Welcome to the Chiropractic Assistant Section @ Chiro.Org! This section provides articles on CA training, billing practices, office management, practice and personal growth, and patient education.
This section was compiled by Frank M. Painter, D.C. Make comments or suggestions to Frankp@chiro.org
Chiro.Org is proud to support AECC and the ICPA for their continuous research into the health benefits of chiropractic care. Please offer them your financial support.
Personal Growth
Who Do You Think You Are? Your Perception Creates Your Reality
While, arguably, some people experience a better all around educational
experience, the bottom line is, YOU are ultimately responsible for your success or failure, both in business and in real life. It’s all about what YOU create. That’s why there is a discrepancy between being at the top of your class and your level of success /failure/mediocrity in the real world! Learn how personal growth books and affirmations can help you become the person you want to be!
Your Adversity Quotient
For a very long time it was believed that IQ (Intelligence Quota) was the primary determinant of success. It turns out IQ has virtually nothing to do with success in life. Then a few years ago Emotional Quotient (EQ) was thought to be a significant indicator of success – and yes, to some degree it is. But more recently, Paul Stoltz, PhD has used the research of Dr. Albert Bandura on Self-Efficacy to demonstrate that peoples’ AQ (Adversity Quotient) probably has a much more dramatic impact on their ability to succeed than anything else.
The Personal Growth Book Shelf
This is our Amazon Book Store. You get great prices, and Chiro.Org gets a small commission for every purchase you make. Thanks for supporting Chiro.org!
CA Training
Join the Chiropractic Assistants E-Mail List
This is a forum for Chiropractic Assistants to discuss professional issues, debate problems that arise, share experiences, ask questions and exchange ideas. All CA's are welcome to join, as are ALL others employed in the Chiropractic field. The website is
ChiroAssistants
Office Procedural Manual
This 66 page Adobe Acrobat (236KB) file may take several minutes for it to load to your machine (unless you're on high-speed). Do you need a copy of the free Adobe Viewer?
The Role of the Chiropractic Assistant
An assistant is someone who helps or assists another person. In this case, the chiropractic assistant assists the chiropractor in the two criteria for a successful office: patient management and office management.
Creating and Nurturing a Successful Chiropractic Assistant
You know you need a chiropractic assistant (CA), but how do you make that step and allow your office to make that transition? Will that position expand your practice or exasperate you? How do you train a successful CA and how do you keep them motivated once the novelty has worn off?
Ever Have a Patient Flirt With You?
The problem is so common, there's even a name for it: transference. It's when a patient confuses gratitude or compassion for love. Some imagine they are falling in love with the doctor. Others, given the physical nature of the encounter, mistake physical contact for sexual overtures.
Check out Chiro.Org's FORMS section
Online forms are available, both paper and "interactive", for auto accidents, narrative reports created on the fly, X-Ray reports generated on the fly, examination forms, personal information, and insurance information forms. This is a very useful section...Thanks Joe!
The Attitude of an A+ C.A.
Two major ingredients of an A+ attitude are having a mission and purpose and a respect and conviction of this mission and purpose. If C.A.s understand the clinic's mission and purpose, they will communicate with an attitude of confidence and certainty. If they respect the mission and purpose they will also communicate with conviction.
The Key to Patient Compliance and Office Efficiency
Problems arise when your patients don't really know what is expected of them. You have to outline your expectations and then train yourself and your staff how to implement agreements with each patient.
Explaining the Subluxation
Our models of the subluxation and goals of care have evolved as our understanding of the biomechanics and neurology of joints has expanded. The database available to the chiropractor today is much larger and more accurate scientifically than what was available to our profession’s pioneers when they originally formulated subluxation theories in the late 19th and early 20th centuries. In addition, recent chiropractic patient surveys reveal more clearly what benefits patients hope to gain by receiving chiropractic care. This information gives us new insights as to how to direct our explanations to best fulfill our patients’ needs.
Creating a Chiropractic-Based Patient Education System
Many chiropractors may ponder why bother to educate patients, but it is well known that a better-educated patient make better decisions about appropriate health care.
Honoring Your Patients by Teaching Them Life's Rules
One of the greatest temptations for a chiropractor is to make your patient’s health problem your problem. This is an especially common mistake among male chiropractors who see “fixing things” as a major source of self-worth. (This is why we don’t like to ask for directions—it makes us feel incompetent.) This internalizing predisposition only obscures opportunities to grow the patient’s understanding and appreciation of chiropractic.
