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In Memoriam: Dr. Donald D. Harrison
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Written by TAC Staff   
Wednesday, 26 October 2011 21:27
harrisondonalddcDonald D. Harrison, DC, PhD, MSE, (also known as Deed by his family and early life friends) passed away 2 months ago on Wednesday, July 20th, 2011. He was 65 years old residing in Wyoming with his loving wife Dr. Sang Harrison. Due to complications from Type II Diabetes, he passed peacefully with his wife Sang, his son Deed, and his daughter Holly by his side. 
 
Don's Chiropractic Path
After struggling with a back injury, Don sought out Chiropractic care. He was so impressed with the recovery of his back injury due to Chiropractic care (when standard medical management had failed for him) as a patient that he wanted to become a Chiropractor. He earned his Chiropractic degree in 1979 from Western States Chiropractic College. 

From 1979-1985 he and his partner at the time, Dr. Dan Murphy, owned and operated Bell Plaza Chiropractic Office in Sunnyvale, CA. In 1985 he sold Bell Plaza and moved to Evanston, WY with his Wife Sang and his boys Erin and Deed. Together, Don and Sang started Evanston Chiropractic Center (1986-1992)

At the age of 47, in 1993, Don and Sang made the decision to concentrate on spinal research and he went to graduate school and received his MSE in Mechanical Engineering in 1997 from the University of Alabama in Huntsville, and a PhD in Applied Mathematics in 1998 from the University of Alabama in Huntsville (UAH).  Don had to get special approval from the UAH education board to work on these two difficult degrees simultaneously; his tenacity and unmatched work ethic allowed him to persevere.

Dr. Don's Professional Activities and Accomplishments.
He was a Member of the Board of Directors of the International Chiropractic Association, was an ICA member since 1977, was nominated as a Fellow of the ICA (FICA in 1990), and received the ICA's Chiropractor of the Year award in 2006. Don was also the ICA Representative for the state of Wyoming in the years 1986-1993, 2001-2004. And he was the past President of the Wyoming Chiropractic Society in the late 1980's. 

Dr. Harrison was an Extension Faculty member for several Chiropractic Colleges including: Life Chiropractic College-West, Life University, National Chiropractic College, Cleveland CCKC, and the Universite du Quebec a Trois-Rivieres.

Dr. Harrison became one of the most published Chiropractic researchers in the history of the profession; with over 80 peer-reviewed publications to his name. These publications appeared in the top physical medicine, orthopedic, biomechanics, and spine research journals around the world. Dr. Harrison was voted in as member of the prestigious orthopedic research society: The International Society for the Study of the Lumbar Spine (ISSLS). 
 
Don's Memorial Funds or Donations 
In lieu of flowers and cards, the family of Dr. Donald Harrison has established a memorial fund in his honor to further Chiropractic education and research. Send donations to CBP NonProfit, Inc. P O Box 1590, Evanston, WY 82931-1590. Or online to donate specific numerical amounts; enter for 'Dr. Don Harrison Memorial Fund' in the comment box:  http://www.idealspine.biz/c-25-cbp-non-profit-research-cd.aspx
 
 
Stay on Purpose: A Report from the Life West Wave Conference
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Written by Arlan W. Fuhr, D.C.   
Wednesday, 26 October 2011 20:04
Over the summer, I attended and spoke at Life West’s investiture of Dr. Brian Kelly, the college’s new president. When Dr. Gerry Clum, the retiring president of Life West, prepared to hand the reins to Dr. Kelly, he gave him some final advice:  “Don’t have your investiture in August because you will have very few people attend.”  

lww2011At the ceremony, which attracted more than 1,000 attendees, Dr. Clum promised that would be the last advice he’d ever give to Dr. Kelly, with a wink and a chuckle. But all joking aside, the enthusiasm at Life West Wave Conference was contagious. The event attracted students and prospective students, alumni and individuals from all corners of the world. 

Even though California, the state where the event was hosted, has experienced some hard times recently, the speakers at the event offered only optimism. I heard a common theme throughout the weekend, that if you truly care about your patients, your practice will thrive, despite negative external pressures. From new graduates to those nearing retirement, every speaker was absolutely confident they were in the right profession and had a mission to fulfill.

