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It's Time to Review
It is amazing to see the changes that are occurring in the acupuncture profession. Let's look at some of the news and events that have contributed to this growth and awareness.
Chinese Herbs and Pulmonary Fibrosis: A Case Study
"Mary M."* recently celebrated her 90th birthday. Even the former sheriff dropped by to kiss the hand of this diminutive retired teacher, to honor the years she interpreted for him during interviews with Latinas and Latinos.
Making Sense of an Increasingly Obvious Conclusion
Where's U.S. health care heading? Like it or not, the list of telltale signs is growing to a point that stands out to even the most myopic observer. Consider this list of facts as you look into the future of health care in the United States:
Acupuncture Rising: From Acupuncture Anesthesia to Assisted-IVF, Part 2
Acupuncture's cultural and historical roots go back to the emergence of Chinese civilization. For more than 2,000 years, acupuncture needling has been continuously practiced on the largest population in the world.
Footsteps of the Sages: An Apprenticeship with Dr. Kezhan Zhang
When I met Dr. Kezhen Zhang in May 2013, I was his translator and the integrity, creativity, and passion he demonstrated as a practitioner and advocate of the medicine convinced me to travel to Beijing to study with him.
Targeting the Bad Apples in the Bunch
While everyone was focused on the conversion to ICD-10, the Office of Inspector General for Health and Human Services released a new report on chiropractic titled "CMS Should Use Targeted Tactics to Curb Questionable and Inappropriate Payments for Chiropractic Services."
Too Many to Remember: Tips to Revive Your Ortho / Neuro Test Skills
When I was at Palmer in the mid-1980s, we were given a set of notes in one of our diagnostic courses. The notes covered approximately 70 orthopedic and neurological tests for various regions of the body.
Your Billing Questions Answered
I hear a lot of the following questions: I am afraid I may doing something illegal. I have heard I cannot have different fees for the same service.
Diagnose Sprain Injuries in MVA Cases With Dynamic X-Rays (Pt. 1)
Am I the only person to notice hospitals are doing a seemingly insufficient job lately in their initial radiological workup of motor vehicle accident (MVA) victims?
Which Way is the Energy Going? Are You Burning Yourself Out?
One of the simple methods that I use to define Yin/Yang theory to patients is to ask the question, "Which way is your energy going?"
Tailor-Made Knee Pain: The Sartorius Muscle
A patient was referred to my office after receiving treatment from various providers with no results. The patient was training for the Olympics as a marathon runner and was unable to run or walk without severe medial knee pain.
Designing a Fitness Plan (Part 1)
It doesn't matter if you come to my practice for pain relief, weight loss, healthy aging or something else. The formula I talk about for each patient's fitness strategy is pretty much the same.
Born to Energize the Human Spirit: Recollections of Sig Miller
Sig Miller, longtime executive director of the Association of New Jersey Chiropractors (ANJC), passed away on Sept. 17 after a long battle with cancer.
Dietary Fat and Prostate Cancer: An Important Update
K.M. Di Sebastiano and M. Mourtzakis published a review paper examining the role of dietary fat on prostate cancer development and progression late last year that does a stellar job of summarizing the available data on fat and prostate cancer.
F4CP Making a High-Impact Impression
The Foundation for Chiropractic Progress has released details of its 2016 strategy, certain elements of which are already in play. The strategy includes ads, posters and other resources available to all F4CP members.
Pro-Con: Swaddling for Newborns
The practice of swaddling has been used for thousands of years and was popular until the 1700s, when it was slowly abandoned by many cultures that considered it old-fashioned or barbaric.
The Concussion-Subluxation Complex
In the Aug. 1, 2014 issue of Dynamic Chiropractic, I reviewed some of the literature demonstrating the role of the chiropractic adjustment in post-concussive care.
Mechanism: Experimental Approaches to Understanding Acupuncture, Part 1
The clinical benefits of acupuncture are difficult to ignore, but also can be difficult to explain to a Western audience. For nearly 50 years, relentlessly inquisitive scientists and physicians have been working toward a conceptual model to explain acupuncture.
The Modern Application of Ancient Mei Rong
Chinese Medical Cosmetology (Mei Rong) has a well-documented and venerated history dating back to the Qin (221-206 BC) Dynasty.
Omega-3 Fish Oil: An Underappreciated Element of Men's Health
As a clinician with many male patients -- and as a man myself -- I am all too aware of the fact that we like to convince ourselves that we are doing great, when that may be the farthest thing from the truth.
One Size Does Not Fit All: Exercise and Nutrition According to Your Yin/Yang Body Type
There are countless new exercise and nutrition plans out there, emphasizing the latest ground-breaking research and claiming to revolutionize the way we view health.
North Carolina Acupuncture Board Files Dry Needling Lawsuit
In early September, the NCALB filed a complaint against the North Carolina Board of Physical Therapy Examiners over the issue of dry needling, a form of acupuncture that uses solid needles to puncture the skin and muscle tissue to relieve pain.
Acupuncture and Oriental Medicine in the West
We know acupuncture and Oriental medicine as the indigenous medicine of East Asia; in particular China, Korea and Japan are the countries of origin of this wonderful healing system.
November, 2001, Vol. 01, Issue 11
Insurance Terminology Defined
By Vivian Madison-Mahoney, LMT
Author's note: Because I have been so busy these past two months, I decided this month's article would be an explanation of the following common insurance or insurance billing definitions.If you would like me to provide more of these terms/definitions in subsequent articles, please let me know. I would like to offer my personal condolences and prayers to any and all of you or your loved ones who are suffering in any form or fashion because of the latest happenings in our country.
