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Straight Talk Provider Bulletin – October 2014

October 30, 2014

In This Issue:

Important Dates
Ebola Response Readiness
COMING SOON! 2014 Provider Survey
Depression and Obesity are Often “Twin Ills”
5 Reasons to Move ICD-10 Implementation to the Top of Your To-do List
Summary of CCMI Fall Business Summit
November is National Diabetes Month
Compliance Corner
Coding Corner

Important Dates 

  • November 22 – Active Care Program 4 with Dr. Andrew Klein Register!
  • January 1, 2015 – Health care providers in Minnesota must have an interoperable EHR system in their clinical practice settings
  • February 21, 2015 Tentative ICD-10 Seminar – Save the Date
  • October 1, 2015 – ICD-10 implementation deadline

ebolaHealth Care Facility Preparedness Checklist for Ebola Virus Disease

Even though the likelihood of an Ebola outbreak appears to be extremely low, DCs are still being encouraged to assess their readiness for Ebola response. This CDC document offers recommendations for preparing to manage patients with infectious diseases. For more information, visit the American Chiropractic Association’s Ebola Virus Disease Information web page.

While the risk of Ebola is low, recent research has found chiropractic tables often test positive for bacterial contaminants or pathogenic microbes. In fact, one study, published in the American Journal of Infection Control in February 2011, confirmed 84 percent of chiropractors surveyed about disinfecting their chiropractic tables responded that they did; however, this same survey showed only 62 percent of these chiropractors actually had a routine chiropractic table disinfection protocol in place.

“This data serves as an important reminder for doctors who are serious about protecting clients from infections and other health issues,” says Vivi-Ann Fischer, D.C., chief clinical officer of ChiroCare. “A recent article in stresses that changing face paper after each visit isn’t enough. Protocol should also include performing a direct surface disinfection of the chiropractic table several times a day.”

COMING SOON: 2014 Provider Satisfaction Survey

CCMI’s annual provider satisfaction survey is just around the corner. A survey link and access code will be emailed to all ChiroCare providers from Survey & Ballot (SBS) on CCMI’s behalf. Please keep an eye out for the survey, which runs Friday, November 14 through Thursday, December 4. To thank you for participating, your name will be entered into a drawing to win one of 10 $50 gift cards once we receive your completed survey. Your comments contribute greatly to improving the provider experience!

Depression and Obesity Often “Twin Ills”

About 43 percent of adults with depression also were obese, and 55 percent of patients taking antidepressants were obese, according to a recent study reported in HealthDay News. Researchers from the National Center for Health Statistics said the data did not suggest a reason for the association, but Tony Tang of the University of Pennsylvania said obesity may be linked to self-esteem, social and health problems that could lead to depression.

There is an increasing amount of evidence that regular exercise prevents and eases depression. U.K. research on more than 11,000 adults, ages 23-50, linked higher levels of physical activity to a lower risk of depression and to a reduction in depression symptoms, as reported in the same issue of HealthDay News. Researchers noted, however, that being depressed could make it more difficult for people to begin exercising. 

With chiropractic care becoming a standard point of entry for patients, chiropractors can play an important role in identifying signs of depression. The Patient Health Questionnaire (PHQ-2) is a two-question self-reporting tool. The purpose of the PHQ-2 is to screen for depression in a “first step” approach. Patients who screen positive should be further evaluated with the PHQ-9, other diagnostic instrument(s), or direct interview. Click here to view the 12 common symptoms of depression.

5 Reasons to Move ICD-10 Implementation to the Top of Your To-do List

ICD-10 implementation is October 1, 2015 — and you may have enough time to do it accurately and efficiently if you begin now. This is far beyond a typical annual update and will require months of planning and testing. In fact, the testing phase is expected to be the most rigorous and time consuming and it is recommended clinics begin testing in June.

Here are 5 important reasons to begin the ICD-10 planning and implementation process TODAY. ICD-10…

  1. ALL current diagnosis codes will change. ICD-10 has 141,000 codes—more than eight times the 17,000 codes in ICD-9. Every ICD-9 code you are using, including 739 and 839 subluxations, is going to change.
  2. Specificity will force your documentation to change. One of the main reasons ICD-10 codes are coming is because they allow for greater specificity. For example, it will no longer be acceptable to code for a muscle spasm, you will also be coding to the right or left side, muscle and/or anatomical location. If documentation does not include the required level of specificity, it could be denied.
  3. Requires training for doctors and, ICD-10 will require much more interaction between doctors and their staff members because the billing, coding and documentation of services is much more complex. For most diagnostic codes there are 2-5 new ICD-10 codes, making crossover coding difficult.
  4. Allows for NO “exceptions.” On all dates of service past October 1, 2015, the ICD-10 codes are required. The ICD-10 codes must be used if you want to be paid. There will be no allowable exceptions.
  5. May result in reimbursement delays. At this point, many billing industry experts are warning that Medicare and Medicaid are drastically behind in ICD-10 implementation and have yet to perform end-to-end testing to see if their systems are compatible with the ICD-10 format. Commercial payers do not appear to be ready either. Experts advise doctors to protect themselves by saving some cash for the “rainy day” that may occur in October 2015. Some advisors are even suggesting as much as three to six months of cash reserves.

