ICA Member News              

    August 25, 2004                                                                              

 

ICA MEDICARE UPDATE

 

FEDERAL STUDY FAULTS MEDICARE ANSWERS:  A new federal government study released on August 16th finds that Medicare carriers routinely give out highly unreliable information to providers and frequently fail to respond at all to inquiries on Medicare claims and filing procedures.    The report, entitled: "CMS Needs To Improve Responses To Policy-Oriented Questions From Providers" (GAO-04-669), found that only 4 percent of the responses US General Accounting Office (GAO) personnel received to their Medicare policy questions were correct and complete.  GAO investigators made 300 calls to 34 carrier information centers.   The GAO investigators asked four specific policy questions, 75 each to the various regional call centers.

 

"These findings are quite consistent with the information we routinely receive from International Chiropractors Association (ICA) members," said Dr. Michael Hulsebus, Chairman of ICA's Medicare Committee.  "Chiropractors nationwide have expressed frustration and irritation because their good faith efforts to obtain information on how to best comply with Medicare policies are ignored or answered in error."  The report also criticized CMS's oversight activity, finding that little effort has been applied to monitoring or improving the quality of carrier responses to provider inquiries, or the timeliness of those responses. 

 

The full text of this US General Accounting Office report is available online at:   http://www.gao.gov/new.items/d04669.pdf.

 

MEDICARE SEEKS TO AMEND PROVIDER APPEAL PROCEDURES - NEW RULES WILL LIMIT PROVIDER RIGHTS AND OPTIONS:  In proposed rules published for comment in the July 25, 2004 Federal Register, the Centers for Medicare and Medicaid Services are also proposing to significantly limit the rights and options of providers in the Medicare appeals process.  In comments submitted to CMS by the International Chiropractors Association, serious objections were communicated regarding this unfortunate abridgement of provider options, and serious new obligations on the provider should the proposed rules go into effect.  Among the more objectionable provisions are new rules that obligate the provider to document and provide argument that their claims appeals are strictly and demonstrably within the jurisdiction of the appeals panel, a function that rightfully should reside with the agency.  ICA stated in its formal comments:

 

"ICA represents the interests and concerns of both patients and providers, and is concerned that the general approach represented by these rule changes will only serve to erode the fairness and effectiveness of an already complex, expensive and time-consuming appeals process, but one that does ultimately work..."

 

"Under the "Provider Hearing Rights", ICA is concerned with new provisions that obligate the provider to document and provide argument that their claims appeal(s) are strictly and demonstrably within the jurisdiction of the appeals panel, a function that rightfully should reside with the agency.  Likewise, requirements for documentation regarding self-disallowance issues seems to unfairly shift the burden entirely onto the provider, without offering detailed and specific criteria for what is and what is not acceptable documentation and standards of argument..."

 

"Under "Provider Requests for Extension", the Agency cites extensive backlogs as a basis for altering the circumstances under which providers may request a good cause extension request.  CMS does not provide for circumstances in which the Agency and/or appeals personnel are a contributing factor in delaying a timely appeal.  The long response times, the frequent failure of carriers and other parties to the review process, to respond to written inquiries, etc.,  is continually problematic, and should be addressed..." 

 

"Under "Expediting Judicial Review", the ICA is concerned that the revision of section L. "Parties to a Board Hearing", that provide CMS with a participation pathway beyond that of "party to the hearing" provides a means for CMS policy officials to influence the process without the prospect of inquiry or cross-examination by the appellant.  We are concerned that this provision establishes a means to skew the process without the basis to appropriately pursue questions regarding statements made and questions raised through that process, directly to those making any amicus curiae submissions. .." 

 

"Regarding the section captioned, "Three Additional Proposals Under Consideration', the third issue, dealing with the reversal of an intermediary denial and the focus of seeking additional means for a further denial raises serious concerns.  From the provider perspective, it appears that this proposed action, along with the greater body of proposed amendments, are following a pattern of added demands and requirements that are designed not to streamline the process, but to have a chilling effect on the willingness and capacity of providers to appeal legitimate concerns.  This is a very inappropriate manner in which to address the backlog issues continually referenced throughout the July 25th proposed rule..." 

 

 

ICA's Medicare Committee will continue to closely monitor Medicare procedures and policies to keep the chiropractic profession informed and to defend both chiropractors' and patients' rights. 

 

 

 

For More Information: Contact the International Chiropractors Association at:  chiro@chiropractic.org

or visit the ICA website at www.chiropractic.org. 


You can also contact us by mail at:

International Chiropractors Association Mailing List
1110 North Glebe Road, Suite 650
Arlington, VA 22201 USA


Or call 800/423-4690 in the US and Canada or 703-528-5000


You are receiving this free e-mail newsletter because you have requested it, or due to your relationship with the International Chiropractors Association or organizational and professional affiliates. If you believe you have received this message in error, or you wish to unsubscribe from this mailing list, send e-mail to chirolist-request@chiropractic.org with UNSUBSCRIBE as the first word in the body of your message.   IF YOU ARE HAVING TROUBLE UNSUBSCRIBING ABOVE, try and send the same e-mail (with unsubscribe as the first word in the body of the message) to icalist-request@chiropractic.org or students-request@chiropractic.org. If you have changed your e-mail address, send e-mail to chirolist-request@chiropractic.org with UNSUBSCRIBE as the first word in the body of your message from your old address. Send

E-mail to chirolist-request@chiropractic.org with SUBSCRIBE as the first word in the body of your message from your new address to re-subscribe to the list.

*Copyright (c) 2004 , International Chiropractors Association (ICA) all rights reserved.

All or part of this message may be retransmitted for information purposes, but may not be used for any commercial purpose, posted on a website, or used in any non-ICA publication (other than that of a ICA affiliate) without the permission of ICA.