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  • 15 Jul 2019 7:40 AM | Chuck Felder - iPT Exec Dir (Administrator)

    This analysis of the Anthem Blue Cross contract due 8/1/19 was prepared by our legal counsel. It is NOT legal advice, you should seek input from your individual advisers.

    However, this contract raises some significant concerns. We strongly urge you to review it and the contract to determine if signing this contract is in your best interests.  Click HERE to download.

  • 27 Jun 2019 5:26 PM | Chuck Felder - iPT Exec Dir (Administrator)

    Use this help your patients understand how the Anthem - AIM pre-authorization process affects their care.

    CLICK HERE to download the sample Patient Notice Word doc that you can modify as desired

  • 25 Jun 2019 10:43 AM | Chuck Felder - iPT Exec Dir (Administrator)

    This handout is from AIM regarding the authorization process.

    CLICK HERE to download the PDF.

  • 20 Jun 2019 9:17 AM | Chuck Felder - iPT Exec Dir (Administrator)

    Cigna and American Specialty Health Agree to Pay $11.8 million 
    in Settlement with Chiropractic Care Centers

    In another blow to middleman rationing activities we recently learned that in April Cigna & American Specialty Health (ASH) agreed to an $11.8 million settlement that will resolve litigation with a proposed class of chiropractic care centers whose patients were denied claims.

    One of the allegations in the case was that ASH's utilization management policies violate the Employee Retirement Income Security Act of 1974 (ERISA) as applied to chiropractic. ASH imposes a pre-authorization requirement after the first 26 visits, which violates the terms of the underlying employee health plans. The chiropractic centers filed a motion asking the judge to approve the agreement that requires American Specialty Health and Cigna to pay monetary compensation for claim denials and to make other changes to its business.

    According to the motion, the nearly $11.8 million settlement amount equals a substantial portion of what the centers would have received had Cigna approved and paid in full the claims that are the subject of the litigation. American Specialty Health also agreed to make certain business reforms, including adding more chiropractic associations or out-of-network providers to its Professional Affairs Health Advisory Committee and offering more free continuing education to providers. According to Mr. Hufford, the American Chiropractic Association now has a representative on the ASH Committee, on which the Illinois Chiropractic Society has had a representative for several years.

    American Specialty Health and Cigna have denied the allegations of the complaint and declined to comment on the settlement agreement. However, this resolution, if approved by the court, provides some compensation for ASH's failure to follow the terms of the affected patients' health plans.

    The attorneys involved in this case came to our 2017 Unencumbered Meeting in Long Beach seeking input on similar situations involving physical therapy centers.

    FINALLY PAYERS & MIDDLEMEN ARE BEING HELD FINANCIALLY ACCOUNTABLE FOR THEIR ACTIONS THAT DELAY, DENY AND INTERFERE WITH PATIENT CARE. PERHAPS THIS WILL SPUR CHANGES IN THEIR BEHAVIOR.

    In any case, iPT and our members will stay diligent in monitoring how Cigna & ASH delay, deny and interfere with patient care in our physical therapy world.

  • 8 Apr 2019 8:08 AM | Chuck Felder - iPT Exec Dir (Administrator)

    iPTCA & CPTA Announce Work Comp Legislation to Control the Middlemen.

    SB 537 (TPA/Middlemen Workers' Compensation Reform Bill)
    will be heard in the Senate Labor, Public Employment and Retirement Committee on Wednesday April 10, 2019 at 9:30 am, State Capitol, Room 2040.

    SB 537 would:

    • Provide that contracted Workers' Comp reimbursement rates shall not be less than the applicable Medicare fee schedule payment
    • Prevent middlemen from illegally meddling with treatment decisions made by treating physicians and PTs
    • Force middlemen to post the names of contracted PT clinics and their phone numbers on the MPN internet directory
    • Prohibit middlemen from upcoding PTs' bills
    • Allow the Administrative Director to investigate and punish middlemen for non-compliance with Labor Code statutes

    Watch your email for calls to action to support this much needed legislation.

    This legislation will focus on limiting the interference that TPAs & Middlemen (bill review companies) can exert on the work comp system along with providing limits to how much they can discount the fee schedule.

    Many PTs are not even aware of the extent of the changes in the work comp fee schedule as the middlemen have rigorously guarded how much they take out and pressured clinics to accept low paying contracts while also increasing your administrative burden.

    Learn just how much the fee schedule has changed since 2014 by downloading the Excel workbook 2019 Calculator...for your locality.

    Members just need to log in at www.iptca.org, choose MEMBERS > MEMBER ONLY > CALCULATORS to download the Excel calculator for their locality to be able to run their own examples. There are also two short videos on how to get the most out of the workbook.


  • 13 Mar 2019 4:31 PM | Chuck Felder - iPT Exec Dir (Administrator)

    Anthem is supposed to implement the pre-authorization requirement with AIM on 3/25/2019 but Anthem reps appear to be unaware of it based on feedback we've received from some PT clinics. AIM reps are a bit confused also, and one said it starts April 1, 2019 (or is that an April Fool?). 

    See the attached document from Anthem.  Anthem Prior Auth begins March-25-2019.pdf

  • 29 Aug 2018 8:50 PM | Chuck Felder - iPT Exec Dir (Administrator)

    Summary-Notice-1 provides a summary of the settlement from the One Call suit.

  • 17 Feb 2018 2:18 PM | Paul Gaspar (Administrator)

    On December 22, 2017, iPTCA won a federal lawsuit settlement with Align Networks.  Both sides were confident that the business practices Align pledged to change would be beneficial to PTs and their patients.

    For the full compliance dispute process agreement, click HERE

    Since then, iPTCA has received dozens of communications regarding the process of compliance with the settlement and potential complaints, moving forward.

    In short, a top level executive at One Call has been appointed to handle the complaints individually.  If the complaint cannot be resolved, a PT may contact the Compliance Dispute Officer chosen by iPT during the settlement process.  PTs may do this independently OR by contacting Chuck Felder, Executive Director, iPTCA for assistance (cfelder@hcsconsulting.com).  

    In accordance with the settlement terms, One Call must pay for the costs of the compliance officer for all compliance disputes made in good faith.

  • 22 Dec 2017 5:33 AM | Chuck Felder - iPT Exec Dir (Administrator)

    Headline Story

    iPTCA and One Call/Align Networks Settle Federal Lawsuit!

    On December 22, 2017, The Independent Physical Therapists of California (iPTCA) announced it reached a resolution of the lawsuit brought in April 2017 by the iPTCA regarding One Call’s business procedures.

    Per the terms of the settlement agreement, One Call will make various changes to certain of its business practices in California, which iPTCA believes will result in improved service to the state’s injured workers and physical therapists. These changes include:

    • Modifications to One Call’s patient referral and authorization process;
    • Increased transparency of how One Call ranks and scores the quality of physical therapists;
    • An enhanced electronic billing and payment system for physical therapists.

    For a summary of these practice changes, please click here for the Summary-Notice-1.pdf

    We are pleased with the resolution of this case and the improvements it promises for injured workers, PTs, and employers.

    We will be setting up an iPTCA meeting after the first of the year to discuss this settlement. Thanks for all your support! Here's to your excellence and patient advocacy!

    Merry Christmas!

    Paul D. Gaspar, DPT, President, iPTCA
    Chuck Felder, DPT, Treasurer, iPTCA
    Simon Gibson, PT, Director, iPTCA
    Sandy Sheklow, PT, Director, iPTCA

     


 
       

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