Chiropractic Coding & Compliance Alert

Reimbursement:

Join WCA In Their Fight Against Optum Per Diem Payment

Published on Tue Feb 16, 2016

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Wisconsin OCI to scrutinize whether Optum limits access to quality chiropractic care.

The WCA (Wisconsin Chiropractic Association) has filed a complaint with the Wisconsin Office of the Commissioner of Insurance (WI OCI) challenging the legality of the Optum per diem payment method. The WI OCI has opened an investigation into the Optum per diem payment method and is gathering information from Optum and Wisconsin Chiropractors on whether this method limits access to quality chiropractic care.

The WCA has asked it members to submit supporting documentation to WI OCI showing that the per diem payment method limits access to quality chiropractic care.

Here Is What Wisconsin DCs Can Do

To help WCA better build their case, WCA has asked Wisconsin DCs to chime in by reporting compelling patient cases (after removing any protected patient and proprietary financial information) where they can demonstrate that the Optum per diem payment method is limiting access to quality chiropractic care and submit it with the completed OCI complaint template letter.

“Contact your local associations and the ACA to see what the status is across the nation,” says Doreen Boivin, CPC, CCA, with Chiro Practice, Inc., in Saco, Maine.

WCA urges the DCs to select specific examples of patients within their know-how, losing access to and/or a decrease in the quality of care provided.

For example, WCA asks, “Does Optum or United Health Group’s payment or cost containment model restrict your ability to address specific patient healthcare needs and instead force you to deliver more cookie cutter services that make no sense for certain patients?”

As another potential example, WCA also asks DCs who have experienced frequent denials of delivered services by United Health Group or Optum and a recoupment of funds paid for those services to provide examples and the frequency at which such denials/recoupment occurs.

The Association’s website displays an OCI compliant template letter, which you can download, complete the blanks, and print on your company letterhead. That done, WCA instructs DCs to send this information to the Wisconsin Office of the Commissioner of Insurance, and also send a copy to the WCA for their complaint records.

For more information, visit http://www.wichiro.org/news/optum-action-page/.