Welcome to the Chiropractic Assistant Section @ Chiro.Org! This section provides articles
about CA training, billing practices, office management,
practice and personal growth, and patient education.

This section was compiled by Frank M. Painter, D.C.
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Billing and Coding

What is Assignment of Benefits?
“Assignment of Benefits” is an arrangement between you and your Insurance Company, asking them to send your reimbursement check directly to your doctor. Learn more now.

Diagnosis Codes (ICD-10) Commonly Used in the Chiropractic Office
This is a cross-section of the ICD-9 Codes commonly used in chiropractic offices, listed by body region and complaint. These codes were compiled from the International Classification of Diseases
(ICD-9) 9th Revision by PMIC.

Medical Records Copying Fees, listed by State
This page (*scroll down a bit*) contains links to each State's Insurance departments, and advised you how much you may charge for record copy and transfer. Very handy!

Appealing Claims Denials
ACA News ~ March 2012 ~ FULL TEXT

Receiving denied claims can be frightening, and appealing them can seem overwhelming, but it’s important to take the time to do it. “Always appeal. Even the smallest amounts,” says Steven Conway, DC, DACBOH, Esq., a member of ACA’s Medicare Committee. “If we don’t, the insurance companies and Medicare contractors will assume that we agree with their decisions and we’ll never be able to move the profession forward.”

How To Use the Evaluation & Management (E&M) Codes Properly
Chiropractic Economics 2011 ~ FULL TEXT

Chiropractic Economics magazine published a three-part series by Kathy Mills-Chang, MCS-P, on the evaluation and management (E/M) documentation guidelines. In order to document your history, diagnosis, and treatment of patients in accord with rules set out by the Centers for Medicare and Medicaid Services (CMS) and the Office of Inspector General (OIG), your patient record should address: (1) Patient history, (2) Examination, and (3) Medical decision-making (MDM). These three components are addressed in the following three articles, which make reference to the sample worksheet also linked below:

   The 3 Key Components of the E/M Guidelines

   A Closer Look at E/M Guidelines

   Mastering the E/M Guidelines

   Sample Worksheet   (PDF)

Bulletproof Your Documentation
Chiropractic Economics

A recent survey of 80 chiropractors revealed that 72 percent of them collected paperwork for their clinic from various sources, creating a patchwork effect. Because very few utilized an actual system of paperwork, they admitted concern that some documentation could fall through the cracks. So, what paperwork should you have in your office?

The Differences Between ICD-9 and ICD-10 Coding   (PDF)
American Medical Association Fact Sheet #2 ~ FULL TEXT

This is the second fact sheet in a series and is focused on the differences between the ICD-9 and ICD-10 code sets. Collectively, the fact sheets will provide information, guidance, and checklists to assist you with understanding what you need to do to implement the ICD-10 code set. The ICD-10 code sets are not a simple update of the ICD-9 code set. The ICD-10 code sets have fundamental changes in structure and concepts that make them very different from ICD-9. Because of these differences, it is important to develop a preliminary understanding of the changes from ICD-9 to ICD-10.

Meeting Medicare’s Documentation Requirements
Dynamic Chiropractic

For a service to be reimbursable through Medicare, the documentation must show clinical necessity for the patient's care. There are several essential elements for required Medicare documentation, including demonstrating a subluxation and thoroughly documenting both the initial visit and each subsequent visit. Let's review that now..

    Letters For Improving Insurance Cooperation    

NOTE:   The following letters are provided as a service to health-care professionals.   You are welcome to use these letters in your office to communicate with Insurers.   However, they may not be sold, reproduced online, or in publications, or used in group or commercial ventures without the written permission of the copyright holder.

     Initial and Progress Insurance Letters   (Word format)     

First Insurance Letter
This is the letter we send when we open a Med-Pay claim with a newly injured person. You should review your State's Insurance laws to rephrase the paragraph about Insurance Law and Interest Charges for late payment.

Progress Insurance Letter
This is the letter we send following re-assessment of the patient.

     Initial and Progress Report Templates   (Word format)     

Initial Report Template
We advise Insurers in the first letter that we do not generate Initial or Progress Reports unless they are paid for in advance.   This is the template for the Initial Narrative Report.
You may also want to review the Initial Report Outline.

