Fall 2012 Volume 8 Number 4 Publication of the Association of New Jersey Chiropractors www.anjc.info Erroneous Use of the –51 Modifier By David Klein, CPC, CHC A s previously published, the ANJC is at the forefront of another major issue that chiropractors all over the country have been dealing with. The issue is where carriers are taking liberties with certain coding ambiguities, and corrupting them to better their reimbursement position. One example of this is the requirement by Optum Health that the -51 modifier must be added to CPT 98943 when billed with any spinal CMT (CPT 98940-98943). This requirement invokes a MPRR (Multiple Procedure Reimbursement Reduction), which results in reimbursement to the provider that is being inappropriately reduced by 50% for the Extraspinal (Adjustment) CMT. In an effort to combat this erroneous coding requirement and on behalf of the Association of New Jersey Chiropractors, Coding and Reimbursement consultant David Klein initiated and coordinated an effort along with five other Continued on Page 12 Aetna-Triad Update By Dr. Mike Goione Inside: Announcement: ANJC Appoints New Chair to Nutrition Education Council — page 10 A s you know, Triad Healthcare, an Organized Delivery System (ODS), expanded its relationship with Aetna beginning on June 1, 2012. However, in the months prior and since June 1st, ANJC has been actively involved in overseeing this implementation. It all started in February 2012, when Triad sent certified letters to all their in-network doctors informing them of the upcoming changes. Doctors were told they had to sign the included addendum to remain an in-network provider for Aetna. The packet was misleading and incomplete in the information that was later to be distributed. Several conference calls between ANJC/Aetna/Triad took place. The implementation date was delayed from May 1 to June 1 and Continued on Page 4 ANJC Sports Council Sponsors Kid’s Triathlon, Provides First Aid Coverage — page 16 The First 48 Hours Dr. K. Jeffrey Miller — page 16 Healthcare Credit Cards vs. Cash Plans Dr. Miles Bodzin — page 17 Electronic Health Records Are Required by 2014! Dr. Paul B. Bindell — page 18 What Makes Chiropractic Attractive? The Political Future of Chiropractic in New Jersey is Doubtful William D. Esteb — page 19 Why Adjust the Extremities? Dr. Mark N. Charrette — page 19 Self Funded vs. Fully Funded: What is All the Hype? Lynette Contreni — page 20 By Dr. Steve Clarke, – ANJC Legislative Chair ANJC Sponsors NJ Champion Cyclist Ryan Pettit Y es you heard it here first — the political future of chiropractic in New Jersey is full of doubt for greater success without a concerted effort from each and every member of the ANJC. Dr. Chris Bump (NEC Chair) at recent NEC seminar talks about the Challenges & Complexities of Treating Overweight and Obese Patients — page 21 Featured Articles From the President’s Desk.......3 Continued on Page 20 ChiroAssist......................... 6 Platinum Sponsors............. 8 Association of New Jersey Chiropractors 3121 Route 22 East Suite 302 Branchburg, NJ 08876 • U.S.A. PRSRT STD U.S. POSTAGE Research Updates........... 10 PAID Foot Loose....................... 13 PLATTEVILLE, WI PERMIT NO.124 ANJC Headquarters Update... 13 Legal Ease........................ 14 Sports Short..................... 15 Dr. Alkie Lapas, medical radiologist presents at ANJC’s NE/NW Regional meeting on MRI Interpretation Legal Q&A.........................17 Insurance Q&A................. 18 Risky Business................. 21 NEW Foot Levelers nniversary 60 A th See inside for details! Webinars Seminars Newsletters For more info contact ANJC HQ Rehab Sports Chiro On Field Prep Join ANJC Sports Council Today For more info contact ANJC HQ Fall 2012 www.anjc.info www.njchiropractors.com 3 By Dr. Joe D’Angiolillo – President NeW ANJC Year-in-Review Best. Biofreeze. ever. ® O ver the past year the ANJC has moved into the next phase of maturity. As Sig has said many times, the ANJC has become one of the most influential associations, not only politically in the state of NJ, but also among our peers nationally. Many of the other states not only look to the ANJC for direction, many times we are called on to help solve some of their issues. I’ll touch a little more on that later. The ANJC is a stable organization with a current membership of just under 2000. While we realize that we may never get 100% membership, we are hopeful to break the 2000 member barrier this coming year and are hopeful to add an additional 250 new members. The ANJC has implemented new programs over the past year. The Nutrition Education Council, NEC, for those who want to expand their understanding and utilization of nutrition in their practice, was created with a special membership fee. This program has been wildly successful with the members raving about the conferences, newsletters and access to the experts in the field. Monday Morning Rehab has also created a lot of buzz. These seminars take place in all regions of the state New, PReFeRReD FoRmula Now AvAilAble iN Colorless and are taught by many of our top docs from the ANJC Sports Council. The One Thing Series brings to you, once a week, a tip for your practice. If the tip of the week doesn’t apply to you just be certain that different ideas will be streaming through over the coming weeks. Should you have a great practice idea that you would like to share with your colleagues, just email Sig and he will make sure our moderator, Dave Graber, gets it. One thing you can be guaranteed as a chiropractor is that you will have to deal with ongoing insurance issues. Just as you have figured out the current game, new challenges will be thrust upon you. In April we experienced the Horizon BC/BS processing glitch. While it affected all provider groups and hospitals, DOBI was unaware of all the issues until the ANJC presented it to them. What impressed the Acting commissioner of insurance and his task force the most is how detailed the ANJC was in presenting the case. DOBI was then able to step in, demanding step by step corrective actions. While most of the issues have been rectified some 5010 claims issues still exist for some national plans. DOBI continues to stay connected to the ANJC with resolving these issues. The Optum Health 98943 Modifier 51 issue, a national issue, was wholeheartedly handled by the ANJC. Because of our financial stability the ANJC is capable of hiring many experts, coding, legal, and claims processing to name a few. Optum had taken the position that whenever an extremity manipulation is performed on the same day as a spinal manipulation, there is enough overlap in the pre-service assessment that the extremity manipulation should be paid 50% of its reimbursement when performed alone. As we all know the pre-assessment of the spine is certainly not the same as evaluating an extremity. Without giving you all of the details, the bottom line is that the opinions generated by our experts were presented to Optum the first week of September. As I write this article we have yet to receive Optum’s response, but I am hopeful that Optum will reconsider their position. TRIAD/Aetna, challenges, challenges, challenges! Whether it is accurate communications with the chiropractors in NJ, with DOBI, or the prompt and accurate payments of claims, we have seen nothing but challenges. The ANJC has tried to win the cooperation of Triad and Aetna regarding answering the many questions pre- sented by our members. Aetna provided a liaison, all to no avail. We were forced to file a formal complaint with DOBI, resulting in DOBI requesting both Aetna and Triad to come in for a conference. Currently DOBI is monitoring Aetna’s and Triad’s resolution process. Currently we have received word that Triad is processing about half of the claims that were submitted from June through August. As the ANJC handles more and varied tasks, we need to add specialized personnel. At the Spring Convention I had the pleasure of introducing the ANJC’s Assistant Executive Director, Diane Philipbar. She is the number two person in headquarters and has extensive knowledge in association management. She is a valuable person who will be helping create our headquarters processes going forward. As I had mentioned earlier, many of our challenges have been insurance related. Having someone who is able to keep their fingers on the pulse of what is taking place, to help create strategies, and to communicate this back to the membership is priority number two. The ANJC board saw that it was time to make another Continued on Page 4 The #1 clinical pain reliever now has an enhanced formulation in original and new colorless options. Our two-plus years of testing and development confirm it is the best Biofreeze ever. 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Biofreeze is a registered trademark of The Hygenic Corporation. Unauthorized use is strictly prohibited. ©2011 The Hygenic Corporation. All Rights Reserved. P05370 www.ncmic.com 14001 University Avenue • Clive • Iowa 50325 We Take Care of Our Own is a registered service mark of NCMIC Group, Inc. ©2012 NCMIC NFL 3120 ANJC_NewBF_2ndQTR_2012.indd 1 4/2/12 1:47 PM Find out how you can benefit from NCMIC’s malpractice insurance plan. Call 1-800-769-2000, ext. 3120. 4 Fall 2012 www.anjc.info www.njchiropractors.com Aetna-Triad Update NEW ANJC Year-inReview Continued from page 1 Continued from page 3 Triad agreed to send more detailed information. As the months progressed, it became evident to ANJC Insurance Committee members that this transition was not progressing smoothly as conflicting information was being sent by Aetna and Triad along with call centers supplying incorrect details of the transition. There are several key changes to the claims management and administration that have taken place since June 1st. First and most importantly, Triad decided to completely change the reimbursement schedule. No longer are in-network doctors reimbursed on a fee for service basis. Now there are maximum reimbursements per day. For example, the reimbursement for treatment without an E/M code is now $50 for HMO and $53 for PPO (note: $3 is deducted by Triad for administrative costs). Also, new HMO and all PPO patients have a 10-visit waiver before paperwork is submitted. However, there is a three year look back period for prior treatment, which quite frankly is still not completely understood by ANJC. Also, in order to be in-network for Aetna, doctors must be in-network for Triad. These key issues are what ANJC has been trying to get clearly explained so that ANJC members could be properly informed on their decision to leave or remain in-network. Almost immediately after June 1st, the ANJC became aware of major claims processing problems as claims were being denied by Aetna and not processed at all by Triad. ANJC quickly notified the NJ Department of Banking and Insurance (DOBI) of the claims issue as well as several other inconsistencies of the new arrangement. It became clearly evident that their claims processing systems broke down. As of the writing of this letter, Aetna and Triad are updating DOBI on a weekly basis on their prog- ress on overdue claims. ANJC remains in contact with DOBI as the situation progresses. Some of the issues that still need resolution are the three year look back; the $3 administrative fee charged to doctors; Aetna postcards misstating that doctors must be in network to treat Aetna patients; proper addresses for claims submission; delayed payments; communication errors from Aetna and Triad, and; wrongful termination from networks without proper notice. The ANJC insurance committee has a strong team in place that is monitoring the issue and will continue to update members as more information is received. Members are encouraged to email ANJC’s director of insurance, Matt Minnella, at [email protected] with their concerns as it is the membership that provides critical information to the committee as to what is happening in the trenches. Why Upright MRI of Cherry Hill? • G. Tom Morea, MD, our Board-Certified Radiologist, is one of the most experienced MRI physicians in the world with over 25 years providing unparalleled MRI expertise. • Dedicated, highly trained, friendly staff and convenient hours. • Most reports are sent to your physician’s office within 24 hours of your study. • Accredited by American College of Radiology. • The Fonar Upright MRI, at 0.6 Tesla, is twice as powerful as most other open MRI scanners and yields high-quality, routine MRI and MRA studies as well as our unique positional studies. • Most insurances accepted including workers comp and MVA cases. • Accommodates patients up to 500 lbs. • Scans done in your position of pain: seated, standing, lying down or bending. Claustrophobic? No worries. At Upright MRI of Cherry Hill, you won’t lie in a tube for your scan. NO MORE TUBE. Instead, you’ll be able to sit and relax while watching a 42 inch flat screen TV during your scan. Conveniently located at 701 Route 38 East, Cherry Hill, NJ 08002 856-486-9000 phone se habla español 856-486-9149 fax Visit us on the web! www.uprightmriofcherryhill.com critical hire—an in house insurance expert. This expert is Matt Minella. Matt comes with years of experience in the insurance industry, and lends his perspective from working on the other side of the fence. The third priority hire relates to having an in house Public Relations/ Marketing person. Currently we are in the initial phases of reviewing resumes and are hopeful about finding a perfect match within a short period of time. Not only do we want this person to proactively make regular positive chiropractic placements in all of the various media outlets, but also be able to respond immediately to various media pieces that may not accurately report the chiropractic perspective. As our society matures, grows and adds new services, so too does our headquarter’s need to constantly keep pace. Currently Sig and Diane are consulting with one of our software vendors to fully update and integrate our computer systems along with our website. In the very near future you will be able to register as well as make online payment for conventions, seminars and products, all within a safe, protected environment. This year our board believed it was time to perform a full audit of our accounting practices. Our budget exceeded the million dollar mark a couple years ago and we wanted to make sure that all of our financial practices and procedures are fully up to the industry standard. We have full faith and confidence in our treasurer and finance committee, and we expect in a few weeks that the audit will reaffirm our sentiment. As a means of protecting you, our members, we were able to receive full bonding of all of our employees and contractors who are involved with handling our finances. The downturn in the economy has brought with it many stresses. In an attempt to ease some of the sting of running a practice, the ANJC created a new subsidy—the ANJC Store—where members may purchase various products and services at a discounted rate. Services such as electricity and telephone are available through the ANJC Store and other products will soon be available. Looking forward, the coming year will be just as productive and exciting as this past year. During the campaign last year Mike Kirk and I spoke about bringing Work Comp to the chiropractors of New Jersey, as well as a paraprofessional/Chiropractic Assistant certification. Processes like this are slow, as cooperation is needed from people outside of the ANJC, but I can tell you things are moving positively for both of these items. I firmly believe this time next year I will be putting both these items in the accomplishment column of my report to you. I thank you for your confidence in the ANJC, as well as your support. Sincerely, True Color Captures 900,000 true color data points Height Mapping Accurate up to 300 microns (width of two strands of hair) Real Insight Visualizes and communicates asymmetry in your patients’ feet Provides a very clear tool to show: Areasofconcern Levelsofasymmetry Call to order your 3D imaging device today! 800.553.4860 FootLevelers.com ©2012 Foot Levelers, Inc. Joseph C. D’Angiolillo, D.C. FLA-111812-ANJC3DBV.indd 1 10/2/12 4:24 PM 6 Fall 2012 www.anjc.info www.njchiropractors.com Your Most Successful FROF By Kathy Mills Chang, MCS-P W hat the heck does FROF mean? It is perhaps the most important meeting your office will have with a patient: the critical Financial Report of Findings. Presenting your patient with an all questions answered report of financial expectations is the best, most transparent way to ensure a comfortable and confusion-free chiropractic experience in your office. Proactively offering this information and explaining the details of how your office manages patient financial responsibility will save you and your patient stress and worry over collection of payments for services rendered. One of the ways you can ensure this information is relayed to your patient, and that your patient is on board and understands these processes is through your FROF. The initial investment of time spent with a new patient between visit one and about visit six, is that vital core period of indoctrination into the system of your practice. Patients who clearly understand that they have a problem, and want to get it corrected, and understand that they have a financial stake in the process, become your best patients. In KMC University, we call this the Core Relationship Management System. Imagine two wheels: The first represents the core clinical steps necessary for proper indoctrination. The second represents the core financial steps necessary. Each has a corresponding counterpart, so that when the wheels are brought together, from side-by-side then merged into one, you find the clinical and then financial steps necessary for the full Core Relationship Management System. Here are the steps of both wheels, in order: • Initial intake NP phone call: gather both clinical and financial information at this first phone contact; • First Visit: set the clinical tone with excellent consultation and exam skills and set the financial tone with first visit collections; • Day 1 ½: (Between initial and second visit, behind the scenes) Clinical preparation of diagnosis and treatment plan and financial preparation of the recommended payment plan system; • ROF/FROF: deliver the clinical and financial report of findings, face to face with the patient; • Embrace Automation: automate the treatment plan with multiple appointments and automate the financial plan with an auto-debit system of payments; • Follow up by Visit 6-8: deliver a clinical Healthy Life Styles Workshop, because a patient can’t get it all at the ROF, and do a Financial Touch Base appointment to recap the payment plan and finances, since they can’t understand it all at the FROF. prescribed care is and all the wonderful ways your office works on their behalf to ease that obligation into something manageable. The idea of transitioning the patient from hearing about the clinical findings to talking about the financial findings is important, because the doctor will take what has been a private conversation between the two of them, and make it public by repeating it to the financial CA. Now the patient knows that everyone knows what has been agreed to behind those closed doors. When the doctor has reviewed the ROF with the patient, he has explained all the reasons why care is necessary as well as what his treatment plan is and what results the patient can expect from this care. The First Visit: set the clinical tone with excellent consultation and exam skills and set the financial tone with first visit collections These 6/12 steps are essential to properly train a patient in becoming a member of your practice. Your expectations and theirs are addressed early in the process and your system is installed, both for you and your team, and for the patient. Let’s focus in on one particular step that is mishandled more often than the others, Step Four: the proper transition from the ROF to the FROF. Should be simple, right? The doctor calls the CA in to say, “Hey, I’m done! Come tell this patient about their insurance!” Or worse, there is no transition because there is no formal Financial Report of Findings. This is one of the most necessary steps in your office’s new patient procedures. In this educational encounter, patients get many of their looming clinical and financial questions answered. This exchange serves as an opportunity to put your patient’s mind at ease, letting them know what their financial obligation for the doctors BEDS with BENEFITS patient has agreed to care. This is the time for a flawless exchange leading into the financial CA’s FROF: Provider: “Ms. Ouchyback, I am so glad you are on board with getting this care you need to help alleviate your pain and correct your condition. I am going to ask Rebecca to come in and discuss more information about your insurance and such. She is the expert in our office on those matters and will be able to answer any questions you may have as well as discuss some different financial options we offer.” (Provider lets Rebecca know that Ms. Ouchyback is ready and walks with her to the room) Provider: “Okay, Ms. Ouchyback, this is Rebecca, and she is going to assist you by going over everything we found out about your insurance. And, now that we know what your treatment plan is, I’m sure you would like to know how we’re going to be able to assist you further.” (Provider addresses Rebecca directly, while still in front of the patient.) Provider: “Rebecca, I’ve explained to Ms. Ouchyback her condition and my recommendations for treatment. She knows she has a problem, and she wants to get it corrected. She has agreed to her treatment plan and we are going to be seeing her three times a week for the next four weeks and at the end of that time there will be a reevaluation. She has agreed to schedule those appointments with you today. She’s agreed to attend the Healthy Lifestyles Workshop with her husband, Bubba, next Wednesday, so please put them on the list. Will you please go over, with Ms. Ouchyback, the information you’ve found and review the financials with her and work it out so she can get whatever care she needs?” As easy as it may seem to simply transition from the Doctor to the CA, if it’s mishandled, a myriad of problems will befall you later, in the form of missed appointments, upsets over finances, and patients who drop out of care prematurely. When you follow this script, you set up the encounter for a successful FROF. No matter how you allow your patients to pay or what your office policy is for collecting, this very important conversation with the patient must begin with the provider, financial CA, and the patient all being on the same page concerning treatment. Taking this time up front will save the worry and headache later! ––––––– Kathy Mills Chang is a Certified Medical Compliance Specialist (MCS-P) and since 1983, has been providing chiropractors with reimbursement and compliance training, advice and tools to improve the financial performance of their practices. Kathy thanks KMC University Reimbursement Specialist Suzanne Ball for her contributions to this article. For more information call (855) TEAMKMC or email [email protected] kmcuniversity.com. Chiromatic™ is proud to introduce the new Chiromatic ANJC Dealer Program featuring the New Chiromatic Ultra Premium Back Support Line! Become a Chiromatic dealer and: Benefits to your patients: ✓ Earn up to $700 per sale ✓ Grow your practice with referrals from Chiromatic and existing customers ✓ Receive training, education, marketing support, marketing materials, and more ✓ Put a link to your practice on our new website ✓ Chiromatic will do a sleep seminar in your office for your patients ✓ Provide your patients with the one piece of durable medical equipment that helps Our products are healthy, unique, better than mattresses available in stores, made in America, and scientifically proven to improve overall sleep quality and reduce back pain and stiffness. We stand behind our products with a 30-day home trial period and delivery is free within 60 miles of our North Brunswick, NJ, international headquarters. them hold their adjustment while they sleep – a high-quality supportive mattress! 