“We understand that the transition from ICD-9 to ICD-10 can seem daunting,” says Tab Erck, CEO of Chiropractic Care of Minnesota, Inc. “Creating a plan of action now will absolutely pay dividends for ChiroCare network providers and their practices when the implementation deadline of October 2015 arrives.”

Summary of CCMI Fall Business Summit

Chiropractic Care of Minnesota, Inc. would like to thank those who attended the 5th Annual Business Summit on October 9, 2014. Your commitment and dedication to providing patients with an optimal health care experience is greatly appreciated.

Physicians’ Diagnostic Rehabilitation (PDR) presented on Cognitive Behavioral Therapy (CBT), explaining how a person’s thoughts cause their feelings and behavior. With psychosocial risk factors the number one predictor of disability from low back pain, applying a bio-psycho-social approach shows promise in improving outcomes for spinal pain patients. By understanding how patients’ thoughts affect emotions and behaviors, doctors can learn to turn negatives into positives.

PDR recommends the book, Managing Chronic Pain by John Otis, and recommended CBT measurement tools include the Keele STarT Back and Patient Activation Measure (PAM) 13. Benefits from these assessment tools are:

  • Patient conversations focus on positive functional goals, shifting patient focus from “pain” scale to “activity” scale.
  • Patients are engaged in setting S.M.A.R.T. (Specific, Measureable, Attainable, Realistic, Timely) goals for returning to activity.
  • Practitioners are armed with information to support advanced forms of treatment with complex patients.

Next was an informative Panel Discussion with Mark Dehen, D.C., Rohaan Mehta, M.D., Jolyn Halverson, D.C., Dale Lawrence, D.O., Molly Magnani, D.C., and Jamie Peters, M.D. They shared their experiences in creating collaborative relationships that assure coordination of care. Key points included:

  • Send patient reports, but first ask M.D.s how they want to be contacted (phone, fax, email) and when they want to be contacted (concerns and follow-up recommendations, or all patients).
  • When an M.D. refers to a D.C. or D.O., they consider that doctor to be the specialist who will provide treatment and send the patient back to the M.D. as needed.
  • Keep the reporting simple, brief, relevant, informative, and legible.
  • Use common terminology.
  • A phone call is appreciated if the case supports urgency.
Time for a Security Risk Assessment?

The Health Insurance Portability and Accountability Act (HIPAA) Security Rule requires covered entities to conduct a risk assessment of their health care organizations. A risk assessment helps ensure compliance with HIPAA’s administrative, physical and technical safeguards. A risk assessment also helps reveal areas where protected health information (PHI) could be at risk. Watch the Security Risk Analysis video to learn more about the assessment process and its benefits.


Last, we reviewed HIPAA privacy and security updates. Key items included:

  • Breaches of Personal Health Information (PHI): “It’s not if a breach will happen, it’s when”
  • Develop privacy policies and step-by-step policies and procedures for when a breach occurs.
  • Appoint privacy and security officers.
  • Conduct regular security risk assessments to identify vulnerabilities and minimize risk.
  • Adopt email policies.
  • Adopt mobile device policies regarding PHI data storage and removal of these devices from the premises.
  • Train employees who use or disclose PHI annually.
  • Develop Notice of Privacy Practices.
  • Enter into Business Associate Agreements.
  • Adopt suspected breach protocols: Document the investigation, conduct the required risk assessment to determine if a breach has occurred, and notify the appropriate parties.
  • Implement policies and use them to sanction employees who violate them.
  • Post privacy disclosure on faxes and emails.
  • Business Associate Agreements (BAA) are required by covered entities such health care providers.
  • If BBA is older than 2013, new, signed BAA forms are required.
  • Audit vendors with BAA to see if they are in compliance (i.e., encryption)
  • See CCMI Compliance Toolkit at ChiroCare Connect for sample BBA, consent forms, and Medicare Audit forms.

