Guidelines vs. Care: Bridging the Gap
Billing / Fees / Insurance

Guidelines vs. Care: Bridging the Gap

Navigating Outside the Reimbursement Grid: A Practical Framework for Success

What happens when best practices for patient care fall outside what guidelines endorse or insurance will cover? More importantly, how can clinicians ethically and effectively integrate non-reimbursed services that improve function, reduce disability and support long-term outcomes? These are not just clinical questions; they are economic and policy challenges that directly affect practice viability and patient access.

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How Corporate Groups, MSOs and Insurers Are Reshaping a Once-Doctor-Owned Profession

The chiropractic profession is undergoing a quiet but profound transformation. For more than a century, chiropractic was defined by small practices, local providers and direct community relationships. But today, a wave of corporate consolidation – driven by private equity, management services organizations (MSOs) and increasingly, insurance-linked musculoskeletal programs – is reshaping who owns chiropractic clinics and how care is delivered.

Sam Wang, DC
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The picture may seem bleak, but denial helps no one. As I said at the beginning [Part 1, February issue], only by confronting reality can we design a better future. So, how do we move forward? Here are three ways to do it: change the financial equation, recruit students earlier, and participate and collaborate to increase practitioner income.

Dennis Short, DC
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Carpal Tunnel / Extremities / Neuropathy

It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.

Charles Annunziata, DC, CFMP
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Do’s & Don’ts to Avoid Delayed or Denied Payment

As chiropractors, we observe signs and symptoms as colors on an artist’s palette, melding them together to determine how they affect the speed, fluency, quality, and ease of activities of daily living. We communicate this vision to our patients in a report of findings. However, converting that vision into the International Classification of Diseases Clinical Modification (ICD-CM) coding language presents challenges.

Mario Fucinari, DC, CPCO, CPPM, CIC
Billing / Fees / Insurance

In the first part of this two part series, I reviewed who can request records, who can review them, what needs to be in the notice, and that Medicare cannot be overly burdensome with its requests. Now let’s consider how much time the reviewer must allow you to respond to the ADR, what they have to consider during the review, how long they have to provide you with the results, and how much information about the review they are required to provide you.

Ronald Short, DC, MCS-P
Chiropractic (General)

Have you ever seen a new patient, done your workup, explained everything, provided the initial treatment, prescribed some nutritional supplements, given them home exercises or a diet change, and then never seen them again? I posit to you that you may have missed the zebra patient.

Cecilia Duffy, DC, DIBAK

For decades, injured athletes have spent countless hours aggressively stretching their Achilles tendons with the misguided belief that a more flexible calf is less prone to reinjury and more resilient when playing sports. Recent research shows that this is not the case; and it turns out there has been a significant amount of research showing the easiest way to tighten injured and/or aging tendons.

Thomas Michaud, DC
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Your Secret Weapon Against Stress and Heart Disease

In today’s fast-paced world, the relentless pursuit of success often leaves little room for rest and relaxation. People often view vacations as luxuries, rather than necessities, amid the constant grind. However, the value of taking vacations extends far beyond mere leisure; it is a vital investment in both mental and physical health. Stepping away from the daily routine offers a chance to recharge, reducing stress levels that can lead to burnout.

Ronald Feise, DC
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