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All rights reserved. 6/8/10 11:01 AM 8 Fall 2012 www.anjc.info www.njchiropractors.com ANJC Platinum Sponsors Directory Fall 2012 www.anjc.info www.njchiropractors.com 9 ANJC Platinum Sponsors Directory Continued from page 8 Silver Sponsorship ANJC Platinum Sponsors are trusted business partners who have supported ANJC for many years. Their valuable contributions help to achieve ANJC’s goals in serving membership and their patients. These business partners meet the highest standards regarding quality of products and services, and they are sensitive and responsive to the personal needs of our members. ANJC Platinum Sponsors have a proven track record in assisting NJ chiropractors with reaching their individual practice goals and in staying on the cutting edge of the health and wellness revolution in their communities. For all they do for ANJC members, you owe it to them to first take a look at their products and services before going elsewhere. Many offer substantial discounts and value-added services to ANJC members. Remember — when buying from ANJC Platinum Sponsors, you are supporting ANJC, it’s that simple! Billing/Coding & Collections ✦ CB&C Inc. • Lynette Contreni 973.827.3544 • [email protected] Description: Specializing in Chiropractic, CB&C offers consulting, training and a full range of Billing/ Collections services, which are tailored to your needs. Also, we offer a verifications department which assists your office in obtaining maximum reimbursement, & handling contracts. ✦ EClaims, Inc. • Kristi Andarews 888.576.0800 • www.zyantus.com [email protected] Description: With EClaims OS from Zyantus, you will experience electronic insurance claims processing that is easy, efficient and economical. With firsthand experience in electronic claims we have created a solution to claims processing that is compatible with many forms of technology and current with today’s government requirements. ✦ MD On-Line • Tom Schweizer 888.499.5465 • www.mdon-line.com [email protected] Description: Provide clearinghouse services to facilitate the electronic transfer of healthcare transactions and information between providers and payers. ✦ Spinal Kinetics, LLC Dr. Bill Puglisi • 908.687.2552 [email protected] www.spinal-kinetics.com Description: The most advanced Computerized Radiographic Mensuration Analysis that helps prove subluxation, objectively and accurately. Key Products: C.R.M.A., DMX, and Free Lectures and education ✦ Stat Imaging @ RiverWinds • Joseph Jarrett 856.251.9100 • www.statimaging.com [email protected] Description: We offer High Field Open MRI and XRay Services. 24 turn around time for reports and Same Day Appointments and STAT Reads. ✦ Tilton Dynamic Imaging • Norm Brettler 609.383.2400 • www.tiltondynamicimaging.com [email protected] Description: Our company features the Upright MRI. 2nd location: Ocean Upright MRI 864 Rt. 37 West Toms River, NJ 732-240-2772 ✦ Upright MRI of Cherry Hill • Marge Beck 856.486.9000 • www.uprightmriofcherryhill.com [email protected] Description: At Upright MRI of Cherry Hill, patients can be scanned weight bearing, seated, standing, bending or lying down to permit the best visualization possible of their problem. Key Products: MRI Scans Business/Financial Services ✦ C&A Financial Group • Robert Pendergist V.P. 732.528.4800 • [email protected] www.CA-Strategy.com Description: A full service financial firm focused on cash flow and quality of life. Key products and services: Business succession planning, disability overhead, life insurance, stock and bonds, mutual funds, commercial mortgages long term care etc. We also provide exit strategies in and around business ownership. ✦ Chiro Finishing School • Ashleigh Mooney 214.954.0302 • [email protected] www.chirofinishingschool.com Description: Chiro Business Finishing School teaches chiropractors to implement “The 12 Foundational Principles of Business.” These principles help chiropractors leverage their time and grow their revenue. ✦ Cooperative Communications, Inc Lou Lombardi • 800.833.2700 [email protected] • www.cooperativenet.com Description: Cooperative provides Telecommunication and internet services to businesses. We specialize in competitively-prices voice, data, equipment, telephone systems (hosted and non-hosted) and cellular services. ✦ David Lerner Associates • Bill Stolow 609.806.2734 • www.davidlerner.com [email protected] Description: Building and preserving assets for 35 years with a conservative investment philosophy offering income producing securities and avoiding the money pitfalls of the stock market. Key Products: Municipal Bonds, Real Estate Investment Trusts, and Insurance Products. ✦ Guardian Life Insurance Company Anthony Campanile • 609.709.0041 www.planningalliance.com [email protected] Description: Guardian Life Insurance Company has been providing doctors with disability and life insurance and investments for over 150 years. Key Products and services: Disability Insurance, Life Insurance, Investments. ✦ Mid Atlantic Resource Group. LLC Donna Scallo • 732.922.6300 X 167 [email protected] Lesley Weiner • 973.890.0800 x 329 [email protected] Description: 2008 ANJC Business Partner of the Year. ANJC member discount on comprehensive Disability and Long-Term Care Insurance. Life, Disability, Long Term Care, Employee Benefits, Retirement Planning. Independent Insurance and Investment Services firm since 1975. www.margfinancial.com. ✦ The Omar Group, CPA • Salim Omar, CPA 732.566.3660 • www.omargroupcpa.com [email protected] Description: Specializing in providing accounting and tax services to chiropractic practice owners. ✦ ChiroHCG. • Frank Zoletich 877.377.7636 • [email protected] www.chirohcg.com Description: ChiroHCG is a professional doctor supervised weight loss company. ChiroHCG uses the strongest form of US derived and manufactured homeopathic HCG and includes a complete TurnKey Marketing System containing both print ads and TV commercials at no cost. ✦ ChiroMatic Sleep Systems • Debbie Carlitz 800.526.5116 • www.chiromatic.com [email protected] Description: Developed with help of chiropractors, ChiroMatic mattresses provide ultra premium support and comfort. ✦ Chiropractic Leadership Alliance (CLA) Jasmine Forsyth • 800.285.2001 ext.130 www.subluxation.com • [email protected] Description: CLA is focused on equipping chiropractors around the world with the profession’s best selling technology, the Insight Subluxation Station for patient assessment and education. ✦ Erchonia • Melissa Morningstar 214.544.2227 • www.erchonia.com [email protected] Description: Erchonia is the global leader in low level laser healthcare applications. All Erchonia lasers are proven safe and effective through independent clinical trials. Key product and service: Low level laser therapy. ✦ Foot Levelers • Kent Greenawalt 800.553.4860 • www.footlevelers.com [email protected] Description: Exclusive provider of custom-made Spinal Pelvic Stabilizers and other healthcare products. ✦ Harlan Health Products, Inc. • Harlan Pyes 800.345.1124 • www.harlanhealth.com [email protected] Description: We provide leading edge modalities as well as the training and support so our customers attain the very best clinical outcomes. We also provide tables, rehab equipment, and all the supplies you need. Key products: Laser therapy, Electric Stimulators, Full line of supplies. ✦ K-Med Services, Inc. • Ken Viafora 800.243.2603 • www.kmedsupplies.com [email protected] Description: Full-service chiropractic supply and equipment company. ✦ Levinson Medical Specialties • Charles Levinson 732.928.4600 • www.charleslevinson.com [email protected] Description: Suppliers of physical therapy equipment, supplies, chiropractic tables, service, serving the profession for nearly 50 years. Key Products: Physical therapy equipment, Chiropractic tables and service. ✦ Patient Media, Inc. • Bill Esteb 800.486.2337 • [email protected] www.patientmedia.com Description: Patient Media, Inc. supplies chiropractic patient education resources created by Bill Esteb that feature high-impact graphics and short, patient-relevant text. Key Products: Chiropractic patient education videos, chiropractic patient education brochures and chiropractic patient education posters and charts. ✦ ScripHessco • Heather Zdan 800.747.3488 x7408 • [email protected] www.scriphessco.com Description: ScripHessco has been a trusted resource to health care practitioners for over 40 years. ScripHessco features over 10,000 products and is the largest distributor of reconditioned tables. Key Products include: Electrotherapy Equipment, new and used adjusting tables and traction, and chiropractic supplies. ✦ The Vitality Depot • Mark Mandell 866.941.8867 • www.thevitalitydepot.com [email protected] Description: Your #1 chiropractic supplier for SpiderTech, TENS and electrodes, Lasers, Clinical Stim Units, Whole Body Vibration, GreensFirst, Tables, SmartStep Wellness Mats, Back Braces, Cold Packs, Pillows, Biofreeze, Sombra and the most innovative equipment at extraordinary value. Chiropractic Equipment/Supplies & Patient Education ✦ BIOFREEZE®/Performance Health 800.246.3733 • www.biofreeze.com www.thera-band.com • [email protected] biofreeze.com Description: Performance Health is the maker of market-leading Biofreeze and Thera-Band products, as well as other vital clinical brands. Key Products: Biofreeze and Thera-Band. ✦ Chiro-Squad Enterprises, LLC Dr. Victor Naumov • 201.265.8688 [email protected] www.chirosquad.com Description: Creators of the Chiro-Squad Super Heroes and exclusive products that connect kids and chiropractic across the globe. Key Products: Chiro-Squad Kids Club Internal Marketing Kit, Chiro-Squad Nutritional Supplements and ChiroSquad Super heroes Trading Cards. X-Ray, Diagnostic Imaging Services & Equipment ✦ Digital Radiographic Equipment, Inc. Allan J. Rubert • 610.385.0722 [email protected] • www.drei.xray.com Description: D.R.E.I. has over 60 years of knowledgeable experience servicing the chiropractic profession. Providing quality and affordable chiropractic equipment, such as X-ray, tables, P.T. Eqpt, Decompression-Traction units and Chiropractic supplies and accessories. ✦ LiteCure Medical • Gioacchina Randazzo 302.709.0408 • [email protected] www.litecuremedical.com Description: LiteCure is a medical device company offering advanced laser products and innovative technology to healthcare, rehabilitation and training professionals. Drug-free, Surgery-Free, PainFree Relief. Nutrition & Wellness ✦ Anabolic Laboratories • Bob Rosenberg Clinical Consultant • 609.239.0358 www.anaboliclabs.com • [email protected] Description: Anabolic Laboratories, founded in 1924, is an active pharmaceutical manufacturer that specializes in the standardization and concentration of natural ingredients to assist with patient management, healing and pain relief. Available exclusively through healthcare professionals. Key Products: Nutritional Supplements for Pain and Inflammation, Nutritional Supplements for general wellness, and condition specific Nutritional Supplements. ✦ Biotics Research • Debra Fish 1.800.231.5777 Ex 140 • www.bioticsresearch.com [email protected] Description: Biotics Research Corporation was formed in 1975 and from day one the foundation has been “Innovation and Quality.” Our goals remain unchanged - innovative ideas, carefully researched concepts, and product development with advanced analytical and manufacturing techniques to develop and produce nutritional products of superior quality and effectiveness available exclusively to healthcare professionals. ✦ Health Centers of the Future Warren Philips Practice Building 888.600.0642 • [email protected] www.healthcentersofthefuture.com Description: Our events infuse cutting edge testing and support protocols for common conditions. The systems you learn can be applied in your office the next day. ✦ Metagenics, Inc. • Adam Banning/Maria DiSallvo 800.692.9400 • www.metagenics.com [email protected] Description: Metagenics is a global life sciences company focused on improving health. Since 1983 Metagenics has helped health care professionals and their patients throughout the world find solutions to their most pressing health concerns with high quality, science-based medical foods, nutraceuticals, and lifestyle medicine programs. Visit us at http://www.metagenics.com. Key Products: Professional Quality Nutraceuticals and Medical, Educational Seminars and FirstLine Therapy foods and Clinical Services Support. ✦ Nutri West Mid Atantic • Nadine Carrick 302.478.5090 • www.nutriwest.com [email protected] Description: Nutri-West provides the highest quality nutritional supplements formulated and produced specifically to support your healing arts. Nutri-West products are sold only through licensed health care professionals. We are committed to quality, purity and efficacy of our products. Our fundamental focus is Patient Well Being. ✦ Nutritional Frontiers • Michael Antonelli 631.767.0945 • www.nutrionalfrontiers.com [email protected] Description: Our Mission is to create, develop and provide safe, effective therapeutic natural solutions and educational programs to chiropractors and their patients with excellent quality, integrity and service. ✦ Science Based Nutrition. • Dr. Van Merkle 937.433.3140 • [email protected] www.nutritionpracticebuilder.com Description: Our Mission is to set a standard or objectivity in nutritional healthcare. We strive to help reach their optimum health so that they in turn, can reach their fullest potential in life. Key Products: Discounted blood testing, discounted hair analysis and detailed test reporting. ✦ Standard Process Inc.® • Bruce Poritzky 800.848.5061 • [email protected] www.standardprocess.com Description: For more than 80 years, Standard Process, headquartered in Palmyra, Wis., has provided health care professionals with high-quality, nutritional whole food supplements. Standard Process offers more than 300 products through three product lines: Standard Process whole food supplements, Standard Process Veterinary Formulas™, and MediHerb® herbal supplements. The products are available only through health care professionals. ✦ VerVita Products, LLC • Dawn Hoezee 616.669.5534 • www.vervitaproducts.com [email protected] Description: VerVita serves to bless communities with a passion to heal and achieve wellness through Nutritional products and essential oils. Nutritional simplicity for maximum effectiveness. ✦ XYMOGEN • Richard Malkin Senior Functional Medicine Consultant 908.310.7333 • [email protected] www.xymogen.com • 1.800.647.6100 Description: Wellness and Nutrition Integration Programs-Clinical Research, Education and Product Development- 22 Years Proudly Serving New Jersey Practitioners Laboratory Services ✦ NeuroScience • Pat Dorsey 732.766.1884 • [email protected] www.neurosceinceinc.com Description: NeuroScience, Inc. is a research-driven company committed to improving human health through a deep understanding of the interconnectedness of the neurological, endocrine, and immune system. Key products and services: Neuro-EndoImmune Testing, GI Repair System. ✦ Sterling Clinical Laboratories Inc. • Naveed Aschfaq 215.741.6000 • [email protected] www.sterlinglaboratory.com Description: A blood testing lab licensed in New Jersey and Pennsylvania with 36 employees including pathologist, quality control consultants and zero deficiency in state inspections. Specializes in blood tests, hormone studies, thematic evaluations, and all allergy testing available. Consultants/Practice Management ✦ Breakthrough Coaching • Debbie Olinger 303.451.9123 • www.mybreakthrough.com [email protected] Description: Chiropractic Consulting services. ✦ ChiroHealth USA • Ray Foxworth, DC 888.719.9990 • www.chirohealthusa.com [email protected] Description: Want to practice with peace of mind? Our network model eliminates worry about dual fee schedules, improper time of service discounts and OIG violations for offering discounts on noncovered services. ✦ KMC University • Kathy Mills Chang 888.659.8777 • www.kmcuniversity.com [email protected] Description: KMC University, a chiropractic training and implementation company, specializes in delivering solutions to a broad array of reimbursement problems and obstacles that DC practices across the nation face every day. Positioned to serve as the ultimate DC ally, KMC University strives to always deliver beyond their clients expectations always assisting to improve their bottom line. That explains why in average, their clients increase their reimbursement levels by 27%. ✦ Positive Impact Coaching and Consulting Services Dr. Michelle Turk • 576.921.6116 www.positiveimpactcoaching.com [email protected]m Description: Positive Impact Coaching is a company focused on helping you grow towards professional success and a balanced personal life. Via coaching and practice development services, we’ll help you define and attain YOUR “point of positive Impact.” We also offer dynamic speaking engagements for groups and organizations on a variety of practice building and personal growth topics. ✦ Target Coding • Marty Kotlar 800.270.7044 • www.targetcoding.com [email protected] Description: Experts in helping chiropractors document properly, get paid properly and in audit prevention. ✦ The Rothenberg Group • Jess Rothenberg, DC 973.694.1981 • www.jrapip.com [email protected] Description: Assist doctors with collection services and advice for auto accident patients. Medical/Clinical Services ✦ Advanced Center for Special Surgery – Montville Health • Dr. David Saint 201.391.8282 • www.montvalehealth.com [email protected] Description: A freestanding state of the art licensed multi-specialty ambulatory surgical center offering a wide range of out-patient surgical procedures Continued on next page ANJC Disclaimer: The company or persons providing the within goods or services, though an ANJC sponsoring entity or individual, is an independent organization of the ANJC and its structure, views, techniques, materials and methods are not authorized, reviewed for accuracy, or otherwise approved or endorsed by the A.N.J.C. The content of the materials and services has not been reviewed or approved by the ANJC for accuracy, completeness or compliance with the various governing statues, regulations, ordinances, or other controlling laws and should not be viewed as a direct or indirect endorsement or verification of the accuracy or legality of the goods, services, or delivery model. The application and impact of laws can vary widely based on the specific facts involved. Given the changing nature of laws, rules and regulations the A.N.J.C. does not engage in rendering legal, accounting, tax, or other professional advice and services. As such, the sponsor’s association with the ANJC should not be used as a substitute for consultation with professional accounting, tax, legal or other competent advisers. Before making any decision or taking any action, you should consult an appropriately trained professional prior to utilizing the sponsor’s goods or services. ✦ Alliance Medical Surgical Group Sean Hajo • 973.650.4688 [email protected] Description: Interventional pain management and Neurodiagnostic services. Key product: Interventional Pain Management, Neurodiagnostic Services and Orthopedic and Orthodontic Surgery. ✦ Allied Neurology & Interventional Pain Practice Jack Koczarski • 201-894-1313 [email protected] Description: Interventional pain management is the discipline of medicine devoted to the diagnosis and treatment of pair related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent and intractable pain, independently or in connection with other modalities of treatment. ✦ Cancer Treatment Centers of America Rocco DeCicco • 215.537.7503 www.cancercenter.com [email protected] Description: Cancer Treatment Centers of America (CTCA) provides a comprehensive, patient-centered treatment model that fully integrates traditional, state-of-the-art medical treatments with scientifically supported complementary therapies such as nutrition, naturopathic and chiropractic medicine, psychological counseling, physical therapy and spiritual support to meet the special, whole-person needs of advanced-stage cancer patients. With a network of cancer treatment hospitals and community oncology programs in Philadelphia, Phoenix, Suburban Chicago, Tulsa and Seattle, CTCA encourages patients and their families to participate in treatment decisions with its Patient Empowered Care model. ✦ Hackensack Injury & Wellness Center Damon J. Noto, MD • 201.288.7246 www.spineandjointcenter.com.com [email protected] Description: A health clinic focusing on pain management and minimally invasive procedures to help patients with orthopedic and spinal disorders. ✦ Mountainside Pain Management Philip Lutz, MD • 973.226.1230 www.montclairanesthesia.com [email protected] Description: Board Certified physicians specializing in pain management. Working with chiropractors since 1989 on the management of patients with pain from spinal disease. ✦ MUA Educators, Inc • Dr. Don Alosio 862.268.3500 • [email protected] Description: Comprehensive training in MUA Techniques resulting in the awarding of a Certificate of training in MUA (30 hours). Legal Services ✦ Davis, Saperstein & Salomon, PC Garry Salomon • 201.907.5000 [email protected] • www.dsslaw.com Description: Davis, Saperstein & Salomon is a plaintiffs personal injury law firm representing injured clients for over 25 years. It’s twelve attorneys have built solid relationships with the Chiropractic community and welcomes their referrals. ✦ Law Office of E. Vicki Arians, LLC E. Vicki Arians, Esq. • 973.513.9980 [email protected] Description: Law firm concentrating in PIP arbitration, insurance company audits and healthcare. ✦ Law Offices Of Jeffrey Randolph Jeff Randolph, Esq. 201.444.1645 • [email protected] Description: Specialize in healthcare law and complex litigation. ✦ Law Offices of Sean T. Hagan, LLC Sean T. Hagan • 732.722.2911 [email protected] www.njpiprecovery.com Description: Specializes in NJ PIP Recovery and Arbitrations at no costs to you, practice management consultation and handles personal injury cases throughout all of New Jersey. ✦ Pond Lehocky Stern Giordano Gina Terzolino • 215.568.7550 [email protected] www.pondlehocky.com Description: Pond Lehocky Stern Giordano dedicates its practice to Workers’ Compensation and Social Security Disability matters. The attorneys at the law firm of Pond Lehocky have over 75 years of combined experience representing injured workers and the disabled. The Firm has three convenient office locations in Center City Philadelphia, Northeast Philadelphia and Pennsauken, New Jersey. For more information, or to set up a free consultation, please call 215-568-7500 or Toll Free at 866 Injury Law (866-465-8795) or visit us online at Pondlehocky.com. Educational Institutions ✦ Bloomfield College • Dr. Alice Ann Sayler 973.748.9000 • [email protected] www.bloomfield.edu Description: Bloomfield College is an independent liberal arts college offering Bachelor of Arts and Bachelor of Science degrees. The college offers a customized Pre-chiropractic Program leading to a BS Degree in Biology with preferred admission to chiropractic colleges around the country. ✦ Union Anesthesia & Pain Management Julia Kovach • 908.851.7161 www.unionspinepain.com [email protected] Description: Union Anesthesia & Pain Management specializes in Laser Spine surgery- our physicians cohesively work together to provide you with effective pain management and comfortable experience. ✦ Collaborans Dr. Nick Tsaggarelis • 416.750.1500 [email protected] www.collaborans.com Description: COLLABORANS provides multimedia education for healthcare providers and fitness professionals. Our product offerings include on-line education, webinars, hands-on courses, DVDs and training manuals. Insurance Services/Risk Management Software – Practice Management ✦ Allstate Insurance Company Bernadette Wanczyk 800.512.9470 • www.allstate.com [email protected] Description: Allstate offers ANJC members discounted and enhanced commercial auto, business owner’s policies and in-home business insurance. Please contact Bernadette Wanczyk. ✦ Cash Practice, Inc. • Dr. Margie Smith 877.343.8950 x220 • www.cashpractice.com [email protected] Description: Cash Plan Calculator- customized patient financial plans with compliant discounting options. Auto-Debit System- schedule recurring payments and make one-time payments. Drip-Education Email Marketing System- systematized patient education. ✦ John C. Crilly Agency • John C. Crilly 732.747.7947 • www.crilly.biz [email protected] Description: Recipient of ANJC ’05 award for Outstanding Effort and Commitment, we offer the following insurances: Professional Liability Malpractice Insurance, business owners, employee benefits, employment practices liability, life, disability, long term care, workers compensation and Health Insurance. ✦ Digital Data Resources • Dr. Robert Sellari 973.625.3716 • www.DDRProfile.com [email protected] Description: Profile Deluxe is a complete chiropractic paperless office solution which operates on a “cloud computing” environment. ✦ LTC Global • Joel S. Allen 334.277.6802 • [email protected] Description: LTC Global has a long term care insurance program available to all association members, their employers and their extended family members. ✦ NCMIC • Mike Whitmer 800.321.7015 • [email protected] www.ncmic.com Description: “We Take Care of Our Own” NCMIC has grown to become the largest provider of Chiropractic malpractice insurance in the nation, covering more than 37,000 DCs. Key Products: Chiropractic Malpractice Insurance, Equipment Financing and Merchant Processing. ✦ OUM Chiropractor Program • Tamara Jackson 888.247.3522 • [email protected] www.oumchiropractor.com Description: OUM’s extensive malpractice insurance policies offer broad protection that cover the range of professional chiropractic services you provide within your state’s defined scope of practice. Key Products: Malpractice Insurance ✦ Life Systems Software Paul B. Bindell, DC, or Avi Bindell 973.625.3716 • www.LifeSystemsSoftware.com [email protected] Description: Life Systems Software provides certified EHR that increases income while providing audit and collection protection. It is Chiropractic specific designed for your practice. Key Products: Certified ChiroSuiteEHR electronic health record system, Certified ChiroPadEMR SOAP & narrative software, ChiroOffice management and billing software ✦ PayDC • David Klein 888.306.1256 • [email protected] www.paydc.com Description: PayDC is a fully integrated EHR solution designed to manage your practice and the entire course of patient care. ✦ Quick Notes • Ken Schenley 800.899.2468 • www.qnotes.com [email protected] Description: Easy-to-Use solutions for Portable SOAP Notes and Electronic Medical Records (EMR). Fully-compliant charting on a PDA or iPad. Templates and Voice Recognition tools. Quick Notes has been supporting Chiropractic in New Jersey for 23 years. Directory ANJC’s Nutrition Education Council and Silver Sponsors work together to educate members on the latest nutritional research, protocols and nutritional supplements. NEC offers Silver Sponsors a unique opportunity to focus on ANJC member doctors who have shown a strong interest in incorporating nutrition into their practices. Dr. Steven Zodkoy, NEC chair states, “NEC is going to serve as THE leader in nutritional education for the chiropractic profession. The goal is to educate and promote nutrition to the profession and the public so that NJ Chiropractors are known as the go-to doctors for all health conditions.” Anabolic Laboratories Bob Rosenberg • 609-239-0358 [email protected] www.anaboliclabs.com Description: Highest quality manufacturer of general wellness and condition specific nutritional supplements. Key Products: Pain and Inflammation Supplements, Pharmaceutical GMP’s and Highest Quality Products in the Industry. Cancer Treatment Centers of America Rocco DeCicco • 215.537.7503 [email protected] www.cancercenter.com Description: Cancer Treatment Centers of America (CTCA) provides a comprehensive, patient-centered treatment model that fully integrates traditional, state-ofthe-art medical treatments with scientifically supported complementary therapies such as nutrition, naturopathy, psychological counseling, physical therapy and spiritual support to meet the special, whole-person needs of advanced-stage cancer patients. With a network of cancer treatment hospitals and community oncology programs in Arizona, Illinois, Oklahoma, Pennsylvania and Washington, CTCA encourages patients and their families to participate in treatment decisions with its Patient Empowerment MedicineSM model. Chiro-Squad Enterprises, LLC Dr. Victor Naumov • 201-265-8688 [email protected] www.chirosquad.com Description: Creators of the Chiro-Squad Super Heroes and exclusive products that connect kids and chiropractic across the globe. Key Products: Chiro-Squad Kids Club Internal Marketing Kit, Chiro-Squad Nutritional Supplements and Chiro-Squad Super heroes Trading Cards. Health Centers of the Future Warren Philips • 888-600-0642 [email protected] www.healthcentersofthefuture.com Description: Our events infuse cutting edge testing and support protocols for common conditions. The systems you learn can be applied in your office the next day. Metagenics, Inc. Adam Banning/Maria DiSallvo 800-692-9400 [email protected] www.metagenics.com Description: Metagenics is a global life sciences company focused on improving health. Since 1983 Metagenics has helped health care professionals and their patients throughout the world find solutions to their most pressing health concerns with high quality, sciencebased medical foods, nutraceuticals, and lifestyle medicine programs. Visit us at http://www.metagenics.com. Key Products: Professional Quality Nutraceuticals and Medical, Educational Seminars and FirstLine Therapy foods and Clinical Services Support. NeuroScience Pat Dorsey • 732-766-1884 [email protected] www.neuroscienceinc.com Description: NeuroScience, Inc. is a research-driven company committed to improving human health through a deep understanding of the interconnectedness of the neurological, endocrine, and immune system. Key products and services: Food Sensitive Testing, Neuro-Endo-Immune Nutrition Program, GI Repair System. Nutritional Frontiers Michael Antonelli • 631-767-0945 [email protected] www.nutrionalfrontiers.com Description: Our Mission is to create, develop and provide safe, effective therapeutic natural solutions and educational programs to chiropractors and their patients with excellent quality, integrity and service. Science Based Nutrition Dr. Van Merkle/Tracy Howell 937-433-3140 [email protected] www.nutritionpracticebuilder.com Description: The most advanced computer laboratory analysis incorporating blood, hair and urine. Providing diet and vitamin recommendations in an easy to read color coded report. And all backed with long term proven results. Key Products: Patented and computerized blood, hair and urine analysis with specific nutrient recommendations, support for tough cases and processing and free discount lab pricing for your patients. Standard Process Bruce Poritzsky • 518-226-0197 [email protected] www.standardprocess.com Description: For more than 80 years, Standard Process headquarters in Palmyra Wi has provided health care professionals with high-quality, nutritional whole food supplements. Key Products and Services: Supplements-whole food based, Herbal Supplements, Education. Sterling Clinical Laboratory Naveed Ashfaq • 215-741-6000 [email protected] www.sterlinglab.net Description: Sterling Lab provides excellent mobile home draw service for patients and performs all kinds of diagnostic tests in huge discount prices. Key products and services: All kinds of blood tests, urine and stool tests, hormones, allergy, pneumatic and nutritional tests. XYMOGEN Jennifer Watters • 407-445-0203 [email protected] www.xymogen.com Description: Wellness and Nutrition Integration Programs-Clinical Research, Education and Product Development- 22 Years Proudly Ser ving New Jersey Practitioners 10 Fall 2012 www.anjc.info www.njchiropractors.com Research Updates Announcement: ANJC Appoints New Chair to Nutrition Education Council O ver the past year ANJC launched a new program, the Nutrition Education Council (NEC), under the leadership of Dr. Steve Zodkoy. NEC has been wildly successful with their website, seminars and newsletters resulting in ongoing accolades from ANJC membership. Currently ANJC has consultants, industry experts, and an advisory board of nutrition practitioners as an ongoing resource serving ANJC members who joined NEC. While Dr. Zodkoy had been busy bringing NEC to fruition, he has also been busy on the national front creating a program for our returning veterans. This program now demands more of his attention so he decided to step down as NEC chair. As a result, the baton to chair NEC has been passed on to Dr. Christopher Bump. For those who attended our spring convention, you heard Dr. Bump speak and answer many tough nutrition questions presented during the nutrition panel discussion. Dr. Bump has a storied past and extensive resume. Here are just a few highlights so you get a snapshot of the man who now will direct NEC in the coming years: • 30 years experience implementing clinical nutrition into his practice. • Obtained a Masters in Human Nutrition at Columbia University; instructor at Columbia’s Institute of Human Nutrition. • Earned diplomat status on the Chiropractic Board of Clinical Nutrition with certifications in clinical nutrition from the American College Dr. Bump has been an integral part of the development of NEC and is committed to continuing and enhancing the NEC member’s experience. of Nutrition, and the International and American Association of Clinical Nutrition. • Worked to create an integrated model of healthcare that fuses chiropractic with clinical nutrition. • Been active on various committees within the community of Vernon, NJ. Dr. Bump has been an integral part of the development of NEC and is committed to continuing and enhancing the NEC member’s experience. His background and clinical experience is second to none. On behalf of ANJC, we welcome Dr. Bump to his new role as NEC chair and wish him much success. Sincerely, Joseph D’Angiolillo, DC - President Association of New Jersey Chiropractors Want more new patients? Use nt onte ncy! c r e Delivcompete with Manual Therapy and Cervicogenic Dizziness 1 A comprehensive literature search in various databases (Scopus, MANTIS, CINAHL, and the Cochrane Library) was conducted to assess the state of evidence supporting the use of manual therapy with or without vestibular rehabilitation in the management of cervicogenic dizziness. A total of 15 articles from 13 separate investigations were retrieved. The results showed that all but one study reported improvement following unimodal or multimodal treatment. Some studies reported improvement in postural stability, joint positioning, ROM, muscle tenderness, neck pain, and vertebrobasilar artery flow velocity. The conclusion was that there is moderate evidence to support the use of manual therapy (spinal manipulation and/or mobilization). Evidence to support the combination of manual therapy with vestibular rehabilitation, however, is lacking. 1. Lystad RP, Bell G, Bonnevile-Svendsen M, Carter CV. Manual therapy with and without vestibular rehabilitation for cervicogenic dizziness: A systematic review. Chiropractic & Manual Therapies 2011; 19: 21. Spinal Manipulation and Chronic Obstructive Pulmonary Disease 1 A case series involving six residents (average age 79.1 years) with chronic obstructive pulmonary disease at a long-term care facility at the Monroe Community Hospital yielded encouraging results. The patients were subjected to a course of twelve thoracic spinal manipulations over a four week period, with lung function measurements recorded by a respiratory therapist at two and four weeks. In four of the patients, a clinically significant increase in forced expiratory volume was seen immediately following the treatment and was sustained at two weeks. It was maintained at four weeks in only one patient. No adverse events were observed. It was proposed that thoracic spinal manipulative therapy increases the functional SPEAK 2020 OUT Complete, brand new PowerPoint talks, handouts, surveys, flyers plus audios with actual closings that engage your audience! Investment per talk (all sold separately) $95 non TLC members $75 TLC members Call 888–TLC–4488 or order at www.tlc4superteams.com Anthony L. Rosner, PhD – ANJC Research Analyst mobility of the chest wall by augmenting the mobility of the thoracic spinal joints and associated rib articulations. This, in turn, would benefit lung function in the elderly. 1. Doughtery PE, Engel RM, Vemulpad S, Burke J.. Spinal manipulative therapy for elderly patients with chronic obstructive pulmonary disease: a case series. Journal of Manipulative and Physiological Therapeutics 2011; 34(6): 413-417. Osteopathic Manipulation and Chronic Obstructive Pulmonary Disease 1 Twenty stable patients (five female) with severely impaired chronic obstructive pulmonary disease were randomly assigned to receive either pulmonary rehabilitation plus osteopathic manipulation or pulmonary rehabilitation plus soft manipulation for five days a week for four weeks. The patients receiving osteopathic treatment displayed superiority in a walk test (72.5 m vs 23.7 m), a greater decrease in residual volume, and an increase in forced expiratory volume. The conclusion was that osteopathic manipulation added to pulmonary rehabilitation may improve exercise capacity and reduce the residual volume in patients with severely impaired chronic obstructive pulmonary disease. 1. Zanotti E, Barandinelli P, Bizzzri C, et al. Osteopathic manipulative treatment for effectiveness in severe chronic obstructive pulmonary disease: A pilot study. Complementary Therapies in Medicine 2012; 20(1-2): 16-22. Altered Muscular Activation during Prone Hip Extension1 : The focus of this investigation was the activation pattern of lumbopelvic muscles during prone hip extension (PHE) in women with chronic lowback pain (cLBP). A convenience sample of 20 women was categorized into two groups with or without cLBP. The research team measured the electromyography (EMG) signal amplitude of tested muscles during PHE, after normalization to maximum voluntary muscle contraction. What was found was (a) a greater EMG signal amplitude when cLBP was present, (b) a significant decrease of the EMG’s of the ipsilaterial erector spinae and contralateral erector spinae muscles, and (c) differences in the gluteus maximus and hamstring muscles (but statistically nonsignificant). PHE is significant because it is theorized to simulate the muscle movement patterns during functional movement patterns, such as gait.2 It was concluded that these muscle activation patterns could be useful either as an evaluation tool or a rehabilitation exercise. 1. Arab AM, Ghamkhar L, Emami M, Nourbakshsh MR. Altered muscular activation during prone hip extension in women with and without low back pain. Chiropractic & Manual Therapies 2011; 19: 18. 2. Arendt-Nielsen L, Graven-Nielsen T, Svarrer H, Svensson P. The influence of low back pain on muscle activity and coordination during gait: A clinical and experimental study. Pain 1996; 64: 231-240. The Secrets to Marketing Weight Loss Many Doctors are Using a NEW and Astonishingly Easy Method to Fill their Offices w/New Patients In today’s economy, many doctors have expressed to me the difficulty in building a thriving practice based on chiropractic alone. Weight Loss is the #1 Health Concern for Millions of Americans. I have a Masters Degree in Nutrition and have built the largest new patient practice in the world based around a wellness model. Join me on an upcoming LIVE and Interactive 2-hour teleconference where I will share these breakthrough marketing strategies with you! Special Bonus: Register today and receive a brand-new Power Point Presentation on Nutrition called “Healthy for Life” valued at $400.00 at no charge! REGISTER NOW! The first 25 doctors to register may attend for just $19 per clinic (regularly $99), call now 800-326-1797 and ask for Megan! (Ask about our LIVE New Jersey Seminars) DAVID SINGER ENTERPRISES The Authority in New Patients and Retention The Secrets to Marketing Weight Loss This is unique opportunity to participate in a special interactive coaching session with Dr. David Singer, the world’s foremost authority on new patient marketing. There are just a few of these training-calls scheduled over the next few weeks with only 12 chiropractors allowed per call. Register now! Call (800) 326-1797 and ask for Megan. Dr. David Singer Built the Largest New Patient Practice in the World in the Shortest Amount of Time! * $19 special (Reg. $99) intended for chiropractors only. Restrictions apply. Call 1-800-326-1797 and ask for Megan for complete details. 