Sometimes we get so bogged down in our daily challenges that we lose sight of the purpose of chiropractic. Impressively, it remains the number-two health profession in the world and its significance and effectiveness will transcend the barriers of insurance changes, economic downturns and more. When I started practice in 1964, the outlook for chiropractic was very uncertain. We simply kept on keeping on, and, lo and behold, these past decades have been golden in so many ways.

Those of us who have kept our patients’ welfare at the center of our mission will continue to succeed in this profession. The enthusiasm about the future of chiropractic at the Life West Wave Conference was proof of that imperative. Having people excited to catch and ride the wave of chiropractic, and always looking ahead for that next big swell is what makes our profession great. 
 
Dr. Arlan Fuhr travels extensively to chiropractic seminars, conferences and events around the world. He will be providing his insights and perspectives from these visits as a regular guest commentator for The American Chiropractor. You can reach him at 602-445-4230 or email This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
 
Doing the Right Thing the Wrong Way Can Cost You!
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Written by Ray Foxworth, D.C.   
Wednesday, 26 October 2011 19:51
Yes, I know. Sounds strange doesn’t it?

S
trange as it sounds, it is far too familiar to those of us who work with doctors on a daily basis to help improve their documentation, billing, coding and collections. We see examples of doing the right thing the wrong way every day in chiropractic clinics across the nation. It happens when doctors attempt to do the right thing in helping patients with no insurance or limited benefits by “tweaking” their documentation and coding to result in an overall lesser charge for the patient. 

rightwaywrongwayBe honest. Have you ever had a patient that required more than a routine workup but you used a lower level exam code because you knew they had no insurance coverage? Perhaps a 99202 instead of a 99203?  No big deal right? 
 
WRONG!  
Or, as long as we are being honest, have you had a patient that you adjusted full spine, 4-5 levels, and you only charged a 98940 for 1-2 levels?  No big deal right? 
 
WRONG!  
Ok, let’s try one more. How about this scenario? Have you ever had a Medicare patient that required a detailed workup and x-rays and you charged a lower level exam code or just billed for 2 x-rays when you actually performed 4, because you know Medicare doesn’t cover your exams or x-rays? No big deal right? 
 
WRONG!
All of these are examples of down coding your services in an attempt to strike a balance between what insurance coverage may allow and what you feel your cash or underinsured patients can afford. 
 
We all know if you don’t perform a service you should not bill for it…it is called fraud. However, few may be aware that if you DON’T report what you did and DON’T charge for services you would normally bill to insurance because you are seeing a cash patient there is also the potential for fraud because of a dual standard of care and a potential dual fee schedule. 

Not to mention, down coding or failure to bill Medicare patients can be considered an inducement and subject to serious fines and penalties according to the Office of Inspector General and CMS.
 
The bottom line is that down coding can be perceived as illegal and inappropriate just as up coding is when it is used to allow you to bill differently based on whether the patient is insured or a cash patient. It is “gaming” the system pure and simple. It is doing the right thing to help the patient, but it is being done the wrong way and it can cost you.  

What drives doctors to down coding or not charging for all their services?  It’s really quite simple. There is the need to maximize reimbursements by billing your UCR fees or contract rates to insurance companies, but you haven’t found a good way to make care as affordable as you would like for your cash and underinsured patients. 

So the only tool you have is to “tweak” the documentation, coding or billing to allow you to do what you would like to do. It really is that simple, but it can REALLY be very costly if you are audited!

It really is one of the most logical, legal, and ethical ways to allow you to accept a lower fee than your normal UCR clinic fees.

So how can you document as you should, bill as you should and code properly for maximum reimbursement when there is insurance available and still be able to help the cash patients?  You MUST join and encourage your patients to join a cash discount program, commonly known as Discount Medical Plan Organizations or DMPOs. 

It really is one of the most logical, legal, and ethical ways to allow you to accept a lower fee than your normal UCR clinic fees. It allows you do what you are attempting to do now…help the cash or underinsured patients. But, with a network contract, you can do it without “tweaking” your documentation, coding and billing and you avoid running afoul of dual fee schedules or illegal inducements. 

