesterol and regulate blood glucose. These seeds lower overall serum cholesterol and reduce triglycerides. In one human study, 2.5g of fenugreek per day for 3 months significantly reduces these cardiac risk factors. Spice cinnamon may also help lower insulin resistance in doses as little as one gram. Finally, the best sweetener for blood sugar balance is stevia. Stevia has proven to support healthy blood sugar and blood pressure.
Dr. Eric Mumbauer’s Notes on Medicare
CERT Contractor Jumped on J1 Provider and hit J1 Provider hard.
CERT probed a select of 100 claims to substantiate CERT prob for progressive action on service specific audit. The service specific audits have ended.
The edit
is off as of last week. There was an 80% charge to denial rate.
What they looked for:
-
Signature missing or illegible.
-
Treatment specificity.
-
Legibility of note.
-
From records or charts is it maintenance care.
-
No appearance in note of an exacerbation of a chronic condition.
What you need to do:
-
Need to provide a summary of prior history if the request is for 1 visit in the middle of a phase of treatment.
-
Include a much prior history and records as possible.
-
Have a place in the SOAP or PART note of recurring history (HPI).
-
History of present illness.
The nurse care manager places
notes in CMS Audit Report. This is a level II Review.
Palmetto customer service is supposed to have access to these notes as to why the
claim was denied, but they DO NOT have that level of access.
Medicare's National Coverage Determinations (NCDs).
Local Coverage Determinations (LCDs, formerly known as Local Medical Review Policies, or LMRPs).
These rules specify the services that are allowed for certain diagnoses.
NCDs are Medicare's standard, national rules; LCDs are local carriers' versions
of NCDs.
Medicare carriers' databases screen your CPT/ICD-9 coding pairs to make sure
they are in line with LCDs and automatically deny those that are not. Because LCDs don't exist for all services and
focus primarily on diagnostic.
The
Carrier Error Rate Test (CERT) audit is a single chart audit. This is more of an audit of the Medicare
carrier than of the physician. However,
you will be asked to refund any overpayment. This is a way to check to see if
the carrier processed the claim correctly.
To calculate error rates, CERT staff randomly selected claims for services each
month from each contractor. CERT staff then request only the medical record
associated with the sampled claim from the provider that submitted the claim.
CERT staff do not request medical records related to complete treatment
episodes for sampled chiropractic claims.
Exacerbations:
An exacerbation is a temporary marked deterioration of the patient's condition
due to flare-up of the condition being treated. This must be documented on the
claim form and must be documented in the patient's clinical record, including
the date of occurrence, nature of the onset or other pertinent factors that
will support the reasonableness and necessity of treatments for this condition.
Recurrence:
A recurrence is a return of symptoms of a previously treated condition that has
been quiescent for 30 or more days. This may require the reinstitution of
therapy.
When the documentation does not meet the criteria for the service rendered or
the documentation does not establish the medical necessity for the services,
such services will be denied as not reasonable and necessary.
When requesting a written redetermination (formerly appeal), providers must include all relevant documentation with the request.
CCA CALENDAR OF EVENTS
Teleseminars
Marketing Chiropractic to Medical Practices, Tues., Jan. 26; Wed., Feb. 10; Tues., Feb. 23 and Wed., Mar.10
For information or to register, call CCA at 916.648.2727, ext. 120.
Next Meeting
Wed March 24th, District Meeting, CSUN University Club, Main Speaker TBA
California Jam
California Jam III is scheduled for March 12th, 13th & 14th, 2010 at the most exquisite and beautiful Orange County Performing Arts Center in Costa Mesa, California.
For more information visit: