A new study finds that low back pain care initiated with a doctor of chiropractic (DC) saves 40 percent on health care costs when compared with care initiated through a medical doctor (MD), the American Chiropractic Association (ACA) announced today. The study, featuring data from 85,000 Blue Cross Blue Shield beneficiaries, concludes that insurance companies that restrict access to chiropractic care for low back pain treatment may inadvertently pay more for care than they would if they removed such restrictions.

Low back pain is a significant public health problem. Up to 85 percent of Americans have back pain at some point in their lives. In addition to its negative effects on employee productivity, back pain treatment accounts for about $50 billion annually in health care costs—making it one of the top 10 most costly conditions treated in the United States.

The study, “Cost of Care for Common Back Pain Conditions Initiated With Chiropractic Doctor vs. Medical Doctor/Doctor of Osteopathy as First Physician: Experience of One Tennessee-Based General Health Insurer,” which is available online and will also be published in the December 2010 issue of the Journal of Manipulative and Physiological Therapeutics, looked at Blue Cross Blue Shield of Tennessee’s intermediate and large group fully insured population over a two-year span. The insured study population had open access to MDs and DCs through self-referral, and there were no limits applied to the number of MD/DC visits allowed and no differences in co-pays.

Results show that paid costs for episodes of care initiated by a DC were almost 40 percent less than care initiated through an MD. After risk-adjusting each patient’s costs, researchers still found significant savings in the chiropractic group. They estimated that allowing DC-initiated episodes of care would have led to an annual cost savings of $2.3 million for BCBS of Tennessee.

“As doctors of chiropractic, we know firsthand that our care often helps patients avoid or reduce more costly interventions such as drugs and surgery. This study supports what we see in our practices every day,” said ACA President Rick McMichael, DC. “It also demonstrates the value of chiropractic care at a critical time, when our nation is attempting to reform its health care system and contain runaway costs.”

The American Chiropractic Association, based in Arlington, Va., is the largest professional association in the United States representing doctors of chiropractic. ACA promotes the highest standards of ethics and patient care, contributing to the health and well-being of millions of chiropractic patients.

ABSTRACT

Cost of care for common back pain conditions initiated with chiropractic doctor vs medical doctor/doctor of osteopathy as first physician: experience of one Tennessee-based general health insurer.

OBJECTIVE: The primary aim of this study was to determine if there are differences in the cost of low back pain care when a patient is able to choose a course of treatment with a medical doctor (MD) versus a doctor of chiropractic (DC), given that his/her insurance provides equal access to both provider types.

METHODS: A retrospective claims analysis was performed on Blue Cross Blue Shield of Tennessee's intermediate and large group fully insured population between October 1, 2004 and September 30, 2006. The insured study population had open access to MDs and DCs through self-referral without any limit to the number of visits or differences in co-pays to these 2 provider types. Our analysis was based on episodes of care for low back pain. An episode was defined as all reimbursed care delivered between the first and the last encounter with a health care provider for low back pain. A 60 day window without an encounter was treated as a new episode. We compared paid claims and risk adjusted costs between episodes of care initiated with an MD with those initiated with a DC.

RESULTS: Paid costs for episodes of care initiated with a DC were almost 40% less than episodes initiated with an MD. Even after risk adjusting each patient's costs, we found that episodes of care initiated with a DC were 20% less expensive than episodes initiated with an MD.

CONCLUSIONS: Beneficiaries in our sampling frame had lower overall episode costs for treatment of low back pain if they initiated care with a DC, when compared to those who initiated care with an MD.

Journal of Manipulative and Physiological Therapeutics (JMPT) 2010 Nov-Dec;33(9):640-3. Epub 2010 Oct 18.

Dr James B. Juenger, D.C., 60, passed away on November 30, 2010 after a one-year battle with lung cancer.  Dr Juenger graduated from Cornell University and Logan College of Chiropractic. He practiced in Trumansburg, NY for the past 32 years where his office staff and loyal patients became his extended family.  Dr. Juenger was a NYSCA member for most of his professional career and held almost every district office at one time or another.  He was always happy to help out a new practioner in any way.  Dr. Juenger is survived by his 5 children, 9 grandchildren and two brothers.  He was a truly devoted father, friend colleague, and mentor.  He will be greatly missed by so many.

President Obama signed into law legislation that delays for one year the scheduled 25% cut in Medicare payment to doctors.

Medicare - Some good news for a change:

The Red Flags Rule requires creditors and certain businesses to develop and implement written identity theft prevention programs to help identify, detect and respond to patterns, practices or specific activities that could indicate identity theft.  The applicability of the rule to health care providers has been debated over the past several months.  On Tuesday, November 30, 2010, the Senate passed legislation (S3987) that clarifies the definition of a creditor and in effect would exempt health care providers from the Red Flags Rule.  On December 7, 2010, the House of Representatives passed S3987 and sent the bill to President Obama.  The President is expected to sign the bill before the Red Flags Rule goes into effect on January 1, 2011.

Thanks to the efforts of the ACA along with other healthcare provider groups whose efforts were instrumental in removing this additional administrative burden for doctors of chiropractic and other health care providers.

And more good news for a change:

The Senate has passed a $15 billion bill that would block the impending 25% cut in the Medicare payment rate to physicians and instead keeps rates steady through 2011. The cut was scheduled to take effect on January 1, 2011. It is likely that the House would pass the bill – it would by the fifth and longest extension of Medicare physican payment rates enacted this year and puts us back in the “yearly extension cycle” that we have all become familiar with. Unfortunately, the bill does not fix the sustainable growth rate (SGR) problem and doctors would be subject to a cut of more than 25% for treating Medicare patients in 2012 unless Congress figures out a long term solution in the meantime.

Update on NYS Workers Compensation fee schedule:

As you know, 97140 was not included in the chiropractic fee schedule. Carriers will be notified that the 97139 code (unlisted therapeutic procedures) will be used instead with the descriptor being the procedure that was performed.  This code usually requires a report for the service, but that will not be necessary. The 97940 omission will be addressed in the future.

Effective December 1, 2010 the “new” C4 family of forms must be used. The exception is in the physician shortage are in Rochester where the forms go into effect Jan 1, 2011. These are the 4 page new patient C4 and the 2 page C4.2. The forms can be found on the NYS WCB website (click on the link below):

http://www.wcb.state.ny.us/content/main/Forms.jsp

And a reminder: Any condition that is resultant from a work related injury is compensable by workers compensation insurance. Under no circumstances, can the doctor charge the patient for any treatment related to a workers compensation injury (even if a variance is denied).
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The New York State Chiropractic Association is committed to the advancement of the chiropractic profession in New York State. Our officers, directors, delegates and district officers are working diligently on your behalf to protect your right to practice and to provide the highest quality services to the patients we serve.

Many plans have limits on how much can be paid out in coverage, limits which would be phased out under the new health reform law.

The feds though have granted waivers from that law, amid worry that certain Unions and Big Companies would drop their health insurance programs entirely. Those waivers are good for one year, and can be considered for renewal.

The list of the 222 733 Unions and Big Companieswaivers are available by clicking on the link below.

THE LIST

Both measures expected to receive quick White House approval

Medicare requires that services provided to a patient are authenticated in the patient health record. Hand written or electronic signatures are acceptable. A handwritten signature is a mark or sign by an individual on a document to signify knowledge, approval, acceptance or obligation. Signature must comply with the following:

*  Stamp signatures are not acceptable.
*  You must be familiar with your Local Coverage Determination (LCD) policy on authenticating records as these policies will take precedence over the guidelines below.
*  If, in the course of a patient health record review, a signature is found to be illegible, Medicare contractors will look for a signature log or attestation statement to determine the identity of the provider.
*  A signature log includes a list of the typed or printed name(s) of the author(s) of the associated initials or illegible signature(s).
*  The signature log can be included on the page where the initials or signature are present, or may be in a separate document.
*  Although a reviewer may encourage providers to list their credentials in the signature log, a claim should be not denied if the log is missing a provider’s credentials.
*  All signature logs should be considered regardless of the date the log was created.

Attesting to a Signature’s Validity
 
Providers can include an attestation statement in the documentation they submit. Only the author of the medical record can attest to the record in question.

Attestations will be accepted by reviewers regardless of the date of the attestation, except in those cases where the regulations or policy indicate that a signature must be in place prior to a given event or a given date. For example, if a policy states the physician must sign the plan of care before therapy begins, an attestation can be used to clarify the identity associated with an illegible signature but cannot be used to “backdate” the plan of care.

CMS recommends that, rather than backdating a patient health record, providers should use the signature authentication process explained below. In some situations, a provider may be contacted by a contractor and asked to submit an attestation statement or signature log. Providers will have 20 calendar days from the date of the contractor’s call, or the date that the request letter is received by the post office, to provide the information. To be valid for Medicare medical review purposes, the attestation statement must be signed and dated and contain sufficient information to identify the beneficiary. An example is included below:

“I, _____[print full name of the physician/practitioner]___, hereby attest that the medical record entry for _____[date of service]___ accurately reflects signatures/notations that I made in my capacity as _____[insert provider credentials, e.g., DC]___ when I treated/diagnosed the above listed Medicare beneficiary. I do hearby attest that this information is true, accurate and complete to the best of my knowledge and I understand that any falsification, omission, or concealment of material fact may subject me to administrative, civil, or criminal liability.”

The current requests for audits by Medicare are not an unusual review.  In New York, there is currently a special services pre payment audit request for 98941 services as of October, 2010 and for 98942 services as of November 2009. Also, Medicare does ongoing CERT reviews on Chiropractic claims in which they will review records for proper documentation to support the claim and diagnosis that has been billed.
 
With the prepayment audit review, they seem to be sending a request letter for each patient and they are only asking for 3 months of records. A special services CERT request letter is usually 3-4 pages long, and they may ask for multiple patients or multiple dates of service, listed in chart form and they usually request 6 months of previous records.
 
According to Dr. Ritch Miller, ACA Medicare Committee chairman, you should and must comply. If for some reason you speak with anyone from the carrier/contractor, log the persons name, ID #, station number or whatever and write word for word what you are told. Normally we recommend not speaking with the contractor. KEEP TRACK OF EVERYTHING, and make 2 copies of everything you send to them.
 
Doctors are encouraged to review the Local Coverage Determination (LCD) for Chiropractic Services (L27350). LCDs can be accessed from the Medical Policy Center on the www.ngsmedicare.com web site; enter keyword L27350 in the Medical Policy Center search form field to access the Chiropractic Services policy. There is a detailed description on what you documentation should include for the initial visit and subsequent visits.
 
We also suggest before you start working on the audit, go to the ACA Medicare Webpage www.acatoday.org/medicare and read the links on audits/appeals. You and your staff should take the free 2 hour ACA Medicare documentation webinar. Then, we recommend that you read everything else on the webpage. You need to know everything you can about Medicare, now. So even if you think you know everything there is to know about Medicare, you need to read everything once again. In particular, some of the things (but not all) they are looking for include the diagnosis with a subluxation to correlate with the service code that is billed (98940, 98941, 98942). There should be a treatment plan for the condition. You should note the level of the subluxation adjusted. A PART exam should be done on the onset date of the condition treated with subsequent periodic re-exams and function assessments. Finally, every visit should be signed in full by the provider of the service.  If you have not signed your notes attaché an attestation page with the visits. This can be found at www.ngsmedicare.com key word signature.
 
Other suggestions from Dr. Miller include the following. With regard to what documentation to send, we recommend you send everything in from the BOX 14 (CMS 1500) date on, even if it is a month or two longer than the 3 months, if that date is less than the 3 months then we suggest you send in 3 months documentation if the patient was treated at that time. Make sure you send all supporting documentation even if it is several years old, like the patients original intake forms if that has historical information on it, if this information is found in no other place in the records.
 
Many doctors’ first react with anger and frustration when they start to get these audits. That is not helpful and in past cases has made things a whole lot worse. Be as pleasant as you can be with anyone you speak with. 
 
Only send in patient records, do not send in any explanatory letters or anything that is not an "official" patient record, since it can be used against you and since it is not official it cannot be used in your favor.
 
If you get denied on any of the claim(s), you we recommend that you consider an appeal, if the documentation supports the service billed, even if you are asked to return only $20. It is a temptation to not go further, but that may be seen as admission of guilt and they more than likely will continue with future audits.
 
Hopefully this won't turn into the battle that many other states are going through across the country, but you must prepare for the worst and expect the best. There are doctors across the country, (and again hopefully you are not one of them), that have been carrying on this battle for over two years. So you must take this very, very seriously.
 
The ACA is working on this with CMS and hopefully we can turn this around. Unfortunately, with the executive branch and administration's increased and well publicized focus on fraud and abuse, don't plan on that.
 
If you have any questions, please first go to the ACA webpage www.acatoday.org and see if you can find the answer there. If not please contact Dr. Lupinacci or Dr. Penna. If you have any questions specific to this notice, please feel free to contact either of us also.
 
Sincerely,
Dr. Louis Lupinacci, DC
NY Medicare Chiropractic CAC Rep
 
Dr. Mariangel Penna, DC
NY Alternate Medicare CAC Rep

WC changes are here as of Dec 1, 2010. Learn how to treat your patients and get paid under the new system.

Chiropractic Services have been Unbundled!

Learn how to correctly bill modalities and avoid costly mistakes.

The forms, the treatment, get the information you need now by clicking on the link below!

Workers’ Compensation Program

The House of Representatives has passed legislation temporarily stoping the 23% cut in physician payments under Medicare scheduled to take effect on Dec. 1. The same measure has already passed the Senate.

The ICC is a non-profit organization that encourages a high code of ethics among practitioners, researchers, educators and others in the chiropractic profession. The Fellow designation is bestowed upon those whose contributions have made or who will make significant impact upon the science of chiropractic and to those who render valuable and meritorious service to the profession.

