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  • 18 Oct 2019 10:48 AM | Chuck Felder - iPT Exec Dir (Administrator)

    Anthem Is At It Again. Why can't they get it right?

    We've learned from multiple members that Anthem is once again denying claims for no AIM authorization, even though AIM is NOT REQUIRED at this time.

    Complain to DMHC. Hopefully they will push Anthem to fix this NOW!

  • 6 Sep 2019 4:26 PM | Chuck Felder - iPT Exec Dir (Administrator)

    Our attorney reviewed the revised contract from Anthem date 8/12/2019. Click on the link below:

    Anthem Revised Contract Analysis 08-26-2019

  • 23 Aug 2019 2:08 PM | Chuck Felder - iPT Exec Dir (Administrator)

    We've heard from members that they want to know what the Fee Schedule is for Medicare and CA Worker's Compensation for their locality. There are 32 localities in California, organized by COUNTY. In some cases multiple Counties are combined into one locality. 

    We have created a Medicare & Work Comp allowed amount calculator for each locality in CA. The files are organized by Medicare Locality number.

    Most Northern & Central California Localities start with 0111...

    Most Southern California Localities start with 0118...

    Use the Medicare & CA WC Allowed tab to play "what-if" scenarios so you can see what various code combinations pay. 

    This workbook can be quite helpful in determining if you should accept a contract requiring discounts off the Medicare Fee Schedule or the Official Medical Fee Schedule (OMFS) for California Worker's Compensation.

    Members CLICK HERE to go the Calculator page.

    Non-members CLICK HERE to jump to the Join Now page.

  • 24 Jul 2019 9:39 AM | Chuck Felder - iPT Exec Dir (Administrator)

    This is an updated version of information shared with Anthem, DMHC and the Department of Insurance and is designed to assist practice owners in determining if signing the new Anthem contract is in the providers, or their patients, best interests. It is a rather lengthy document as it discusses the rationale and compares specific sections of the contract to existing law.

    CLICK HERE to download your copy

  • 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

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