Progress Report Template
This is a template for the Progress Report.

     Other Useful Forms   (Word format)     

Records Request Slip
We advise Insurers in the first letter that we do not send copies of the patient file unless they are paid for in advance. This is the form we send.

Care Plans
Finally, along with the first letter we also send a Care Plan that most closely describes the patient's status and intended care. These 11 plans we developed by Robert Mootz, D.C. in his article "Chiropractic Care for Common Industrial Low Back Conditions". They are formatted so that you can print them onto your own letterhead.

Reduced Charges Agreement
In the case of financial hardship, you may have a patient who will not comply with your care plan because of the cumulative cost (and frequency) of the first month's care. In that case, during the report of findings, I use this form. I ask, "Knowing that we will need to see you between 9 or 12 times during the first month, (and already knowing how much I charge for each service), how much can you afford to pay for these visits, such that you will actually comply with the care plan?" Often people say "Oh, 45 per visit is fine". Then we document that and they sign the form.

    <--- End of Letters Section --->    

The Difference Between “Consultation” and “Counseling”
The definition of a “consultation” in coding refers to a “second opinion”. However, if you are billing for talking to your own patient, it is referred to as “counseling”.

Modalities vs. Therapies
Someone asked: “Is there a difference between the two terms (Modalities vs. Therapies)? Does it have to do with attended/non-attended? Do different insurance companies have different wording for them?”. Susan McClelland provides the answer.

Bulletproof Your Coding, Fees, and Documentation
Today's Chiropractic

The cause of low reimbursement doesn’t always lie with the payer, however. It may be the result of improper coding and documentation by the provider. By understanding how the coding process works, we can more easily develop our coding and fee schedule for our office to assure maximum reimbursement. Let’s address the three major points your office must be aware of in order to assure proper reimbursement.
You may also want to review our Documentation Section.

Better Documentation, Better Reimbursement
Today's Chiropractic

Though Shakespeare’s character Hamlet never asked, “To document or not to document?” this question should be answered in your office as soon as possible. And here are two reasons why: Can you say “medical necessity” and “over utilization”? Here’s another question to ask yourself, “Do you have a compliance program in your office?” Such words are the chosen language of the new millennium. If you haven’t started a compliance program in your office yet, now is the time. A program of self-monitoring and self-audit works to ensure that federal and state mandated issues are complied with in your office.

Insurance Assignment Program
It is our desire to assist our patients whenever possible. The following insurance assignment program allows you, our patient, to receive the care you need without undue financial strain.

Decoding Manual Therapy: Unraveling the New Rules for Reimbursement
Today's Chiropractic

In 1999 the CPT code 97140, Manual Therapy, replaced three codes: Joint Mobilization, 97260; Manual Traction, 97122; and Myofascial Release, 97250. Since that time chiropractors have been frustrated by continually having their claims denied for dates of service on which manual therapy was performed in conjunction with other procedures, including the chiropractic adjustment. As of April 1, 2002, a “bundling virus” in the National Correct Coding Initiative (NCCI) edits was corrected. Now chiropractors must be paid for neuromuscular reeducation (97112), massage (97124), and manual therapy (97140) when “performed on separate anatomic sites or at separate patient encounters on the same date of service as a chiropractic manipulative treatment (98940—98942).” This was perhaps the biggest reimbursement news of the entire year for chiropractors.


CA Training

Join the Chiropractic Assistants E-Mail List
This is a forum for Chiropractic Assistants to discuss professional issues, debate problems that arise, share experiences, ask questions and exchange ideas. All CA's are welcome to join, as are ALL others employed in the Chiropractic field. The website is ChiroAssistants

Introduction to a Rewarding Career
Chapter 1 from:   “The Chiropractic Assistant”

By Richard C. Schafer, D.C., FICC and the ACAPress

The terms chiropractic assistant (CA) and chiropractic paraprofessional are synonymous. A chiropractic assistant is a professional aid to the doctor of chiropractic under whose direct guidance and supervision performs various technical duties, office and business functions, and/or assists in the preparation, control, and care of patients. The term chiropractic assistant may refer to either an administrative assistant or a clinical assistant.