Please feel free to contact us if you have any follow up questions or concerns about this presentation at 763-204-8570, or

November is National Diabetes Month! Share Diabetes Prevention Tips with Patients

The following lifestyle modifications will help your patients prevent diabetes and lead a healthier life:

  1. Eat a low-fat diet. Reduce total daily fat intake to no more than 20-35 percent of your diet and keep saturated fat below 10 percent (the less, the better).
  2. Control your calories. Consult to determine your optimal daily calorie intake and do your best to stick to it.
  3. Increase fiber. Fiber fills you up and replaces less healthful foods, especially sweets and sugars. Your body metabolizes fibrous foods easier and requires less insulin than to absorb simple sugars.
  4. Limit carbohydrate intake. Eat carbohydrates and sugars in moderation—no more than 30 grams of carbohydrates in each meal is recommended. Read the product label to determine the amount of carbohydrates per serving. To find the carbohydrate content of non-packaged foods, visit
  5. Mix carbohydrates with a protein when possible. Some examples include a trail mix of nuts and dried berries, apples with nut butter, oatmeal raisin cookies with walnuts, or even a nut topping on your ice cream. Proteins slow the digestion of carbohydrates, keeping you satisfied longer and reducing the need for quick bursts of insulin.
  6. Stay active! Aim for a minimum of 30 minutes of moderate physical activity five days a week. More may be necessary if you want to lose weight. If this is difficult at first, try starting with two or three days and work your way up. If you have a condition or schedule that does not allow for 30 minutes five days a week, consult with your health care provider to set a goal and work toward it. You can also include shorter periods of exercise into your day if 30 minutes at one time is not realistic. Walking is a great way to stay active!

Source: American Chiropractic Association, Share Sensible Diabetes Prevention Tips with Patients

Coding Corner

  • CPT Codes. ChiroCare has posted a table, identifying CPT codes that represent the various levels of chiropractic manipulative treatment. For each code, the definition and the requirement for billing is provided.
  • ChiroCode Institute: Providers can take advantage of free, weekly news alerts regarding coding and compliance by signing up for the ChiroCode Institute newsletter.
  • ICD-10 Update. MedScape is offering a free training activity for health care providers who will be involved in clinical documentation with ICD-10.  
  • Coding and Documentation Seminar Highlights: A summary of the September Coding and Documentation seminar has been posted to com by Dr. Vivi-Ann Fischer.

Compliance Corner

  • CCMI Financial Disclosure Form. The Medicare Advance Beneficiary Notification of Noncoverage (ABN) Form may no longer be used for Medicare Advantage members with administration through ChiroCare. Instead, we encourage you to use the CCMI Financial Disclosure Form, available through ChiroCare Connect, with HealthPartners, UCare and Cigna plans to notify patients about services they will be responsible for paying. If you choose to use a different form, please ensure that it meets all requirements outlined in CCMI’s Billing for Non-Covered Services policy to avoid any potential billing issues.
  • Medicare Electronic Health Record (EHR) Incentive Program. Effective January 1, 2015, Minnesota Statute 62J.495 requires that all hospitals and health care providers working in Minnesota have an interoperable EHR system in their clinical practice settings. If you are participating or planning to participate in Stage One of the Medicare Electronic Health Record Incentive Program this year, it’s important to be award of milestones and changes. The official website offers all the details that will help with implementation, and gov offers a clear explanation of the 2014 definition for Stage One of Meaningful Use. CCMI also offers resources to help you implement EHRs, including videos and no-cost EHR courses.
  • Record Keeping Tips:
    • Conduct a self-audit, using the ChiroCare Chart Review Checklist.
    • Medicare requires that all patient chart entries be signed by the treating doctor.
    • Assessments must be updated after each visit.
    • Treatments need to have a clear beginning and end date.
    • Measurable treatment goals must be clearly stated and updated:
      • Using neck and low back indexes to track improvement
      • Using Outcome Tools on ChiroCare Connect
    • The treating doctor must match the billing doctor.
  • Signature Compliance: SOAP notes must be signed by the provider:
    • An electronic (typed) signature is not sufficient; it must include the signature image, initials, or be accompanied by a Signature Attestation or Signature Log
    • Guidance Documents:
    • Compliance Hotline: ChiroCare has a 24/7 compliance hotline for providers, patients, ChiroCare employees, and other individuals who are concerned about a possible compliance issue. Doctors have a duty to report themselves if a breach occurs (e.g., a laptop with unencrypted patient data is stolen; a flash drive containing patient data disappears).
    • Locum Tenens Reminder: If you will be having a doctor who is not contracted with CCMI fill in for you on a temporary basis—even if it’s only for an hour—you are required to inform ChiroCare in writing of your intent, and have written approval from ChiroCare, before the substitution may occur. Please call the ChiroCare corporate office for assistance and forms: (651) 389-2006 or (866) 714-0524. 
    • Meaningful Use Hardship Application Deadline Extended. The Centers for Medicare & Medicaid Services (CMS) announced on October 7 plans to reopen and extend the deadline for eligible professionals to submit a hardship application for not demonstrating “Meaningful Use” of Certified Electronic Health Record Technology (CEHRT). The hardship application deadline has been extended to November 1, 2014. The CMS Hardship Exception Application can be found here.