1. Adjuster: The insurance company's designated person handling the patient's insurance claim. The adjuster investigates and pays or denies the claim. The adjuster is also the person to get authorization from prior to beginning treatment in a workers' compensation case.
2. Allowed Charges: The maximum amount, according to the individual policy, that the insurance will pay for each procedure or service performed.
3. Assignment of Benefits: The patient's signed permission for the provider to be paid directly, rather than sending payment to the patient.
4. Authorization: Permission from the insurance company to treat the patient. Authorization is also the patient's approval for you to release records, and for you to be paid directly for your services. For a workers' compensation case, most states require that you obtain authorization from the carrier/adjuster or case manager to treat the patient.
5. Carrier: The insurance company or self-insurers' fund.
6. Case Management Services: The process in which the attending physician or agent coordinates the care given to a patient by other health care providers and/or community organizations.
7. Claim: Demand by the insured to recover payment under an insurance policy.
8. Claimant: The employee injured on the job, once said employee has been accepted for medical and/or indemnity benefits by the workers' compensation system.
9. Claims Attachments: Additional claims documentation needed to adjudicate the claim.
10. Claims Department: The department of an insurance company that handles and services claims.
11. Copayment: Also known as co-insurance. The copayment is the portion the patient pays when his/her policy does not cover 100%. This amount is pre-established by the policy and is due at the time of the office visit.
12. CPTTM Main Number: The five-digit medical procedure code assigned in the Physicians'Current Procedural Terminology CPT™ coding system to identify a specific medical service.
13. Customary Fees: The average fee charged in a geographical area by all like providers, or the 90th percentile of all fees charged for a specific procedure by comparable providers in the same geographical area.
14. Deductible: Amounts payable by the policyholder before the insurance company is obligated to pay benefits. Pre-selected at the time of policy purchase.
15. Dependent: A person financially supported by the policyholder; meets the legal requirement for inclusion in a policy.
16. Diagnosis: The art or act of identifying a disease or illness based on its signs and symptoms. Only an MD or a chiropractor can provide a diagnosis. Massage therapist licenses do not allow for diagnosis. Important: be sure the diagnosis on MD prescription/referral, the body areas you treat, and what you document coincide with one another.
17. Diagnostic Code: The statistical code number assigned by the World Health Organization for a specific diagnosis. The number appears in the International Classification of Disease, 9th edition. Also called ICD, or ICD-9-CM code. A physician assigns this code.
18. Disability: partial or complete inability to perform work duties.
19. Disability Compensation Program: Programs that reimburse insured workers' for loss of income due to injury or illness.
20. Disability Insurance: Reimbursement for lost income resulting from a temporary or permanent illness or injury.
21. Documentation: The process of record-keeping and documenting the patient's conditions; therapy; progress or lack of progress; recommendations; and patient management.
22. Employer Self-Insured Programs: Programs whereby employers with sufficient capital insure their own employees against loss of medical expenses and or wages, without contracting with a commercial carrier for coverage. Some of these companies contract with commercial carriers for the administration of their policies.
23. Employer-Sponsored Group Health Plan: A company-sponsored group health plan covering 50 or more employees. Primary to Medicare.
24. ERISA - Employee Retirement Insurance Security Act (federal). Self- insured employers, usually with a large number of employees, come under this act.
25. Established Patient: A patient who has an established chart and has received medical services within the last three years from the original physician, or from another physician of the same specialty in the same group practice.
26. Explanation of Benefits (EOB): Insurance company report to the patient or provider to explain the claims benefits paid, reduced or denied.
27. Fee Schedule: The schedule of fees that the insurance company lists in the policy, stating the maximum dollar amount the insurance company will allow for specific medical procedures performed.
28. Fraud: Deliberate misrepresentation of facts.
29. Group Policy: Written and purchased by an organization or association as a benefit for the employees or members. Employer, union, trade, professional, or other groups with common interests obtain group policies.
30. Health Insurance: A product written to provide protection against the policyholder's losses for the injury, illness or disability.
31. Health care Provider: Recognized licensed practitioner who provides health care to patients independently or pursuant, to the prescription of a physician. Florida LMTs, as well as massage therapists in other states such as Tennessee, are recognized health care providers of massage therapy services.
* Please notify me if your state recognizes massage therapists as health care providers.*
32. HCFA 1500 Form: (Health Care Financing Administration.) This is the claim form most widely accepted by insurance companies when billing for insurance-related services. Also known as the Universal Claim Form.
33. HMO (Health Maintenance Organization): A prepaid managed care, health care provider group practice with responsibility for providing health care services for a fixed fee to subscribers in a specific geographic location. Plan covers preventative services with little or no out-of-pocket expenses. In most cases, members must use the physicians and facilities authorized by the HMO.
34. IME (Independent Medical Evaluation): The examination an insurance carrier may require the patient to have performed by a physician other than the treating physician. This evaluation is used to make a judgment regarding the health-related status of the patient ,to determine the need for further medical services or to discontinue services.
35. Individual Insurance Plan: An insurance plan sold to individuals who are not eligible for medical insurance under a group policy, or to those who need more coverage than is available through their group plan.
36. Insured: The person in whose name the policy is registered, or the subscriber who contracts with an insurance company for insurance coverage. The insured is not necessarily the policyowner or the person being treated. The insured may also be a family member, dependent, or one given permission to drive your automobile. In short, the insured is the person protected under a given policy.
Click here for more information about Vivian Madison-Mahoney, LMT.
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