The Mission: Educating Families about Chiropractic
As chiropractic assistants, we serve our doctors and clinics in two capacities: assisting in administrative procedures and policies that manage the "business" of the clinic; and educating
our patients and others in our community about the benefits of chiropractic care.
Your Attitude Affects Your Health
It has long been a popular notion that "dis-ease" is something that happens to us, something outside our control. Disease is an outsider that invades our bodies, rendering us helpless to resist. Excellent health, the opposite of disease, is viewed as a blessing bestowed only on a select few. It is precisely this viewpoint that sometimes keeps us from experiencing the optimal level of health.
Computer Terminology
If you’re using a computer in your office, you can never know too much about its operation. For that reason, this article is devoted to information about computer networks.
Practice Growth
The ABCs of Inter-Professional Marketing – Learn to identify medical physician’s needs and objections to working with chiropractors
Chiropractic marketing to medical physicians has traditionally focused on campaigns dedicated to letters of introduction. These campaigns have had consistently lackluster results for most chiropractors. It’s understandable that some doctors of chiropractic feel certain trepidation when considering personally approaching a medical physician, but they shouldn’t. Surveys illustrate that medical physicians want to learn more about chiropractic care and that they prefer personalized presentations focused on scientific literature. [1]
Nine Common Business Mistakes
From a strictly business point of view, there are nine common marketing mistakes made by chiropractors that prevent the chiropractic profession from moving beyond a market percentage of 6 percent. The intention of this article is to bring these mistakes to light so that more chiropractors and chiropractic itself may move beyond survival by obtaining an appropriate percentage of the health care marketplace.
Health Professional: Practice-Building Tip
Please keep in mind a fact
of life: "Doctors need patients. Patients do not need you as their doctor. You can be easily replaced." The key (yp practice building) is simply this. You are in health care. Thus, you are concerned with correcting health problems, maintenance, prevention, and monitoring a patient's health status according to your scope of practice. To accomplish this, a simple act is necessary. That is, every patient that leaves your office departs with an appointment card for a specific future date and time --be it a week, a month, or several months in the future. Assure that every patient is convinced that you care about them, that they occupy a special place in your thoughts.
Cultivating Relationships with Medical Doctors
Notorious bank robber Willie Sutton was once asked, "Why do you rob banks?" "Because that’s where the money is," he replied. So where should we be looking for patients? Let’s take a tip from Willie Sutton: Seek them from medical doctors, because that’s where the patients are.
Niche Marketing for Chiropractors
Finding a niche sometimes just happens. For example, when I was in practice, I also was active in racing cars on road courses. Since I knew the physical stress a race car driver and even members of his pit crew undergo when participating in that sport, it was natural to offer my services to that market. I wanted to make it easy for the people in my niche to get familiar with my chiropractic services. One of the things I did was to bring a portable adjusting table to the races. I also had a sign in my pits which stated, “Free chiropractic consultation to race car drivers.” The drivers visited between races, bringing along members of their crew, which was usually comprised of family members. The driver’s crew watched while I administered palliative treatments to the driver.
Four Essential and Inexpensive Ways to Build Your Practice
Some of the most successful practices I have ever been privileged to work for or visit use these four simple tools to build their practices, and they do it without the use of any outside advertising.
Building a Winning Chiropractic Team
The most successful people surround themselves with incredible teams. Yet so many chiropractors have a distorted attitude about their staffs. Some doctors hold onto ineffective team members because they shudder at the thought of hiring and training someone new. So, begin by retooling your attitude about your team. Value and esteem your team members for the right reasons: Not out of fear, but out of mutual respect about the incredible difference that they make in your practice.
Creating a Family-Based Practice
If there’s one thing chiropractors have in common, it’s their search for the secret of how to attract and retain a larger share of patients in their communities. Reaching and attaining your percentage of that market can seem like a complex number game, but there is one simple and effective way it can be done, and it starts with a family focus. Can you imagine the impact it would have on your practice enrollment if instead of marketing your services to singular patients and their individual health problems, you began to focus your efforts on educating and enlisting entire families into a chiropractic wellness model that mirrors your own lifestyle?
Public Relations on a Shoestring Budget
The shoestring budget—most entrepreneurs know it all too well. But even if you don’t have much to spend, take heart: There’s no rule of thumb on how much capital you should allocate to your public relations efforts. Besides, you can more than make up for a shortage of cash by promoting yourself creatively. If you’re looking for some advice, here are a few guidelines that should help you determine where to spend your PR money and energy.
What People Value When Choosing a Doctor
A recent poll of 2,267 adults, surveyed by Harris Interactive® for The Wall Street Journal, revealed that interpersonal skills were of greatest importance to patients. It’s no surprise that patients changed doctors due to failures in this regard. Fourteen percent changed because they didn’t feel their doctors listened to them carefully, 12 percent felt as though their doctors didn’t spend enough time with them, and 11 percent felt they weren’t treated with respect. Read the results of the survey now!
Position Your Practice to Market It: Define Your Practice’s Unique Benefits to Set Your Mission
Even the most experienced chiropractic practitioners often make a common marketing mistake: They shortchange the value of developing their mission and positioning statements. Of course, it’s only natural to want to jump right in and advertise to bring new patients in the door. But this can be a big mistake. Before you can successfully market your practice to others, you must clearly define for yourself the unique benefits of your practice.
Getting Known in Your Community
One way to become better known in your community is through contact with local businesses and factories. Place a telephone call to a local shop or factory, asking for the personnel department. Inquire as to the name of the personnel director or plant secretary. Send a letter to the shop in care of this person (see sample below).
Using Contests to Involve Kids with Chiropractic
Holidays such as Mother’s Day, Christmas, Easter, 4th of July and Thanksgiving are a great time for contests that motivate children and get them into the office. In fact, it’s not necessary to build a contest around a holiday — you could structure the contest around some aspect of chiropractic care.
Doctors - Help Your C.A.s!
A few months ago we ran an article about the pet peeves of doctors, issues that have been brought to our attention over the past few years of seminar speaking. Now it’s time to turn the tables — and air the pet peeves of C.A.s. We’re putting it in writing because C.A.s don’t always feel that they can confront the doctor directly. Obviously, that would be the ideal situation. But since that can’t always happen, we’ll play the surrogate role and do it for you. Here are some of the pet peeves as they’ve been discussed with us.
Billing and Coding
Meeting Medicare’s Documentation Requirements
For a service to be reimbursable through Medicare, the documentation must show clinical necessity for the patient's care. There are several essential elements for required Medicare documentation, including demonstrating a subluxation and thoroughly documenting both the initial visit and each subsequent visit. Let's review that now..
What is Assignment of Benefits?
“Assignment of Benefits” is an arrangement between you and your Insurance Company, asking them to send your reimbursement check directly to your doctor. Learn more now.
Letters to Improve Insurance Cooperation
NOTE:
The following copyrighted letters are provided as a service to health-care professionals. You are welcome to use these letters with Insurers. However, they may not be sold, reproduced online, or in publications, or used in any group or commercial venture without the written permission of the copyright holder.
Initial and Progress Insurance Letters (Word format)
First Insurance Letter
This is the letter we send when we open a Med-Pay claim with a newly injured person. You should review your State's Insurance laws to rephrase the paragraph about Insurance Law and Interest Charges for late payment.
Initial and Progress Report Templates (Word format)
Initial Report Template
We advise Insurers in the first letter that we do not generate Initial or Progress Reports unless they are paid for in advance. This is the template for the Initial Narrative Report. You may also want to review theInitial Report Outline.
Records Request Slip
We advise Insurers in the first letter that we do not send copies of the patient file unless they are paid for in advance. This is the form we send.
Care Plans
Finally, along with the first letter we also send a Care Plan that most closely describes the patient's status and intended care. These 11 plans we developed by Robert Mootz, D.C. in his article "Chiropractic Care for Common Industrial Low Back Conditions". They are formatted so that you can print them onto your own letterhead.
Reduced Charges Agreement
In the case of financial hardship, you may have a patient who will not comply with your care plan because of the cumulative cost (and frequency) of the first month's care. In that case, during the report of findings, I use this form. I ask, "Knowing that we will need to see you between 9 or 12 times during the first month, (and already knowing how much I charge for each service), how much can you afford to pay for these visits, such that you will actually comply with the care plan?" Often people say "Oh, 45 per visit is fine". Then we document that and they sign the form.
End of Letters Section
Diagnosis Codes (ICD-9) Commonly Used in the Chiropractic Office
This is a cross-section of the ICD-9 Codes commonly used in chiropractic offices, listed by body region and complaint. These codes were compiled from the International Classification of Diseases (ICD-9) 9th Revision by PMIC.
Medical Records Copying Fees, listed by State
This page (*scroll down a bit) contains links to each State's Insurance departments, and advised you how much you may charge for record copy and transfer. Very handy!