12 Fall 2012 www.anjc.info www.njchiropractors.com Fall 2012 www.anjc.info www.njchiropractors.com 13 Erroneous Use of the –51 Modifier Continued from page 1 coding experts, to create an advisory detailing the aberrant coding position held by the Optum and submitted it to the carrier for review. Subsequently, representatives of the ANJC took part in a discussion via conference call, with representatives of Optum Health, regarding the issue. Based on the relevant guidance already provided to Optum, the modifier -51 was never intended to be applied to CPT code 98943. On the surface it is easy to see where a reasonable person would assume that this would directly apply, when a spinal CMT and an extra-spinal CMT are performed on the same patient, at the same visit, by the same provider. However, it is our contention that it takes more than a cursory understanding of the use of this modifier, and a deeper grasp of coding principles in general, to arrive at the actual appropriate reporting of the CMTs performed at the same encounter as opposed to a simple otherwise blanket approach. The immediate simple counter-explanation is that neither a spinal CMT nor an extra-spinal CMT is considered a major primary code to the other; they are in fact separate, independent and identifiable services whose service values rarely overlap, if at all. CPT code 98943 for an extra-spinal manipulation includes Chiropractic Manipulative Treatment rendered to any and all regions identified as “extra-spinal” including the head, abdomen, upper extremities, lower extremities, and rib cage—regardless of the number of regions addressed at the encounter. Since there is not necessarily a contiguous relationship between these regions and the spine, CPT code 98943 is established as a separate code with its own defined scope different for the spinal CMT codes. The AMA CPT Guide clearly establishes CPT code 98943 as its own stand-alone primary procedure. This separate and distinct nature of the extra-spinal CMT code 98943 is further supported and delineated by the recognized and designated official CMS coding guidelines, and in the similarly recognized and designated CMS reimbursement guidelines, this guideline is called the National Correct Coding Initiative (NCCI). In terms of the work involved with these services being distinct and of a certain value, CMS has established by means of reimbursement policy a formula called the Relative Value Unit (RVU) to determine the value of each CPT code that takes into consideration the relative level of time, skill, training and intensity to provide a given service. CMS reimbursement policies then take into consideration additional issues including work value affected by other services reported at the same encounter to establish final reimbursement for providers. It is from this concept that the association of new Jersey chiropractors (coDe: Va) it pays to belong! Help support our fundraising efforts by joining TD Bank’s Affinity Membership Program. Your participation earns us an annual contribution based upon the number of members enrolled. Eligible accounts include: • Checking • Money Market • Savings • CDs • IRA Existing TD Bank Customers are eligible, too! Just give them our organization’s name and they’ll take care of the rest. to open an account, visit your nearest tD bank or call 1-888-751-9000. Multiple Procedure Reduction Rule (MPRR) evolved. MPRR is when two or more procedures are performed during the same session by the same provider, Medicare does not reimburse all procedures at the full billed or allowable amount. Under the multiple procedure reduction rule, Medicare will allow 100 percent of the fee schedule amount (or billed amount if it is less) for the first procedure reported, and 50 percent for the second procedure. It should be noted that there must realistically be a reduction of the service to then result in the reduced reimbursement. The mere fact of there being multiple services does not automatically determine an MPRR applies—as one might assume that from the cursory reading the definition of modifier -51 as detailed previously. As the ANJC had already also argued, the work and service attributed to this code is unaffected by any other service, including a spinal CMT. The AMA, CMS, and as we have recently discovered, both Optum and UnitedHealthcare official published policies agree with us. In order to further elaborate on this explanation, United Healthcare Multiple Procedure Policy (Policy # 2012R0034D) states: …When multiple procedures are performed on the same day, by the same individual physician or other healthcare professional, reduction in reimbursement for secondary and subsequent procedures will occur… UnitedHealthcare uses the Centers for Medicare and Medicaid Services (CMS) National Physician Fee Schedule (NPFS) multiple procedure indicators 1, 2, and 3 to determine which procedures are subject to the multiple procedure concept, and thereby are subject to multiple procedure reductions as addressed in this policy. [Emphasis added] United Healthcare, and by direct connection Optum itself, appears to have already correctly published a formal policy upholding the exact position put forth by the coding professionals on behalf of the ANJC—specifically the argument that CMS clearly establishes that CPT code 98943 should not be subjected to the MPRR and never should have been. It appears that inexplicably and quite astonishingly, the claims adjudication applying the MPRR to CPT code 98943 has been in direct opposition to the clearly stated and published policy, which is at the crux of the ANJC’s frustration in this matter— particularly since such a contradiction has resulted in significant financial gain by Optum and its affiliated payors, at the expense of the members of the ANJC and other doctors nationwide. “The use of the 51 modifier appended to a code is not a factor in determining which codes are considered subject to multiple procedure reductions by United Healthcare…The reduction list contains all codes that are subject to the multiple procedure concept as described above.” Notably, CPT code 98943 is not on the list of procedures that are subject to the MPRR concept—either at CMS, UnitedHealth or Optum. We hope Optum is prepared to correct the issue of inappropriately applying an MPRR to CPT code 98943, particularly in light of the apparent contradiction with the existing United Healthcare and Optum published policies. Stabilizing Orthotics: A “Supplement for Your Spine” By Brian D. Jensen, DC T here are moments in life when you recognize that a profound nugget of truth has been revealed in a simple, elegant fashion. One of those moments happened to me while speaking to a class of students at Life University, when Dr. Debra Bisiacchi introduced me and said that I was going to be talking about a “supplement for your spine.” That statement struck me, because it was a simple and accurate explanation of what stabilizing orthotics are and what they do. At first, one might have images of a bottle of calcium pills or a tall glass of ice cold milk, because that is the media’s message that has been touted as the path to strong, healthy bones. However, the supplement I was to be talking about was quite different. Why Supplement? I have often asked this question to patients: “What is the most important supplement?” The answers I get run the gamut of nearly every nutrient they have heard of, including air and water. The simple truth is that the most important supplement is the one that is missing. The missing supplement relating to the spine is often biomechanical stability. If stability is missing because of deficiencies in the foundational structures of the feet, providing supplemental support is appropriate. When it comes to looking at the concept of a supplement for the spine, the question has to be raised: How does one know if the spine needs supplementation? With nutritional supplementation, we look at diet, symptoms and even the time of year to determine how to best accomplish our dietary objectives. With the spine, there are several evaluation criteria to consider. Symptoms of pain in the spine and postural distortion patterns are the first clues that that we may have a stability deficiency. Don’t Miss the Obvious Any postural distortion you see— including uneven hips or shoulders, head tilt, or forward head carriage— should be a clue that there may be a fundamental functional failure present, and that it is often hidden in the asymptomatic structures of the feet. What do I mean by a fundamental functional failure? The word “fundamental” literally means “serving as, or being an essential part of, a foundation or basis; basic; underlying” (1). The functional structures of the feet are the basis or foundation for proper, efficient biomechanical function of the lower extremity, pelvis and spine. A failure of any of the three arches of the feet compromise the functional integrity of the entire kinetic chain and can contribute to chronic biomechanical stress, which can lead to ankle, knee, hip, pelvic and spinal stress, injuries and degeneration (2). Additional visual clues of underlying structural deficiencies are asymmetrical gait patterns. Most commonly seen is a flaring out of one foot compared to the other. Often accompanying this is an asymmetrical valgus distortion of one knee compared to the other. When you see these two distortion patterns, you will often see further evidence in an uneven wear pattern on the shoes. The area of heel contact during the gait cycle, the posterior lateral area of the shoe, will be the most evident area to observe this. Get the Full Picture To get the most accurate assessment of the structural foundation, you need to be able to evaluate all three of the arch structures of the foot to determine if supplementation is appropriate. Digital scanning assessment lets you determine if one, two or all three of the arches of each foot are functionally deficient (3). If a deficiency is detected, supplementation is appropriate. Individually designed, flexible stabilizing orthotics have a long history of providing the support that is missing and contributing to the structural and neurological stress that patients seek relief from in chiropractic offices. How Long Do You Need to Supplement? Due to the supportive characteristics of the feet’s arches, lifetime stability supplementation is necessary. Plastic deformation of the plantar fascia creates a permanent structural deficiency, which requires ongoing support. The good news is that the consistent use of this time-tested supplement for the spine will complement chiropractic care, ensuring optimal structural support and neurological function. References 1.http://dictionary.reference.com/ browse/fundamental?s=t 2. Hyland JK. Arch stability with spinal pelvic stabilizers. Practical Res Studies 2007; 21(4):1-4. 3. Foot Levelers. Confirmation of the associate platinum’s reliability. Balanced Insights 2012; 1(3):1-4. By Diane Philipbar – ANJC Assistant ED ANJC staff is working on a number of projects to better serve members: • Staffing Up! – In August ANJC hired a Director of Insurance, Matthew Minnella, to assist members with their insurance challenges. HQ is in the process of searching for its next staff member who can manage business development, member services, and public relations. • ANJC Website Redesign – In 2013, the ANJC website will have a new look, new functionality and valuable resources for both ANJC members and the general public. The new website will give members the ability to register for events, update their membership profiles, and allow non-members to join. • 2013 Calendar of Events - HQ is in the process of preparing 2013 programs for members. Among programs in the works include Spring and Fall conventions; two Nutrition Education Council (NEC) seminars; two technique seminars; a series of programs from the Documentation and Coding Institute (free to members), and, of course, monthly webinars for free CEUs. More information will be available later this year. • Membership ID Cards - HQ is moving forward with providing Membership ID Cards for all ANJC members. These cards will be bar-coded and can be used to scan in and out of all ANJC CEU programs. All members will receive their ID cards by the end of 2012. • New Member Packets – Staff is developing a more robust new member welcome packet, which will be mailed to all new ANJC members. This packet will feature a membership ID card, list of member benefits, the latest issue of the NJ Chiropractor, a Platinum Sponsor Director, and additional information to give them a full understanding of the value of their ANJC membership. • ANJC Member & Sponsor Logos – Over the summer, HQ developed both ANJC member and sponsor logos. These logos can be used by members and sponsors on websites, email signatures, flyers and other promotional materials. For more information, contact a staff member today at [email protected] info! Holiday Stress The holiday season is a stressful time of year. With cards to mail, family portraits to take, gifts to purchase, meals to prepare, family gatherings to organize and travel to plan, the list is endless! Fortunately, there is nutritional support for stress, particularly short term stress: De-Stress™ from Biotics Research supplies an all natural, bio-active peptide having anxiolytic activity. De-Stress™ can be used to reduce stress and anxiety and has been shown to be safe and free of any of the side effects seen with other pharmacological agents. eive Call now to relec of a FREE bott !* De-Stress™ ––––––– Dr. Brian Jensen is currently the Associate Director of Professional Education at Foot Levelers. He speaks on a wide variety of topics, including orthotic therapy, posture, structural preservation, breaking free of the medical model of healthcare, and innovations in nutrition. Dr. Jensen can be reached at 800.553.4860. * Call 800-231-5777 and mention code NJ4 to receive your FREE bottle of De-Stress™! Offer expires December 31, 2012 and applies to eligible healthcare professionals only. Shipping and handling fees apply. To place your order or for additional information please contact us: Biotics Research Corporation www.bioticsresearch.com (800) 231 - 5777 These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease. 14 Fall 2012 www.anjc.info www.njchiropractors.com 15 Fall 2012 www.anjc.info www.njchiropractors.com LEGAL EASE By Jeff Randolph, Esq. – ANJC General Counsel Unpublished Appellate Case Finds Chiropractor Competent to Testify on MRI Findings in Superior Court T he New Jersey Appellate Division issued a decision in the case of Capasso v. Cavalusso, A-4040-10T2, on July 26, 2012, which held that there is no per se ban on chiropractors testifying as to MRI film findings in Superior Court actions. This decision correctly analyzes a chiropractor’s qualifications to provide expert testimony under the Rules of Evidence and the court’s decision should be adopted by courts throughout the state. However, it is an unreported decision and, thus, is merely persuasive authority to other courts and not absolutely binding. There has been a long running dispute as to whether chiropractic physicians in the state of New Jersey have the requisite education, training and experience to testify regarding MRI film interpretations in Superior Court trials. In 2006, the Appellate Division issued a decision in the matter of Brun v. Cardoso, 390 N.J.Super. 409 (App. Div. 2006), which was widely (and incorrectly) interpreted by both trial judges and litigants to impose a per se ban on chiropractors testifying as to MRI findings in Superior Court matters. The Brun decision, however, did not impose such an across-the-board ban though the misinterpretation of the decision has been perpetuated ever since in many trial courts throughout the state. The Brun decision concerned the bootstrapping of inadmissible evidence at trial by a clearly unqualified chiropractic expert witness that had not actually reviewed the MRI films and, instead, relied on the hearsay radiologist’s MRI report. Despite the fact that the decision clearly stated. “[t]o repeat, this determination is not because the witness was a chiropractor. The same result would have obtained if the witness were a medical doctor unqualified to interpret an MRI,” the decision has morphed into a per se ban on chiropractors testifying as to MRI findings at trial. This is so even in situations CHIROPRACTIC SUPPLIES & EQUIPMENT 800.243.2603 Chiropractic Physical Therapy Massage Therapy Rehab Modalities To remedy this situation, the ANJC State Board of Directors authorized its legal counsel to submit a petition to the Administrative Office of the Courts to publish this opinion and make it precedential on the basis that it resolves the conflict of authority discussed above and is a matter of public importance and interest. where the chiropractor is eminently qualified in MRI interpretation and actually read the MRI films at issue. The per se ban on chiropractors testifying as to MRI findings in court was perpetuated by further misinterpretation of the New Jersey Supreme Court decision in Agha v. Feiner, 198 N.J. 50 (2009). Similar to the factual scenario in Brun, supra, the Agha case concerned an attempt to permit a treating doctor (chiropractor and anesthesiologist) to testify at trial regarding MRI findings where the doctors never reviewed the MRI films and only relied on the hearsay radiology report. The Court affirmed the preclusion of such evidence based on the fact that the doctors had never independently reviewed the MRI films and could only testify as to the hearsay report issued by the radiologist. This decision, similar to Brun, has been interpreted to impose an across-the-board ban on chiropractors testifying at trial as to MRI film findings. Fast forward to 2012, the Appellate Division now has issued its unreported decision in Capasso v. Cavalusso, which clears up the confusion and previous misinterpretation of the case law by correctly discussing the actual holdings in the Brun and Agha decisions and holding that no per se ban exists precluding chiropractors from testifying as to MRI findings provided the chiropractor had education, training, and experience in MRI film interpretation and had actually read the MRI films. The court opined that the prudent approach, based on long- standing evidentiary precedent, was to admit the testimony into evidence and permit the chiropractors’ actual competency in this regard to be addressed through cross-examination. It is this author’s opinion that the Appellate Panel in Capasso v. Cavalusso has reached the correct conclusion. Provided the chiropractor can establish experience and training in reading MRI films and that they have actually read the films in a particular matter, there is no legal basis to preclude the chiropractor from testifying as to the MRI results under the Rules of Evidence or other legal precedent. However, as mentioned at the beginning of this article, this decision is an unpublished decision, which means that it is not binding on any court or judge in the state. To remedy this situation, the ANJC State Board of Directors authorized its legal counsel to submit a petition to the Administrative Office of the Courts to publish this opinion and make it precedential on the basis that it resolves the conflict of authority discussed above and is a matter of public importance and interest. The petition was submitted on August 29, 2012, and the ANJC will keep its membership notified as to the status of this important request and if, and when, the decision is published and becomes a binding precedent. If you would like a copy of the Appellate Division decision in Capasso v. Cavalusso, please email me at [email protected] with a request for the decision in the subject line. I will reply with a pdf copy of the decision. Shop for more products on our new updated website! 609.259.9700 fax: 609.259.3632 ■ www.kmedsupplies.com 800.243.2603 ■ At recent NEC meeting, NEC members listen to Dr. Tom Bilella talk about Optimizing Athletic Performance Through Nutrition and Treating and Diagnosing Fatigue. Concussion: What You Need to Know By Dr. Andrea J. Sciarrillo I n today’s ever changing landscape of healthcare, doctors will constantly be pressed to generate a better understanding of the human condition. With advancements in research and technology specific to healthcare, more detailed analysis of injuries and diseases will be conducted. Subsequently, diagnoses will become more accurate, and ultimately treatments will provide for better outcomes of patients’ conditions. A current topic that has gained significant media attention is that of concussion. The current state of one’s ability to recognize and treat concussed patients is in an upswing and the need to cultivate our understanding of this condition is timely. Our media outlets have brought to light the urgency and gravity of NFL players, NHL players and boxers who have sustained concussions. As chiropractors, it is becoming quite clear that our patients need us to sharpen our skills at recognizing potential mechanisms of injury and the early signs and symptoms of concussion. We can all agree that our patient athletes put themselves at greater risk of concussion, but we should be aware of the fact that it is not just the athletes participating in football and hockey. Statistically those sports have a higher incidence of concussion than soccer and tennis, but all athletes are susceptible. Recent study has provided us with statistics indicating that, for example, female athletes are at just as much risk of concussion as their male counterparts in sports like soccer and lacrosse. In fact, they may have even more difficulty and take longer to recover from such incidents. The current standard to which many of the present concepts on concussion have manifested is the Consensus statement on Concussion in Sport—The 3rd International Conference on Concussion in Sport held in Zurich, November 2008. This paper is a conceptual review utilizing a consensus-based approach compiled from some of the most experienced, scientific minds on the topic of concussion. This is not specific to chiropractors, but in fact, its intended use is for all physicians, therapists, certified athletic trainers, health professionals, coaches and anyone involved in the care of injured athletes, whether at the recreational, elite or professional level. From this paper, the current state of our ability to diagnose and subsequently treat a concussed patient has matured. As chiropractors, we can look to one of our own certifying bodies for sports chiropractors, the American Chiropractic Board of Sports Physicians, for a position on management of concussion: 1. Concussions may be caused by a direct blow to the head or elsewhere on the body. 2. Loss of consciousness is a key but not a required factor in the diagnosis of concussion. An individual may be concussed without a loss of consciousness. 3. Individuals with concussion may present with a wide range of signs and symptoms such as physical signs of neurologic impairment, or/ and symptoms of impaired brain function, which may include abnormal behavior. 4. An athlete suspected of concussion must be removed from play and immediately assessed. 5. The concussed individual must not be allowed to return to play the same day they were concussed. 6. Any individual with signs or symptoms of concussion at rest or with exertion should not be allowed to participate in sport until the signs and symptoms have resolved. 7. Consultation with a qualified healthcare provider, including a DACBSP or CCSP, is essential after suspected concussion. 8. Individuals with concussion should be directly observed, receive serial examinations and not be left alone after the injury until their constellation of symptoms are static. 9. Any increase of symptoms (especially increasing headache, decreasing neurologic deficit, altered vital signs, or repeated vomiting) in a concussed individual requires urgent evaluation of the individual in a hospital setting. 10.A graded return-to-play protocol must be followed prior to resumption of full sporting activity. 