So, do the right thing! Document correctly. Code correctly. Bill correctly. And, consider joining one of the cash discount plans which allow you to “contract” with cash and underinsured patients so you can discount correctly. 

The contract model is not new. The contract model is what allows you to contract with multiple insurance companies for different rates for the same codes without it being considered a “dual fee schedule”. 

Cash discount plans simply provide you the protection of a “contract” and allow you to document, code and bill properly and still pass on some savings to your cash and underinsured patients. 

If you are documenting properly, coding properly and billing properly, good for you! Just make sure you don’t do the right thing the wrong way by trying to use a “bookkeeping reduction” or Time of Service discount that can be open to interpretation as to what is a “reasonable” discount. Far too many clinics use these tactics or strategies improperly in trying to help cash and underinsured patients. 

Most all patients are familiar with “buying clubs” like Sam’s Club and networks and they don’t hesitate to join these plans to save money!  A good cash discount plan solves so many of the potential problems for you as a provider when it comes to avoiding dual fees and creating inducements. And, they really help the patient…the RIGHT WAY!
 
THE MAIN THING IS....THERE IS NO WRONG TIME TO DO THE RIGHT THING!
If you’re offering discounts and you are not sure you are following state AND federal rules and regulations, doing NOTHING is NOT an option! There is NO good reason to put off solving this problem when it can be fixed so easily! Take action and start looking at the cash discount plans that are available and use the one that best suits your practice.

Article submitted by ChiroHealthUSA

Dr. Foxworth is a certified Medical Compliance Specialist and President of Chi­roHealthUSA. A practicing Chiropractor, he remains “in the trenches” facing challenges with billing, coding, documentation and compliance. He is a former President of the Mississippi Chiropractic Association and served 12 years on the Mississippi State Board of Health. He is a Fellow of the International College of Chiropractic, as well as member of the ACA. You can contact Dr. Foxworth at 1-888-719-9990 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it
 
Multidisciplinary Practices Require Keen Compliance Tactics
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Written by Mark Sanna, DC, ACRB Level II, FICC   
Wednesday, 26 October 2011 19:24
M
any healthcare providers have begun to recognize the potential benefits — in patient care and in practice growth — that can be obtained when MDs, DOs, DCs and PTs work together. By working together all participants add valuable expertise to their practices, resulting in improved patient care, convenience, and better patient service.

multidisciplinarypracticeIf you are thinking about transforming your clinic into a multidisciplinary practice — one that offers multiple healthcare and healing professions and disciplines in one legal entity — you cannot afford to be misinformed. Misinformation can lead to noncompliance. And noncompliance is something you do not want to happen.

A failure to be in compliance means that you will not be allowed to participate in federal or state funded programs; you could lose your license to practice; and you could be subject to civil and criminal penalties.

