Empowering Women in Chiropractic – Managing Moro Across all Ages & Stages – Monika Buerger

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Hello, happy Thursday. This is the third Thursday of January. Welcome to the amazing ChiroSecure, uh, platform. Big use of ChiroSecure again for giving us this opportunity to bring you, um, the Look to the Children’s show. So under house, Dr. Monika Buerger, hopefully you’re all doing fantastic. This, um, great, uh, third Thursday of January, 2121. So today I want to hang out a little bit. I’m getting a lot of questions and emails and blasts on social media and et cetera about what can we do for our little fiddle farts that are so stressed out these days. We are, um, we are in a time where not only the kiddos are stressed out with the adults are stressed out. So today I want to talk about how some things that we might see manifesting in our patient population group. And one of those is primitive reflexes.

So we throw this term around a lot, but one thing to keep in mind is this isn’t just for our little ones. This is really across all ages and all stages. And what I mean is, um, we’re going to see this happening in our adult population as well. And why is that so important? Why do you want to talk about that with on a peat based to show because our kiddos are going to feed off of their parents and the adults they’re around. So we have, um, adult stress ramped up anxiety, um, this unsettling, um, future that we’re trying to look at. So the kiddos are going to pick up on that and that’s especially true with during the prenatal period. So those pregnant mom was out there right now that are high stress. The, the, the, the, uh, the child will actually inherit mom’s stress patterns, mom’s stress resolve moms, um, the way she’s going to respond to her environmental stressors.

So I wanted to pick Moro reflex for, uh, this topic. Uh, the Moro I say is kind of the, uh, head honcho of the reflexes or the head honcho of actually of the sensory motor systems. And what I mean by this are primitive reflexes. Each primitive reflex kind of represents the maturation has part to do with the maturation, um, of our sensory motor systems and how we respond to sensory different sensory cues, sensory feelings, and the Morrow really represents maturation of all of our sensory systems. So the, the ability to respond in a good neuro, uh, integrity to all of our sensory environment, vestibular visual, tactile auditory, that moral reflex kind of runs the roost. So it’s a big kahuna. So when we’re in times of stress, when our resiliency goes down, those primitive reflexes can emerge. So a person, a child, a, the Mar reflects in particular integrates it should no longer be active.

So to speak after the age of about four months. However, if our overall, um, neuro adapted to their ability to handle stress is compromised because of infectious of traumas, whatever those re those reflexes, even if they were integrated, can reemerge. And this can be true with our adult population as well. It’s particularly true after, um, concussion, head trauma, et cetera. So, first lesson first take home. Pearl is we can use this information to assess all of our patients across all pages. And especially if you’re working a family practice paradigm, because if mom or dad are ramped up and stressed out, those kiddos are going to follow, um, and all stages of neural integrity. And what I mean by that is I’m going to show you different ways to assess the Moro reflex. Many of you are, um, first on the trust fall way, but I’m going to show you a couple of different ways, and I’m going to talk about different ways to integrate it depending on a person’s neuro functional capacity.

So let’s dive in and let’s have some fun. All right. So again, the more we flex sometimes has been in the past is referred to as the startle reflex, some will, um, there’s, there’s some controversy on that, um, on using it as the, the term, the startle reflex, it is a, it, the precursor to the Mar reflex, um, is called a fear paralysis reflex, and that develops in utero, and it should be integrated in uterus. We shouldn’t be born with it, but those two kind of go tandem together. And we work with them in the same manner, but again, the more reflects should disappear or integrate it at about four months of age. Um, if you see a little fiddle fart that six, eight, nine months a year old at a still very, um, start very easy, one telltale sign is when you try to go lay them down, they might be asleep and calm in the arms, but you’d go to lay them down.

And that head drops a little bit and they, they wake up and they start all, and then they’re inconsolable after that, they won’t go back to sleep. Um, they’re crying. They’re very much, um, dysregulated and disturbed. Okay. So that’s a telltale sign that that’s, that moral may be still too active. Um, if retained, this is very important. The moral tends to drive us in a more sympathetic dominant state, all the primitive reflex as well, right? Because they’re going to drive us back to that. The brainstem, that primitive part of the brain, these are brainstem reflexes. They don’t have cognitive control. It’s a reflux that makes me want to always break out into that song by the clash we flex. I won’t sing on this. So those would be that know me like the dummy in person I like to sing, but it doesn’t work out well, usually.

So anyway, um, so we, we shift, but the Morrow in particular leaves us in this fight or flight pattern. The Morrow is known as the first breath of life in the child. It’s responsible for that first breath of life in the child. When they’re born. I have seen clinically that, um, those little ones that are born, particularly with the cord around their neck or that, um, needed resuscitation afterward, or need oxygen or anything like that, having to deal with breathing that that Morrow tends to linger longer and tends to be more active throughout life. So just keep that in mind, if you’re looking at a history, um, areas that we want to look at from a spinal standpoint is looking at, um, uh, up regulate the parasympathetic nervous system. Since it will lead us into the sympathetic fight or flight shift, um, the respiratory diaphragm working the diaphragm, the rib cage can be huge because little, any individual that has this actively retained a Mar reflex might be breath holding a lot.

Um, they might not be expanding their red page. Um, well, and so we get some, uh, lack of oxygen, good oxygen flow concerns. This, um, also is very much tied with adrenal activity. When the adrenals tank out our immune system can be compromised. Um, we see things like allergies, eczema, asthma, um, and poor immune integrity associated with an active Mar reflex. So keep that in mind. Um, this can also really drive us into that limit, what I call limbic lock and load mode, and, uh, being held hostage by our amygdala, our fearmonger. So we can see anxieties and depressions and so forth associated with this constant Moro reflex, um, and very much, um, high, uh, muscle spasms, muscle spasticity, um, especially at the posterior muscles, the extensor muscles can be hypertonic and stress all the time, the posterior calf muscles. So these individuals, you might have them doing stretching routines as stretching routines, and you’re like, why can’t I get these muscles to relax?

They’re constantly stuck in that cortisol state because that morals fired up too much. So, um, Moro things like Annette, being able to unfold to not focus at one thing at a time, kind of that squirrel mode, okay. Poor impulse control, poor emotional maturity, um, easily distracted and that the poor impulse control and emotional maturity that comes because that prefrontal cortex is usually flipped off when we’re stuck in with these primitive reflexes. Um, so we’re stuck in that primitive part of our brain. So our executive functioning skills are not as great, um, aggressive, hypersensitive, anxious, startles, easy, a big one is having trouble paying visual attention to the center. They tend to pay attention to the periphery there everything’s distractive. So if we take this into the context of trying to sit and study or listen to in class, or as an adult, listen in a large lecture hall, we might be deferring our visual attention to the periphery all the time.

And, and so again, that squirrel attention. So we’re missing a lot of that information coming in. Um, they might crave sugar or caffeine, those stimulants to keep their adrenals driving because they’re, you know, burning out so much with their adrenals, um, things that, um, poor balance and coordination stamina we’ve talked, you know, brief some of this here already, um, blood sugar levels, blood sugar levels could be a big one because they’re constantly that sympathetic dominant shift. And, um, the adrenals are dysregulated, so they can, big times a blood sugar drops are between 10 30 and 1130 in the morning and three and four in the afternoon. So essentially after breakfast and lunch. So watch these individuals again, not just your kiddos, but your adults as well. Do we need to help supplement them with more blood sugar stabilizing snacks? Okay. Um, good proteins, good fats, et cetera.

They may be hypersensitive to light touch, sound, smell, or our sensory system, um, very troubled with adaptability. They want to make sure that they know what’s coming. They want to be the predictable situ in predictable situations. So, because they want to, they don’t change it. Routines is not a great thing because they want to know what’s going to feel like in the situation that they’re going to be presented in. So if they’re familiar, they know they’re going to be walking into their classroom and what that feels like, what it smells like, how loud it is and everything. But we switched that up and them and say open today, you’re going to go to Mrs. Jones class. Instead, they might come become unhinged because they’re always on guard and they don’t know what they’re going to feel like in Mrs. Jones is class. What’s going to fill out like to their brain.

Okay. Um, they can have trouble with hyperactive activity and fatigue. Um, because again, they’re being so drained. Tell me time is going to be a big, big milestone that we need. We need to look at with, um, helping to foster integration of the moral reflex tummy time. And then at about three months of age or so when they roll onto their side and they kind of kind of come together to midline, moral reflex is a core, it’s a core base centering reflex. Um, those of you that if you work on any energy or shock residents, a lot at solar Alexis area. Okay. So let’s go into some ways that we can evaluate the integrity of the Mar reflex. So let’s remember, I always say when I’m teaching, the more a reflex mimics an infantile response, that’s the it, the more active it is in that individual.

So in the, in the infant, we know that, um, they are going to inhale and everything extends. And then the exhale, like a, like a sigh of relief, the exhale, and come in into a flex position. So the Mo when you’re doing these testing patterns is T evaluations. You look for how much do they mimic that infant towel reflux? Okay. So it’s a good idea to get your hands on some little fiddle, farts, some newborns, and test that Mar reflex, you’re holding them. And basically you can drop them and you should see that inhale and then exhale. And they settle and come to come to inflection. The Murray flex was, has, um, been much associate with the vestibular system because of that change. It had movement. However, they’ve done some studies where they, um, basic what has basically shown that it’s very much associated with vestibular and proprioception, especially of the upper cervical spine.

Okay. So it’s an extension based stimulation that we’re looking for, that if it’s still active, we’re going to talk. We’re going to look at a few different ways to, uh, to look at this. One of them is actually in a supine position. You might not get these little fiddle farts that are, um, that have such an active Morrow to want to do the trust, fall maneuver, where they’re standing with feet together. I think I put a little video in here or a picture of that. Um, but that while they’re standing be preferably feet together, good posture. Cause we want to load up the system, especially at proprioception arms would be flexed elbow, slightly up the side, their head extended, and you ask them to fall back and you look, if they can, they do it with ease, do they hesitate? Um, do they, do they do this?

And then come back in. So the more amendments that mimics that infantile response, the more active it is in that individual that you’re evaluate. But I want you also to look at things like, do they flush? Do they have a sympathetic response? Do they get red? Do they get sweaty? Sometimes what I’ll do? Let’s say I’m doing the trust fall on a eight or 10 year old or an adult. Um, just make sure you can. You’re strong enough to match their body size. If you’re going to do the trust fall one. Okay. You can handle them if they, that dead weight comes back at you. Um, but my little fiddle parts I might say did that. And they, I see no action of their arms, no reaction. They just fall straight back. Okay. I will touch their PA. I’ll say, let me feel your hands. I want to feel that, are they breaking out into a sweat? Am I, am I picking up any sympathetic response? And I’ll also ask them, did that, um, how did that make you feel? Did that give you butterflies in your belly?

And some of them say, no, that was fun. Some might say you little, you know, and I’ll say little butterflies, medium, or a lotta meaning. Did that feel? Give them a feeling of being anxious. Okay. So you want to dig a little bit, um, you want to look for the overt signs, but you also want to did, like, is it maybe hanging out a little bit? Another thing you can do is you can walk into a room and you can either come from behind. If, if you feel it’s appropriate, if you know this person or, you know, they’re old enough, you think they can handle it, et cetera. And you can see if you can start a limb boot, um, or you can see, um, when you, some people say is, um, when you run up to somebody and meet them face to face, and if they’re equally to embrace you or they’re like freaking out, okay.

So those are some, some other subtle signs you might look for that is this moral hanging out a little bit, the older person or adult you might ask, how do you do somebody scares you? Or if you are, um, walking in front of the cards and we slammed slams or horn, do you like startle? And it’s hard for you to settle afterwards when Morrow integrates, it’s taken over by what this, what we call the stress reflex, where if I’m sitting here at a cafe, having a nice glass of wine with somebody in relaxing and conversing, and all of a sudden, I hear a loud crash behind me. I should appropriately take a breath in my shoulders. Go up. I turn, I look, I’m available, able to evaluate that I am safe. I’m okay. And I can come back and I can pretty quickly relax and calm down again with the adult, with the oldest child, do they startled?

And they have a hard time coming down and, and, um, self-regulating afterward. So those are some other things we want to look at if looking for an active Mark. So another way to test, we can do that the trust fall, but you can also have the person, the little fiddle part’s supine have, you know, a rolled up. You’re going to see on here, the rule that pillow under her shoulders. So you want the head about four or five inches off the table or the floor, depending where you’re at, put your hands underneath them. Their arms should be out to the side elbow, slightly bent with palms down legs extended and be fairly relaxed. And what you tell them is first of all, do it with the eyes open. Um, when I, as soon as I dropped your head, as soon as I let your head fall, I want you to cross your arms across your chest. First of all, make sure they can do this. Make sure they can, they know, understand the directions and they know how to do this. They can use both arms in a coordinated fashion

To do this. So

You simply hold their head. And at a given point, just drop it down and you see how fast they can react. Do they initially splay out like tomorrow and then come to midline appropriately? Do they hold their breath? Do they grimace? Do they flush? Are they sweaty? How active does that? Their motor pad, their response mimic an active model reflux. So this is another way we can do it. And then there’s also what we call the duck and pigeon walk. So what I’ll do is if I am not sure, or I see a very slight then thinking that’s kind of the slight active model, but I’m not sure I’ll put them in a duck and pigeon walk. And oftentimes you’ll pick it up here. And what that is is you have them stand. You have their elbows bent at a 90, 90 degree. As you see here, her thumbs are pointing inward and then her feet are pointing

Out

And you have them walk about 10 feet forward and 10 feet back up several times. And you see if they can keep that posture. The thing you’ll know is that they’re there, their thumbs or hands want to come out of that position. And, um, and then the pigeon walk, his feet are turned in toe to toe and thumbs are turned out and can again, can they keep that posture as they walk forward and backward? And so this sometimes will bring out that, um, that moral, that you’re not sure if it’s linear in there or not. So I do this on my older kiddos and my adults, if I’m not seeing, if I’m, if I do the trust fall, um, and or the supine, and nothing’s really sh I’m not sure. I’ll see if I can bring it out this way. So those are three ways we can evaluate the moral along with the things that we talked about, of, of, uh, history, questions, and presentation that might be indicating, um, an active Morrow.

And then look again at your history. Are they complaining of anxiety? Are they complaining of inattention, um, sleep issues, blood sugar dysregulation, look at those as well. So tie those into the picture. So how are some ways? So this is a pretty, um, standard exercise to help integrate Morrow. But again, we want to bring this across all ages and all stages. Not everybody can do this, right? So I’m going to hold your breath. Don’t hold your breath because it’s part of Morrow. Um, I’m going to show you some ways we can modify things to help those, those individuals, depending on their age and their functional integrity, how we can modify this. So I have this little one in, in a chair. You can do this either supine, or you can do it in a chair depending on their capability. And we, I call this the Venus fly trap.

It’s like that plant, right? That you drop something into and it eats it up. So I call it the Venus fly trap. I think some people call it the star flower. Okay. So you’re gonna see it called different things, but this little one’s in a chair everything’s extended. Okay. Palms facing outward. And then the first thing is they cross one leg. They cross the same arm on that side, and then they roll up. Now what I tell, because you also want that head to come into flexing and what their whole body to come in into flection. Okay. So what I tell them, as I tell them, um, cause you want the pump when they’re doing this, you want the Palm space in their face. So I tell them that pretend your hands are like butterflies. And that they’re always facing the butterflies are, are, are facing you.

Okay? And they’re flying right here because I want those palms open. And as a side note, sometimes you’ll see individuals that have an active, retained Morrow. They they’re fisted they’re there. They don’t relax their fists open. So palms open facing you. All right. Um, and then as they they’re going to cross and they’re going to roll and they’re going to kind of take the butterfly wing to their nose and then the unroll uncross. Okay. Um, and the reason I liked that I like having their eyes on their hands as well, because you’re now you’re getting some hand eye coordination built into this. Um, so it’s, it’s kind of killing multiple birds with multiple stones. So you have them do one side first and then unroll and uncross. And then the other side crosses over and they roll up. Now again, I start them out with these basic movements because that’s all they may be able to do.

And then I can add breathing with it. So as they extend the inhale as a flex, the exhale, and it’s great to do like a five count breath with that. So as a extend five count, inhale as a flex five-pack five count by point. Exhale. Okay. How many do you do on each side? It depends on the, on the person. Do they cook out? Do they get kooky brain after three? You don’t want to push the goat. So to speak on these because you don’t want to drive them into a sympathetic state where they don’t like doing these, especially with their kiddos, their excuse will be, Oh, this is dumb. This is stupid. This is too easy. When actually it’s really hard on our brain. So, um, you might be able to get three on each side for the first week and then they can do five and then they can do 10. You need to step them up as tolerable. Okay. Because who wants to feel cookie? Now I want to show you over. This will play okay. On the child that can’t do this. How can we start laying the foundation to help them do this?

Can you do this? Maybe your right leg comes over to your left. Okay. And then do you remember your right hand? CO’s over on top, but your left. Okay. And can you roll up into a ball or you can do a roll, everything up and the head comes up too. There we go. Awesome. Okay. Unroll and unfold unfold. And now the left side comes on. Talk. Is it like paper? Kind of, can you put the website on the top? The left hand on top. Okay. Remember it’s like, butterflies are looking at you. It’s like your hands are butterflies because you want always the palms to be facing the face. Okay. Okay. So that gives you just again, how do we modify these things? Right? How do we make it applicable? The other thing I call it’s called clamps again, Morrow is a centering. It’s a core reflex.

So I use, um, hold on. If you’re out there. Okay. I’m going to show you actually with little babies to how to do this. Okay. We’re going to modify it for the little, little, little, little ones. Okay. But clams are, um, I use either, you’re going to see two different versions here. You’re going to see me using a deflated plated physio ball. And you’re going to see me using a beanbag chair B back because we want to mimic, we want to get an action that they can carry out that gets them into that center. All right. So this is kind of fun. The boys, especially like it. Um, so I’m going to show you. Okay. Ready, buddy. Okay. Everything comes up and squeezes it. Here we go.

Beautiful. Beautiful. Ready to go again? I think I have it ready. Okay. So you want their arms and their legs to kind of come up, see how the end phases here has legs. There’s those bits spread apart. You want them that kind of squeezing that whole, the upper and lower extremities. And then you’ll see this guy. Awesome job three, because especially this, the second one that I showed you, that little guy would, can not figure out right. Left more reflex. It’s going to be, uh, uh, uh, right left body, right. Left brain, upper lower body, upper lower brain brainstem to frontal lobe. Okay. So they can’t figure a lot of this. These kids can’t figure this stuff out, so we’re helping them and we’re playing a game at the same time and they love it. Um, so how do we modify this with the baby? Okay.

Okay. So with the infant, with a positive Mara, we can do the same type of things that we did with the older child. We’ll just modify it. So we saw that video clip where we had the little toddler and we had mom had him sitting in at her lap and we put the ball and we call it the clam. So what we can do with the little ones is get the small step in and we’ll okay. We have our quality

And we just use that boom. And we just modify ends up squeeze. Okay. And then maybe get her attention and then, and roll up and squeeze. Okay. So we’ll do that three to five times, and then we can do a model

Venus flytrap as well, where just like you saw in the video with the older child where we’ll just

Do the, um, maneuvers for them

And then roll them up and roll and I’m cross. And you can have the parents do at home again, three to five times on each side with the little ones it’s really easy to do for just one person, because they are so small, so modifications depending on functional capacity, age and size. So there’s some tips for the Morrow, with the iPad.

Jeez, gotta love that hair in that video. Hi, wild hair day there. Um, now what I want to say is, um, you saw me do the clams with that older child. The other way I’ve had them like, like a three-year-old where I’ve had them, where sit in mom’s lap and they’re facing out. And we just use a big step down, a big Teddy bear when they’re step animals or a big physio ball or whatever. Okay. And you just kinda put it into their core. And mom, um, mom would help them maybe squeeze with the arms and dad or me depending where they’re at would help him curl up with their legs. So they’re the comfort of mom’s lap. The object is coming out to their core and they help them squeeze. And what I found, especially with my autistic kiddos is they end up really liking this.

And sometimes they’ll end up dragging that step down and what’s mom or dad, or the physio ball. And, and they want this done because with some of them, it’s very calming actually. Um, I’ll give you one more thing. The other thing you can do with the older individual is you can have them in this position. So again, they, the unused arm is out the side, Palm up, you have the arm and the leg at a 90 90 position. You want them in a 90, 90 position. And you’re simply again, in, in the picture here on the left, I’m pushing into their core and they need to resist me. You’re not using more than 20, 25% of your body strength. Okay? You don’t want them overpowering you. And a lot of the kiddos will try to overpower you because it’s harder for them to do more of an isometric push.

So you’re pushing, you’re, you’re re having them resist as you’re pushing in. And then on the other picture, you see I’m Abby, I’m pushing out a wave from their core, and they’re supposed to try to maintain that position. So not easy to do. Um, and so what I do is I’ve done some cheat sheets for y’all. I, what they like to do is like this little dude, how he likes to rest his he’s resting his hand on his head. They like to cheat. Okay. When we’re in the sympathetic dominant shift, it really shuts up our prefrontal cortex and motor control and motor strength is off. So I I’ve used these little plates where they have to try to entice them to keep that position. I’ll show you this real quick. Right.

Keep that one bent. So we bounce a little bit like this there and bounce that place. Okay. That goes, this goes

Up. Okay. Bounce that plate. Okay. Right. Push in. Where do you push outward? So don’t let those plates drop. Oh, you’ve got to keep up. Awesome. Okay. So that gives the older kiddo a challenge. I’ve also used slink from, for the little kids slink from toy story. It was a perfect stuffed animal to, to rest on their leg. And then I said, don’t let slink flaw fall. Okay. So these are just ways again, to have some fun modify things, to get where you want to get with the little kiddos. And so again, you start with the easy stages and work your way up to harder, do harder maneuvers. So I think we had a pretty good fun time for you enjoyed this. Um, please reach out to me if you have any questions, this is going to be a big one right now because people are in, um, again, second a spider flight mode.

And, um, we want to help to be able to, uh, pull out all the red stops in addition to adjusting them, getting lifestyle management, diet regulation, blood sugar regulation. Um, look at that more reflects in a little bit can go a long way. So again, thank you again, ChiroSecure. You’ve been amazing for the chiropractic profession. Um, what would we do without you? Thank you for letting me share this information and be sure to check in on the first Tuesday in February with the amazing Erik Kowalke and his amazing information. And I’ll be back the third Thursday of February until then keep changing lives, keep changing the future.

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Empowering Women in Chiropractic – Playing the Compliant Discounting Game

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.

As we jump into those slides together, uh, we’re going to be able to see what we’re going to be working on. It’s your vet from games, university. So glad to see you. And as I stated, we’re going to be playing around with the complaint discounting game today. Sometimes it’s a little bit difficult to know exactly what you’re going to do, and we’re going to get started with those slides so that we can get moving quickly. As you know, I try to keep it power packed and moving fast as we go. So as we start the slides now, uh, we’re going to be able to move along and get those things underway. Are you ready? Welcome to 2021. So today, while we’re talking, we’re going to discover how we can do legal discounting options. So many times here at KMC university is I’m bringing in clients who are coaching my own clients or just doing consultations.

Overall. We noticed a lot of issues in the way that people are discounting, even with some of their compliant coupon offers that they think they have, just because someone told you to do it and they’re getting by with it down the street doesn’t necessarily make it okay. We always need to verify those things, make sure that they dot all the I’s cross all the T’s as far as any federal regulations, any type of other things may be going. So always want to make sure we have that in place. We’re going to also recognize where you may have some inconsistencies in your patient fee schedules learn how to properly implement some hardship agreements in your office and men. It may be appropriate to use something more like a professional courtesy policy. So again, these are the things that we’ll be covering today. Um, as we move into the rest of our slides and I do walk them, you, I do appreciate Carver secure giving me these opportunities to speak to you and coming to you again from KMC university.

So as we talk about this one person said, very famous person said, your fee is your fee is your fee. And you know, with real estate it’s location, location, location, but when it comes to having compliant fee systems in your office, it is your fee is your fee is your fee. And we want to always make sure that we’re abiding by those rules dotting our I’s again, crossing those T’s just so we can be compliant rest at night. Don’t worry about the fee police to come get you and say, Oh, that’s wrong. And we’ll figure out who some of those players may be. And then we need to figure out where are the discounts coming from? So we’ll have some that are imposed that are like some of our regulated contracted. And then we may have some of those that are a little bit more elective in nature.

And we’ll talk about those. So we’ll get a clear understanding about that as we go along today. So as we continue to move forward, I’ve kind of wanted to start with some of the dangers and pitfalls that you could fall into. If your fees are not compliant in your clinic. So oftentimes we’ll see inducement violations. We’re not necessarily doing it to induce some may be, but we’re not necessarily doing some of our practices to induce, but it’s what necessarily our intention was. It’s what the perception is by those governing entities. Many times, anytime we have an issue in our fees or any other area with our billing, it’s no balls into the next area of false claims act. Nobody can afford these things. Number one, you don’t want to have recoupments number two, you don’t want to have any issues with, um, what you’re going to be noticing.

Um, when you’re sending over to a pair and they’re saying that’s inappropriate, or we’re going to find out somebody else who’s playing some really dirty tricks lately. Um, as we go along and then the anti-kickback violations, we need to make sure these are not being identified with our office. And we’re going to learn how to safeguard that as we go along. So Medicare vocabulary goes inducement and remuneration. So when we’re talking about that inducement, that’s influencing someone to come in and, uh, maybe giving away something for free. That’s, uh, maybe higher than the value that’s allowed or we’re giving away discounts through our waiving of copays deductibles and things like that. You may not give any item or service away that exceeds $15 or $75 aggregate, um, to a Medicare patient. This really falls over into federally funded patients. And what happens is when it falls over here, generally, you’re finding a lot of the payers piggybacking on this and saying, Hey, you know, we can’t do this for, uh, for our patients either, or our patients.

You need to have fraud, waste and abuse in place because you’re dealing with us. Everybody’s moving to this model. But right now we know that there are penalties imposed from federal entities when we do inducements and the remunerations waiving copays and things like that. So it’s in the regulation. We have the, the patient solicitation, anti inducement provisions. You can see it here on the screen, someone who’s offering or transferring to a Medicare and Medicaid beneficiary, any remuneration that the person knows should or would likely influence their decision to come in. This is applicable to Medicare and Medicaid. We know that VA, uh, moves over into that and we have some other programs and you’re talking about the affordable care act. And some of those things, you gotta be very, very careful. And why said you can’t afford it? Look at the bottom sentence. It says up to a $10,000 penalty for each wrong for act.

Oh, all right, well, let’s get it stopped. Now. We can’t afford to be over here in playing in the non-compliant game. You know, where it’s like playing Stratego, we’re playing chess. We got to move our pieces just right. We can still get to the other side and win what we want to win, but we avoid being captured and avoid the bomb when you’re playing Stratego. And we just want to make sure that we’re matching the right places together. And we’re still moving towards our goal of being profitable, getting our patients in the door and not scaring them off. So as we go ahead and move to our next slide, we’re going to talk about again a little bit more about that remuneration. We’re going to waive your copay. I had a local dentist, um, asked me several years ago when I was working in the local clinic.

He said, what my office thought we’ll do is we’ll have a doctor or even our staff members get treated. We’ll submit it to their insurance, just to help them meet the deductible. And I’m asking you to do that for me. I know you do a write off for doctors and, but I want you to submit it because I know you’re going to write it off. And, um, I want that way. It’ll help me meet my deductible. It’s not going to hurt you guys. I’ll still pay the bill. Uh, he did not like my fight back. I said, I can’t do that. I can not waive your deductible or copay. I don’t have any financial, uh, hardship in place or anything saying that this is okay for you. And he got a little Tifft. He said, I do it at my office. I can’t help what you do at your office.

We can see it’s usually way well laid out, especially in our federal programs, but we can also find it in our commercial programs. So always be sure that you’re just, again, dotting I’s and crossing T’s that we’re playing our chess pieces or our Stratego pieces. Right? And we’re being a little bit more intuitive where those bombs may be laying there waiting to capture us. So we’ve got to be so careful. We had a poor guy, all the one chiropractic. He was in Iowa. And this is out. We’re not, this is not something we’re displaying of one of our clients. This was something published. You can go find it on the department of justice website. Yourself probably could do it through the Google search of any type of search engine would bring this up. But while he was doing, he’s like, Oh, my poor Medicare patients.

They can’t afford a STEM. I hear this all the time. I’m not joking. I am not kidding you one bit. I hear it constantly. Well, they can’t afford it. Medicare doesn’t cover it anyways. Why does it matter? All I have to do is pull this up on the screen and say, this is why it matters. They feel, even though your intent was to help them out, they feel your intent was to influence them to come to your office because maybe Dr. So-and-so down the street is an offering that, but you’re sitting here going, yeah, Yvette, the doctor so-and-so down the street is offering that. I’ve never talked to them. I don’t know what’s going on there. And we can’t help if they’re doing it wrong, it doesn’t make their wrong BR right. So we’ve always got to be careful, but this poor guy in his innocence and just trying to be nice, ended up with the $79,919, uh, payback that he had to do.

And you can see there after the highlighting, it hit the anti-kickback statute. And the false claims act happened between. And look at that span of time, they looked at, they looked at a long span of time. You can pull it up and read a little bit more. But, uh, the thing is, is that you’ve just got to be so careful. And as you know, the old saying goes, don’t let your good be evil spoken of always make sure that if you’re going to do good, you can do the good or you find the legal way to do the good. And we’ll talk about that. So the biggest thing that this member rev represents is that we want to avoid dual fee schedules altogether. This is not something that you want to have in your clinic. And I’m going to just kind of hit the nail on the head here in a minute.

When I tell you why a with somebody you’re not expecting it to be somebody playing tricks, I told you earlier, they’re playing these crazy tricks on everybody, but we want to figure out what is the dual fee schedule, because it can misrepresent charges to a carrier. I had the pleasure to do an onsite back in October, we talked about it a couple of times, since I was here, they were just having the patients pay $55 here. I’ll take your credit card right here, $55. And they were billing the insurance company 150 I’m like, how did you know that was their co-insurance their copay? Oh, well, we just do it. Uh, we’re out of network. I just sat back. And I said, well, that will stop. It has to stop. Now we have to clean this up. And, uh, needless to say, they’re probably one of the top producers with one of the medical discount plans.

I’m going to talk about here in a little bit, because we got that straightened out for them. Again, false claim act violations. And then it may very well violate your provider agreements. Think about it. You know, we’ve got blue cross patient Lang here and blue cross representative behind him, PI patient here, PI representative behind them, cash, patient, ear cash, patient behind them. Everybody has the same thing. Everybody goes to the front desk together. You will bill your insurance. Two 50 we’ll bill you two 50 and that’ll just be 50 today. Same service don’t work it. And very well may violate your provider agreements, but keep watching here. It is the PAI complex. I cannot stress with you how much this is happening. We had one of our members call him the other day. What do we do? Oh Lord, what do we do? Well, we’re like, well, first may we do a consultation with you to see if we can get this worked out together, figure out what you did, figure out what needs to be cleaned up and what we need to stop.

And we looked at it and what had happened is they had Geico, give them a call and say, I don’t have insurance. I was just calling to figure out if you have a cash break for your patients. Oh yes. If you don’t have insurance, your visit will only be blocked. Next check. That’s what they send. And guess what? They reported them. They reported them for having a fee schedule that they were giving to cash patients that they weren’t giving to them. There was no legal reason. So everybody starts with the same fee. There was no justifiable legal reason on that next line for a deduction that said they should get something. There was nothing regulating it, nothing contracting it. They were just giving it because that’s the way they do their cash patients. Well, state, farm, and Geico doesn’t understand why that doesn’t pass along.

So we ended up having some pretty major issues. There got to clean it up, got to write some policy. Luckily we were able to work on it a little bit creatively with them. Uh, obviously some reeducation of the staff up front at the front desk and how they’ll answer the phone needs to take place. But overall, their feast systems need space systems needed to become compliant. So we talked a little bit about those impose discounts, the ones you can’t do anything about. You signed the dotted line, you get the dog and pony show that comes along with it. So those are the regulated, which is more like your Medicare, your worker’s comp, some personal injury, no fall and Medicaid. Can’t do anything about it. It is what it is now. Your workers’ comp and personal injury. Mainly your personal injury can differ from state to state.

Sometimes you can expect your full, uh, reimbursement of whatever your charge is. Other times you’re going to be part of some type of regulated or some type of contracted because you’ve got a silent PPO or maybe they’re pigging backing on some other type of pair. Then we have those contracted discounts, which are, I signed the dotted line because I want to be a provider with blue cross. I signed the dotted line because I want to be a provider with Aetna. This payer, that payer, these are those you can avoid. These are the conundrums you can get into, especially when you have those per diem payers that say I’ll pay you $65 a visit, no matter what you do. We have people all the time trying to circumvent that we’re like, Hmm, go back first, read your EOB. Did it tell you it can go to patient responsibility.

Now, go back and read your contract. Look at your medical review policies. Make sure that you know, what you’re doing is appropriate. This is why you can’t take your fees lightly in your clinic. They have to be every I dotted and every T crossed in order to be compliant and be most profitable. I think when you’re looking at impose discounts, one of the most profitable things you can do for your office is one take the services that you do and find out does that payer exclude them. Aetna has a very long list of CMT services. They consider experimental and investigational. Are you on that list? Does it even make sense to go in is everything you do on that list of experimental and investigational that’s one step. The next is if they won’t give you your fee schedule or a fee schedule prior to enrolling with them, ask a peer down the street, Hey, what does it look like for the fee schedule for this insurance company?

Know what it costs for you to be profitable in your clinic, and then gauge if you can go in before you sign the dotted line. Because remember once we signed the dotted line, we are now either regulated, contracted with an imposed discount. Can’t do anything about it. So you get out and with Medicare, we know you can’t get out how to give that commercial one more time. So that relationship with the payer and network, it really starts here. The doctor joins the payer, the patient pays the premium. They have an insurance card, you have this type of agreement. Everything comes back to the central hub of that payer and that network telling you what you can charge. That relationship is between the provider in the patient. But again, a lot of times we’re relying upon that and that requires the enrollment of the doctor and, and the enrollment of the patient into that plan.

So again, this is going to be part of your imposed, contracted, regulated, uh, type of discounting. That’ll go on. So we’ll skip over to the next part, which everybody’s probably wondering why are you taking so stinking long to get to this part about it? I need to know how I can do discounts. You told me what I can avoid. Now tell me what I can do, because now that you scare me to death, I need a way to deal with these patients that are cash, or maybe don’t have a great insurance plan. Maybe don’t want to use their insurance plan. Maybe have limited benefits. So let’s go there together. There really are. There really is one fee in your office that is if your spinal CMT for a nine, eight, nine, four, one is 55, then it’s 55. Then it’s 55 and it’s 55 next payer.

It’s 55. Everybody starts at the same level. Now the next line down. Why? Why is it not 55? Tell me why it’s not well, because it’s regulated. Okay, great. Well, because it’s contracted great. Well, because they’re a cash, they’re a cash patient. Okay. Can we talk about that cash patient for a moment? How large is that discount with discount by half, sometimes 75% wrong answer. We’ve got to make sure that’s within spec. Although the federal government has some rules that we believe are five to 15% on a time of service discount. Do you know that your state or your payers may have something to say, but again, we’ve got the actual fee next line down. Why shouldn’t they pay that fee? And we’ve always got to make sure we have checked with every entity that we’re doing that appropriately. So again, the discounts go imposed an elective.

We’re on the elective side. Now these are the ones that are at your discretion that you decide to implement in your clinic. As we move down, we’ll go the other direction. We can see that those are elective fees could be your five to 15% time of service savings, financial hardship, professional courtesy, or maybe your discount, medical plan participation, something like Cairo health USA to where they are set up in most States, I believe the only state is Washington, where they’re not in where you can offer your patients a compliant discount, go to bed at night and know you did it right? Setting up your own fees in your office. So even though it may fall in kind of that contract land, it’s your fees that you picked. We already know insurance. Isn’t going to pay you your full fee. You’re not going to chase your tail with this cash patient.

Why not give them a little bit of a discount? Uh, so they don’t have to pay you 565. Maybe they pay you 200. Plus the joining fee to Cairo health, which covers them and all their dependents for an entire year. It’s crazy. It’s like Costco or Sam’s, but these are the elective discounts that you can do, but you have to do them right again, dot the I’s and cross the T’s. So again, actual fees, discounted fees, or where are we going to focus our attention? And here are four possible fee structures that will help you pass the muster. When it comes to doing this compliantly one charge your actual fee. My fee is my fee is my fee. And if you’re cash, that’s my fee. That’s my fee. Absolutely. You charge it to the insurance company. They come back and say, write it off. You write it off.

Everybody going out the door gets charged the same. That is super compliant, no issues. Everybody pays your actual fee. You’re not discounting. You could charge a reasonable time of service of five to 15% for your federally funded patients. Always make sure to see if your state has a more strict role. Whichever is most strict rule, real rule and be the one that you’ll have to implement for your office. But when you find the state may be more lenient that may apply towards those outside those federal programs. So charge a reasonable time of service discount. Five, 15%. For me personally, I would not want to think about this as federal. You get 15, this is you. You get there. I would pull out my hair. I would either do five to 15 based on my bookkeeping savings and or do something like Kira health. Make it simple.

Don’t complicate it for your patients. We’re already in uncertain times with money and they don’t want somebody feeling like they’re jacking around with their money. They want to know this is what it is or this is what it is. You can pay our full fee. You can join this discount medical plan, and this is what your fee will be. Which one would you like? Let them make the choice, give them a choice. You could use a network-based legally discounted fee of choice ups, Kira health. And then you have those legal options with the hardship indigents policies for those patients who qualify. And I did say qualified. So these are the ones we’ll look at Cairo health, a little bit hardship, professional, and then billing for family members. I’m not going to cover a slide specifically on billing for family members. I just want to cover it verbally with you today.

Please know that with Medicare and many payers, they restrict you from billing, your immediate family members, and they do give you a list of what that is defined as they saved your mother, your father, brother, sister. And they go on. It’s a list probably if you’re looking at the page about that long, that tells you who you should not be billing to the payer. A lot of times we find family that I’m kind of tempted to help exhaust a deductible for their family members, or I’ll just send it in. I need a little extra cash family’s demanding to pay. Please look at these rules, please make sure you’re dotting your I’s and crossing your T’s. So the compliant time of service discount, it is based on viable bookkeeping savings. Pick one of them. What does it truly look at your overhead? What does it truly saving you to not have to send the claim, chase the claim, get authorization for the claim.

Go back and get authorization again, to see them for five more visits, chase your tail, wait, uh, appeal. Do all that. Send a statement. What are you really saving? Are you saving 5% great? Are you saving 15% great. Write a policy. There’s your time of service discount? It’s often, um, found that a lot of people are using something that’s not within those guardrails. And it’s unreasonable when we get up into 50% or, Oh, I just have a flat rate for cash patients. Can I ask you what you’re billing the insurance? Well, typically about $180. Okay. What is your flat rate for your cash patients? Oh, it’s 50. They just come in whenever. And the other one I hear that makes me want to scream is, Oh, well when they’re with their insurance, we just always use the nine, eight, nine four one. And when they’re cash, we just use the nine, eight, nine, four.

Oh, I’m like, Oh Lord, you can’t play with your codes. You can’t play with your fees to make it fit what you need. So you gotta find what you need and get it to fit what you have to have. So understanding again, that when we’re using these time of service discounts, there are guard rails, and they really should be because it’s a time of service be paid in full at the time of service, maybe lingering just a day or two after, but it’s got to have some parameters on it, not loosened it. So that relationship, when we talked about Cairo, health USA kind of works like this. I love them. By the way. Uh, before I came to KMC university, I said there were a couple of things I wouldn’t live without and practice. And that was Tusa Cairo health and KMC because they helped me to get to, you know, to the knowledge I have today.

They a part of how I got here. And when I joined Caro health, what I could do was now legally offered discounts. So at the office I served last, we were a specialty clinic. Uh, I know a lot of you say, Hey, all of us are specialty clinics and we truly are, but we did something that no one in a very large geographical region did here. We have pizza. People travel in from thousands of miles away. We have people that traveled in from States. We had about a five state surrounding area that came to this practice. And, uh, so we needed to make sure that we had some way to compliantly offer them a discount. So we looked at Kira health USA, and here’s in that specialty niche. Our typical first visit was $565. It’s just what it was. We knew when we bill blue cross and blue shield for those services, that would qualify that generally we could get back somewhere around three 70 when we build Aetna and we’re coming down closer on two 25 and we’re like, number one, we’re not chasing it.

We’re not having to get authorization. Um, that’s we want to just count more than 15%. What can we do? We went with Cairo health and how it ended up being that $565 visit came down to $200. All the patients had to pay that day was $249. They’d paid 49 to Cairo health. They paid 200 to us and they didn’t pay five 65. And they kept getting all the discounts that we made available through Cairo health. From that point forward through the rest of that year. So doctor joins, he sets his own fees of what he wants it to be. You can do discounting for multiple family members. You can set it up that, Hey, I want to cap these visits here. Or, Oh, I want them just to be this percentage off, or I want this service to be that don’t include that in my cap.

As you see, I’m telling you all kinds of things you can do. You can’t do that with Medicare. You can’t do it that with a payer where you can order it and have it your way. But with Kaiser health, in many ways, you can have it your way compliantly and your patient has an option. If they don’t want to pay 55 and they want to pay 35, then they join Cairo health. If they say no, then they really said, I’ll pay 55, no problem cash check or credit card, but the patient joins. And again, they, and all their dependents are covered. This relationship is about between that doctor and the patient. And we have compliant discounting. I cannot tell you and stress to you enough. This is a huge Savile. When you’re looking at discounting in your practice, the other one may be that professional courtesy.

Did you know that you actually need a policy when you are treating your staff members for free? Please don’t play that game. If I’m going to help them meet their deductible, please don’t do it please. You can’t waive the deductible. Their insurance is banking on you to collect that this is part of the plan they chose. But if you’re going to treat them in your immediate family members for free habit in your professional courtesy, um, what about others in the community? Maybe it’s all the first responders. Maybe it’s ministers. Maybe it’s all other doctors define that, put it into policy. But for the love of the Lord, don’t be like what that doctor asked me to do. He didn’t get me to budge, which was no. We offer this service for free. I cannot charge your insurance for something we offer for free to you, nor will I help you meet your deductible.

The only way I could have done this was told him you are going to forgo our professional courtesy. And when that bill comes in and it tells us what your deductible is, we will have to assess that charge to you. So keep in mind, this is one legal way. You just gotta make sure you’re dotting your I’s and crossing your T’s and no isn’t for all your friends. And the quick way, we’ll just do a bunch of professional courtesy. No, they’re still dotting of I’s and crossing of T’s that need to take place. What about hardship first visit, take their word. I can’t afford it. Okay. Well, we offer hardship for people who can’t afford service, and we kind of can get by with taking their word the first time, but not after that, we actually have to verify don’t just take the word and my office.

I had one way you could qualify if you were on government assistance and you could show me proof of government assistance and I checked it on a consistent basis, then I would qualify you. I did not think about some of these other things to implement. Ours was just pretty short and sweet. We had Cairo health and we knew we could fix most problems and we have payment plans. So we knew we could fix most financial considerations for patients, but that was one consideration. And when I did it, it’s like, you can come for $25 a visit. If you’re having an exam, it’s another 25. If you’re having x-rays that’s another 25. So the most they ever paid was 75, but that’s the way my hardship was set up, but I couldn’t just offer it because they said they did, especially if they’re coming in with their Prada shoes and their Gucci purse or their nails are always done.

I’m not disqualifying those people. I’m not saying they’re in a financial hardship, but I’m saying we have to use a systems of measure to verify this. Or then this is not having an I dotted and T crossed. We do know that those federal poverty guidelines are about to come out. They’re just right out of. They’re always a little slow for some reason, but once they come out, we’ll be able to see what those federal poverty guidelines are and what percentage that particular patient falls under. You have the ability to set that up down. You can see this as one of our forms, by the way, that’s in the library. If you’re a library member, you can find this in the office management section one, and that’s going to be in less than three. And you’ll be able to go in there and tweak. You can see any of that great out areas, something they can do, but you can set what your fees will be.

Put your exclusions in there and make sure that you’re able to just do this appropriately, going by those guidelines. Again, a little bit of leeway with you on what you want to set up. There’s any questions on this? This is a bigger topic than what I’m able to cover here. Definitely let us know. And just a little bit of role playing. So let’s say you treat Medicare part a and part B patients. So are you enrolled? No, we already talked about it many sessions ago. We can’t see the Medicare part B patient. If you are, you’ve got to charge the appropriate fee for the excluded services. Even if they’re a, QMB a duly eligible, you still on the excluded services have to, you’ve got to bill on behalf of them. Your collections will be based on their co-pay, their co-insurance deductible, figuring all that out.

There’s one of your regulated then what about the part C if you’re not enrolled, we fill, these are cash patients to your office. You can see down at the bottom that we have cash paying patient, not insured. We have actual fee, um, or that discount medical plan. They get a super bill. Make sure if you’re giving a super bill and you’re doing discounts that there’s a line item that shows what that discount is. Don’t send that patient out the door with, Oh, it was a hundred dollars and you only charged them 50 because they’re going to get paid to come in your office. If their insurance, as an allowable higher than your 50, they will actually make money coming to you. So it needs to have everything listed there that shows that actual financial transaction that you have. What if you’re not enrolled with the insurance plan, then you have that cash play game that you can do again.

But over here on the other side, you’re going to be abiding by those contracts, looking for deductibles, obeying those rules of medically necessary and active maintenance and all that type of stuff. But you’ve got to bill, according to them, you sign the line. You’re there. You can see a little bit with the non par and the par there at the bottom. What about worker’s comp? Well, with some worker’s comp, you have to be enrolled in order to treat them. So please make sure there’s a lot of rules in my state alone that you got to jump through hoops. If you weren’t the first person who saw that patient a little bit of here that you can look at, but if you’re one option with PI patients, if you feel like you’re always getting stung by it, make them cash patients. When they get paid in their settlement, have the lawyer incorporate what they already paid to you.

That’s probably one of the most simple ways to get rid of the problem of lingering bills. So this is what it looks like when you’re done setting up your fees. We’ve got the doctor’s actual fees up here. Next rainbow down is our contract and fees are regulated fees in our hardship fees. And when it all starts coming together, we can see that Cairo health USA, that legal way to do a discount gets the fall in the green it’s right there. It’s part of our contract. And we got to pick what it looked like. Imagine that it wasn’t $9 for a therapy, unless you want $9 for a therapy. I have seen reimbursements be that low or say, Oh no, that’s bundled. Oh no, we don’t pay for that. On the same day, Kyra health USA is a great work around, especially with, for high deductible patients.

You can see that you’ve start piling in those other things with Cairo health, you’ll have those cap fees or your discount and name it. What you want it to be, make it that way. It includes everything. Oh, no includes everything. But this, this is you. It’s an elective discount. You get a set, a lot of it up. Then you’ve got some of the other things that come down in there where you’ve got this hybrid of Medicare and Cairo health. What the same service cannot have medic cannot have Cairo health, but we know Medicare only covers spinal CMT. So there’s a bunch more, we could apply that to. So it makes a very beautiful product for those patients. And then down at the bottom, we have our hardship fee schedule. This makes it all look beautiful. One pretty rainbow everything’s in there. Everything’s compliant. Nothing’s out here on the perimeter.

That’s kind of not okay. We fit all of our discounts nicely into this beautiful rainbow to where we can rest at night and be compliant. So you’re free to choose, but you’re not a free free from the consequences of your choice. So be careful when you’re doing fee changes in your office, making sure that you’re doing it by dotting I’s and crossing T’s. If you’re a member, if by chance you didn’t have this in your, a member, we do free schedule a fee schedule consultations, either help you, uh, get Kira health USA put in place at which we will. We’ll take you all the way up to it. Almost being implemented, just what they have to do at the very end, or if you’re not interested in that we still do. If you’re a member, that’s something we did. So it’s free for you as a member.

Um, the very next thing I want to show you are hot topics. And then we got to go hot topics. One, one that ABM form had to be implemented. Look at the bottom of your form. If you’re an Anon version, six 2023, starting January 1st. If you’ve got more questions about what you do about the one signed in December or November, you’re glad to give us a call. But as far as the new ones being signed, ABM must be implemented. When you’re looking at box D your mandatory is spinal CMT only don’t have anything else on it. And know when to issue it, big issues going on misconceptions, going on in this industry regarding how to use an ABN appropriately. And it can get you in big trouble because when they pull your records, they pull the ABNs in M coding went into effect. January 1st one code is gone for the new patient.

Do you know which one it is? You should never be using the nine nine two one one. That’s an established patient, but there’s one of them went away. The change in the coding methodology, how you’ll get to it is all lining up over on the medical decision-making. And although the AMA and all those rules have come out and said, Hey, history and exam, you can do it. If it’s warranted for us as a profession, it is warranted because that’s how we establish the medical necessity. Everything is built off the history and the exam next down Medicare fee schedule update. We had a big 10% drop this year. It was a huge disappointment and the middle of COVID and everything’s shutting down practices. It shocked everyone. However, we saw about as quickly as those one up on the website, they got pulled back down because the COVID relief came a bias about sort of bipartisan act that removed the full 10% gave us back 3.7, 5%.

The reduction is still sitting at six two five. And I’m just telling you if you want to be a part of the solution and not have to sit back and accept the problem, contact your state representatives. Remember it’s time to verify benefits again. And if you don’t remember why I go back and listen to a couple of my sessions a little bit ago, one more thing. If you are a KMC university member, please keep in mind. You’re going to be seeing a lot of stuff coming from us. Go in this spring, don’t put your head in the sand or not look at an email cause there’s a new website launch. You’re going to go to the, our website. You’re going to, uh, what happened, make sure you’re paying attention. And if you have any questions with what we’ve discussed today, feel free to give us a call. Uh, we’re always here to help. We’ll be more than happy. That’s (855) 832-6562 or info@kmcuniversity.com next week. Make sure you’re here because Janice Hughes will be presenting again. It seems like she follows me up a lot, but I think that’s really great. And I’ve watched these people and they’re wonderful if you miss these, just let us know we’re here for you. Good to see you. Thank you for spending some time with me again today. Bye-bye

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Empowering Women in Chiropractic – Don’t Get Left Behind – F4CP

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Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.

Thank you for joining us for today’s presentation. Don’t get left behind the secrets to staying ahead in your practice. I’m Dr. Sherry McAllister, the president of the Foundation for Chiropractic Progress. Today, we’re going to walk you through how to utilize some of the foundations materials and our marketing design, which is going to help you grow your practice. Even amid a pandemic. First and foremost, I want to thank our sponsors. Before we get started today, our corporate sponsors make a huge difference. It is because of their generous support that the foundation is able to create and distribute awareness campaign materials across the nation. This makes a huge difference for all of us, because the more we share across the nation, the more awareness our consumers are going to have about chiropractic and all of the benefits that come with it. Now, 2020 campaign shift, what we’re focusing on is optimizing health.

Now let’s dive in. We all know 2020 has been a pivoting year for all of us. We never expected a global pandemic to strike, but here we are today and we have to learn to adapt and thrive. During these circumstances, the foundation expected 2020 to be the year that our Olympic commercial aired. Instead, we found ourselves shifting our focus to a brand new campaign geared toward optimizing your health. Today, I’m going to walk you through some of our new materials, as well as what the benefits of membership with the foundation for chiropractic progress is, listen, I’ve never momentum in my entire 25 years of being in chiropractic and it’s happening now with the foundation. And that is because we’re all coming together to use marketing materials and the marketing materials we’re seeing, coming up on the screen, our new papers as we look to continue to optimize health during our campaign and throughout the pandemic, we have recently launched these two new white papers.

Why is chiropractic sat out by millions of Americans? It’s a paper that focuses on the chiropractic adjustment and what it is, and it’s bad if it’s, we’ve actually never had a paper that focuses on what we do every single day. I know it’s presses you. It surprised me. So let’s use this paper, let’s get it out as far and as wide as we can, because this is going to make a difference because patients actually need to know what it is and why we think it’s important. Speaking of important, we also put together this complete, your health includes mind, body, and spirit for white paper. And we want you to also focus on the stresses and the managements of sleep and nutrition. You’ll see these infographics, you see them on the screen right now, one of the favorite resources. In fact, some of the reasons why our gold members come to us is they can customize these infographics for their practice, what they want to communicate to their community on the benefits of chiropractic.

You’ll see a variety of topics in the enhance your health campaign from sleeping better to working out, to home and posture. In fact, I just had a chiropractor yesterday, reach out and thank us for the tips for ergonomic lifestyles, for many of their patients, because many of us are working from home chiropractors. You are the blessing in their life. You’re there to support them in every InVenture that they take on, whether it’s a new workout or a new environment working from home. So we want you to be able to utilize these infographics and make them work well. Now, the next one is posters. And the part about posters is you can make these available to your patients in your newsletters. There’s nothing wrong with sending out zoom meetings and getting people in your community, excited about what you do and including one of these posters, I cannot wait till 2021 happens.

And you’re seeing in that second infographic Erica Dean Witter, which is a fabulous representation of the chiropractic profession. Not only is she a chiropractor, she came to chiropractic from an injury. And from that injury, she became a chiropractor. Who’s now treating Olympic hopefuls. So it’s very exciting to see, and I want to make sure that these posters get as far and wide as you can make them. The next one you’ll see as Clinton Romesh. Um, he is a, uh, an outstanding example of a medal of honor recipient, and he is an advocate for chiropractic. So next month he is a veteran. And I would ask that you share that poster either on your website or any of your social media cover pages, um, outstanding way to promote the chiropractic profession and also to give, thanks to those that have served our country. Well, coming up is brochures and flyers.

Why are these important? Well, we have an abundance of brochures and flyers on our website, and you can access them by going into our media center. But one of the reasons why brochures and flyers are helpful because you never know where they’re going to end up. In fact, one of the brochures was made for hospital, ER doctors. And that’s why I think it’s important for us to really relate to where our material is going. There is no greater time than now to reach out virtually to anybody in your community, whether it’s a healthcare provider, a patient or a association, Toastmasters might want a speaker that talks about enhancing your health and that’s you and boy, do we have opportunities for you to be successful because we know that your hands are on patients and for us to really be successful, we need to get this information out in a variety of different ways.

The next one is tip sheets. I love tip sheets because they’re short and they’re precise. And patients indulge in them. If you can’t read something in 30 seconds or less attention spans can be lost and pending the generation gap that we have from our older patients, 50 plus to our younger patients, tend to 16, that timeframe, which we lose their attention is smaller and smaller as they get younger and younger. So listen, a tip sheet is a valuable way to get people starting to think about it. Now here’s the one that I was talking about working from home series, specifically, designed to help our doctors guide their patients through how to newly work from home in a safe, ergonomic way. And we know there’s pets and there’s little, little people running around. We need to start to recognize that stress is just part of a daily routine for us.

And there is no new normal right now. It just is. And we’re working through it together. Smile through it, laugh. The foundation has you. We know that this is a important time to be able to get our messaging out and help our audiences. And speaking of helping our audiences, now that advertisements are coming out. And if you haven’t seen it yet, you’re going to see as seen in prevention magazine on this slide are two ads. One on the left is a full colored ad. I’m so excited to let you know it actually is running now and prevention magazine. So don’t be afraid to pick up one. If you’re at the grocery store, grab a prevention magazine, flip through, you’re going to see our full page prevention ad. And now on the other side of the screen, you’re also going to see an ad that you can print and post in your practice, either in your reception area.

If you like, maybe you run it in a note, a local news outlet. You can share this digitally on social media or anywhere you feel fit. Second to being able to engage our audience is optimizing your health. The 32nd video. Now I’d love to share it with you here, but I’m going to keep you in suspense. If you go to our Facebook page, you will actually be able to share this, optimize your health 32nd video. It talks about doctor of, and it tells everybody about what a doctor of chiropractic is. No drugs, a doctor for energy and passion. Think about what this messaging is going to mean to those that are suffering. We want them to be aware of what we do and how we do it. So if you go onto our YouTube channel or a Facebook site, or you just want to come into your, your membership page, you’ll be able to download this 15 or 32nd version.

When we did it on Google in two weeks, we got over 50,000 views and we haven’t even reached out to you to get it out to our audience. So please be aware it’s out there. And it’s an important aspect to making sure patients are aware of what we do. Chiropractic adjustments. That is a big key. A few months back, the foundation issued a public statement in support of the findings of a randomized controlled trial. It was published in the journal of American medical association, the study effect of spinal manipulation and mobilization therapies in young adults with mild to moderate chronic low back pain. And what it concluded was when performed by a doctor of osteopathy or a physical therapist, neither spinal manipulation or spinal mobilization appeared to be effective for mild to moderate chronic low back pain. This is an important finding, stay with me because I’m going to tell you that this is what helps consumers understand the difference between spinal manipulative therapy provided by a doctor of chiropractic performed with other healthcare providers.

It’s not as effective. So this is a wonderful study actually, to showcase that we as chiropractors have fantastic results taken in conjunction with the previous study, we can demonstrate that spinal manipulation is more effective when we start to point down and drive into what the patients are experiencing with a chiropractic adjustment. Now here’s the reality. Don’t become almost dally. Now this next slide is talking to you about the recently released governor’s report that does not mention chiropractic in its full capacity. You want to read this because it’s, it’s getting out to the public and the governors are reading it. And it says, we know that 94% of spinal manipulation is performed in the U S by chiropractors when spinal manipulative therapy is mentioned chiropractic, and the chiropractic adjustment should go hand in hand. The material the foundation is creating is designed to educate the public and general awareness of what we need to disseminate this material in your local communities and grassroots efforts.

It’s imperative that we don’t get labeled as a modality. We’re a profession of experts that really care about the health and wellness of our patients. And that’s one of the key pieces to being a very well versed chiropractor right now. And knowing that we need to promote this and being left behind is why this topic is so very important. Now are your marketing dollars working for you? That is the question. Are your marketing dollars working well for your chiropractic practice? When you enroll as a member of the foundation, listen, we grant you access to the already designed marketing materials that have been designed to implement by your staff. So you can focus on treating patients. The best one is the gold level. This is where you get to customize what we produce and showcase it in any way you desire. And that’s a key. What are some of the ways you might desire to be a gold member?

Let’s take a look national, find a doctor listening. When the Olympic commercial runs next year, you do not want to get left behind. What do I mean? Well, 214 million people are going to see our Olympic commercial. Our 32nd commercial is going to run five times and it’s going to showcase, find a doctor if you’re looking for a chiropractor and that’s you. And that’s in our listing. Now on top of that, you’ve got 14 million people that see our listings in web MD, vitals.com and American Academy of spinal physicians, critical aspect to be part of our national listing. Why is it so critical? Listen to me, Epic moment happened in September during our drug free pain management awareness month, we had over 10,000 hits to our find a doctor listing that is historic for the foundation. And it means that you and the foundation are making a winning combination.

We can’t do it without you United. We stand the parted or diverse or trying to conquer. Um, others is where we’re going to fall. So we are one profession that stands for enabling the health and wellness across the nation, web MDs and vitals.com. As I said, 14 to 15 million views are being seen and that they can come right to our specific listing. Next one, Monday marketing memo. Each week, the foundation sends its members out our Monday marketing memo. In this weeks, it’ll show your weekly emails. You have access to fun, little sound soundbites that will walk you through different action steps that you can take each week to market. Your practice can not get any simpler. You have a lot going on many patients to see, and you want to be able to implement a marketing roadmap. That simple, well studied. Everything we use at the foundation is well researched and efficacious.

Cause we’ve got 16 colleges in 37 state associations working with us. So please use that. The next one is the marketing roadmap. Week by week, helping you decide, have I conquered all of my social media platforms because some of your patients may be on LinkedIn. In fact, a lot of nurses, nurse practitioners, medical doctors are on LinkedIn. Did you post a LinkedIn article? And if you don’t have time to write an article four Oh one from the foundation, but we want to make sure you’re hitting all aspects because there’s no one way to market in today’s society. It’s all over the map. And that’s why we have a roadmap on our next part. I want to thank you. I want to thank you that you come every month to join the foundation on ChiroSecure’s, Facebook live, you are making a difference. You are a passionate envisioned chiropractor. That’s changing the future of health and together we make a difference. And I want to thank you for being with us every step of the way United we stand and together as a profession, we will change the healthcare of millions of Americans. Thanks for joining me on today’s Facebook live, please. Don’t miss me next month and come back next Tuesday for the next episode of ChhiroSecure’s, Facebook live.

Please subscribe to our YouTube Channel (https://www.youtube.com/c/Chirosecure) Follow us on Instagram (https://www.instagram.com/chirosecure/), LinkedIn (https://www.linkedin.com/in/chiropracticmalpracticeins/) Periscope (https://www.pscp.tv/ChiroSecure). Twitter (https://twitter.com/ChiroSecure) If you have any questions about today’s show or want to know why ChiroSecure is still the fastest growing malpractice carrier for over 27 years, then call us at (866) 802-4476. or find out just how much you can save with ChiroSecure by visiting: https://www.chirosecure.com/quick-quotes/malpractice-quick-quote/.

Empowering Women in Chiropractic – GY Does the Payer Never Cover My Care – KMC University

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Hi, this is Yvette I’m with KMC University. I hope that you’re able to hear me today. We’ve had just a little bit of a hiccup as we’ve been getting started. Um, I will be able to share my screen in just a moment with you all and get everything moving in the right direction for us today. But again, I appreciate ChiroSecure for inviting me to join you for today’s call and hope that we find this time together to be very informative for you in your office. Wanting to take a quick moment, just kind of update you on where I’ve been. Since we were last here, I was at a client’s office last week and was able to notice that there were some significant issues going on and which is common. When we go out to do an onsite visit, we love doing them. There’s nothing like walking in and seeing fresh with our eyes, what we know to be wrong.

I hear commonly, I don’t know what I don’t know, which is very true. And I think if I had a dollar for every time that I heard that I would probably be a very wealthy woman. And that’s why people come to things just like what Kira secures putting on, or maybe even come over to KMC university for help. But last week, the very topics that I’m teaching on today was so laid out as, as an issue for this office, that we were able to make some changes quickly. I have a coaching client. I don’t take them often. My, my hands are quite full here with what I do at KMC University, but have been able to make a lot of progress with them on this very topic. And I think one of my favorite things that I heard recently, and I, I actually teared up.

I had spent quite a bit of time helping my particular coaching client with her fee schedules, getting the foundation set, to make sure that she was set up for success. And I got an email the next morning I was tired. I’m not going to lie to you. I was like, I’m so, so exhausted. And I thought, man, is it worth it? Is it worth it? And I get up the very next morning and here’s an email from her that I, I cried. She said, Yvette, I was so afraid of those three little dots that would show up and show me this whole list of errors. And it took me hours and hours and hours to correct it. She said they were gone. She had a couple, but they could fix them. So we were able to make some fast progress. And it’s probably the most powerful thing you can do in your practice is be proactive.

Instead of being forced to be reactive. She said, I cannot begin to tell you how much time that I saved. I had a coaching call with her this morning and it’s been such a game changers. And I want to give a little piece of that to you. Obviously I’m not going to be getting it on your system and setting things up appropriately, but hopefully some of the tools that I’ll share today and answer some of those questions that may be out there, that I hear all the time will be beneficial for you and your clinic. So we’re going to go ahead and get that PowerPoint started for you and definitely cover as much ground as we can in the short time we have together. But I had to just take a moment and tell you from my heart, what I saw last week, I’m not going into depth.

That’s their story. I’m sure you have your story in your clinic, but please know that a lack of foundation, a lack of training of your CAS will spell a disaster for your practice. It did for this one. And, uh, I literally, when I left, I don’t tell this to too many people, but now I’m telling it out here on Facebook world and out in the world of Congress secure and all who watch. I cried when I left, I literally started crying. I have next, maybe that wasn’t the COVID thing to do, but it was the thing here. And I cried because I realized such work ahead of them. I’m honored to have the opportunity to walk this journey with them, but please, please, please think about these foundational pieces. Think about training your staff. I’m telling you what, I couldn’t even say. The numbers nine, eight, nine, four one.

And that staff understand that there’s a problem in your office. So make sure they’re getting the training they’re needed. They’re needing for you to be seated successful. And the doctor was so afraid staff was going to walk out and I told her, I said, one reason staff will walk out of your office is because they’re untrained. They don’t know their expectations. And some things they don’t have to necessarily be trained on if we build the foundation appropriately. So hopefully some of this will be a little bit of foundation, but training for you and your staff today. So as we move along, going to talk quickly about the things that we’ll cover in this call today, um, we are going to cover the art of using appropriate modifiers, that there was so much that was left undone, that they were chasing their tail. I looked at the report from their biller, looked at the report from their clearing house and it was so massive and realizing it was probably just simply the modifiers not being put in their system.

Their ledgers were a mess, nothing matched. They were creating, I don’t know how many different case types to manage it. And while I was there, it was, I was kind of peculiar. I’d done some training. And one of the staff members defaulted to her old system and she went back and created a new case type. And I’m like, may I ask why you did that? And she said, well, well, that’s the way we’ve done it. I said, but understand the groundwork that I have laid for your office. You don’t have to do it that way. So improved efficiency, definitely improved having to go from ledger to ledger, to ledger, to find out where to find things and chase your own tail. Getting the foundation set up correctly is just paramount.

Also an issue

With denials, you may be seeing can come specifically, um, can come specifically from the, uh, diagnoses pointing that you may or may not be doing. So let’s talk about that for really quick. Anytime we’re doing a spinal CMT service with the muscle therapy, maybe we’re doing the nine seven one four zero. We know as an NCCR bundle that those cannot be reported in the same region. However, well, what if you adjusted the cervical and maybe you did some, uh, work in a hip with the myofascial release. If you just use the traditional ABCD, I did ABCD for this ABCD, for that ABCD, for that look at your claim form. If am box 24, I believe it’s easy says ABC D you have not mastered the art of diagnoses pointing that CMS claim form is the only thing that they really get to tell the story of what happened in that clinic.

And did you really do that nine seven one four zero four, the whole spine at the same region, you did the spinal CMT. We’ll talk about that a little bit. Um, coverage limitations, and how that applies out the patient responsibility. Other big pitfall of this office I was at last week, and then just recognizing their requirements for non-coverage. We know Medicare has an ABN form, very specific rules to that, uh, when we use it, when we don’t use it. And what do other payers say? It’s not the ABN form, but it may be a little bit similar. So let’s go ahead and dive right in. When we’re talking about the modifiers, I went out to one of the Macs, Medicare administrative contractors, and I pulled a sheet that they had that showed all of the different modifiers. And I thought, my gosh, you know, we really think in chiropractic, we’re in a very small code set, but when it comes to modifiers and I’ve started pulling them off, I’m like, all right, well, there are a lot.

And these categories that apply several, I got to leave off. So don’t worry. I didn’t pull surgical over here. And I didn’t pull some of these different therapy codes that we don’t deal with or those things. But I thought it was really interesting that the modifiers that we deal with in the office are going to be regarding the advanced beneficiary notice. We know that the CMT code get the a T or the GA, hopefully not the GZ. That means you didn’t get the ABN sign before you did that maintenance adjustment. Or for that series, we don’t have to get them signed to every visit, but there’s some specific rules and that GA and GZ are used one or the other, depending on the proper execution of your Arabian form, bilateral. And did you do that on the left? Did you do it on the right?

We have the chiropractic modifier. That’s the 80 can’t use it. Please. Let me impress upon you. Something that I see every day it came to the university is a very high usage of 80. Oh yeah. Well, that’s built into our fee schedule. We build that every single time and I just sit there and I’m glad I don’t always share my video because I’m going, Oh, it’s either or Oh, like that, because we don’t always use the 80 modifier. I dare to challenge anybody who uses that constantly, unless you completely discharged patients, your pain office and you discharge them, tell them don’t come back until you have an issue that could be active, a treatment that we’re rendering for you for your condition. That may be the extreme, but it’s going to be very hard to substantiate that 18 modifier, especially when your box 14 tells them it started about three years ago, a statutorily excluded modifiers, which is with Medicare, G Y Medicare.

You may have noticed the title of what I was going to cover in day G why Medicare do you never, ever, ever cover this? And, uh, we just have to go with the flow of what they tell us to do then that I touched on just a minute ago, those NCCR bundles, where they say, well, you can’t do this together. Uh, these two don’t go on the same. You can’t do this in the same region. Oh, you can’t do a spinal CMT service at any and M service in the same. Well, okay. That’s why we have 25 modifier. That’s why we have an X S that’s why we have a 59 modifier. Um, that takes us down into that evaluation and management modifier fee for time compensation. Maybe somebody needs to come in and maybe needs to, uh, fill in for you for 60 days.

If you’re going to be out of the office, you will have your fee for time compensation. You may also have when there’s reciprocal, uh, billing, that’s going on, which I didn’t list here. Technical components, the TC, the 26 on some of your, um, of your radiology services, telehealth. That’s big right now. I will tell you a tele house. You may want to check individual payers and then the therapy modifiers, which for us generally that third one down is where we live in the outpatient therapy, which is that GP. So you may be seeing some denials with Medicare, a VA with United healthcare regarding therapy, nine, seven codes of the GC, or two eight, three, simply because you’re leaving off the GP modifier. Now we know with Medicare, always get, gee, why Medicare do you never cover this? And then GP goes with it. There’s too.

So with all of your services that you do for Medicare, there is only that certain subset of the 97 and the [inaudible] that actually have to have two modifiers. The rest are either gee, why? Because gee, why Medicare? Do you never, ever cover that? Or we have the 80 or the GA and the, hopefully not the G-Eazy. Um, so keep that in mind. So we’ll go ahead and move along to the next. Now, one of the things I hear hear commonly, well, I was told I have to do this modifier first, or I have to do that modifier first. Well, when it comes to coding, we think of this in the realm of payment, modifier and informational modifier. Some people have the words statistical modifiers, but I want as far as to go that deep and say, all right, tell me which ones have to go first.

Now from a coding perspective, payment modifiers, go first. Then you put your information, all the ones that kind of tell us the story. Well, Medicare, I know you don’t cover it. Well, this was a part of therapy care. Well, this was a part of this. And they literally listed out. Those that would apply to chiropractic care would be your, uh, technical component professional component, which you would be using with your x-ray, believe it or not. And, um, Massachusetts, I did an onsite visit back in March and before I got there, I took one of my DCS with me. That’s on staff here. And she told me, she said he never gets paid from blue cross and blue shield for x-rays. And I said, well, that will stop. The minute I hit the door. I’m not tolerating that that’s not okay. I went and I did medical policy research and found out there was no exclusion.

And so we sat down to dinner Sunday night, we sat down to dinner with the doctor and I said, that bucket is right here. I’m done with that. That’ll be settled in the morning. Well, anybody who knows me, it’s not waiting til the morning I got on. And I started doing some research and I’m started sniffing something. And I’m like, what’s going on here? I get up the next morning. I think her name was Suzy. I got ahold of I’m there with blue cross and blue shield of Massachusetts. And I said, tell me what’s going on. It was the strangest thing I’d ever heard. I had to train one team member to be able to handle this. I wrote some policy on how it worked. They had you send the TC with one NPI, the 26 with another. So if you’re in Massachusetts and you’re having an issue, I encourage you to reach out to us because I have all this written out for them.

So I know how to help you guys fix it, but it’s crazy. But know that those are your payment, modifiers, your bilaterals, your a technical professional component. And you can see there at the bottom. It said these payment modifiers are not limited to the first position, but if another pressing modifier, it goes to talk. But pricing modifiers always go first. So some people like to argue with me, is it GP or DUI first? Well, next screen. It really doesn’t matter. It’s an informational modifier. So it can go in either direction. Um, some people say, well, I’ve always heard it’s this one, right? Here’s the Mac telling you, these are informational modifiers. And these modifiers, um, should be placed after the pricing modifier. So we go back, we see pricing modifier. And then we see the informational. Now that we have that out of the way.

And then it really doesn’t matter if you got your GP or your G why first let’s go on. We can see here that as far as the 80 modifier, which we referenced, I told you, I do not feel that all spinal CMT services will have the 18 modifier. I can just about say 99% of the time. It will not. Again, if you’re a pain doctor and telling them, I don’t want to see you, you send them out for wellness care and they only come to you for active treatment, which doesn’t mean you’re flipping diagnoses codes to get more coverage. Oh, we’ll change it up here. Oh, okay. So we’ll, let’s change the date of onset. That’s not how you manage it. I encourage you to go look at the stipulations of using the 18 modifier, because right here, straight from Medicare, not from your vet’s library, but from Medicare’s library, we see that there is inappropriate usage.

When we use the 18 modifier for maintenance services, Medicare defines maintenance. We have to observe and recognize, but they are who defined maintenance. So as a doctor, you get this big you’ve. If you’ve seen me talk before on here, you’ve seeing this, this big bubble of clinical appropriate thinking, because you’re a doctor, you’re free to think that’s your bubble to thinking, but inside that bubble was a little compartment way over here, where the payer, Medicare, whoever it may be says, well, this is my bubble. You put in my bubble only so much. You keep thinking what you want, but watch what that does. It really shrinks down on what they accept and on what you build to them as medically necessary care. Um, and getting that concept down, really reduce your risk. I know that’s what all this is about. Really reduce your risk and, uh, really will assist out in times of audit, record review and things like that.

You don’t want to have inappropriate billing, nor do you want to have false claims act violations. I can tell you I won’t go into detail, but in the short time that I spent with this office, we had to write four compliance incident reports. And it’s just the start. So make sure that you are doing things up. Propriate like, um, next we’re going to look at payer specific modifiers. So you’ve got your Medicare maintenance here. I told you it’s or Z Jay Z a GA. I got my ABN ahead of time Jeezy. Oh, geez. I forgot it. You’re not going to collect, but still make sure you get the appropriate modifier on, um, if the patient already was touched, jeez, you forgot if the patient wasn’t touched yet. And you’re telling them ahead of time. It’s GA I got that ahead of time. Always verify with the Medicare advantage companies.

Um, I had some around here where I’m at in West Virginia that, uh, did not observe this GAGC. They actually spoken that language that a lot of commercial payers speak in. And that’s S eight, nine, nine zero. I’m going to pause here for a moment. Cause I think it’s important for someone to know here today. Um, when you’re submitting services to Medicare, the patient has elected option one on that ABN form for the spinal CMT to go over for maintenance, please be cautious when you get payment from the secondary. Now, if they have a true secondary supplement, won’t do it, but they have a true secondary. So around here, we have a lot of federal blue cross blue shield, Medicare primary, federal blue cross, and blue shield secondary. No, that, that secondary generally does not talk in the language of GAGC. They talk in the language of a state nine, nine zero.

So when you send it over to Medicare and it’s maintenance, because patient chose option one, a lot of times you’re going to be paid from that true secondary, which is a mistake. Yes, the air just left your room. I encourage you to do proper verification of services with that secondary. And when that secondary pays you, when Medicare said looked at it as maintenance, you need to notify that secondary payer that they paid an error because it was maintenance. You may have to go back and switch to [inaudible] to get it, to go across. Definitely look into this further because I commonly say, well, they’re secondary covers it really. I know federal blue cross and blue shield, like the back of my hand. And I can tell you right now that they don’t cover maintenance. Look at the medical policy. You’ll be able to find out there that they don’t.

And when you get paid, unfortunately, the patient’s not going to be happy. But if you get audited, your office will be a lot happier. And that’s who you have to protect. Um, as we move along, we can see that we have also some payer specific again with Medicare, but it also hits over there in that land. You see me dropping out is gee, why Medicare do you never cover it? Every service minus spinal CMT. And then I’m not even talking about GX. If you want to talk about it, give us a call. I don’t think you should ever talk about it. Um, because there’s other ways to handle that. But then there’s that GP got some PT, got therapy going on and therapy plan of care. We see that Medicare requires it, VA UHC. And then I put down there. What about your payer? Do you know, that’s where you go out and refined all these medical review policies as specific questions, uh, keep in touch with those payer specific, uh, bulletins that they release their webinars and things like that.

Know your payers and know what their modifiers are, because what you’re going to end up doing is just like the office I’m coaching right now. Like I said, I don’t coach very often, but there’s sometimes I have to come out because of complexity of issue or a specific topic. And I have to take someone on and get us over this hurdle and then pass them on over to someone else. Similar with Kathy, we both will take some intense cases and pass along. But many times we find it’s at this very root of modifier issues. The denials are piling. They’re not understanding how to fight it. And really the fight was way back here. And it was in being proactive modifiers for statutorily excluded services. I’ve talked about that. Gee, why is the only one for the ENM and the x-ray and then on all the therapy codes, we have a combination.

So you can see that I laid that out there. And when they have a supplement, it’s a voluntary submission. It really is a voluntary submission to Medicare for their statutorily excluded services. Um, as we move along, we have those distinct things that are separate and distinct. This is a denial, automatic denial. I’m just going to put it out there. You’re not going crazy. Uh, probably I think it was back around 2017 for some of the payers. They implemented a new software at the payer level that said we’re throwing out every 25, every 59 excess out of here. It’s an automatic, prove it to me. Um, so don’t take that laying down because really all they’re doing is saying, prove it to me. But no, when you are using those that you are meeting the bullet points to be able to substantiate using the 25, it was separate and distinct. No, the policy on what qualifies with that payer know what happens when they say, I only allow one of these a year. Okay. How do I shift this responsibility to the patient? Sorry, patient. You owe me today. Wrong answer. If you’re dealing with Ash,

You’ve got it.

The form that has to be filled out every single time signed off on every single time you’re going to do a service. They don’t cover. Medicare was spinal CMT will allow you to do it for up to one year unless it’s interrupted by another period of active care. So you’ve got to know the payer you’re dealing with. You’ve got to know what the contract says, what the policy says on shat, on shifting over the liability to the patient. Sometimes it’s possible. Sometimes it’s not 59 modifier in our land. If you’re having to move over to the X series, remember this 59 means it’s something above and beyond. This is how you’ll never forget it. X S it’s an X S of something 59. Generally. We’ll cross walk over to the excess modifier. Xs is more distinct in its description. A lot of payers will say default back to the 59.

If you can’t use one of the excess ECC or XPX you, uh, but typically access will work quite well. But again, we talked about the nine seven one four zero the nine seven +1 497-124-9711 two. Those codes generally cannot be performed in the same region as the spinal CMT. If you are. It’s just part of the work of the CMT service. If it’s truly separated and you’re not using diagnoses pointer, it reminds me of Barney Fife, um, that shot himself in the foot all the time and just make sure you’re not shooting yourself in the foot. And you’re like, but that shouldn’t be, what story did you tell on your claim form? That’s the only thing they get to say, tell the story from the beginning and up your chance on getting paid without having to be reactive, be proactive, common chiropractic modifiers for radiology services, Aetna, uh, Medicare started it.

We know that doesn’t pertain to us, but it’s like one, two, three, here comes a little duck, four, five, six, and a little duck. Aetna was one of the first ones. If you’re using digital, if you’re not using digital film in your own plain film include the FX modifier. We will see more and more payers going towards this plain film. I’ll call it penalty as if it doesn’t take you more time to go back and develop that in the suite and deal with all the smells and all that. But they say FX modifier. I put down there, the blue cross and blue shield of Massachusetts. So you could see that that 26 and TC separate MPIs, crazy, crazy, but it was their rule. And guess what they’re getting paid now. Um, the G Y the FX, what does your payer say? KX? We’ve seen a lot of KX.

It used to be years ago when I worked for a third party billing company, KX was more with just your, uh, therapy clinics, your outpatient, occupational, physical, uh, clinics. We saw that, but I’m seeing that come up more and more, uh, could even be in your DME stuff. Ladder reality. We’ll notice that we have some of the modifiers coming in as in your LT and RT your fee for service time compensation or your reciprocal billing. Those are some of the others. Uh [inaudible] you got somebody coming in, um, and they’re going to be covering for a period of no more than 60 days at a time, or maybe somebody just filling in from their office from a distance. Obviously some rules around that DME in you, a new unit are, are they’re renting it LT specifies the left R T right. Uh, you’ll see that a lot with, um, however, you’re doing your billing with orthotics, a one unit LT, one unit RT or two, uh, definitely want to verify with your payers on any other requirements that may be there.

So where does this all lay out? As you’re looking here on my screen, um, this is common issues we have, um, I encourage you to take a screen snip right now, uh, because it’s more than what I’m going to talk about. So you might as well take a look and take Kate take advantage of Watson front of you. This is one of our tools from KMC university, but it is 24 III with the diagnoses pointer where we’re seeing the issue. Um, one thing just to put in front of you, October 1st, there were some updates to some ICD 10 codes, make sure you’re not using any deleted and always using those more specific codes that were just released, uh, kind of staying cognizant of our time. Uh, just make sure that 24, he tells the story. Where did you do the scene? Empty. Okay. Abe C and C.

Great. Where did you do the nine seven one four zero because you can’t do a, B, C, D. Oh, yeah. I did that in F don’t put ABC D down there. It happened enough. That’s your story? Stick to it. This is the only way to be proactive. Get your modifiers on here correctly. Get your diagnoses pointers on here correctly to up your chance. And again, it’s not foolproof because they want you to chase your tail. As we move along to the next slide, you can see some of them that we just highlight those areas, and you can see they’re a little bit better, kind of without all the garbley around it, that we’ve got 24 elide out there as one of your big places of issue. And also in D those you’re modifying your diagnoses pointers. Um, no, anything that you’re putting on that claim form has your signature at the bottom.

You may not be getting out your pen and writing your name every time, but I bet you, it says signature on file. So be careful of anything that you’re sending out, uh, because if you haven’t read the back of the form, I encourage you to do that. I pretty much lays it out there that you know what you’re doing, and you’re testing, you know what you’re doing when you’re sending it. And by signing the other side, you take all liability. I tell people, know your risk. If you’re willing to do auto bond speed and your 25 mile an hour school zone be prepared for that penalty that comes along and they tell you ahead of time, what it’s going to be. So if you’ve never taken the time to flip over that CMS 1500 form do so, it is a federal document. Make sure you’re doing it appropriately.

So going back, recapping a few things, making sure on your, uh, in CCI edits, which member back in the beginning, I talked about your CMT, your ENM services, your CMT, your, um, muscle therapies and things like that. Utilize your diagnosis, pointing, utilize appropriate modifiers, reference your payer policy, follow the rules and know that they have them there for a reason. Why do they not allow CMT and ENM? Because there is a pre post and intro work to the, to the CMT service that does mimic some Waterman and M service. You’ve got to evaluate, especially if you’re a full spine adjuster, you’re evaluating, you’re doing some form of evaluation, but there’s times it’s above and beyond that. And that’s when your documentation should prove it back it up 25 modifiers should stand and appeal as necessary KMC university and our third party billing and collections department down in section six or seven.

If you’re our member, you’ll see that we already have template letters that you would use for these very situations for appeals. When they try to deny your CMT with your evaluation of management, when they try to deny your CMT with your muscle therapies, there’s a whole host of them that we have there. Um, one of the biggest ways I told you to build it out is making sure your modifiers are correct input, output, whatever you’re putting in at the very beginning, when you get the key to that software, remember this is success. The key to success, turning that key to the software, set yourself up for success from the beginning, because if it’s not there, it’s not going to show up in that imageable low it. And we’re going to have all kinds of issues. Now, this one, I didn’t what I gave you here in front of me as that sample wasn’t Medicare.

So nobody scrutinized me. You’re missing the T or the GA. I’m not, I’m using this for an example of something like UHC, where you’ve got to have your GP modifier on there. And it was an addition. So I needed my 59 or maybe my excess with this payer, make sure you build that foundation. So when you hit that little magic button, it automatically does the work. Why chase your tail, having your staff go back and say, okay, that’s UHC. I did GP here. Who’s next 150 patients later. You don’t have time for that. Set yourself up for success. I think this is kind of my unsaid job here at KMC university is the passionate about that. And usually if somebody needs their fee schedules blown out, I, they purchase multiple hours with me and I set it up remote in as if I’m sitting there and fix it for them.

And then again, remember your diagnoses pointing, where did it happen? Don’t tell me your CMT and your exercise or wherever you can have your exercise and CMT together. But tell me where you did it. Your CMT needs to say, this is where I adjusted. Don’t let it tell us a region. You didn’t adjust and same with your exercise. If you didn’t exercise from STEM to stern, don’t tell me, catch me right in the middle and tell me, I just did STEM. And let me know where you went. Um, as we’re coming towards a little bit closer to close, we’ll know that 10 minutes is the average length of time. It takes to locate and research and medicals payer policy all throughout this I’ve said, know what your payer says? It’s your key to success. Know how to set yourself up? If I had moment, which I don’t, I don’t work in an office anymore.

I work at KMC university, but I would blow your mind with all of the medical review policies that I keep here for my staff to reference, to help our clients. And it’s not all of them. I had over 150 policies before I left the local office. And I needed to know that the health plan of the upper Ohio Valley did not pay for spinal CMT services. I also needed to know, well, how do I have the patient pay for that? Oh, I use your form. I give it to the patient at this frequency before we do it. And then I can charge them. Got it, got it. And then my fee schedule would keep that as a patient fee. Then we look over here that 55% of DCS and CAS admitted. They didn’t seek guidance. Shame on you, shame on you. You’re setting yourself up to send in a services under a code that they say is experimental and investigational you’re success.

You’re setting yourself up for denial. After denial. You’re setting yourself up to lose money. No one can afford that. If you had that old Facebook video, ain’t nobody got time for that. No one has time to lose money. And when you lose money, because one, it got denied. Your staff has to chase it. Your staff doesn’t know what to do. You’re just setting yourself up for failure. A lack. The plan is a lack to succeed and just make sure that you’re doing that correctly. Looking at medical review policy is very easy. I’m the queen. I’m known to have a magical computer, but while I was traveling on the onsite last week, one of my specialists said, I need some help and they couldn’t find it. And they’re like, I know you don’t have your magic computer on, which is right here. This is the magic computer, but you know what I said, it’s not my computer.

I just found it on my phone. And it’s kind of a joke around here, but it literally took me no time to find exactly what that client was looking for. Answered the question like that. Ask them if you don’t, can’t find it on their website, ask them Aetnas is the easy. Everybody has an assignment from here. Go Google, Aetna chiropractic policy and read it. It’s going to scare you. I promise it scares everybody. Uh, this is theirs. Go look for it yourself. We don’t have time to go over it, but I’m telling you, please, please, please has oxygen on standby. Especially if you do any of the services that they say is experimental and investigational, it will blow your mind. The last office I worked in, we had to go off, off, off. Why are we even in with that net? They don’t cover anything.

We do. They have a right to monitor. This is in Nebraska, that they have a right to monitor your compliance program. So know that. And anytime you’re going to do a new service in your office, investigate, check your board, check your payer, check your coding. Don’t rely on the person who made that piece of equipment. I’m not going to call Magnolia homes. That’s where this is from Magnolia, my Magnolia and heart. Oops. Well not going to call them and say, how do I code this? How do I code this? No, you have to know how to code it per the CPT guidelines. CPT tells you how to code it, FDA, how that thing was approved. So I’m, I’m pulling out really quick just to show you this tells you how to code it. Not the manufacturer. They may have an idea that can point to it, but know for a fact exactly what that is.

And then in charging the patient, find out what you can do to charge the patient and have them be liable. Is it with Medicare and ABN form? Is it, you don’t have to do the ABM form for the statutorily excluded services with Medicare. Does the payer have their own policy? Can you use a generic one like in the office management section of the KFC library and section one, uh, we have that in there for you and just know the rules. Do they cover rehabilitative therapy and keep your fees consistent? Don’t change your fees or your code because they’re cash. No, the rules. This was specifically from Arkansas blue cross and blue shield. They have their own form. Limited patient. Financial waiver is common language. It’s definitely not going to be ABN because they don’t speak that language. But know if the payer has their own in closing.

I don’t know if you know this yet, but you should know by now KMC university keeps their ears very low to the ground. Sometimes we’re slower to say something than others because we know it’s in comment phase and we’re not going to cause unnecessary havoc. But we do know that the ICD 10 change took place. And it is an in comment it’s in live and we have every tool that you need to help navigate through that, uh, ABN implementation. Remember that that is going to be due on January 1st and in M coding. Um, if you’re a member of KMC university, you can find the ICD 10 codes on the dashboard top, right? ABN implementation is down on the bottom, right in the ABN alphabet soup lesson. And then the new ENM coding is going to be on the right under our recent webinars. So you’re going to notice all the tools you need there.

Uh, if you need any help and you need some KMC University, just know that we have you covered, uh, definitely appreciate you guys attending today. If you should have any questions, there’s our phone number. You know where to find us, press option one. Tell them that crazy lady. You talked to me today and told me all this crazy stuff about everything that I have to do and get myself set up for success. I encourage you next week. I pardoned for going on a couple of minutes to join with Dr. Sherry McAllister, when she’s going to have your next session of Growth. And I’m sure you’re going to have a great time. She’s an excellent speaker. I’ve enjoyed looking at some of these. Thank you for attending.

Thank you for letting me spend some time with you today. I hope it’s been helpful. I know it should have been have a great day. Bye. Bye.

Empowering Women in Chiropractic – A Chiropractic Birthday Buzz in Your Community F4CP Dr. McAllister

Click here to download the transcript.

The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors. 

Hi everyone. And thank you for joining me today for ChiroSecure’s’s Facebook live presentation, delighted to have you with me. We’ve got a lot to cover today and very important information. I know we’re all going through the pandemic and it’s not been easy for any of us, but with the help of a little spice of fun, a little bit of happiness. And then we walked through some of the things that are going to be so important for your community to engage in. I’m going to start with today’s corporate sponsor. Thank you. ChiroSecure has been so generous, but also please look at these corporate sponsors. That’s, who’s helping us make a huge difference, an impact in the world that we’ve never seen before. So let’s start with looking at everyday opioid awareness as we go through, and we start looking at our optimum awareness and how the chiropractic birthday celebration is having an impact. I just want to share.

So just to make sure you saw the 125 years of chiropractic celebration, I want to share some fun facts with you. You can share this in your YouTube videos. You can share it. Um, maybe you have an, an E newsletter that you’re sending out, but let’s celebrate 125 years of drug free chiropractic care. Another fun fact is did you know that in 1979 chiropractic in New Zealand, the report of the New Zealand commission of inquiry into chiropractic was published. This was the first government commission to adopt a full judicial procedure, hearing evidence on oath and subject to cross examination. When examining patients, this is a big next step for the chiropractic profession. We also noted that in 1988, the world Federation of chiropractic was formed. So many fun facts that all of us just need to jump into. Remember today is all about celebrating our birthday box and we could not be more happy to do something for our community.

That really, that here’s a little sheet that just shares with you more about the fun facts that are available. The other best part of this particular handout is that it has the latest, greatest research in it that you can also share with your medical community. Maybe there’s a physical therapist in the community that you want to share a little bit more about chiropractic or a physical therapist, a pardon me, a medical, um, physician who’s into orthopedist or a, um, acupuncturist. The more you share the better we’re going to be able to examine and exhibit the benefits of chiropractic care. Now there’s a lot of parents at home right now with little people and those little people need something to do well, what better way than to get them coloring and to share with them the benefits of chiropractic care. So happy birthday chiropractic. And as you can see, we’re looking to enjoy our celebration, even though we’re during some very difficult times, if we can just spread a little bit of sunshine and a whole lot of happiness, we’re going to do so much better for our community.

We have trifold brochures that are celebrating 125 years of chiropractic excellence in your community. One of the things that I think is very important is you, as a thought leader in your community, want to be able to share your clinic and your expertise no better way to do that than to share some of these important information pieces on your website, your website, or any social media platform that you have allows you to adopt the information that you want your community to know about who you are and what you do in your practice. Speaking of that, let’s use your social media platforms, Facebook, Twitter, and Instagram, to really get to know more about chiropractic. Here’s about three of our social media infographics share showcasing a little bit about the fun of chiropractic. There’s nine of them. So you could get started today. And by September 18, you will have shared with the community that you are proud to be a chiropractor, celebrating 125 years of growth.

And that really makes a lot of buzz because people need positive information out there in the communities to make them feel like we’re getting kind of back to healthcare and not sick care. I want to also share with you in our birthday box is a very nice way to explore the celebration a little bit deeper and have something that you can hang on to for years to come. That is our commemorative chiropractic coin. You can go to frcp.org/one 25, and you can get one of these beautifully crafted coins. On one side, you can actually Pell pate the spot and the hands. And on the other side, it’s showcasing 125 years of chiropractic excellence. This is a special way because in many other professions, they have challenged coins. In fact, one of my patients gave one to me. I felt blessed that they did so, and it was a celebration of their profession.

And you could do the same in celebrating, maybe, you know, another chiropractor that mentored you. Maybe there’s an instructor that you’d love to share this with a state association leaders or just a friend, a family member, or a colleague that has made a difference in your life. FRCP your dollars. Go back to our national funding. So every dollar that comes back into the foundation is going to go back out in national advertising. So feel free to get your coin at FRCP dot or slash one, two, five. Now I just went through a birthday present box. Isn’t it nice for all of us just to open up something that really makes us feel good and happy in these days. And the answer is yes. So if you’re a member of the foundation, you have a birthday box waiting for you. How do you get it? You can see there’s a line there that really opens it up.

It’s it’s a clicking go and you found your birthday box ready to go. This is how you get your staff members excited too, because if you’re not passionate about what you’re doing, your staff will know, and I know you’re passionate cause you wouldn’t be on this. Facebook live with me right now. If he didn’t want to celebrate chiropractic 120 fifth anniversary. Now let’s go over some updates, fabulous updates from the foundation. One of them being very important and that’s today on thrive global as thought leaders, we need to be able to share with our community more than just, yes, we do chiropractic adjustments, but we really care about their health. And as I said, we’re in a pandemic. So one of the ways that we can share with our community is getting on our platforms, Facebook, LinkedIn, and Twitter pages on thrive global. Today, you can go on our FRCP Facebook site and you will see an article about how to blow off steam today.

And what does steam stand for? Steam is an acronym for stretching, strengthening, having a cup of tea, meditation and mobilization. Isn’t that what chiropractic really wants for all of our patients be able to enjoy your day by enhancing your health and really having the excitement of being able to ensure that you’re not just drilling down into your computer, but that your chiropractor’s reminding you on how to blow off some steam. And that’s the way that we capture their, the audience. We give them information that’s relevant to them right now. I know personally behind my screen, 16 hours a day can be really difficult, but as we start to help our audience and our community learn more about what’s important, just getting up and moving around or making yourself some tea or learning a little more about meditation. These are all fabulous things that you can do.

So get out there and help your community blow off some steam today. Let’s talk more about September. As you know, the foundation for the past four years has put together drug free pain management awareness month. This is an outstanding way for us to connect back with our communities and let them know that we do not offer drugs for painkillers so that we are helping them take care of their health in a natural holistic way. We want you to submit your September’s drug fleet proclamation to some of your council, men members is this important and why? Yes, it’s important if you don’t believe me. One of the top headlines that’s trending right now is on wall street journal wall street journal title today was state associations or States are looking for $24.5 billion in restoration for the opioid epidemic. $24 billion in litigation is being had right now.

And that’s because of the opioid crisis. So we want to still continue the awareness and the opportunity to connect with the community representatives and a proclamation. Isn’t a fabulous way to do that. Also, if you want to reach out and bring your proclamation as well as a new ebook. Now look at this beautiful new ebook. This ebook is a opportunity to open the conversations. It’s talking about our effective drug free FirstLine approach to pain. Remember 50 million people during a pandemic are actually creating a world of more sadness and depression that we need to help them with those 50 million suffering in chronic pain need to know. We care need to know that we’re right there with them. And that trying a non-pharmacologic logical option is right there with you in your practice. These pages, we’ll talk a little bit about chiropractic care and more importantly, how they can find your office. So that ebook should be on your website. I’m hoping that you’ll put it out there on a LinkedIn article, or maybe you’ll put it onto a E newsletter that you’re sending out to your patients. Don’t even be afraid to do a YouTube video, just flipping through the book and talking about correct.

Okay, take care.

We’re here to help you in marketing. The August monthly roadmap is out and it’s a click easy step through your, your front desk and your chiropractic assistant or your office manager should be aware of this roadmap resource because week by week, moment by moment with you, it’s going to give all of the ways to which we can connect with our patients. It happens to be for August. We’re focusing on motor vehicle accidents, her particularly, um, in the personal injury, we have one infographic that you can see on the other side of the screen, the sign about chiropractic’s role in personal injury cases, more specifically, maybe an MBA. We bring this up because we want patients to think of us first, when they’ve been injured, not last, which is how oftentimes being 25 years in this profession. I see patients that come in years after an injury.

So we want them to be fully aware week by week on what we do, especially if they’ve been in an accident. Now I want to thank you for being part of the foundation. If you’re not frcp.org, we’ll help you get more information. Don’t forget. Next week, we have a fantastic opportunity to be back here on the Facebook with ChiroSecure, ready to listen to another opportunity and information that they so generously give you week by week. Last but not least, remember when we get together next time we will be celebrating 125 years of chiropractic Goodness. It is you that makes the difference. It is your messaging to your community, that makes us one of the fastest growing healthcare professions in the nation. And I am so proud to call you my colleague and I’m hoping you’ll join me in celebrating September 18th. Happy birthday chiropractic!

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