11.Clearance by a qualified healthcare provider must be sought prior to the athlete returning-to-play. 12.An athlete must be symptom-free at rest and with exercise prior to return-to-play. The evaluation and management of concussion is in transition and will continue to change as more research is conducted and new advancements are made in the diagnostic tools used for evaluation. It is our responsibility as doctors to stay current on this information. The ACBSP has provided a vehicle for this in their concussion registry. Doctors have the opportunity to study the latest academic materials and test their knowledge on this subject. Upon successful completion of the online course, doctors can be listed on the concussion registry. With this, chiropractors will be able to arm themselves with the knowledge and skill to better diagnose and treat patients who have sustained a concussion. ––––––– Dr. Andrea J. Sciarrillo maintains a Certified Chiropractic Sports Physician credential from the American Chiropractic Board of Sports Physicians. She holds a position on the Board of Directors for the ACBSP. She is the acting Vice President for the ANJC Sports Council and member of the Wellness & Exercise Science Advisory Board at Bergen Community College. She operates her own sports chiropractic practice in Cranford, NJ. Nutrition & Blood Chemistry: Keeping it Simple & Effective to Improve Outcomes Hartford, CT Dec. 1-2, 2012 Seminar 12 CEU For more information: www.nutritionpracticebuilder.com ëGenerate Additional IncomeëGet Motivatedë ëHelp your Patientsë “Easily the best CEU presentation I’ve ever attended... He made me proud to be a chiropractor.” Jenn K., DC Presented by: Van. D Merkle DC, DABCI, DCBCN FREE SERVICE: Discount lab blood testing for your patients approved for NY & NJ. This will save your patients hundreds of dollars! Details at the lecture. Register Online at: www.nutritionpracticebuilder.com or Call: 937-433-3140 16 Fall 2012 www.anjc.info www.njchiropractors.com ANJC Sports Council Sponsors Kid’s Triathlon, Provides First Aid Coverage O n Sunday, August 26th, ANJC’s Sports Council sponsored the third annual Princeton Kid’s Triathlon both financially and with manpower. Drs. Veera Gupta and Len Ershow were co-leaders of an experienced team of sports chiropractors that included sport DCs from all over the state. The first aid team of Drs. Andrea Buccino, Tony DeLuca, Christopher Peterson and John Volpe interfaced with the Princeton First Aid and EMS Squad to provide coverage for the triathlon, which had approximately 80 kids from ages 7-14 participate. The ANJC SC has been involved with providing sports chiropractors for the volunteer first aid team and a significant financial sponsor of Princeton Tri Kids from its inception in 2010. ANJC SC believes in supporting the concept of raising awareness of a healthy lifestyle in children through participation in events like Princeton Tri Kids. The triathlon was broken into four age groups and the swim, bike and run courses were calibrated to be challenging but achievable for each age group. The sports chiropractic first aid team covered all aspects of the course and helped ensure the safety and health of all the participants. Approximately 80 athletes from the ages of 7 to 14 competed in the event. The competition was broken up into four different groups, based on age. The ANJC assisted in sponsoring the event with a donation of event signs, Power bars, and most importantly, the event’s medical team. The medical team worked from the wee hours of the morning, starting at 5:45 a.m., until the final athlete left the course at approximately 12:00 p.m. The medical staff consisted of Drs Andrea Buccino, Anthony Delucca, Len Ershow, Veera Gupta, Christopher Peterson, Peter Scordilis, and John Volpe. Drs. Ershow and Scordilis provided mobile medical assistance by riding the bike course for hours, assisting and monitoring the health status of the athletes. Drs. Buccino and DeLucca were in a key location to observe and assist athletes in the 2.4 mile run. Drs. Gupta and Volpe provided First Aid assistance at the medical tent, as they are both EMTs and chiropractors. Dr. Peterson monitored two of the greatest points of injury on the course—the swim-to-bike and biketo-run transition points. The event was extremely successful on many levels. Besides being a beautiful day, only one athlete needed extensive care. Due to the months of the preparation ahead of time, EMTs, DCs, the police, and the Princeton Recreation Center had assembled a team that was prepared for the worst scenarios but had the very best present itself. For more information on joining ANJC Sports Council email Dr. Marc Jenkins at [email protected] Union Anesthesia Associates PAIN MANAGEMENT Healthcare Credit Cards vs. Cash Plans By K. Jeffrey Miller, DC, DABCO By Dr. Miles Bodzin T he television series The First 48 Hours follows police detectives during the first 48 hours after a crime, usually a homicide. The show stresses the fact that the best chances of solving a crime are within the first 48 hours. The likelihood of a crime being solved deteriorates steadily beyond this point. The first 48 hours can also be important in healthcare. For example, the first 48 hours following a cervical injury sustained as a result of an automobile accident are critical. They are critical for proper diagnosis, initiation of appropriate care, and establishing accurate records. Proper diagnosis requires thorough history and examination, often beyond those used for the average chiropractic case. Appropriate care must begin as soon as possible and correspond to the stages of soft tissue injury. Records are crucial as these injuries can take months to heal, result in permanent impairment and/or lead to legal ramifications. With this said, it is obvious that an article of this length cannot cover the magnitude of information required to diagnose, treat and document a cervical injury of this nature. It can however, offer a procedure the author has found helpful over the years when dealing with cervical injuries of traumatic origin. Cervical trauma results in inflammation and the region expands in proportion to the degree of inflammation. As a consequence, the patient may report shirt collars feel tighter than normal, neck ties or scarves are uncomfortable to wear or heavy necklaces create soreness. These signs and symptoms fade as inflammation decreases with time. Reports of this nature warrant recording in the case history. It also warrants investigation by measuring the circumference of the patient’s neck. This is critical during the first 48 hours to document the initial inflammation. If more than 48 hours has lapsed between the trauma and the doctor’s evaluation, the signs and symptoms reported by the patient will remain important but the usefulness of the neck measurement will be diminished. If a patient’s neck circumference is 16.5 inches within 48 hours of the injury and measures 15 inches four weeks later, the implication is significant inflammation occurred from the injury and is resolving. The measurements provide proof of injury and positive progress. Further proof is provided if the patient reports shirt collars, ties or scarves are once again comfortable. To further establish neck circumference as an objective clinical finding, the patient’s body weight should be recorded. Since weight loss often reduces neck circumference, the doctor must determine if a decrease in neck circumference is related to weight loss. A reduction in neck circumference in a patient trying to lose weight, without significant weight loss, indicates the change can be attributed to decreasing inflammation. A reduction in neck circumference in a patient trying to lose weight, with significant weight loss, indicates the change will be difficult to attribute to decreasing inflammation. Although this article discusses cervical trauma as a result of automobile accidents, measurement of neck circumference and body weight can be instrumental in the evaluation of cervical trauma of any etiology. Adding these simple procedures to your examination format can improve diagnosis, patient care and case documentation. ––––––– K. Jeffrey Miller, DC, DABCO serves as director of clinical operations for Tuck Chiropractic Clinics in the New River and Roanoke Valleys of Virginia. He has authored over 150 articles in thirty seven different publications. He has also authored seven books. His eighth book, Practical Assessment of the Chiropractic Patient 2nd ed., is set for release in early 2013. Dr. Miller teaches post graduate seminars in orthopedic and neurological examination throughout the country each year for a variety of chiropractic organizations. He can be reached through his website www. examdoc.com. Raritan Anesthesia Associates From Left to Right: Randolph Kahn, D.O., Michael Wilcenski, M.D., Wayne Fleischhacker, D.O., Edward Novik, M.D., Steven Shane, D.O. • Non-Surgical Techniques • Minimally Invasive and Laser Spine Surgery Union County 695 Chestnut St, Union, NJ 07083 Middlesex County 40 Route 34 South, Old Bridge, NJ 08857 Hudson County 654 Broadway, 2 nd Floor, Bayonne, NJ 07002 Somerset County 141 Main St, South Bound Brook, NJ 08880 Essex County 40 Union Ave, Irvington, NJ 07111 135 Bloomfield Ave, Suite B, Bloomfield, NJ 07003 Call us for an appointment today: 908-851-7161 www.unionspinepain.com UAA_4-75.indd 1 Se habla español 10/12/12 10:02 AM 17 The First 48 Hours Board Certified Pain Specialists & Anesthesiologists Providing the best treatment for neck and back pain. Fall 2012 www.anjc.info www.njchiropractors.com At NE/NW regional meeting, Dr. Alkie Lapas takes break time to explain to members intricacies of MRI interpretation. T hink about all the times you were checking out your favorite home improvement, department or super store and before you can pay the bill and be on your way, the cashier will politely ask you to open a credit card. The hook is simple and straightforward. “Would you like to save ten percent on your purchase today by applying for a credit card?” It is as though the words come out like a track on a broken record. However you can’t blame the employees for trying, since they are more than likely financially rewarded for the number of credit accounts they can open. From the superstore’s perspective it’s an excellent opportunity to make twenty-seven percent interest on loaned money. It turns out department stores and superstores aren’t the only companies looking to cash in on those who buy now and pay later. Recent news has reported that doctors, dentists, and even chiropractors are pushing healthcare credit cards on patients who can’t afford the care or have limited or no insurance benefits. In fact, there have been a number of complaints that doctors are pressuring patients while they are in a vulner- able state—suffering with pain and desperate for a solution. Even worse, they are often misled about the credit card’s high interest rates and its terms and agreements. The way it usually works is as follows: once the patient has been approved, the credit card companies forward full payment for the services to the provider, many times before the treatment has even been initiated or completed. For example: Patient A comes in for a consult and treatment. They don’t know if their insurance will cover the care and finances are a little tight so they decide to go with the LEGAL EASE By Jeff Randolph, Esq. – ANJC General Counsel healthcare credit card that office XYZ provides. They fill out the credit application and the office obtains instant approval from the card company. Office XYZ receives an entire lump sum payment for care from the credit card company that normally would be billed over weeks or months. It has also been reported that some of these physicians will recommend more costly treatments and/ or more procedures than necessary knowing the lending company is going to pay. What isn’t being disclosed is that if the patient discontinues care, the patient is still liable for the lump sum payment made to the doctor. The negative press and patient complaints and grievances these healthcare credit cards can cause actually harm practices that are based solely or primarily on cash plans where patients will pay a monthly fee for care. It is extremely important to educate your patients on the difference between healthcare credit cards and cash plans. Explain to them that cash based plans are not based on any sort of financial background checks or credit score, no money is being financed, no interest charges are being incurred, and no care is being paid for before it is rendered. Furthermore, the doctor is not being paid in a costly, upfront, lump sum payment. Cash plans versus financed healthcare credit cards are as different as night and day. No credit applications, no high interest rates or misleading tactics to sign patients up. What your patients can expect is straightforward honest pricing and convenient care. Make sure your patients understand these important differences. ––––––– Miles Bodzin, DC founded Cash Practice ® Systems in 2003 with the goal of providing an all-in-one webbased application for chiropractors to get everything they need for running a cash-based practice. Dr. Bodzin developed a successful model for running a profitable, cash-based wellness practice, and created software to automate many of these systems. For more information call 877-343-8950 ext. 101 or visit www. cashpractice.com. LOWER BACK PAIN RELIEF • Comfortable • Portable • Easy to use • Designed for patient in-home Q: Do self-funded insurance plans have to pay claims in accordance with the time frames required by the New Jersey prompt pay law (30 days for electronic claims and 40 days for paper claims)? No, federal ERISA law governs selffunded plans and they are not subject to the requirements of the New Jersey Prompt Pay Law. ERISA regulations generally state that claims should be paid or denied “within a reasonable period of time.” The rule of thumb is that exceeding 90 days is unreasonable. However, the ERISA regulations also permit the plan or its administrator to obtain a 90 day extension by giving notice to you or your patient, thus, extending the payment deadline to 180 days. Q: Is a PIP insurance carrier permitted to delay my PIP reimbursement pending my office sending them proof that I collected my patient’s co-pay and deductible amounts? No. Though you are not permitted to routinely waive co-pay and deductible amounts as an inducement for a patient to treat with you, there is nothing in the PIP statutes or regulations that would authorize a PIP carrier to withhold payment of a clean claim from you pending proof of co-pay/deductible amounts. PIP carriers, by statute, must investigate and pay or deny a claim within 60 days of the claim submission though they can request one 45 day automatic extension in writing. If these time frames have expired and coverage has been determined, the carrier must pay the claim and cannot with- hold payment for arbitrary requests such as proof of patient cost sharing payments. It is standard practice in the industry for a provider to delay (not waive) collection of co-pay and deductible payments by asserting a written lien on the patient’s personal injury file and waiting until the case is resolved. There is no authority to permit the carrier to withhold payment to you until the case is over if you have agreed to such a delay as this is contrary to the intent of our PIP/No-Fault laws that promote prompt payment of first party medical expense benefits without having to prove fault in a third party claim. Q: I received a request for copies of my patient records related to a post-payment audit by a major medical insurance carrier. They told me they would fax me a list of patients and I would have 24 hours to provide them all of the copies. Am I required to provide these copies in such a short time frame? The threshold question is whether you participate with the carrier or not. If you participate, you must first review your participating provider agreement to see if there is a response deadline for providing file copies following a request from the carrier. If there is such a provision and it requires a 24 hour turn around, it is most likely enforceable as you have contractually agreed to it by signing the agreement. On the other hand, if you do not participate with the carrier, there is no contractual agreement Continued on Page 21 Single unit price .......$285.00 each 2 unit price ...............$275.00 each 3+ unit price .............$259.00 each Prices subject to change without notice. All Prices are in U.S. Dollars 30 Day conditional money back guarantee Suggested Patient Price $385.00 C.O.D. or prepay by check LASHAW DISTRIBUTORS LTD. 9631 Bakerview Drive, Richmond, B.C., Canada V7A 2A2 Tel: (604) 270-4263 = Fax: (604) 277-2154 = Toll Free: 1-800-667-7795 Website address: www.invertrac.com E-mail address: [email protected] Proud ANJC Platinum Sponsor since Inception! Bob Rosenberg (609) 239-0358 18 Fall 2012 www.anjc.info www.njchiropractors.com Insurance By David Klein, CPC, CHC – ANJC Insurance Consultant Q. I have a question regarding cervical/lumbar radiculopathy. We have been using ICD-9 code 722.71 and 722.73 to rule out, pre-cert and bill for cervical/lumbar radiculopathy, which we retrieved from the PIP care path guidelines. Now an automobile insurance company is stating that is an inappropriate code to use since that code is for myelopathy. Can you advise us of the appropriate code to use for radiculopathy? A. ICD-9-CM 723.4 is defined as: Brachial neuritis or radiculitis NOS. The short description is brachial neuritis NOS. It is the appropriate code for Cervical Radiculopathy. It should also be noted that you should never choose a diagnosis code to rule out but rather code the diagnoses that are confirmed. Q. Do we need to go electronic/ paperless by 2014 for our notes and documentation? A. No. However, Medicare-eligible professionals who do not successfully demonstrate meaningful use of a certified EHR software by 2015 will have a payment adjustment to their Medicare reimbursements. At this time the payment reduction starts at one percent and increases each year that a Medicare-eligible professional does not demonstrate meaningful use, to a potential maximum of five percent. However, if you are considering implementing EHR now is a good time since you will be required to make a change to ICD-10 in October of 2014. This change to ICD-10 will result in significant changes to how you report diagnoses and document. An EHR system will surely help with the changes and, if you are trying to learn the new codes and convert to an EHR system at the same time it will be a bit overwhelming. Q. What codes can I use when I give a patient a cold/warm wrap for home use? A. Prior to 2012 providers were supposed to bill E0238 (hot pack) and E0230 (cold pack) when issuing for home use. However in 2011, both of these codes were deleted and a new code was created. The new code for these products is A9273 – Hot water bottle, ice cap or collar, heat and/or cold wrap, any type. PIP COLLECTION SPECIALISTS Family owned and operated for 18 years Over 75 million dollars collected Serving over 100 medical providers Minimize Arbitration delays Don’t be a victim of the Arbitration System Most Chiropractic services don’t require Arbitration & can be resolved quickly. Free in office seminar, teaches patient intake, treatment & billing strategies, precert, denials, appeals, carepaths, medical necessity and permanency. R THE ROTHENBERG GROUP , LLC Our system allows the patient to receive all necessary services, under the “current regulations”. Learn how to continue to prosper under the new proposed regulations, when they are enacted. Call today for low tax deductible rates and references! 973.694.1981 • e-mail [email protected] Electronic Health Records Are Required by 2014! By Paul B. Bindell, DC T he choice is no longer whether or not you will computerize; the only choice is when, as long as it is before 2014. In the State of the Union speech by President George Bush in January 2004, the President stated, “by computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.” In April 2004, he issued an executive order mandating computerization of health records by 2014. Congress passed legislation turning the edict into federal law. President Obama intensified the pressure with Electronic Health Records (EHR). He gave speeches lauding the benefits of EHR and with Congress enacted an economic stimulus bill that rewards those using certified EHR and punishes those not. If you already use a certified EHR system then you are eligible to receive bonus payments from Medicare or Medicaid, but not both. Reward for Certified EHR: The Medicare stimulus is up to an extra $44,000, added to Medicare payments over a three year period. The Medicaid stimulus is up to $64,000 paid over five years. The Punishment for No Certified EHR You do not get the up to $44,000 stimulus money, and Medicare payments will be reduced by 1% in 2015, by 2% in 2016, and by 3% in 2017. At this time, there are a few chiropractic specific EHR systems that have the proper certification. However, the certification should not be the only criteria to select the software for your office. Make sure the certified software also includes the State Board requirements for documentation, any special features that you would like to have, and that its price is in your ballpark. And verify what the price includes. Some inexpensive programs do not include everything and then nickel and dime you until you have paid more than the seemingly expensive systems. Does your purchase include support, updates, training, etc., and if yes, for how long? The insurance industry placed requirements on health records, exceeding the timetable set by the government. Tom Lee, CEO of Partners Health Care System in Massachusetts, reported that for doctors that did not implement EHR by January 2008, or commit to implementing EHR by January 2009, they are out of the Partners network. Other insurance programs are getting on this bandwagon. The best thing you can do is computerize today, and not wait until the government or insurance forces you. Know the terminology of electronic health records. Recognize that different entities use the terms differently. We frequently use the terms of EHR, EMR, and ECR interchangeably. The insurance industry gives them separate meanings. In the December 2007 issue of Risk Review Online, Sharon Koob (the Healthcare Risk Consultant for Princeton Insurance) explained that EHR referred to the patient’s complete record including personal data, clinical info, demographics, insurance material, phone logs, reminder messages, letters, reports and anything else found in a patient file. She notes that EHR spans all the records of doctor offices, labs, nursing and rehab facilities, all insurance companies and “any other part of the massively complex healthcare system.” By contrast, Ms. Koob identifies EMR or ECR as being only the clinical record, that is SOAP notes, exam findings, and narrative reports about the patient. EHR provides many benefits. James B. Couch, MD, Managing Partner and Chief Medical Officer of Patient Safety Solutions, LLC noted in the December 2007 issue of Risk Review Online that “the healthcare industry is finally getting swept into the electronic information age” and that doctors “who want to continue practicing …must prepare themselves for the inevitable transition into this electronic information age.” He itemized some benefits of EHR to include • More thorough knowledge of the patient’s condition prior to making a diagnosis • Instant accessibility to test results and consultations, allowing for a faster and more accurate diagnosis • Documentation support for therapeutic decisions In addition to the items listed, EHR has many other benefits; EHR makes your office paperless, so no one is wasting time in the filing cabinet. EHR enables your staff to be more productive with building your practice. Each file is always at your fingertips. The mandate for Electronic Health Records, also referred to as EMR, EHR, or ECR, is very unusual for a government program because EHR gives us very great benefits including reduced expenses, saved time, greater staff productivity, and increased income. Paper filing is minimal, and in the not too distant future, even more paper will be eliminated when patient forms are completed by the patient using tablet computers. In other words, the sooner you implement full computerization of your health records, the better it will be for you. ––––––– Dr. Paul Bindell is founder of Life Systems Software, and as a computer consultant he assists chiropractors to improve office efficiencies and profitability, and to grow successfully. For more info call 800.543.3001 or visit www.lifesystemssoftware.com. Fall 2012 www.anjc.info www.njchiropractors.com 19 What Makes Chiropractic Attractive? By William D. Esteb M any chiropractors forget what makes chiropractic care attractive to patients. Distracted by the challenges of running a small business and deep into the doing of chiropractic, it’s easy to forget why chiropractic is so appealing to patients. Here’s a quick refresher course. 