The committee after careful consideration has invited Dr. Penna to become a Fellow. In his letter to Dr. Penna, James Mertz, D.C., Secretary-Treasurer of ICC, stated, “your record of outstanding service has richly earned this honor for you.” Dr. Penna is immediate past president of NYSCA and remains active on assorted committees and the organization’s goals of protecting NY patients and Doctors of Chiropractic rights to equal healthcare access and reimbursement.

The 31st Annual Meeting and Conference of the Association for the History of Chiropractic will be May 20-22, 2011, at the Crowne Plaza Hotel, 801 Greenwich Avenue, Warwick, Rhode Island. Hotel reservations can be made by calling 401-732-6000. Be sure to mention the Association to get the $135 conference rate.

Registration fee for the conference is $100, which includes the Lee-Homewood Recognition Luncheon. Registration forms are available on the AHC website [historyofchiropractic.org] and should be sent to the AHC, 4430 8th Street, Rock Island, IL, 61201.

Submissions for the Lee-Homewood Award are due by December 31, 2010 and should go to the above address. The Award is made annually to a person who has made a lifetime contribution of lasting significance toward the advancement of chiropractic in the scientific and academic communities, and the public acceptance of the profession.

The deadline for paper submission for presentation at the conference is January 15, 2011. Those also go the AHC office, address above.

Increasingly the New York State Board for Chiropractic has been receiving questions and concerns about certain types of advertising. The information provided in this brief article may help clarify some of the responsibilities we have as practitioners when we advertise.

The New York State Board for Chiropractic frequently receives requests for information regarding spinal decompression from practicing doctors and from the general public.These treatments can become expensive and often are not covered by insurance. Coding for these services can also be confusing. There were a series of articles recently authored by James Edwards, D.C and Cynthia Vaughn,D.C.,F.I.C.C. which were published in Dynamic Chiropractic from the middle of 2008 through March of 2009.These articles would be of interest for anyone considering decompression in their practice. These should not be considered a complete guide but rather a starting point.

The most recent meeting of The New York State Board for Chiropractic was October 2009 in NYC.

The American Chiropractic Association (ACA) hosted its annual meeting in Newport, RI September 30-October 2, 2010.  The 2010 ACA Alternate Delegate of the Year was awarded to Louis Lupinacci, DC, FICC.  Dr. Lupinacci is the ACA NY Downstate Alternate Delegate and current NYSCA Vice President.  Accepting the award on behalf of Dr. Lupinacci was Dr. H. William Wolfson ACA NY Downstate Delegate.  Dr. Wolfson acknowledged Dr. Lupinacci’s service to the ACA, “Mild mannered, bright, even tempered, kind, professional, gentleman are only a few of the words you can use to describe this respected, admired and loved doctor … He is deserving of this prestigious ACA award and honor”.  Dr. Wolfson added how appropriate it was for Dr. Lupinacci to receive this award in Rhode Island, as Dr. Lupinacci was born here!  NYSCA extends our best wishes to Dr. Lupinacci on this well deserved award and the ACA by recognizing Dr. Lupinacci for his service to the profession, its doctors and patients!

"We ain't one-at-a-timin' here. We're MASS communicating!'" - Pappy O'Daniel

If you think of Facebook as a place for high schoolers and soccer moms, think again. Facebook has quickly earned a following of over 500,000,000 fanatical users who tune in early and often every day. Moreover, as of March 2010, Facebook surpassed Google in daily pageviews. However, that alone is not the reason to make Facebook a part of your chiropractic online advertising strategy.

EVERYONE KNOWS WHEN YOU "LIKE" SOMEONE

Until now, when a new patient found you via Google, Yahoo, Bing, Dogpile, or NYSCA.com, how many friends could you assume they'd tell about your site. Answer: zero. They might make it a bookmark or favorite but probably did not tell anyone else about your site at least not until after their first appointment. THIS IS WHERE FACEBOOK CHANGES THE MARKETING GAME.

HOW does Facebook spread the word virally?

(Arlington, Va.) -- The Council on Chiropractic Guidelines and Practice Parameters (CCGPP), with assistance from the American Chiropractic Association (ACA), has established terminology that describes chiropractic care using conventionally recognized terminology across the accepted continuum of care. The terminology was established by a formal consensus process conducted in early 2009.

The chiropractic profession is making great strides with integration among health care providers and insurers. Doctors of chiropractic now practice in many military and Department of Veterans Affairs (VA) sites, in hospital settings and in a variety of integrated practice models. As our nation’s health care landscape changes and the primary care shortage becomes more acute, the stage will be set for even more integration of doctors of chiropractic among other health care providers—traditional and alternative. Therefore, it is vital that the scope of appropriate chiropractic care be clearly defined relative to overall patient case management.

The terminology that was established by the CCGPP consensus process relates to levels of care across the spectrum from acute care, to chronic/recurrent care and on to wellness care. The process specifically defined the following: