Complete Story
03/01/2011
The OSCA is Taking the Lead on Provider and Patient Rights
At the beginning of 2011 the Ohio State Chiropractic Association (OSCA) created a subcommittee of its current Insurance Committee. This subcommittee was developed to create a more user friendly system to advocate for medically appropriate health care services for all chiropractic patients. On January 12, 2011 the PPACA committee was formed and given structure. The name PPACA comes from the newly effective federal health reform law, Patient Protection and Affordable Care Act.
Dr. Jim Powell was appointed chairman of this subcommittee by the OSCA Insurance Committee Chairman, Dr. Ronald Vargo. This committee also voted and approved a mission statement laying out their main objectives:
“It is the official policy of the PPACA Committee of the Ohio State Chiropractic Association (OSCA) that an Ohio chiropractic physician is encouraged to advocate for medically appropriate chiropractic health care services for his or her patients. For purposes of this policy, “to advocate for medically appropriate chiropractic health care services” means to appeal a decision to deny payment for health care services in compliance with applicable federal laws, PPACA, ERISA, Medicare and state laws, and pursuant to the reasonable grievance or appeal procedure established by the health care plan or to protest a degree of learning and skill ordinarily possessed by chiropractic physicians practicing in the same or similar locality and under similar circumstances, reasonably believes that it impairs the chiropractic physician’s ability to provide appropriate chiropractic health care services to his or her patients.”
“OSCA is dedicated to serve the public on behalf of our members and all other chiropractic physicians throughout the state by providing compliance assistance and guidance for effective claim appeals or any claim denials and delays. Chiropractic care is covered by an estimated 87 percent of employer-sponsored health plans, yet our members experienced frequent noncompliant claim denials, abuses and discrimination. OSCA is going to stop those abuses through expert advocacy for the new Patient's Bill Of Rights under PPACA," said Dr. Jim Powell.
The first action step of this committee is to educate OSCA members. “These laws are very specific and complex. We created the subcommittee to help the association and its members better understand these new laws and implement them. We have contracted with the leading educator on PPACA & ERISA, Dr. Jin Zhou of ERISAClaim.com to do an eight part certification of the subcommittee members. We feel knowledge will drive the systems needed in our state; we must start there.” says Bharon Hoag, Executive Director of the OSCA.
“Our certification training begins on March 3, 2011 in Columbus Ohio. There will be 3 other trainings in 2011. We have selected doctors from each district to ensure the information would be disseminated throughout the entire state. It is important to understand that new federal claims and appeals regulation went into effect on September 23, 2010, with an enforcement grace period until July 2, 2011, for all non-grandfathered group health plans and individual policies in claims timely reimbursement and appeals. Because group health plans calendar year begins on Jan. 01, 2011 they must comply with the new federal internal and external prompt pay laws, the internal and external claims, and appeals regulations”, explained Dr. Jim Powell.
The OSCA will continue to remain in the business of protecting both its provider members and their patients. In a world where everyone is fighting over the same dollar we will do our part to hold EVERYONE accountable for their actions. Be sure to look for more information on this subcommittee and the benefits of its labor in your districts soon!