1. Chiropractic is attractive because it’s different from medicine. As much as we wish it weren’t so, chiropractic is often a last resort for many patients who investigate chiropractic only after exploring medical solutions. That’s why you’d want to create a distinctly different patient experience than the medical model they’ve already tried and abandoned. In other words, patients don’t want same, they want different. That’s good news. It means you have incredible latitude to show up truly different. You could even lose the white lab coat if you wanted to. Gasp! 2. Chiropractic is attractive because it’s completely natural. Perhaps it’s due to the Baby Boom Generation who avoided polyester in favor of natural fabrics. It seems there’s a growing interest in things au naturel. Consider the popularity of organic produce, antibiotic-free poultry, growth hormone-free milk and a myriad of other all-natural products. Those who tend to be more highly educated and attempt to live consciously are inclined to avoid processed foods and artificial just about anything. When given the choice, most people would prefer natural over artificial, authentic over phony and the truth over a lie. 3. Chiropractic is attractive because it’s safe. What makes this so ironic is that many chiropractors are more sensitive to this than patients or perspective patients. Sure, the bogus stroke thing is paraded out from time to time by chiropractic detractors, but they overlook the fact that people make decisions based on how they feel (emotions) rather than what they know (intellect). In other words, most people don’t consult actuarial tables before choosing a treatment option. Credibility, trustworthiness and cultural authority are far more influential than some statistical analysis or comparison with adverse reactions to drugs or iatrogenic statistics from medical interventions. This is why patient testimonials can be so powerful, and financial inducements—“Save $100 off our regular exam fee”—and other questionable marketing practices are so damaging. The real safety patients and prospective patients want is social safety. Proof that choosing a nonmainstream solution won’t make them look foolish. 4. Chiropractic is attractive because it trusts the wisdom of the body. Many chiropractors overlook this when explaining chiropractic to patients. Perhaps this is because the allure of showing up as the hero, mimicking the attitude of traditional doctors, is more gratifying than telling the truth about the nature of healing. In other words, doctors, of any ilk, don’t heal. Nor do drugs. Or adjustments! Recovering one’s health is a shedding process not an acquiring process. Which is to say, we each have within us the ability to heal. Usually, health can manifest by reducing obstructions or interferences rather than filling a void because something is missing. We’re not flawed, we’re merely blocked. We’re not deficient, we’re merely constrained from our fullest expression. We’re not suffering a drug shortage, we’re merely exceeding our ability to accommodate one or more stressors. 5. Chiropractic is attractive because its side effects are largely positive effects. Virtually every intervention can have an unintended consequence or adverse reaction. Even chiropractic. Fortunately, these are overwhelming positive, even if unintended. Such as the patient whose allergies improve after receiving chiropractic care for headaches. Or the patient whose indigestion disappears after receiving chiropractic care for back pain. Or the expectant mother whose restored fertility seems to have coincided with her chiropractic care for low back pain. You know the list. The danger when seeing these frequent associations is to make the leap that chiropractic treats allergies, indigestion and fertility. Of course chiropractic doesn’t treat anything. However with a revived nervous system, just about anything is possible. Even the relief of headaches and back pain. 6. Chiropractic is attractive because it can help anyone regardless of age. Chiropractic care helps people who have assumed a defensive posture we call subluxation in an attempt to accommodate physical, emotional or chemical stress. That’s no guarantee of cure since countless other factors can impair the healing response. However, all things being equal, if the stressor is no longer present, people tend to function better without subluxations than with subluxations. Naturally, anyone who expects to benefit from chiropractic care must meet one important condition: they must be alive. Granted, this is the same criteria that medical interventions require, however, the important distinction afforded chiropractic is that it focuses on the person with the condition, not the condition in the person. 7. Chiropractic is attractive because it’s simple. By the second quarter in chiropractic college, many chiropractors have lost the simple elegance and minimalism of chiropractic. Obfuscated by technique, practice procedures, physiology and beneath layers of dogma and seminar rhetoric, many chiropractors emerge later as spinal therapists, medical doctor wannabes, patient pleasers or just confused. The principles of chiropractic often take a backseat to the practice of chiropractic and the how of practice often eclipses the why. In the process, patients rarely learn that their nervous system controls the whole show and reviving their ability to self heal, mediated by the nervous system is the focus of chiropractic care—not pain relief, posture restoration or even treating subluxations. ––––––– William D. Esteb is the Creative Director of Patient Media, Inc. and co-founder of the Perfect Patients website service. The above is excerpted from his weekly broadcasts of Monday Morning Motivation during the summer of 2012. Subscribe at www.patientmedia.com. Why Adjust the Extremities? By Dr. Mark N. Charrette N eurological research has presented us with a model that gives an explanation to why chiropractors achieve positive clinical results when patients’ extravertebral articulations are examined and appropriately adjusted. The model known as dysafferentation gives an explanation why a variety of symptom complexes not usually associated with altered joint function are reduced or eliminated. The first chiropractor, D.D. Palmer, was well aware of the clinical significance of adjusting extravertebral articulations, particularly the feet. In his 1910 book, The Chiropractor’s Adjustor, the Science, Art, and Philosophy of Chiropractic, D.D. states, “Why adjust in the lumbar for displacements in the joints of the foot?” (1). In 1906 both B.J. Palmer and D.D. Palmer wrote in The Science of Chiropractic, “Were we to know of a dislocated shoulder, hip or any one of the fifty-two articulations of the vertebral column being luxated...and did not replace the dislocation...it would show our patients and students that we were not doing our duty...” (2). Though the explanations given by D.D. Palmer are considered crude by today’s standards, the clinical significance of extremity/extravertebral adjusting cannot be understated. A deeper look at the model of dysafferentation gives some insight as to why I recommend the examination of extravertebral articulations and the appropriate adjustments based on indicators, not symptomatology. This explanation deals with the two main types of sensory receptors, nociceptors and mechanoreceptors that innervate the joint structures. Depolarization of nociceptors occurs via noxious mechanical stimuli and the chemical mediators released in response to injured tissue. The depolarization of mechanoreceptors occurs only via mechanical stimuli such as that associated with touch and normal body movements. Examples of mechanoreceptors are Pacinian Continued on Page 23 Hurry! Offer Ends Soon! SpiderTech Kinesiology Tape Headquarters Pre-Cut with Instructions Buy 10 Get 2 FREE Buy 20 Get 5 FREE Small and Bulk Rolls Now Available! 1-866-941-8867 WWW.THEVITALITYDEPOT.COM New Easy Order Website! AD-NJJA12 20 Fall 2012 www.anjc.info www.njchiropractors.com Self Funded vs. Fully Funded: What is All the Hype? B y now you must be hearing the terms ‘self funded’ and ‘fully funded’ thrown around a lot! So…..what’s the big deal? What is the difference between the two and why is it so important? This is a subject that chiropractors need to get a handle on—sooner rather than later! It’s evident that there is still need for clarification based on some of the emails that come into the ANJC. So let me help! Fully Funded Policies: Small employers are typically fully funded or fully insured. An employer group or individual contacts a broker or an insurance carrier and is provided with a schematic of plan options (usually a spreadsheet with the monthly premium and the various plan specifications such as in and out of network benefits, hospitalization coverage, chiropractic coverage, etc.). There is no altering those plans. What you see is what you get. You cannot combine or make changes to create your own plan. Once the policy is purchased, the insured receives a Certificate of Coverage (COC). From then on a monthly premium will be paid to keep the policy active. These polices are under the jurisdiction of the Dept of Banking & Insurance (DOBI). (www.state.nj.us/dobi) Self Funded Policies Most mid to large employer groups are self funded or self insured. As the number of employees an employer group has increases, it often By Lynette Contreni – ANJC Insurance Consultant becomes less and less cost effective to pay those monthly premiums for a fully funded policy. Instead, an employer group may choose to become self insured or self funded. Once the model is established, the employer group needs to hire an administrator for the plan. They may choose to hire an insurance carrier (such as BC/BS or Cigna) or they can hire a managed care company (such as Qualcare or First Health, etc.). Basically, the employer group hires the insurance carrier or managed care company to function as a TPA (Third Party Administrator) for use of a provider network, claims processing, fee schedule, etc., etc. In this self funded model, the employer group provides the TPA with a Summary Plan Document (SPD). This tells the TPA exactly how to administer the benefits for the covered members under that employer group. In the SPD, the employer dictates all the benefit information. In addition, the employer group actually funds the TPA with the money to pay the claims. These policies are not under the jurisdiction of DOBI, but are rather under ERISA law and the administration of the benefits need to follow ERISA guidelines. ERISA is the Employee Retirement Income Security Act. This is a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans. (www.dol.gov) Now you have clarification on self funded vs. fully funded. But how does that affect your practice? Well, truth be told, whether the policy is self funded or fully funded affects so many areas of a provider’s office. Just to name a few: **Who’s getting paid—the provider or the patient? **Appeals **Complaints you may have regarding a particular carrier **EOB follow-up **If you are entitled to interest on claims not paid timely **Copay Maximums For example, many providers are confused about why some BC/BS checks continue to go to the patient. Well, the assignment law that was passed a few years back was a DOBI decision. Remember that DOBI only has authority over fully funded policies, so if BC/BS is administering a self funded plan (like the NJX prefixes), the assignment law does not apply and the payments can still go to the patients. It is the same with the copay maximums. Again, that decision to put a cap on the maximum amount a copay can be is a DOBI decision; so therefore, self funded accounts do not have to honor such limitations under ERISA. Appeals have different processes for self funded policies and fully funded policies, and EOB follow-up and time frames are slightly different from a fully funded plan to a self funded plan. There are so many reasons why making sure you obtain this information at the time of verification is imperative. If you have not already done so, add it to your insurance verification immediately. If you obtain this information at the beginning of the patient’s treatment, you would be prepared for the checks to go to the patient and act accordingly before it becomes a problem. You can anticipate that the copay maximum will not apply. You can prepare your staff to watch for runout periods that go along with changes of TPAs, you can be educated as to what appeal process you may have to follow if there is a medical necessity dispute, etc. My point is that knowing this information is another very important way to set yourself up for success. Unfortunately, gone are the days that you could just love the patients and get paid for it unconditionally. We find ourselves in an industry now where it is imperative that you always stay one step ahead of the payer to ensure a proper payment for your services. I strongly encourage providers to continue to educate themselves. It is true when they say knowledge is power and power is money! ––––––– Lynette Contreni is founder of CB&C, Inc. and an ANJC Insurance Consultant. As an ANJC Platinum Sponsor. CB&C, Inc. offers insurance patient billing & collection services, consulting services, insurance verifications, webinars, managed care contracting, and more. For information visit www. cbcbilling.com or call 973-827-3544. The Political Future of Chiropractic in New Jersey is Doubtful Continued from page 1 For the past several years, just a handful of ANJC chiropractors (15%) throughout the state have donated to the ANJC Political Action Committee (ANJC-PAC) to help support those legislators that support chi- ropractic patients and the concerns of the chiropractic physician here in New Jersey. Just think about how politics and the laws that were created by politicians affect virtually every aspect of Nutri-West Mid Atlantic Toll Free 866-502-1200 Wilmington, Delaware Do you use a hot tub or pool? The chemicals in your hot tub or pool can lead to heavy metal toxicity which can affect your thyroid! When the delicate hormonal balance usually established by the pituitary & thyroid glands becomes disrupted, it can cause major health issues. Protect your health this summer with Total Bromine & Total Chlorine Add to the protocol Total Chelate & an oil; Complete Essentials, Super EPA Total Flaxseed Oil, to help eliminate heavy metals. Call us today for more information on the “Heavy Metal Protocol” (866) 502-1200 chiropractic. Taxes, licensure registration, insurance regulations, chiropractic law; it goes on and on. Whether you know it or not, you’re in the middle of the political world by having to comply with each and every one. You do not have to even like politics to understand that politics affects every day of your life whether you are a bystander or a participant. As a bystander you’re controlled by these outside voices with absolutely no input. The MDs could put in laws designed to stymie other professions from advancing. PTs have always looked to dismantle chiropractic and if you have not been negatively affected by an insurance carrier, consider yourself in the minority. Choosing to be a participant as a PAC contributor can make incredible changes in your profession and your life so that you and your patients might have a better future ahead. Someone once said “We can either do politics or politics will do us.” PAC fundraising is vital to protecting as well as advancing our profession by 1) participating in legislators’ functions throughout the state; 2) discussing and debating the issues, and 3) demonstrating that we will support legislators who support our profession and the rights of our patients. Yet very few in our profession take ANJC’s PAC seriously enough to make voluntary donations, even a small amount of $25/month. Put simply, donating monthly to ANJC-PAC builds power for your profession and your patients, and makes a dramatic impact on legislators who have stood up and taken notice that the chiropractic profession is on the map like never before. ObamaCare, Triad, PIP changes, and Optum are just a few of the uncertainties our profession faces, and without building a strong PAC it is very easy to see our future as doubtful, or even slipping and sliding backwards. I urge you to join us as an ANJCPAC supporter with a simple $25/ month credit card donation. This way ANJC can continue to do all the necessary work required. Whether a PAC participant or bystander, you talk to your patients about maintenance being important for their health and prevention of future problems. Think of ANJC-PAC as your profession’s maintenance program, not only working to prevent problems, but also working to improve your overall health. For more information please contact ANJC HQ at 908.722.5678 or email [email protected] Thanks in advance for your consideration. Dr. Steve Clarke ANJC Legislative Chair Fall 2012 www.anjc.info www.njchiropractors.com 21 ANJC Sponsors NJ Champion Cyclist Ryan Pettit: Answers to Your Rider to Showcase How Important Malpractice Chiropractic Has Helped Questions His Performance By Keith Henaman, NCMIC Assistant Vice President-Claims Q: A couple of weeks ago, my CA informed me that one of our elderly patients made a sexual comment to her. I told the patient it couldn’t happen again, and he agreed. But today my CA said she heard the patient making innuendos under his breath when he walked by. She threatened to quit if she has to continue to deal with him. Should I dismiss the patient from the practice? A: As the employer, one of your primary duties is to protect your employees. A patient like this one not only causes strife among staff members and disrupts the flow of the practice, he exposes you and your practice to a complaint to your state board or even an employee lawsuit. That’s why you may have to dismiss him from your practice. Obviously, dismissing a patient who still needs healthcare attention is not to be done hastily or without good cause. What’s more, it should only be done if there are no other viable alternatives. Be aware that the dismissal itself could become grounds for an allegation of abandonment if not handled carefully. Here are a few ways to help protect yourself: • Document thoroughly. If a patient’s dismissal ends up in litigation or in a complaint to your state licensing board, good documentation will help you justify your decision. The records should show that you discussed the behavior and told the patient it must stop, and yet the patient failed to comply. Your documentation should paint a clear picture of the patient’s behavior and noncompliance, and that you had little choice other than to terminate the doctor/patient relationship. It may also be advisable to document the situation in a separate incident report outside the chart. • Verify dismissal steps with thirdparty payers. If the patient is a member of a PPO or HMO or other third-party payer, it’s wise to check to see what steps are required to dismiss one of their covered patients. • Communicate the reasons for ending the doctor/patient relationship at the patient’s next appointment. Explain any need for continued healthcare, document this in the patient’s record, and follow up with a letter. The letter should be on practice letterhead, include the doctor’s signature and be sent via certified mail, return-receipt requested. It should clearly explain your rationale for terminating the relationship, any need for continued healthcare and the possible consequences of noncompliance. A copy of the letter should be kept in the patient’s chart. • Offer to provide patient care for a limited time to allow the patient to find another doctor. The timeframe will depend on the specific healthcare needs of the patient and the availability of other healthcare in the area. Many practices give patients 30 days to find another doctor. If appropriate, your letter can provide information on finding a new doctor. Also, make arrangements so the staff member does not have to deal with the patient in the meantime. ––––––– NCMIC is a company trusted by more than 37,000 DCs and growing. Policyholders know our strength is summarized by our motto, “We Take Care of Our Own®.” For more information call 1-800-769-2000, ext. 3809. ©2010 NCMIC Group, Inc. All rights reserved. Legal Q & A Continued from page 17 wherein you must provide copies of records within