The Language of the Health-Care Professions
Chapter 7 from:   “The Chiropractic Assistant”

By Richard C. Schafer, D.C., FICC and the ACAPress

When more than one person is involved in any task, good communication is basic for success. Thus, a sound foundation in chiropractic terminology is an important functional skill to be possessed by any chiropractic assistant. It is a requisite to becoming an important asset to the office. If a CA’s duties include taking dictation of case histories, examination findings, or narrative reports, she must know how to record scientific terms in shorthand and know how to spell them accurately. A good medical dictionary will be an important reference. Even if dictation is not required, she still must know what the doctor means when certain terms are used. He will expect his assistants to have a fundamental grasp of commonly used medical terms, abbreviations, and acronyms. Do not enter this study lightly. On the other hand, do not let yourself be appalled by the formidable and specialized vocabulary used in health care. The learning of professional terms will not come overnight. It will extend the entire length of your career as new and unfamiliar words are confronted.

Introduction to the Duties of a Clinical Assistant
Chapter 13 from:   “The Chiropractic Assistant”

By Richard C. Schafer, D.C., FICC and the ACAPress

The scope of practice for doctors of chiropractic is determined locally be existing statutory enactment and judicial determination in the separate states. The same is true for chiropractic assistants: scope of duties and responsibilities are determined locally be existing statutory enactment and judicial determination. The procedures described here are general. They may or may not be applicable in a particular state at this time.

Training Manuals for Chiropractic Office Assistants
Review these textbooks written by Dr. Richard Schafer, the most published chiropractic author.

Office Procedural Manual   (PDF)
This 66 page Adobe Acrobat (236KB) file may take several minutes for it to load to your machine (unless you're on high-speed).

Introduction to Office Procedure
Thanks to Phil Mancuso, DC, who created the New Doctors section of Chiro.Org for the use of his excellent materials!

The Role of the Chiropractic Assistant
An assistant is someone who helps or assists another person. In this case, the chiropractic assistant assists the chiropractor in the two criteria for a successful office: patient management and office management.

Creating and Nurturing a Successful Chiropractic Assistant
Today's Chiropractic

You know you need a chiropractic assistant (CA), but how do you make that step and allow your office to make that transition? Will that position expand your practice or exasperate you? How do you train a successful CA and how do you keep them motivated once the novelty has worn off?

Check out Chiro.Org's FORMS section
Online forms are available, both paper and "interactive", for auto accidents, narrative reports created on the fly, X-Ray reports generated on the fly, examination forms, personal information, and insurance information forms.   This is a very useful section...Thanks Joe!

College Addresses,   Phone Numbers & E-mail addresses
Just in case you want to check out any of the school's CA programs.


Patient Education

Children in the Chiropractic Office
Human Relations in Health Care for Chiropractic Assistants

Any chiropractic practice adopting the philosophy of preventive therapy should emphasize the treatment of children, for childhood presents the golden age of prevention. Care during childhood can often foresee serious consequences of apparently slight abnormalities, thus offering the best time to take preventive measures.

What Are You Really Saying?
Today's Chiropractic

Actions may speak louder than words, but for the busy chiropractic office and the average patient, words may not be doing much at all. In an ideal world, a patient would seek out care, ask pertinent questions, provide all relevant information and leave feeling secure they had been heard, understood and, most importantly, treated well. Unfortunately for far too many patients—and their chiropractic caregivers—the world is far from ideal. To this end, numerous experts agree miscommunication generally arises either during the course of chiropractors’ lay lectures or discussion of case histories.

Explaining the Subluxation
Today's Chiropractic

Our models of the subluxation and goals of care have evolved as our understanding of the biomechanics and neurology of joints has expanded. The database available to the chiropractor today is much larger and more accurate scientifically than what was available to our profession’s pioneers when they originally formulated subluxation theories in the late 19th and early 20th centuries. In addition, recent chiropractic patient surveys reveal more clearly what benefits patients hope to gain by receiving chiropractic care. This information gives us new insights as to how to direct our explanations to best fulfill our patients’ needs.

Creating a Chiropractic-Based Patient Education System
Today's Chiropractic

Many chiropractors may ponder why bother to educate patients, but it is well known that a better-educated patient make better decisions about appropriate health care.