To avoid legal problems and to make sure you create a clinic that helps your patients in the best possible ways, let’s look at a number of things you should put on your checklist:
  • Engage a healthcare attorney. If you are considering establishing a multidisciplinary clinic, hire a healthcare attorney in the state in which the multidisciplinary practice is to provide services. State corporate laws and scope of practice regulations control how multidisciplinary practices must be formed and operated. These requirements vary dramatically from state to state. Only an attorney who specializes in healthcare can make your corporate structure complies with the law.
  • Take a multidisciplinary approach to compliance. Your professional support team should take a multidisciplinary approach, with non-lawyer professionals working in conjunction with lawyers. When lawyers and other professionals from various disciplines such accountants and management consultants work together, the results are excellent. The professionals from the nonlegal disciplines are typically pleased with this approach, since they no longer have to attempt to understand or interpret laws. Each specialist works within his or her expertise.
  • Hold proper shareholder meetings. The courts consider observance of corporate formalities as important evidence in deciding whether or not your professional corporation is 2 operating as a legal entity. Properly held meetings of shareholders and directors are the key to a formal operation. These formalities are often the source of authority for those who act on behalf of the corporation. Officers, directors and employees who act without authority (that is, without proper approval of the shareholders or the directors, properly made and recorded in the corporate minutes) may be personally liable for their acts. If your state’s legal structure requires you to form two or more corporations to establish a multidisciplinary practice, meetings must be held for each corporation. Each corporation must have two meetings: One for the shareholders to re-elect the directors and one for the directors to have a business meeting. Minutes must be taken, voted on and approved.
  • Review your corporate documents regularly. Your corporate documents are living entities and should not be shelved in a box but should be reviewed by a team of counselors on a regular basis to assure compliance. Your attorney should review the corporate agreements comprising your multidisciplinary practice, which describe the duties and obligations of each corporation to the other. Have your attorney check with your state to be sure that all required forms, documents, and reports are filed with the Secretary of State on a timely basis. Be sure to make your state aware if you hire a new medical director who is a shareholder. Be sure that your corporate documents reflect the new medical director’s financial contribution. Review the direction of your practice. Have any changes been made? If so, review them with your attorney to be sure that you are compliant.
  • Implement appropriate accounting procedures. Accounting is not just a yardstick to figure out how much money you made last year or what your tax liability is. Used properly, accounting also helps you identify trends in sales and expenditures. The ability to track and identify trends allows you to make decisions that can boost your profitability and enable you to avoid cash shortages. If you operate in a multiple corporate structure, pay particular attention to the invoicing between the companies. You must keep very careful, meticulous, well-organized records. One reason to keep good records is for tax purposes. If you ever get audited, the tax people are going to want to see invoices and receipts, not just cancelled checks. If you can’t 3 produce the invoices and receipts requested during an audit, the IRS will not be understanding about it! Be sure that your accountant compiles a quarterly audit of the documentation for funds flowing between corporations. And be sure that all charges and receipts are substantiated by invoices at “fair market value.”
  • Comply with Stark regulations. Under Stark regulations, physicians (including DCs) are prohibited from referring patients for certain designated health services reimbursable by Medicare or Medicaid to any entity with which the physicians have financial relationships. This law applies to virtually every multidisciplinary practice, as designated health services include physical therapy services and rehabilitation. Even referrals within the same corporate entity or partnership are subject to this restriction. As a result, unless a legal exception from Stark can be satisfied, such relationships are fraught with illegality.
  • Maintain an OIG compliance program. Your compliance program serves as prevention — not a panacea. Be sure that your compliance manual is up to date with your baseline audit; policies; procedures; record of ongoing training; reporting and corrective action; and ongoing prospective auditing reports. Keep your practice is up-to-date on all CPT coding changes by regularly checking updated coding resources.
  • Adhere to HIPAA compliance rules. Ask each patient to sign the HIPAA Notice of Information Practices and keep the document on file. Review all contracts with outside vendors and suppliers to be sure that they are OIG- and HIPAA-compliant. Check to make sure that you have HIPAA Business Associate Agreements signed for all applicable business associates to ensure that they are complying with HIPAA regulations. Remember that all new employees must sign a document stating that they have received or read a copy of your Compliance Policies and Procedures and a your Employee Office Policy. You should perform employee reviews minimally on an annual basis. Your practice team also needs feedback on how well they are carrying out their duties. Update job descriptions minimally once a year and ask affected employees to sign the updates. Keep a record of your employee reviews — even when favorable. (Employees should also sign all reviews.)
  • Keep a daily practice journal. This journal, kept in a bound notebook, is a detailed log of all the daily occurrences in your practice. Maintaining this journal, whose entries should be signed or initialed, is a particularly important procedure in a multidisciplinary practice. The journal includes hiring of new staff members, new equipment acquisition, equipment maintenance and calibration schedules, staff training and meetings. In a multidisciplinary practice, the team approach to care requires interaction and communication between the physicians and physical therapists comprising the practice. These meetings should occur on a regular schedule and should be documented.

Dr. Mark Sanna is a member of the Chiropractic Summit and a board member of the Foundation for Chiropractic Progress. He is the president and CEO of Breakthrough Coaching (www.mybreakthrough.com 1-800-723-8423).
 
