Report of Insurance Committee Meeting:
By Amanda Wheat, DOM;
NMSAAM Insurance Committee Chair;
The ASA insurance committee and all state liaisons had their first meeting on October 27th. The meeting was brief with introductions from each state’s representatives and discussion of the VA/TriWest issues taking the majority of the time.
TriWest was lowering reimbursement rates per the changes in the CMS RVUs for acupuncture prematurely on April 1st instead of June 24th asking for recoupment from practitioners to reflect these lower rates. They were paying acupuncturists as mid-level providers at only 80% of the CMS rates. After the ASA contacted both TriWest and the VA, the VA backed the ASA’s view that we should be reimbursed 100% and recoupment should only go back to June 24th. The ASA recommends that practitioners do not ignore recoupment letters. These should be kept track of and reconciled with the EOBs to ensure the proper amount is being recouped. They are also trying to get TriWest and Optum to allow the 3 acupuncture units per the CMS guidelines.
There was a very brief mention of the ASA working with utilization management companies such as ASH. In their October newsletter the ASA mentioned reviewing the policies that these UMs are using for acupuncture. This collaboration should help with the current poor way that we are reimbursed.
The ASA has come up with an insurance committee inquiry form for members to use when they need help with insurance claims they have not been able to resolve on their own. This form would be distributed to our members and once filled out they can return it to us. We can follow up with the complaint ourselves or we can forward it to the ASA. They have said they are willing to help any of our members who are having trouble with claims, but this form will ensure the practitioner has made all of the proper steps to resolve it themselves before asking for help. Mori West said she will be forwarding this form to us by the end of the month.