The Difference Between “Consultation” and “Counseling”
The definition of a “consultation” in coding refers to a “second opinion”. However, if you are billing for talking to your own patient, it is referred to as “counseling”.
Modalities vs. Therapies
Someone asked: “Is there a difference between the two terms (Modalities vs. Therapies)? Does it have to do with attended/non-attended? Do different insurance companies have different wording for them?”. Susan McClelland provides the answer.
Bulletproof Your Coding, Fees, and Documentation
The cause of low reimbursement doesn’t always lie with the payer, however. It may be the result of improper coding and documentation by the provider. By understanding how the coding process works, we can more easily develop our coding and fee schedule for our office to assure maximum reimbursement. Let’s address the three major points your office must be aware of in order to assure proper reimbursement. You may also want to review our
Documentation Section.
Proper Coding for Billing Timed Therapeutic Procedures or Attended Modalities
The AMA CPT-4/HCPCS Level I allows you to bill procedures in increments of 15-minute units of time. But what should you do when you don’t use the entire 15-minute block? How do you bill? A CMS coding rule called the “8-minute rule” governs when and how many units of a procedure that you can bill, based on the time of performance of that and associated procedures. (The CMS transmittal that defines the 8-minute rule is AB-00-14 and was published in March of 2000.) Read more about this topic here!
Better Documentation, Better Reimbursement
Though Shakespeare’s character Hamlet never asked, “To document or not to document?” this question should be answered in your office as soon as possible. And here are two reasons why: Can you say “medical necessity” and “over utilization”?
Here’s another question to ask yourself, “Do you have a compliance program in your office?” Such words are the chosen language of the new millennium. If you haven’t started a compliance program in your office yet, now is the time. A program of self-monitoring and self-audit works to ensure that federal and state mandated issues are complied with in your office.
Insurance Assignment Program
It is our desire to assist our patients whenever possible. The following insurance assignment program allows you, our patient, to receive the care you need without undue financial strain.
Decoding Manual Therapy: Unraveling the New Rules for Reimbursement
In 1999 the CPT code 97140, Manual Therapy, replaced three codes: Joint Mobilization, 97260; Manual Traction, 97122; and Myofascial Release, 97250. Since that time chiropractors have been frustrated by continually having their claims denied for dates of service on which manual therapy was performed in conjunction with other procedures, including the chiropractic adjustment. As of April 1, 2002, a “bundling virus” in the National Correct Coding Initiative (NCCI) edits was corrected. Now chiropractors must be paid for neuromuscular reeducation (97112), massage (97124), and manual therapy (97140) when “performed on separate anatomic sites or at separate patient encounters on the same date of service as a chiropractic manipulative treatment (98940—98942).” This was perhaps the biggest reimbursement news of the entire year for chiropractors.
Practice Management
Can Doctors Delegate Care to Unlicensed Assistants?
Therapeutic procedure codes 97110 – 97546 are defined in the Physical Medicine & Rehabilitation section of CPT to include: "Physician or therapist required to have direct (one-on-one) patient contact" [during the reported procedure]. Some have argued that the codes permit a doctor to bill for this code by an unlicensed therapist since CPT’s definition does not say "licensed" therapist. But that argument is found to be invalid by contacting CPT for clarification, where CPT reports that the term therapist is referring to anyone who is licensed to perform the service.
Expand Your Capacity, Expand Your Practice
Expand your capacity for service, for commitment to chiropractic, for establishing clear priorities, for leadership, and for living, and you will expand your practice. The ability to do this starts with your vision for your future and your desire to make a difference in the lives of your patients, in your community, and in the world.
Mobile Computing: Charting With PDA Technology
In the early 1990s, I sat in front of my office computer, a 286 Hewlett Packard Vectra desktop model with a 10-gigabyte hard drive. The salesman assured us we would never need anything bigger or better. The salesman told me many other things, but I had no idea what he was talking about. I felt like I had been parachute-dropped into a foreign country, where the citizens spoke pure techno-babble. It was then that I decided that I had to be technically informed about computers or else I would be at the total mercy of salespeople.
Join the Chiropractic Assistants E-Mail List
This is a forum for Chiropractic Assistants to discuss professional issues, debate problems that arise, share experiences, ask questions and exchange ideas. All CA's are welcome to join, as are ALL others employed in the Chiropractic field. The website is
ChiroAssistants
Palmer College Chiropractic Technologist Training Program
This 4–semester program trains you in office management, improved communication skills, chiropractic philosophy, and also trains you how to take diagnostic quality X-ray films.
