Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 72

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time.

As I have been telling you for over a year, “Get your house in order.”

They are Here

Last week it was Medicare, this week it is Optimum Health, formally known as ACN. They have adopted formal policies to do retrospective reviews on manual therapy techniques and others...the codes chiropractors are required to use, as well as additional services. They outline in their policy change that you are contractually bound to, the parameters for a retrospective review. Their policy guidelines were released 2 days ago and as always, CMCS Management strives to keep you ahead of the rest of the profession to prosper and sleep well at night.


THEY ARE COMING AND AS A MEMBER YOU HAVE AGREED TO THIER PARAMETERS BY BEING A PARTICIPANT, NO MATTER THEIR POLICIES, FAIR OR NOT. I am not saying their parameters are good or bad, but you need to get a copy of the policy and read it. You are at the mercy of your own records.


In addition, they claim 25% of notes submitted are illegible. This is a very bad place to be and will be reason to lose a retrospective review and cause you to start writing very big checks giving money back. That is the game of the carriers. In fact, President Obama, in his speech to the nation this week, claimed Medicare fraud was one of the prime areas the federal government is aggressively going after to reduce the deficit. Illegible notes will help this country reduce the budget deficit. Are yours legible? Medicare last week, ACN this week, and who will be next week?


If you haven't had your charts audited, what are you waiting for?? Stop procrastinating...Fax me a blank template of your inital evaluation and a SOAP Note to 661-843-1062. Getting a lawyer to simply respond to a retrospective audit request with an acknowledgement letter will cost more.


The insurance companies are telling you formally, publicly and very loudly, "We are coming." Be prepared. I am disheartened every week when another doctor calls me after the fact, saying they should have listened to me...I enjoy the calls saying, "Thanks. We were ready for them and they went away." Take action right now if you haven't...Mark

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