Honoring Your Patients by Teaching Them Life's Rules
Today's Chiropractic

One of the greatest temptations for a chiropractor is to make your patient’s health problem your problem. This is an especially common mistake among male chiropractors who see “fixing things” as a major source of self-worth. (This is why we don’t like to ask for directions—it makes us feel incompetent.) This internalizing predisposition only obscures opportunities to grow the patient’s understanding and appreciation of chiropractic.

The Mission: Educating Families about Chiropractic
Dynamic Chiropractic ~ May 1, 2000

As chiropractic assistants, we serve our doctors and clinics in two capacities: assisting in administrative procedures and policies that manage the "business" of the clinic; and educating our patients and others in our community about the benefits of chiropractic care.

Your Attitude Affects Your Health
It has long been a popular notion that "dis-ease" is something that happens to us, something outside our control. Disease is an outsider that invades our bodies, rendering us helpless to resist. Excellent health, the opposite of disease, is viewed as a blessing bestowed only on a select few. It is precisely this viewpoint that sometimes keeps us from experiencing the optimal level of health.

Computer Terminology
If you’re using a computer in your office, you can never know too much about its operation. For that reason, this article is devoted to information about computer networks.


Personal Growth

Who Do You Think You Are? Your Perception Creates Your Reality
While, arguably, some people experience a better all around educational experience, the bottom line is, YOU are ultimately responsible for your success or failure, both in business and in real life. It’s all about what YOU create. That’s why there is a discrepancy between being at the top of your class and your level of success /failure/mediocrity in the real world! Learn how personal growth books and affirmations can help you become the person you want to be!

Your Adversity Quotient
For a very long time it was believed that IQ (Intelligence Quota) was the primary determinant of success. It turns out IQ has virtually nothing to do with success in life. Then a few years ago Emotional Quotient (EQ) was thought to be a significant indicator of success – and yes, to some degree it is. But more recently, Paul Stoltz, PhD has used the research of Dr. Albert Bandura on Self-Efficacy to demonstrate that peoples’ AQ (Adversity Quotient) probably has a much more dramatic impact on their ability to succeed than anything else.


Practice Growth

Getting Known Within the Community
Chapter 8 from:   “Developing A Chiropractic Practice”

By Richard C. Schafer, D.C., FICC and the ACAPress

This chapter describes individual responsibilities and projects in patient and public relations. It also portrays some of the more important aspects of national public relations developed by organized chiropractic, along with implementation in various degrees at the state, district, community, and office levels. Initial efforts, sustaining efforts, and development efforts are explained.

Medical Marketing: Priorities for 2015
ACA Today ~ January 2015

Here are some medical doctor marketing priorities to firm up for 2015:

1.   Capitalize upon chiropractic successes.
2.   Optimize and grow core customer business.
3.   Generate great brand and market awareness.
4.   Develop a world-class experience for patients, and
5.   Create a high-performance culture.

Low-Cost Marketing Solutions
ACA Today ~ January 2014

James Lehman, DC, MBA, adjusts spines, but rubbing shoulders is how he really grew his chiropractic practice in Albuquerque, N.M.

“One strategy that really worked for me involved volunteerism,” says Dr. Lehman, who later left his New Mexico practice to become associate professor of clinical sciences at the University of Bridgeport College of Chiropractic. “I volunteered to work with young politicians running for office. I’d make phone calls, hand out brochures. I developed friendships with a lot of decision-makers, some of whom got elected. Those young politicians, even if they lose, they’ll never forget you.” And being involved in political campaigns allowed Dr. Lehman to introduce himself to thousands of people he would never have met otherwise — each one a potential new client.

Growth Strategies for the New Year
Dynamic Chiropractic ~ January 1, 2013

Building a successful chiropractic practice can be a competitive business. You must continually advance your practice by attracting new patients, maintaining the ones you already have and incorporating new technologies and techniques. This is something you must do continually or your practice will stagnate rather than expand. Here are a few simple strategies to advance your practice in the new year and beyond.

