Chiropractors meeting notes- September 2008
Welcome and introductions: From TCA, Dr. Kevin Kanz, Dr. Ed Fritsch, and Dr. Todd Whitehead attended via conference call and Patte Kent attended in person. Melissa Hield, Valerie Brown (Consumer Protection), Teresa Carney (Division of Workers' Compensation), Katrina Daniel, Doug Danzeiser, Judy Wooten (Life, Health & Licensing), and Dennis Pompa (Fraud) represented TDI.
Melissa Hield reviewed the antitrust statement.
TDI complaints summary and update on workers' compensation complaints
Health insurance complaints: In 2008 through September 1, Consumer Protection has received 7 complaints from chiropractors about claims. In 2007 there were 7 and in 2006 there were 6 complaints.
Workers' compensation claim complaints: In 2008, the Division of Workers' Compensation (DWC) has received 112 complaints from chiropractors. The top reason for complaints is improper denial of medical bills, followed by insufficient reason for denial, then not complying with medical orders/agreements. Teresa Carney asked TCA to help get the word to chiropractors that complaints about improper denials and insufficient reason for denial should first go through DWC's medical fee dispute resolution (MFDR) process. If the matter is received as a complaint, it will be sent back to the chiropractor with a letter explaining the matter should go to MFDR. More information about the MFDR process is at www.tdi.state.tx.us/wc/mfdr/index.html or call MFDR staff at 512-804-4812. For more details about workers' compensation claim complaints, please go to the DWC System Monitoring & Oversight main page at www.tdi.state.tx.us/wc/pbo/index.html
Regarding electronic billing or e-billing, Teresa explained that all providers should be submitting bills electronically as of January 1, 2008; support documentation can be faxed. Small practices with less than ten employees and less than 10 percent of the business is workers' compensation are exempt. Also some carriers have waivers from accepting e-billing, however, these waivers will expire in the fall. For more information visit the E-billing web page at www.tdi.state.tx.us/wc/ebill/index.html. Please note that the March 2008 memo to system participants found on the E-billing web page at the link Improper Denials Based on Lack of Documentation explains that carriers must have a way to associate supporting documentation with a claim.
Teresa said the performance-based oversight assessment for FY 2009 has been completed. Of the 276 providers that will be reviewed, two are chiropractors.
Outreach events: Dr. Fritsch invited TDI to have a representative at a TCA District 11 meeting on September 11 from 7 - 9:30 p.m. in Houston. The TDI representative would be there as a resource to reinforce our message that "TDI is here to help." Melissa Hield will coordinate with Patte Kent.
Patte said a link will be added from the TCA website to the TDI Chiropractors resource page at www.tdi.state.tx.us/hprovider/cpmchiropractors.html.
Fraud: Dennis Pompa noted that reports of medical identify theft are increasing. Providers should take extra precautions to keep information secure. TCA asked, does TDI have regulations about maintaining health records? The answer is no. These regulations are established by provider licensing boards. A copy of the Texas Chiropractic Board's rule on medical records is attached.
Open discussion: TCA asked about post-pay audits that are being conducted by third-party firms hired by carriers, and these audits are occurring years after claims have been paid. Also a new insurance product is being marketed to providers that offers coverage for such audits. Under the TDI prompt pay statutes rules (that apply to fully insured and managed care plans), there is a time frame for audits with an exception where material misrepresentation or fraud may be involved. TDI is not aware of this new insurance product and asked TCA to provide examples about each issue for further review. Also chiropractors may wish to review the "prompt pay" FAQs for providers at www.tdi.state.tx.us/hprovider/pp_sb418faq.html. Chiropractors are welcome to submit a question to the TDI "prompt pay" e-mail box at PromptPay@tdi.state.tx.us.
TCA can submit complaints on behalf of chiropractors. Complaints can be submitted via a letter, fax, e-mail to firstname.lastname@example.org or the online complaint form at https://wwwapps.tdi.state.tx.us/inter/perlroot/consumer/complform/complform.html.
Next meeting: December 4, 2-3 p.m., via conference call and in person in Room 102, Hobby Building, 333 Guadalupe.
For more information contact:
Last updated: 12/03/2013