Insurance news
Diet and Exercise Covered by Medicare (but not for DCs)
Written by Editor   
Tuesday, April 22, 2014 02:22 PM

Medpage Today reports that Medicare will pay for visits to a luxurious spa.  The story originated with a note from the Pritikin Longevity Center & Spa's PR representative that reported "Luxurious days at a Miami spa, and 'qualifying guests can have their trip covered by Medicare.'"

What the author learned was that Medicare reimburses spa visits for Intensive Cardiac Rehabilitation (ICR), which is similar to cardiac rehabilitation programs covered regularly outside the spa.  Patients are covered by Medicare for one stint in cardiac rehab, at Pritikin or elsewhere, per "heart event" such as an acute myocardial infaraction or a stent. "Covered" doesn't necessarily mean "completely covered," however.   On average, Medicare covers roughly half of the $9,300 bill for the two-week treatment. 

Welcome to Insurance News
Wednesday, April 09, 2014 12:09 PM

Welcome to our new news and information structure. Here we will post news relating to documentation and coding and other news pertaining to the insurance industry.

It will take us a few days to populate this particular news section with news.  In the mean time be sure to check our Communications Archives for news from March 2014, and before.

Where Are You on the ICD-10 Preparation Timeline?
Written by Jill Foote, Insurance Quality Analyst III   
Monday, March 31, 2014 12:00 AM
Recently, the Medical Group Management Association reported on ICD-10 that, "fewer than 10 percent of physician practices say they've made significant progress in their readiness for implementation."1 This  indicates that 90 percent of practices are not fully prepared to make the transition. In which percentage does your clinic fall? If your staff is relying on a clearinghouse or software company to handle preparation, there may not be a clear understanding of what is involved.
PQRS Reporting in 2014
Written by Meghann Dugan-Haas, Director of Federal and Regulatory Affairs   
Monday, March 31, 2014 12:00 AM

The 2014 reporting period (Jan. 1 - Dec. 31, 2014) is the last opportunity providers have to earn an incentive payment for participating in the PQRS program. If you have never participated in PQRS, you may not know where to begin. For those doctors of chiropractic who are continuing their participation in PQRS in 2014, please be advised that significant updates and revisions have been made to the PQRS Measures applicable to chiropractic practices. To assist the profession with the proper implementation of PQRS reporting, ACA has developed the 2014 PQRS Guidebook - This resource was created specifically with the chiropractic practice in mind. ACA researched all of the 2014 regulations and measure specifications, identified the information that DCs need to know, and compiled that information into this succinct and efficient resource.

Texas SpineCare Network–TCA Contracts with Palladian
Friday, October 04, 2013 07:51 AM

Palladian Health® (Palladian) today announced that it has contracted with the Texas Chiropractic Association (TCA) as part of a larger initiative to encourage state chiropractic associations to partner in leadership to change the way chiropractic care is considered and used by America's health plans.

“Palladian has developed a comprehensive approach to total spine care which encourages the increased, appropriate use of conservative care to reduce the incidence of surgeries and injections in insured and other at-risk populations,” said Kevin E. Cichocki DC, Palladian President and Chief Clinical Officer.

Lack of consensus and conflicting guidelines on chiropractic care have caused  insurers to impose restrictions (visit limits, low annual maximum benefits) on chiropractic care, in essence impeding patient access to this key conservative care modality, rather than embracing the treatment pathway as a primary vehicle to achieve quality results with reasonable cost.

“TCA is looking forward to our new partnership with Palladian,” said Jack Albracht, DC, TCA President.  “This new collaboration will help us to further our efforts to promote and support chiropractic in Texas, and is part of our strategic vision to seek out a more cooperative relationship with insurers. We anticipate this will result in an increase in the number of medically-appropriate patients receiving treatment from our member’s practices.

As an organization, Palladian has developed their proprietary care management program called Coordinated Spine Care® (CSC), which promises to educate and guide patients to medically-appropriate use of conservative care such as chiropractic, in order to reduce spine-care spending and to maximize the quality of care provided to health plan members. “By bringing the key constituencies of chiropractors and insurers to the table, CSC can help resolve the issues that have kept these parties at-odds over the decades,” Cichocki said.

TCA is leading the way to unlock the potential of chiropractors and health plans working together. As a key component of Palladian's CSC program, the network will be used to reorient the current spine care system from a culture of escalating referrals to surgeons and injectionists to one that emphasizes spinal manipulation and other conservative care modalities as a means to reduce cost, improve patient outcomes and engender enhanced quality of care.

About Palladian Health:  Palladian Health provides large and small insurers, hospital systems, and physician/employer groups with quality, integrated health programs focused on improving both clinical and economic results for the management of spine and musculoskeletal health conditions. Palladian's unique services incorporate a collaborative approach that educates decision makers and stakeholders across an entire care cycle, supporting our mission to provide the best access for clinically excellent and affordable musculoskeletal health. Palladian currently services nearly four million lives nationwide in the areas of Chiropractic, Physical Therapy, and Coordinated Spine Care (CSC).  Palladian Health is a trademark of Palladian Health, L.L.C. The Palladian Health logo and product names are also service marks or registered service marks of Palladian Health, L.L.C.

About The Texas Chiropractic Association:  The Texas Chiropractic Association provides education, representation and advocacy for chiropractor members within the state of Texas. TCA works hard to advocate for access, quality care and   input into health care regulation related to chiropractic services and offers members information and education about the profession both statewide and nationally as well as networking opportunities throughout the state to benefit a members’ practice.  The TCA is governed by an elected, voting board of directors and is served by numerous dedicated committees and volunteers.

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