a certain time frame. In the absence of a participating provider agreement, the carrier is requesting copies of the patient records as an authorized representative of the patient. N.J.A.C. 13:44E-2.2(e), which governs chiropractic record keeping in New Jersey, only requires a chiropractor to provide copies within thirty days of a receipt of a written request from a patient or their authorized representative. Accordingly, if you are non-par, you have up to 30 days to provide the copies to the carrier. ––––––– The author of this article is an independent person of the ANJC and his views are not authorized, sponsored, or otherwise approved by the ANJC. The information provided is for general guidance on matters of interest only and may not take into account particular facts relevant to your individual situation. The application and impact of laws and healthcare can vary widely based on Continued on Page 25 R yan Petitt of Hammonton, NJ is a three-time New Jersey Category 1 State Cycling champion. However, earlier this summer, the 30-year-old Petitt was not experiencing the success he had in the past as his body started showing the effects that grueling competitions can have. Looking for a competitive edge and knowing how chiropractic care helped him years earlier when he played club lacrosse in high school, Petitt returned to the care of Medford chiropractor Dr. Brett Wartenberg a few weeks ago, and since then has returned to his winning ways, including winning four consecutive events this summer. Pettit, a member of the Heart House Cycling Team and CC Evesham Elite Racing Team, now has the entire chiropractic industry in New Jersey supporting him. ANJC has agreed to become a sponsor of Petitt, who will serve as a showcase to the benefits of chiropractic care. An ANJC banner will be on-site at his cycling events and Petitt will wear the ANJC logo this fall in all of his races. “I was in shape before going back to Dr. Wartenberg, but like any athlete, I was looking for that 1-2% extra,” noted Petitt. “I had been doing well, but not winning and I was looking to find an edge. After three weeks of treatment, I won a race and have now won four in a row.” The physical toll on a cyclist’s body can lead to lower back pain, elbow, shoulder and problems with the feet. “When I compete with my road bike, there is no suspension,” Petitt notes. “Your wrists, elbows and shoulders are all affected. Dr. Wartenberg has been adjusting my right shoulder and it has made a big difference.” “Riding a time trial bike, which is all geared for aerodynamics and keeps the body in an aggressive position, also causes physical problems. Prior to being adjusted I could not ride back-to-back days in time trial competitions. My chiropractic adjustments have enabled my body to recover and I have won two straight time trial events.” “When Ryan came in to see me and I examined him, his feet and ankles were a mess,” commented Dr. Wartenberg, the ANJC Chiropractor of the Year in 2010 and the past 1st Vice President of the ANJC. “We did a digital scan of his feet and began treating his feet as well as his back and shoulders. Ryan is experiencing the benefits of chiropractic care as have hundreds of athletes ranging from Olympians to weekend warriors.” Those watching Ryan compete will easily find him in the crowd of cyclists. He rides a pink bike, with pink accented wheels and wears pink shoes and socks as a tribute to his late daughter Brianna, who passed away three years ago from a heart defect. 22 Fall 2012 www.anjc.info www.njchiropractors.com Despite a Recommendation for Surgery, A C6-7 Disc Herniation Causing Arm Pain into the Fingers and Upper Back, an Inability to Sleep, and Emotional Upset, Relieved with Cox® Technic By Dr. Joseph C. D’Angiolillo INTRODUCTION This is a case study of a Patient with a congenitally narrow central spinal canal with a large right paracentral disc herniation at C6-C7. HISTORY On December 21, 2011 an obese 47 year old Caucasian male presented himself for examination and treatment. He was cooperative, alert to time and place and in obvious discomfort presenting with a right Bakody Sign. He related that approximately one month before, while traveling in an airplane to Spain, his neck began to feel uncomfortable and stiff. He described his neck pain as a constant pressure sensation. Then five days prior to coming into the office the pain spread out to his right shoulder, right upper back, between his shoulder blades and into his right arm. The pain shoots into his right arm causing the muscles in his forearm to spasm. He has numbness into his right hand which comes and goes. His right hand feels weaker than his left hand. Moving his head in certain directions, like rotation, increases the intensity of his pain. The patient is emotionally upset because he claims to have not slept in the past few days as he cannot find a comfortable position. He also relates that over the past few months’ side sleeping has caused his hands to fall asleep. Prior to seeking care in my office the patient saw his primary care physician who prescribed a muscle relaxor and a non steroidal anti-inflammatory. The patient has also self treated with a heating pad, therma-care patch, Ben Gay, and hot showers. The patient’s past history includes an episode of left sided sciatica in 1999 leaving him with a permanent loss of his left Achilles reflex. He had the surgical removal of a benign growth from the roof of his mouth. He currently takes over the counter medications for acid reflux. His family history reveals that his father has a history of back problems and his mother has hypertension. EXAMINATION Examination revealed that the patient carries his head in an anterior antalgic lean. While the Foramina Compression Test was essentially negative, the RT/LT Shoulder Depressor Tests and RT/LT Maximal Cervical Compression Tests produced right sided cervical spine pain. The seated Dorsolumbar Circumduction Test bilaterally produced pain in the upper thoracic spine. Using a goniometer the cervical ranges of motion were: Anterior bending: 30 degrees with pain. Posterior bending: 20 degrees with pain. Left lateral bending: 35 degrees. Right lateral bending: 10 degrees with pain. Left rotation: 50 degrees with pain. Right rotation: 15 degrees with pain. The deep tendon reflexes of the Biceps, Triceps, Brachioradialis, and Patella were +2 bilaterally. The left Achilles was 0 the right Achilles was +2. Using a Whartenberg Pinwheel the right C7 and C8 dermatome levels were reduced, all other dermatome levels of the upper Are you being investigated by the nJ Board of ChiropraCtiC examiners or audited by an insuranCe Company? extremities were noted to be within normal limits. Using a dynamometer the left hand grip strength was 105/105/105 lbs per square inch; the right hand was 85/90/85 lbs per square inch. The patient reports to be right handed. Paravertebral muscles spasms were present from the sub-occipital region to the midthoracic spine, the trapezius muscles and SCM muscles. Tenderness on digital pressure extended from the sub-occipital region to the mithoracic spine. RADIOGRAPHIC EXAMINATION: On December 21, 2011 the patient had two cervical films taken. Analysis of these films reveals the following: essentially negative for evidence of recent fracture as visualized. Spondylosis is noted at the C5-C6 joint level with Lushka Joint hypertrophy, anterior and posterior spur formations. The C5-C6 disc space is thinned. There is a bilateral elongation of the C7 transverse processes. The lateral film reveals a loss of the normal cervical lordosis. The A-P film reveals a lower right shoulder along with a right lateral lean to the upper thoracic and cervical spine. CERVICAL SPINE MRI FINDINGS: I referred the patient for an MRI of the cervical spine as my suspicions were of a HNP of the cervical spine, which was performed on December 23, 2011. The MRI reveals the following significant findings (See the axial and sagittal MRI images.): Figure 1 Axial Image 10/40 T2W FFE 3D shows the large right sided C6-C7 disc herniation (See arrow.) Representing yourself could be a costly mistake. You could be subject to fines, recoupment or even the loss of your license. Protect your livelihood! Hire someone who has insider experience working with deputies and investigators as former Acting Director of Regulatory Affairs for the NJs Consumer Affairs Department. Ms. AriAns drafted many of the laws that regulate the health care community. She will aggressively defend your interest. Call today and put your mind at ease. The LAw Offices Of e. Vicki AriAns, LLc (973) 513-9980 Figure 2 Sagittal T2 TSE section 10/15 showing the large C6-C7 disc herniation (See arrow.) “There is a mild to moderate diffuse congenital narrowing of the cervical spinal canal.” “At C5-6, there is a small left paracentral disc protrusion and uncovertebral degenerative change especially on the left. There is mild to moderate narrowing of the central spinal canal and left lateral recess. The left neural foramen is mildly narrowed.” “C6-7, there is a moderate to large right paracentral disc herniation that fills the right side of the spinal canal and causes severe narrowing of the right lateral recess and proximal right neural foramen. The central spinal canal is moderately narrowed. There is potential for impingement on the right C7 nerve roots.” “T1-2, there is a small to moderate right paracentral disc protrusion that causes mild to moderate narrowing of the central spinal canal on the right. Tiny disc protrusions are seen at the T2-3 and T3-T4 levels as well.” DIAGNOSIS: HNP of C6-C7 resulting in a right sided cervicoradiculopathy, hypoesthesia, paravertebral muscle spasms, and weakness of the right upper extremity, complicated by a congenitally narrowed central spinal canal. TREATMENT: Cox Decompression Spinal Adjustments, along with trigger point ultrasound, electrical muscle stimulation, ice packs/hot packs as needed. Initial course of care three times per week for four weeks or until pain reduction of 50% is achieved, with a re-evaluation at the conclusion of this trial of care to determine the patient’s future needs. TREATMENT GOALS: To reduce the patient pain level by 50% within one month of care. If the patient does not improve during this trial of care I may consider referring the patient for a consultation with a neurosurgeon. DISCUSSION: This patient presented himself in obvious distress and emotionally upset. My initial impression of a herniated nucleus pulposus of the cervical spine compressing the C7, C8 nerve root levels, was confirmed by MRI two days later. I explained to the patient that our goal is to first reduce the pain and that I expected to achieve at least a 50% reduction within the first month of care. I informed him that the cervical headpiece on the Cox 7 table is designed to accomplish decompression of the spinal nerve roots as well as the spinal canal, that his feedback during the testing and treatment phase is needed to test his tolerance of the adjustment. Continued on Page 25 Fall 2012 www.anjc.info www.njchiropractors.com 23 The Corporate Athlete: How to Avoid Injury in the Modern Workplace By Dr. Clifford Daub W ho is the corporate athlete in your office? Is it the former football player who always gets volunteered to change the heavy five gallon bottle on the water cooler? Is it the MVP of the company softball team? Is it the person who goes for a five mile run every day on their lunch hour? Yes, they certainly are athletes in the traditional sense, but in order to avoid some of the physical dangers of the modern workplace everyone needs to look at themselves as a corporate athlete. Anyone who works in an office environment and spends time sitting at a computer is at risk for disability associated with tension headaches, neck and back pain, rotator cuff injuries and carpal tunnel syndrome. These are all classified as musculoskeletal conditions, which are the number one cause of missed work days and decreased productivity in the United States. The human body is designed for varied movement and the prolonged periods of sitting at a computer or the small repetitive movements with our hands, wrists and shoulders associated with using a smartphone can cause big problems. These physical ailments are becoming so prevalent that terms like “text neck” and “Blackberry thumb” have been added to the lexicon of workplace postural and overuse syndromes. Fortunately, with a little training, you can improve your fitness so that your body can withstand these biomechanical stresses without breaking down. If you spend a good part of your day using this modern technology, you are probably developing a posture that is overly stressing certain muscles, ligaments and joints that can put you at risk for one of these workplace ailments. Your head probably sits forward from your upper back, your chin probably protrudes forward, your shoulders are rotated inward, your forearms are pronated (palms face downward), your fingers always flexed and your low back is slumped forward. Try this simple test: Stand with your back against a wall. Try to keep your heels, buttock, lower back, upper back, shoulders and head flat against the wall at the same time without tilting your head backward. Then raise your hands above your head with elbows at shoulder height and keep your elbows and backs of your hands flat against the wall while still keeping the rest of your body against the wall. If you have difficulty holding this position, then you have already developed some postural faults and lost flexibility that puts you at risk for the pain and disability associated with the above noted injuries of the modern workplace. The good news is that you can decrease your risk if your start thinking and training like a corporate athlete. A simple way to improve your workplace fitness and start limiting the physical stresses on your body is to take frequent micro-breaks to change position, stretch and undo some of the cumulative stress on your muscles, ligaments and joints that develops from sedentary posture. 1. It has been said that the only good chair is one that you get out of frequently; every 30 minutes stand up and take a short 2-3 minute break to move around. 2. Perform the following stretches every hour throughout the workday: • Neck: looking straight ahead, relax your shoulders and gently pull your head backward as far as possible; hold for five seconds and repeat three times • Shoulders: with your arms at your sides, turn your palms outward and squeeze your shoulder blades together and downward; hold for five seconds and repeat three times • Back: stand up, place your hands on the back of your waist and gently press downward as you slowly bend backward; repeat three times • Wrists: place a rubber band around all five fingers and extend your fingers as you open your hand as far as possible against the resistance of the rubber band; repeat three times with each hand If you incorporate these stretches into your workday, you will begin improving your workplace fitness from that of an average desk jockey to that of a true corporate athlete. ––––––– Dr. Clifford Daub is a Diplomate of the American Chiropractic Rehabilitation Board and practices in Morristown, New Jersey. Why Adjust the Extremities? Continued from page 19 corpuscles, Meissner’s corpuscles, Ruffini corpuscles, Merkel’s receptors, muscle spindles and Golgi tendon organs (3). It appears that with joint subluxation/misalignment/hypomobility, nociceptors will excessively fire while the mechanoreceptors will decrease their firing rate. Research of Hooshmand demonstrates how restricted joint motion causes an increase in firing of nociceptive axons (A-delta and C fibers) and a decrease firing of large diameter mechanoreceptor axons (A-beta fibers) (4). Remember that an important function of mechanoreceptor input is to inhibit nociception at the level of the spinal cord. So, it would be reasonable to think that reduced mechanoreception (decreased firing rate due to subluxation) may magnify the symptoms generated by excessive nociceptor input. Dysafferent input can and does produce a variety of symptoms that one would not usually associate with dysfunctional joints. In research written by Nansel and Szlazak, it explains that nociceptive input from dysfunctional joints can cause symptoms such as sweating, pallor, nausea, vomiting, abdominal pain, sinus congestion, dyspnea, cardiac palpitations, and chest pain that mimics heart disease (5). Cabell authored research that states, “nociceptor activity reflexively activates the sympathetic nervous system...” (6). In addition to relieving symptoms classically associated with joint subluxation/misalignment, most chiropractors experience their patients leaving their offices with a much more relaxed and lighter feeling. In a paper written by a chiropractor, Dr. Patterson, it states, “Adjustments to decrease nociceptor input to the spinal cord seem to be an effective way to decrease the hyper-excitable central state” (7). Based on my clinical experience and this research, it is my opinion that examination of extremity/extravertebral articulations and their appropriate adjustment and rehabilitation be considered an integral part of proper chiropractic procedure. Extremity examination and adjusting should be performed on a routine basis and not only when a patient complains of extremity symptoms. In my opinion another important aspect of proper chiropractic procedure is stabilization and rehabilitation. This is where taping, orthotics, pillows, rehabilitative exercise and a variety of other procedures fit into comprehensive chiropractic care. All of the aforementioned will enhance the proprioceptive response and ultimately stabilize the patient to a greater degree. I do not believe that extremity/ extravertebral adjusting is a specialty or add-on technique. I also believe that extremity adjusting and stabilization should be based on indicators, not symptomatology. All chiropractors are aware that an asymptomatic joint is not necessarily a non-subluxated joint. In closing I would like to stress the importance of including extremity and extravertebral adjusting procedures in the chiropractic care of patients. Like D.D. Palmer said in 1910,”When we as chiropractors, have adjusted all displaced bones of the skeletal frame...what more can we do?” (1). References 1. Palmer DD: The Chiropractor’s Adjustor, The Science, Art, and Philosophy of Chiropractic. 1910, Portland Printing House, Portland, Oregon. 2. Palmer DD, Palmer BJ: The Science of Chiropractic. 1906, Palmer School of Chiropractic, Davenport, Iowa. 3. Guyton A. Basic neuroscience. 2nd ed. Philadelphia: w.B. Saunders,1991. 4. Hooshmand H. Chronic pain: reflex sympathy dystrophy, prevention and management. Boca Raton,FL: CRS Press:1993. p.33-35. 5. Nansel D, Szlazak M. Somatic dysfunction and the phenonena of viscral disease simulation: a probale explanation for the apparent effectiveness of somatic therapy in patients presumed to be suffering from visceral disease. J Manipulative Physiol Ther 1995:18:379-97. 6. Cabell J. Sympathetically maintained pain. In: Willis W. ed. Hyperalgesia and allodynia. Raven Press. NY: 1992. 7. Patterson M. The spinal cord: participant in disorder. J Manipulative Physiol Ther: 1993:9(3)2-11. Call 888-390-7865 Fully EH R Certifie d Easy. Fast. Affordable. No Hardware. Free Updates. No Worries... A Complete EHR System Advanced SOAP Notes Compliant Documentation Billing & Scheduling PayDC is the only Patented Chiropractic Software to constantly incorporate new and changing industry requirements into the system for your protection. For EHR Certification Seal and official details, visit PayDC.com/paydc-certified-software Call For Free Demo! 888-390-7865 24 Fall 2012 www.anjc.info www.njchiropractors.com Despite a Recommendation for Surgery, A C6-7 Disc Herniation Causing Arm Pain into the Fingers and Upper Back, an Inability to Sleep, and Emotional Upset, Relieved with Cox® Technic Adjustments, Strokes and Errors in Medicine Continued from page 22 By Christopher Kent, DC, JD F or decades, in both Canada and the United Stares, reports have appeared in the popular media suggesting that chiropractic manipulation of the cervical spine is associated with strokes. Some writers have suggested that such procedures be banned, or that patients be informed of the possibility that a stroke may follow an adjustment. These allegations require a swift and vigorous response. A common error in logic is equating correlation with cause and effect. The fact that a temporal relationship exists between two events does not mean that one caused the other. As Keating (2) explained, “To mistake temporal contiguity of two phenomena for causation is a classic fallacy of reasoning known as ‘post hoc, ergo propter hoc,’ from the Latin meaning ‘after this, therefore caused by this.” Consider the application of this fallacy in the case of chiropractic adjustments and strokes. Lee (3) attempted to obtain an estimate of how often practicing neurologists in California encountered unexpected strokes, myelopathies, or radiculopathies following chiropractic manipulation. Neurologists were asked the number of patients evaluated over the preceding two years who suffered a neurologic complication within 24 hours of receiving a chiropractic manipulation. Fifty-five strokes were reported. The author stated, “Patients, physicians, and chiropractors should be aware of the risk of neurologic complications associated with chiropractic manipulation.” What’s wrong with this? Let’s change “neurological complications” to “automobile accidents.” Would it be reasonable to suggest that if 55 patients over the last two years had car accidents within 24 hours of seeing a chiropractor that the D.C. caused the accidents? Want to see how absurd this can get? Change neurologic complications to ice cream consumption. Or sleep. Is there anything that would either strengthen or weaken a case of alleged causality? Yes. We can compare the number of times the event in question (in this case, stroke) occurs as a random event to the number of times the event occurs following the putative causative event (in this case, a chiropractic manipulation). In a letter to the editor of JMPT, Myler (4) posed an interesting question: “I was curious how the risk of fatal stroke after cervical manipulation, placed at 0.00025% compared with the risk of (fatal) stroke in the general population of the United States.” According to data obtained from the National Center for Health Statistics, the It’s just business, but we take it personally LIFE & DISABILITY HEALTH & DENTAL BUSINESS OWNERS POLICIES WORKERS COMP PROFESSIONAL LIABILITY LONG TERM CARE John C. Crilly Agency www.crilly.biz 732.747.7947 An ANJC Platinum Sponsor CrillyJournalAd2008.indd 1 1/23/2008 8:24:47 PM • Dynatronics • Hill Tables • MR4 Laser/Stim • ErgoStyle Tables • The Best Products Get The Best Results Proud ANJC Platin Sponsum or Let Us Help You With All The Products You Need... & The Personal Service You Deserve! Harlan Health Products, Inc. PO Box 8421, Pelham, NY 10803 www.HarlanHealth.com (800) 345-1124 Tables • Chattanooga • Eurotech Tables• Rehab Equipment • Supplies Rehab Equipment • Supplies • Dynatronics • Hill Tables • MR4 Laser/Stim • Dynatronics • Hill Tables • MR4 Laser/Stim • ErgoStyle Tables • Chattanooga • Eurotech Tables • ErgoStyle Fall 2012 www.anjc.info www.njchiropractors.com mortality rate from stroke was calculated to be 0.00057% If Myler’s data is accurate, the risk of death from stroke after cervical manipulation is less than half the risk of fatal stroke in the general population. But is Myler’s data accurate? His 0.00025% figure is from a paper by Dabbs and Lauretti (5). Their estimate is probably as good as any, since the basis for it was a reasonably comprehensive review of literature. Jaskoviak (6) reported that not a single case of vertebral artery stroke occurred in approximately five million cervical manipulations at The National College of Chiropractic Clinic from 1965 to 1980. Not one. A study by Cassidy et al (6) was described in the Canadian newspaper The Globe and Mail (7). The article, titled, “Chiropractors don’t raise stroke risk, study says” reported that “Researchers say patients are no more likely to suffer a stroke following a visit to a chiropractor than they would after stepping into their family doctor’s office.” The illusory concept of chiropractic manipulation and stroke should be considered in the context of the de facto standard for healthcare safety—allopathic medicine. In an article in the Journal of the American Medical Association, Kilo and Larson (8) describe the real issues surrounding our current healthcare crisis. “On balance, the data remain imprecise, and the benefits that US health care currently deliver may not outweigh the aggregate health harm it imparts…it is time to address possibility of net health harm by elucidating more fully aggregate health benefits and harms of current health care.” In a review of errors in medicine, Leape (9) reported that if the results of the papers reviewed were applied to the U.S. as a whole, “180,000 die each year partly as a result of iatrogenic injury, the equivalent of three jumbo-jet crashes every 2 days.” Even apparently innocuous diagnostic procedures can be lethal. Myocardial infarction occurs in 1 out of 2,800 persons undergoing treadmill exercise testing. One out of 20,000 individuals will die as a result of treadmill exercise testing (10). Those with suspicious results may undergo cardiac angiography, a procedure with a mortality rate of 0.10% to 0.25%. This translates to 1 in 1,000 to 1 in 250 (11). There is no scientific evidence establishing a causal relationship between stroke and chiropractic adjustments. 