Prepare for Price Hikes
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Written by Rich Van Loan, CFP®, CRPC©   
Tuesday, 23 August 2011 22:47

 

moneystack

Y
ou can forgive Americans for being caught off guard by talk of the potential for more dramatic price increases in the coming years. For the past two decades, inflation has not been a significant concern. In only six years out of the last 20 has the inflation rate (as measured by the Consumer Price Index) turned in more than even a modest annual increase of 3 percent. By contrast, in the prior 20-year period, prices rose by more than 3 percent annually in all but one year. Annual price increases topped 12 percent in three different years during the late 1970s and early 1980s.

Are we headed for another era of high inflation? There are concerns on some fronts, particularly given rising prices for commodities such as food, metals and energy. The World Bank reports that food costs globally rose 30 percent in the 12 months ending in January 2011.While some price increases are being felt in the U.S., consumers here so far have been spared any serious impact. According to the Bureau of Labor Statistics, the price of a basket of common food items in the U.S. rose just 1.5 percent in 2010. However, the average price of a gallon of regular gasoline, according to the U.S. Energy Information Agency, jumped 18% in 2010.

Are we headed for another era of high inflation?

The sudden focus on the risk of inflation is a surprising shift from just a few months ago, when many economists were raising concerns about deflation, the threat of prices for goods and services declining. Deflation is a sign of economic weakness. Modest inflation, on the other hand, tends to reflect a stable and growing economy. However, rapid inflation can create a real strain for consumers, businesses and the economy as whole.

 

Making sense of the numbers

The government reports inflation numbers every month using the Consumer Price Index (CPI). This is only meant to portray an average rate of cost increases across a broad spectrum of the economy. You may think that rising prices for food, gasoline, health care and college tuition are reducing your purchasing power more than the CPI indicates. But the CPI also accounts for other costs, such as housing, labor and services, which in some cases have been flat or declining in price in recent years.

Higher inflation in certain items, however, can have an impact across other parts of the economy. If higher prices for commodities like food and energy products persist, the effect is likely to spread to other areas of the economy where companies will be forced to increase prices as well. This can lead to more substantial hikes in the cost-of-living that are felt by nearly everybody.

 

Protecting your money if severe inflation returns

Faster increases in living costs can clearly create challenges for you. Here are some steps you can take now to prepare for the potential impact of higher inflation:

•  Closely review your spending – now is a great time to think about your living expenses. The more you spend, the more costly life becomes if inflation develops into a serious issue again in the future. Try to find ways to limit driving to reduce gas costs. Adjust your food shopping habits to make your budget more efficient.  Steps you take today will ease the burden of potential future inflation concerns.

•   Consider making “big ticket” purchases sooner – buying a home or car or completing a major home project may be less expensive today than it will be in several years if inflation picks up. Now may be the time to take advantage of the purchasing power that exists today – if it fits your budget.

•  Lock in low rates for borrowing – if you have borrowed money using an adjustable interest rate (many homeowners do this with their mortgage), you might want to consider locking in a low fixed rate for an extended term. If inflation does rise, it is likely that interest rates will follow a similar course. Better to lock in the lowest rates you can if it is appropriate for you to do so now.

•   Don’t lock into low rates on a long-term savings vehicle – there is little advantage to putting a large amount of money into a bond or certificate of deposit for an extended period of time if it pays a very low interest rate. On an after-inflation basis, the return you earn today is nominal. If inflation becomes more significant down the road, your return could actually be negative after rising living costs are taken into account.

•  Invest in assets that can appreciate in value – stocks of companies positioned to grow during inflationary periods, commodities such as precious metals, agricultural or energy investments and real estate historically tend to perform reasonably well if living costs rise more dramatically. Be certain that any investment decisions you make are consistent with your long-term objectives and your risk tolerance.

 

Rich Van Loan is a CERTIFIED FINANCIAL PLANNER TM Professional and Chartered Retirement Planning Counselor. A graduate of Harvard University and Boston University, Rich has been helping his clients achieve their retirement, education and investment goals for over 12 years. Visit his website at www.ameripriseadvisors.com/richard.r.vanloan

 
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