Help Referral Sources Find You
Tailor Your Web Site to Medical Visitors

ACA News

Just as media and the Internet have evolved, our relationships with medical physicians have also progressed. Utilizing the Web site to help inform your local medical community about your services gives you another outlet of communication to continue to foster this positive, forward motion of MD/DC relationships. Providing information that helps overcome some common misperceptions about chiropractic will help non-chiropractic providers understand how you address patient care. Here are some highlights to consider including on your Web site:

Market Your Practice Through Collaborative Public Health Lectures
ACA News

Public health lectures offer chiropractors exposure to potential patients while improving wellness in the local community and providing an informative message about chiropractic services. As small business owners or associates, we must continually strive to attract new patients, and public speaking plays a prominent and cost-effective role in these efforts. By collaborating with other health professionals and local businesses to hold public health talks, you can also expand your prospective audience and further limit the costs and planning associated with public lectures by sharing the responsibility for material, marketing and hosting.

The ABCs of Inter-Professional Marketing – Learn to Identify
Medical Physician’s Needs and Objections
to Working with Chiropractors

ACA News

Chiropractic marketing to medical physicians has traditionally focused on campaigns dedicated to letters of introduction. These campaigns have had consistently lackluster results for most chiropractors. It’s understandable that some doctors of chiropractic feel certain trepidation when considering personally approaching a medical physician, but they shouldn’t. Surveys illustrate that medical physicians want to learn more about chiropractic care and that they prefer personalized presentations focused on scientific literature. [1]

Inside-Out Marketing ~ Nine Keys To Keeping Your Patient Calendar Full
Today's Chiropractic

If you have the desire to help more people, here are nine keys to consider in taking a long-term, inside-out approach to solving problems that can thwart new patient referrals.

Nine Common Business Mistakes
Today's Chiropractic

From a strictly business point of view, there are nine common marketing mistakes made by chiropractors that prevent the chiropractic profession from moving beyond a market percentage of 6 percent. The intention of this article is to bring these mistakes to light so that more chiropractors and chiropractic itself may move beyond survival by obtaining an appropriate percentage of the health care marketplace.

Health Professional: Practice-Building Tip

Please keep in mind a fact of life: "Doctors need patients. Patients do not need you as their doctor. You can be easily replaced." The key (yp practice building) is simply this. You are in health care. Thus, you are concerned with correcting health problems, maintenance, prevention, and monitoring a patient's health status according to your scope of practice. To accomplish this, a simple act is necessary. That is, every patient that leaves your office departs with an appointment card for a specific future date and time --be it a week, a month, or several months in the future. Assure that every patient is convinced that you care about them, that they occupy a special place in your thoughts.

Cultivating Relationships with Medical Doctors
Today's Chiropractic

Notorious bank robber Willie Sutton was once asked, "Why do you rob banks?"   "Because that’s where the money is," he replied.   So where should we be looking for patients? Let’s take a tip from Willie Sutton: Seek them from medical doctors, because that’s where the patients are.

Niche Marketing for Chiropractors
Today's Chiropractic

Finding a niche sometimes just happens. For example, when I was in practice, I also was active in racing cars on road courses. Since I knew the physical stress a race car driver and even members of his pit crew undergo when participating in that sport, it was natural to offer my services to that market. I wanted to make it easy for the people in my niche to get familiar with my chiropractic services. One of the things I did was to bring a portable adjusting table to the races. I also had a sign in my pits which stated, “Free chiropractic consultation to race car drivers.” The drivers visited between races, bringing along members of their crew, which was usually comprised of family members. The driver’s crew watched while I administered palliative treatments to the driver.

Four Essential and Inexpensive Ways to Build Your Practice
Dynamic Chiropractic ~ April 10, 2006

Some of the most successful practices I have ever been privileged to work for or visit use these four simple tools to build their practices, and they do it without the use of any outside advertising.

Building a Winning Chiropractic Team
Today's Chiropractic

The most successful people surround themselves with incredible teams. Yet so many chiropractors have a distorted attitude about their staffs. Some doctors hold onto ineffective team members because they shudder at the thought of hiring and training someone new. So, begin by retooling your attitude about your team. Value and esteem your team members for the right reasons: Not out of fear, but out of mutual respect about the incredible difference that they make in your practice.

