Surprise visits by insurance company Special Investigative Units seem to
be on the rise. While providers are
required to cooperate, they are often caught off-guard while the SIU
investigators employ bullying tactics that disrupt both staff and
patients. This article serves to provide
some useful tools and information for if and when your office receives one of
those surprise visits.
The American Chiropractic Association (ACA) recently provided information in response to member requests, regarding EmpowerChiro,TriWest Healthcare Alliance and Veterans' chiropractic care under the new Veterans Affairs Patient-Centered Community Care (VAPC3) program that permits Veterans access to care locally and not only in VA treatment facilities. Here is what the ACA reported:
Many of our members have received letters from Optum Health introducing their new products Compass and Navigate. Does the requirement to obtain a referral from a PCP before seeking chiropractic services apply to Florida?
(From the ACA "Week in Review" of December 19, 2013) Doctors of Chiropractic (DCs) will be listed equally with other types of physicians and will no longer have any limitations attached to their definition of physician under the 2014 Blue Cross and Blue Shield (BCBS) Service Benefit Plan, as authorized by the Federal Employees Health Benefits (FEHB) law.
Although BCBS of Florida will reimburse DCs for massage by an LMT if the LMT is an employee under direct supervision, BCBSFederal does not cover massage rendered by an LMT. The FederalBCBS policy clearly states that physical therapy services, which include massage or manual therapy, are not covered when rendered by an LMT.
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