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Southwest Acupuncture College Brings It to Division 1 Athletes
When Michael Phelps' photograph with the distinctive round marks left by cupping went viral, the Division 1 student athletes treated through the Dal Ward Athletic Center at the University of Colorado (CU) could relate.
Dedicated to Defending Chiropractic
Whether you're a veteran DC or a first-trimester student, the name George McAndrews should be part and parcel of your professional vernacular, as familiar as the word chiropractic.
Can a Multivitamin Reduce Breast Cancer Recurrence?
There is a great deal of controversy regarding the value of multivitamin supplements in cancer prevention. However, with respect to preventing breast cancer recurrence, an important study was published in the Journal of Breast Cancer Research and Treatment in 2011 by Kwan ML, et al.
6 Steps to Make 2017 Your Best Year Yet
People often ask me what defines success. Success, for me, is simple: doing exactly what you want to do in life. Whether it's the kind of practice you run, your life at home, your hobbies or something else, it's achieving anything you put your mind to.
Molecular Motors: Tiny Machines Behind the Rhythm of Life
In the clinic, we aim to restore healthy patterns of movement for qi that has gotten trapped or misdirected, or may have even collapsed. We may be focused on freeing stagnation, releasing heat or redirecting counterflow qi, but it often comes down to helping re-establish a flow of sorts.
All Fiber Is Not Created Equal
Sometimes the best place to start is at the end. So, the conclusion of this article is that all fiber is good ... but some fiber is better. Let's break it down. There are two main types of fiber: soluble fiber and insoluble fiber.
Herbs for Digestion: The Power of Bitter
Many cultures (and indeed herbal clinicians) around the world have long respected the role of bitter herbs and foods for promoting digestion. For example, aperitifs – drinks consumed before a meal to stimulate appetite and digestion – were originally derived from bitter herbs.
Branding: Set Your Practice Apart
Dr. Brad started his practice seven years ago on a shoestring budget. He created his generic logo in five minutes using a website because he didn't have the time to figure out how to make something special.
Meshing TCM With Environmental Pediatrics: Where's the Overlap?
Pediatrics has a long history within Chinese medicine dating back to the late Han dynasty (i.e., the late 200s CE), with the two primary areas of emphasis being herbal medicine and xiao er tui na (pediatric massage).
DVT: Know the Signs and You Could Save a Life
I lost a friend several months ago. He died from a pulmonary embolism (PE) secondary to a deep-vein thrombosis (DVT) that originated in his lower leg. Bobby was in his mid-60s, soft-spoken and had a big heart.
A Letter to the Profession from the New President at AAAOM
Volunteering for a national, nonprofit organization brings with it such highs, lows, and accomplishments, as well as a steep learning curve.
Little Sticker, Big Impact
It's the end of an election year. Hilary Clinton and Donald Trump were the subject of conversation for everyone, everywhere for the entire 2016 calendar year. I don't think any of us can deny that this election affected us all very deeply on a personal level.
2016: A Year in the Life of Acupuncture
Happy Holidays, may you, your family and friends have peace, joy and blessings throughout this special time of year. As 2016 comes to a close, we can look back and celebrate the many events and accomplishments for the profession of acupuncture.
News in Brief
New President / CEO Takes Office at Yo San University. Electroacupuncture for Constipation?
Chiro School Reunion: Whatever Happened to...?
I opened the door to the closet slowly, carefully, since I knew it contained a large number of precariously stacked file boxes. It also held numerous outdated gizmos with electrical cords of various lengths that could trip or strangle a person.
Assessing Core Stability and ROM: 5 Basic Checks
One of the first steps in addressing core stability is assessing static posture, ranges of motion, and motion of the pelvic bones, sacrum, femurs, lumbar spine and thoracic spine.
Another Chance to Make a Difference
Just a few months ago, "the worst natural disaster to strike the United States since Hurricane Sandy" hit Louisiana. During this storm, one area experienced 31 inches of rain in 15 hours as almost 7 trillion gallons of water rained down in just one week across the state.
End of an Era Looms at NYCC
New York Chiropractic College recently announced that Dr. Frank Nicchi will retire in August 2017 after 36 years with the college, the past 17 as president.
A Simple Protocol for Holiday Stress
It's winter, a time when we should be deep in reflection, eating warming foods and sleeping long hours. Following nature's rhythms, we restore our bodies and minds in preparation for the renewal of spring.
Overuse Injuries in Young Athletes (Pt. 2)
Most overuse injuries are benign, but there are some high-risk injuries that, if unrecognized or inappropriately treated, can result in significant loss in time from the sport or even require leaving the sport.
A First for the Profession: CCE Accredits First Chiropractic Residencies
The Council on Chiropractic Education (CCE) has awarded accreditation to all five chiropractic residency programs currently administered at Veterans Administration facilities, "the first residency programs in the nation ever to be awarded this distinction, a significant advancement in the evolution of chiropractic education," according to a VA press release announcing the milestone.
What We Can Learn From Spine Surgery
Patients with lumbar stenosis presumably present for conservative care to improve their quality of life and avoid surgery. However, providing clear guidance to these patients can be difficult for a number of reasons.
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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