Creating a Family-Based Practice
Today's Chiropractic

If there’s one thing chiropractors have in common, it’s their search for the secret of how to attract and retain a larger share of patients in their communities. Reaching and attaining your percentage of that market can seem like a complex number game, but there is one simple and effective way it can be done, and it starts with a family focus. Can you imagine the impact it would have on your practice enrollment if instead of marketing your services to singular patients and their individual health problems, you began to focus your efforts on educating and enlisting entire families into a chiropractic wellness model that mirrors your own lifestyle?

Public Relations on a Shoestring Budget
Today's Chiropractic

The shoestring budget—most entrepreneurs know it all too well. But even if you don’t have much to spend, take heart: There’s no rule of thumb on how much capital you should allocate to your public relations efforts. Besides, you can more than make up for a shortage of cash by promoting yourself creatively. If you’re looking for some advice, here are a few guidelines that should help you determine where to spend your PR money and energy.

What People Value When Choosing a DoctorChiropractic Economics A recent poll of 2,267 adults, surveyed by Harris Interactive® for The Wall Street Journal, revealed that interpersonal skills were of greatest importance to patients. It’s no surprise that patients changed doctors due to failures in this regard. Fourteen percent changed because they didn’t feel their doctors listened to them carefully, 12 percent felt as though their doctors didn’t spend enough time with them, and 11 percent felt they weren’t treated with respect. Read the results of the survey now!

Getting Known in Your Community
One way to become better known in your community is through contact with local businesses and factories. Place a telephone call to a local shop or factory, asking for the personnel department. Inquire as to the name of the personnel director or plant secretary. Send a letter to the shop in care of this person (see sample below).

Using Contests to Involve Kids with Chiropractic
Holidays such as Mother’s Day, Christmas, Easter, 4th of July and Thanksgiving are a great time for contests that motivate children and get them into the office. In fact, it’s not necessary to build a contest around a holiday — you could structure the contest around some aspect of chiropractic care.

Doctors - Help Your C.A.s!
A few months ago we ran an article about the pet peeves of doctors, issues that have been brought to our attention over the past few years of seminar speaking. Now it’s time to turn the tables — and air the pet peeves of C.A.s. We’re putting it in writing because C.A.s don’t always feel that they can confront the doctor directly. Obviously, that would be the ideal situation. But since that can’t always happen, we’ll play the surrogate role and do it for you. Here are some of the pet peeves as they’ve been discussed with us.


Practice Management

Can Doctors Delegate Care to Unlicensed Assistants?
ChiroCode Institute

Therapeutic procedure codes 97110 – 97546 are defined in the Physical Medicine & Rehabilitation section of CPT to include: "Physician or therapist required to have direct (one-on-one) patient contact" [during the reported procedure]. Some have argued that the codes permit a doctor to bill for this code by an unlicensed therapist since CPT’s definition does not say "licensed" therapist. But that argument is found to be invalid by contacting CPT for clarification, where CPT reports that the term therapist is referring to anyone who is licensed to perform the service.

Expand Your Capacity, Expand Your Practice?
Today's Chiropractic

Expand your capacity for service, for commitment to chiropractic, for establishing clear priorities, for leadership, and for living, and you will expand your practice. The ability to do this starts with your vision for your future and your desire to make a difference in the lives of your patients, in your community, and in the world.

Mobile Computing: Charting With PDA Technology
Today's Chiropractic

In the early 1990s, I sat in front of my office computer, a 286 Hewlett Packard Vectra desktop model with a 10-gigabyte hard drive. The salesman assured us we would never need anything bigger or better. The salesman told me many other things, but I had no idea what he was talking about. I felt like I had been parachute-dropped into a foreign country, where the citizens spoke pure techno-babble. It was then that I decided that I had to be technically informed about computers or else I would be at the total mercy of salespeople.

Thanks to Marilyn Gard and Ces Soyring for the use of her files!


Suggested Links

Join the Chiropractic Assistants E-Mail List
This is a forum for Chiropractic Assistants to discuss professional issues, debate problems that arise, share experiences, ask questions and exchange ideas. All CA's are welcome to join, as are ALL others employed in the Chiropractic field. The website is ChiroAssistants

Join our Chiropractic Assistants FaceBook Page
This growing online community is a place to share your experiences, ask your questions, or look for new jobs or employees for your practice.

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