1. Any attempt to mandate a disclosure of such a putative relationship constitutes consumer fraud. 2. While it is human nature to attempt to attribute a catastrophic health event to a specific cause, it must be remembered that the mere fact that one event follows another does not mean that one caused the other. 3. Things more likely to occur than a stroke following a chiropractic adjustment: • Being killed in a car accident • Asteroid impact • • • • Being struck by lightning Drowning in a bathtub Electrocution Assault by a firearm See: http://www.squidoo.com/ oddsdying If chiropractors are to be required to communicate to patients that a cervical adjustment may cause a stroke, then physicians, dentists, podiatrists, optometrists, beauticians, barbers and plumbers should be compelled to disclose to their clients that visiting them may be followed by a stroke, car accident, electrocution, a lightning strike, or asteroid impact. Despite this, attorneys continue to file stroke-related lawsuits against chiropractors, and muckrakers masquerading as journalists stir the emotions of the populace. It is time to replace yellow journalism with scientific investigation. Chiropractors should respond swiftly and vigorously to these allegations. References 1. Keating JC Jr: “Toward a Philosophy of the Science of Chiropractic.” Stockton Foundation for Chiropractic Research, 1992. Page 189. 2. Lee K: “Neurologic complications following chiropractic manipulation: a survey of California neurologists.” Neurology 1995;45:1213. 3. Myler L: Letter to the editor. JMPT 1996;19:357. 4. Dabbs V, Lauretti WJ: “A risk assessment of cervical manipulation vs. NSAIDS for the treatment of neck pain.” JMPT 1995;18:530. 5. Jaskoviac P: “Complications arising from manipulation of the cervical spine.” JMPT 1980;3:213. 6. Cassidy JD, Boyle E, Cote P, et al: of Vertebrobasilar Stroke and Chiropractic Care. Spine 2008;33(45):S176-S183. 7. Chiropractors don’t raise stroke risk, study says” http://www.theglobeandmail.com/life/article16388.ece 8. Kilo CM, Larson EB: Exploring the Harmful Effects or Health Care. JAMA 2009;302(1):89. 9. Leape L: “Error in medicine.” JAMA 1994;272(23):1851. 10.Mildenberger VD, Kaltenbach M: “Lifethreatening complications of ergometry.” Fortschr Med 1989;107(27):569. 11.Jansson K, Fransson SG: “Mortality related to coronary angiography.” Clin Radiol 1996;51(12):85 8. ––––––– Dr. Christopher Kent is president of the Foundation for Vertebral Subluxation, co-founder of the Chiropractic Leadership Alliance (CLA), and owner of On Purpose (http://www.chiroonpurpose.com). Dr. Kent was named the ICA “Chiropractic Researcher of the Year” in 1991 and selected ICA “Chiropractor of the Year” in 1998. He received Life University’s first Lifetime Achievement Award in 2007. He is former chair of the United Nations NGO Health Committee, the first chiropractor elected to that office. On December 21, 2011 the patient received his first Cox Decompression Adjustment of the cervical spine, Protocol 1, along with electrical muscle stimulation and ice packs at the cervicothoracic junction. The patient tolerated the procedure well. The patient had not been able to obtain a full night sleep for a week. In order to properly heal the patient must also be able to rest and sleep. He therefore was directed back to his medical physician to seek some assistance so he can sleep. His physician prescribed Tylenol with codeine on December 24, 2012, which allowed him the ability to get a few hours of rest. On this day I also changed the physiotherapy modalities to trigger point ultrasound to the posterior cervical spine and trapezius muscles. On December 27, 2011 the patient had his fourth visit and related that he was beginning to feel better. The MRI report was received this day and I discussed its findings with the patient. Since the disc herniated at C6-C7 was so large, compromising the central spinal canal and right neuroforamen, I referred the patient for a neurosurgical consult. The patient was adamant that he did not want surgery, and I informed him that this was a prudent decision in the event conservative care was unsuccessful. By January 3, 2012 the patient described that he primarily had an ache under his right shoulderblade and slight numbness at the tips of his right thumb, index finger and middle finger of his right hand. He was now being adjusted using protocol 2 for the cervical spine on the Cox 7 Table head piece. On January 9, 2012 the numbness in the fingertips of his right hand was easing up, he primarily felt a “deep pain” into his right elbow. On January 18, 2012 I performed a re-examination, which revealed that the LT/RT Shoulder Depressor Tests and LT Maximal Cervical Compresion Tests were now negative. The RT Maximal Cervical Compression Test was positive for cervicothoracic junction pain. The Seated Dorsolumbar Circumduction Test was essentially negative bilaterally. Using a goniometer the cervical ranges of motion were: Anterior bending: 50 degrees. Posterior bending: 45 degrees. Left lateral bending: 35 degrees. Right lateral bending: 30 degrees. Left rotation: 50 degrees. Right rotation: 50 degrees. The deep tendon reflexes of the Biceps, Triceps, Brachioradialis, and Patella were +2 bilaterally. The left Achilles was 0 the right Achilles was +2. Using a Whartenberg Pinwheel the right C7 and C8 dermatome levels were reduced, all other derersary nnivextremimatome levels of theth A upper ties were noted to be within normal limits. The patient also noted that his pain level was now a 4/10, describing that he felt 70% improved. The patient saw the neurosurgeon on January 20, 2012, who recommended surgical decompression of C6-C7. The patient related that 60 he declined this suggestion and he wanted to see if he would continue to improve without surgical intervention. The neurosurgeon then recommended that he return in six weeks for a follow-up visit. Over the course of the next six weeks I saw the patient 10 additional times with the patient making continued positive progress. On February 24, 2012 he had his last visit in my office with him stating that he primarily has a tight sensation in his neck, which is noticed primarily if he sits poorly. He has no pain in his upper extremity and “no numbness in his right hand to speak of.” I present this case to highlight that spinal decompression using the Cox 7 Table cervical spine headpiece may be an effective tool in dealing with a significant HNP. It is also important to note that while the chiropractic approach to care is non drug and non surgical, at times the appropriate use of pain medication is essential in order for the chiropractor to have the opportunity to care for the patient. This patient was in such extreme pain initially that he was not sleeping, which ultimately inhibited the healing process, and the patient’s ability to function. With the assistance of the patient’s primary care physician, a pain medication was prescribed allowing the patient the opportunity to sleep and undergo a non surgical decompression protocol, thereby avoiding surgery. Respectfully submitted, Joseph C. D’Angiolillo, D.C. 25 Legal Q & A Continued from page 21 the specific facts involved. Given the changing nature of laws, rules and regulations, there may be omissions or inaccuracies in information contained in these materials. Accordingly, the information you receive is provided with the understanding that the author and the A.N.J.C. are not herein engaged in rendering legal, accounting, tax, healthcare or other professional advice and services nor are they providing specific advice with regard to your practice, the treatment of any specific illness, disease, deformity or condition, or any other matter that affects trade, commerce, or legal rights of others. As such, this article should not be used as a substitute for consultation with professional accounting, tax, legal, healthcare, or other competent advisers. Before making any decision or taking any action, you should consult an appropriately trained professional. Millions of Patients 34 Peer-Reviewed Articles No other custom orthotic is engineered quite like a Stabilizing Orthotic. Introduced 60 years ago, the intelligent design stabilizes the three arches of the foot, providing a natural balance of flexibility and stability for the whole body, not just the foot. No wonder 81.8% of chiropractors in the U.S. said they prescribe orthotics for their patients.1 Stabilizing Orthotics improved balance (eyes open) and proprioception (eyes closed).3 Stabilizing Orthotics improved sporting performance such as driving the ball up to 15 yards farther.2 Stabilizing Orthotics increased hip and pelvic joint ranges of motion.4 NEW Stabilizing Orthotic PMS 361c PMS 298c Stabilizing Orthotics significantly decreased blood pressure and improved Heart Rate Variability.6 Clinical trial showed back pain relief by 44% and improved function by 38% in 6 weeks,5 when wearing Stabilizing Orthotics. take the Stabilizing Orthotics reduced knee injuries by 31%.7 800.553.4860 FREE Proprioceptive-friendly orthotics. Allows normal ranges of motion. Choose 3 patients. They will Supports all three arches of the foot. Unique 10.2% increase in O2 levels. have an improved quality of FootLevelers.com life within 6 weeks or your money back. FootLevelers.com/3patients References for the published peer-reviewed scientific research papers: 1. National Board of Chiropractic Examiners. 2005. 5. Cambron, JA. JMPT May 2011 (Vol. 34, Issue 4, Pages 254-260) 2. Stude DE. JMPT 23 (3) April 2000 6. Zhang, J. J of Chiropractic Medicine June 2007 6:2, 56-65 3. Stude DE. JMPT 1997; 20(9):590-601. 7. Jensen B. J Chiro Ed 2007; 21(1):109 4. Stude DE. JMPT 2001; 24(4):279-287 The World’s leading authority on individually designed Stabilizing Orthotics since 1952 ©2012 Foot Levelers, Inc. FLA-052012-ANJCSO.indd 1 3/29/12 3:22 PM 26 Fall 2012 www.anjc.info www.njchiropractors.com When It Comes to Over-Utilization, What Do Carriers Expect? By David Klein, CPC, CHC – ANJC Insurance Consultant P assive care, or care where the patient passively receives treatment, is something that all chiropractic offices provide to their patients. Electric muscle stimulation, ultrasound, manual therapy, and mechanical traction are examples of this type of care. It has become more common, however, that much of this type of treatment is being denied by third party payers as inclusive to another therapy or entirely denied as a non-covered service. This trend is beginning to frustrate and concern many providers all over the country. Why are they denying this type of care for patients? In many cases the CPT codes in question are not mutually exclusive or component codes and should be separately reimbursable. The most obvious answer is that the insurance companies are looking Welcome New Members! Dr. Michelangelo Anzalone Dr. Yola Barbosa Dr. Benita Battaglia Dr. Gene Boucher Dr. Lorrie Bove Dr. Neil Bressler Dr. Erin M. Budow Dr. Gerald Chavez Dr. Tisha A. Cozart Dr. Elaine M. Cram Dr. Kristin DeEugenio Dr. Anthony DiLiberto Dr. Peter E. Frechtling Dr. Michael Friedberg Dr. Frank Gazzillo Dr. Roman Gont Dr. Arrio Gont Dr. Greg Hedgepeth Dr. Maria Jinks Dr. Edward Kalinowski Dr. David Kirstein Dr. Leonid Kruglyak Dr. John Liaci Dr. Josephine Mahnken Dr. Lindsey Mansueto Dr. Ronald Martin Dr. James Matthews Dr. Kim Oman Dr. Vincent Pacilio Dr. Andrea Redondo Dr. Yongki Colin Ryu Dr. Craig Scarpelli Dr. Linda Schultz Dr. Joseph Scordo Dr. Lori Sinisgalli Dr. Albert Stabile Dr. Haja Taylor-Kamara Dr. Taryn Terry Dr. William H. Weimer The New Jersey Chiropractor is a bimonthly publication of the Association of New Jersey Chiropractors. To assist with the many challenges of everyday practice, it is filled with updates and extraordinary ideas from our profession’s best and brightest minds and serves as a leading information resource for the more than 3000 chiropractors located throughout the Garden State. We hope you enjoy ANJC’s latest effort to keep you updated and informed. The Association of New Jersey Chiropractors - The kind of association you’ve been aching for! ANJC Leadership ANJC Elected Officials • Dr. Joseph D’Angiolillo President • Dr. Michael Kirk Vice President • Dr. Jim Campbell 2nd Vice President Executive Director • Dr. Sigmund Miller ANJC Appointed Officials • Dr. Richard Healy Treasurer • Katherine Lusk Editorial Assistant Immediate Past President • Dr. Steven Clarke ANJC State Board Members Central Dr. Bob Blozen Dr. James Campbell Dr. Joseph D’Angilillo Dr. Kostantinos Linardakis (Alt.) South Dr. Barry Coniglio Dr. Michael Kirk Dr. Blaise Glodowski Dr. Brett Wartenberg (Alt.) Northwest Dr. Don DeFabio Dr. James Fedich Dr. James Santiago Dr. David Graber (Alt.) Northeast Dr. Steven Clarke Dr. Tom D’Elia Dr. Joseph Garolis Dr. Robert Haley (Alt.) Council Dr. Larry Marchese Dr. Alan Vargas Dr. Lenny Siskin (Alt.) Committee Chairs • Dr. Joe D’Angilillio Legal Advisory • Dr. Robert Blozen COCSA Rep • Dr. Richard Healy Medicare Consultant • Dr. Steven Clarke Legislative • Dr. John Cerf Hospital Protocol • Dr. Marc Jenkins Sports Council • Drs. Mark Spratford Joe Garolis Communications • Dr. Tom D’Elia Insurance • Dr. Barry Coniglio Rules and Regulations • Dr. Joseph Garolis NJ Board of Examiners • Dr. Steve Zodkoy Nutrition • Dr. Frank Zaccaria College Liason • Dr. Mark Magos Senior Advisory Advisors Consultants • Dr. Richard Healy Finance • Dr. Joseph D’Angiolillo Executive Committee • Dr. James Fedich HQ Committee • Dr. Mike Kirk PR Committee • Dr. Richard Fellows PAC Committee • Dr. John Hamada Work Comp Committee • Jon Bombardieri Lobbyist • Lyndette Contreni Insurance Consultant • Dave Klein, CPC, CHC Insurance Consultant • Chip Dutcher Regulation • Tom Cosentino PR Consultant • Dr. Mike Goione Insurance Consultant • Anthony Rosner, PhD Research Consultant for ways to cut costs and removing a benefit for a particular service from a specific health plan offered to its clients is an easy cost saving measure. While I believe that this is a significant contributing factor, there are most certainly other issues involved, the most likely being over-utilization. I have performed hundreds of audits over the last 20 years, and have found that over-utilization of services, especially when it comes to passive modalities, without supporting documentation, is one of the most common negative findings. So ask yourself, how often and when can I perform these services on my patient? How do I justify my care? Many payers stress that treatment consisting of passive care for extended periods of time is palliative and thought to foster chronicity. Generally, a transition to active care is expected within 1-4 weeks. Using Landmark’s medical policy as an example, providers can get a feeling for what payers may view as within normal guidelines, as follows: “Passive Care - Application of treatment/care modalities by the practitioner to a patient, who “passively” receives care. The patient receives treatment from the caregiver rather than actively participating in the treatment process (see active care).” The policies comments on Active Therapeutic Treatment: “Only medically necessary care that is active and therapeutic, with the expectation of symptom resolution and/or maximum therapeutic benefit within a reasonable period of time is eligible for acupuncture and chiropractic coverage. All other forms of care are considered palliative and/or are given to promote optimal function and are not considered medically necessary.” Aetna’s clinical policies get even more specific when it comes to services provided, for example: “Massage therapy is not considered medically necessary for prolonged periods and should be limited to the initial or acute phase of an injury or illness (i.e., an initial 2-week period).” And another example: “Ultrasound — Deep heat by high frequency sound waves to relieve pain, improve healing — constant attendance. This modality is considered medically necessary to treat arthritis, inflammation of periarticular structures, neuromas, and to soften adhesive scars. Standard treatment is 3-4 treatments per week for one month.” We’ve Made PRACTICING Chiropractic EASIER PROFILEDELUXE The Most Cost-Effective, All Inclusive, Chiropractic Paperless Office Solution on a Cloud Computing Platform Based on the above examples, providers can get a glimpse into what many insurance companies adopt as acceptable treatment parameters. If care consistently falls outside of these norms, then the provider should know that their profile could be affected. They must be sure to clearly document the rationale supporting the necessity of treatment or provide some sort of clinical research backing up treatment that falls outside the norms. Denials from third party payers may be a fact of life. However, there are a few ways to help limit the denials, and if they occur, help you to effectively appeal the denial: 1. Create an effective treatment plan and follow it; update as necessary. 2. Know the coding rules, and when to properly use modifiers. 3. Limit passive care for extended periods of time without proper justification. 4. Document everything and make sure to tell the story. 5. Make sure to show functional improvement and outcomes achieved. 6. When maximum improvement (MI) is reached discharge the patient or transition to wellness care. In summary, over-utilization of services is a common but easily avoidable problem. By following the above guidelines, chiropractors can effectively avoid over-utilization and limit costly denials. When providers have a better understanding of what insurance companies are looking for, they can begin to combat unnecessary denials and audits and still provide the care that their patients need. No Up Front Costs No Expensive Hardware Required ––––––– David Klein, CPC, CHC, ANJC insurance consultant is the co-founder of PayDC, a web-based fully integrated Electronic Health Records system that focuses on compliance and reimbursement. He is a certified professional coder through the American Academy of Professional Coders (AAPC), and is certified in healthcare compliance through the Health Care Compliance Board (HCCB). For more information visit www.paydc.com or email [email protected] paydc.com. No Support Fees One Low Monthly Fee Call Today for a FREE Online Demo ANJC Vision & Mission (732) 821-7776 • DDRProfile.com Vision: To position Doctors of Chiropractic as providers of first choice for New Jersey families to obtain optimal health and wellness, while improving the quality of their lives. Mission: To improve the health of patients, families and communities by promoting high standards of professionalism and patient care through chiropractic methods, education, advocacy and accountability. Practice Management Electronic Billing Office Notes Narrative Reports Document and Image Storage Automated Forms Chiropractic EHR DICOM Reader Outcome Assessment Research Based Reports Offsite Backup PROFILE DELUXE By Digital Data Resources, LLC Association of New Jersey Chiropractors 3121 Route 22 East, Suite 302 • Branchburg, New Jersey 08876 908.722.5678 • 908.722.5677 – fax www.anjc.info • [email protected] ANJC Board Meet – ANJC State Board of Directors at a monthly meeting working on full agenda, including strategies for 2012-13 Platform independent – Works with Mac, Windows, Linux, etc.