Member Benefits & Practice Solutions

Bookmark and Share

TABLE OF CONTENTS

 

SPECIAL TREASURE MEMBER BENEFITS

 

Insurance Claims and Denials Solutions

 

Erisa and Self-Insured
Health Plan Tools

 

MD-DC Practice and Referrals

 

Record Keeping and Documentation Compliance Guidance

 

Miscellaneous

 

Personal Injury Tools

 

Lien Forms for Health Insurers...

 

How to Qualify as a Courtroom Expert in Clinical Biomechanics 

 

HIPAA Compliance 

GREETINGS ARIZONA CHIROPRACTOR!

          Read below to see what is available to ACS members. The Member Benefits and Practice Solutions are indispensable to a successful practice in Arizona.

           Click here to join now with our secure online server and you will gain immediate access to all of the essential documents,  products and services listed below! They have all been developed to meet the needs of Arizona chiropractors in daily practice. Here are the ACS membership dues:

Full Time Doctor                $50 per month

Part Time Doctor                $25 per month

Employee Doctors:             $25 per month

Retired Doctors:                 $25 per month

Out-of-State Doctors:         $25 per month


Special Treasures Member Benefits

Attention ACS Members: You can now log in to the ACS webpage and then all of the documents below will become "live" and will open when you double-click on them. Just go to to the Login Button on the top left of every page. Enter your email address and click "Forgot Password." Your password will be emailed to you. Use it to log in and then return to this page and you will have instant access to all of the documents. New members gain access immediately upon joining.


Insurance Claims and Denials Solutions

1 -- What to do when an insurer says your fees are above "usual and customary"

2 – Chiropractic Lifecare of America Page.pdf: The solution for your cash practice. Your patients can join a healthcare plan with discount rates for $49.99 per year and use the plan in your office.

3 -- Sample Financial Hardship Agreements One and Two

4 -- Grievance Letters -- The Best Way to Get Insurers to Pay.pdf: How to use the Arizona grievance law, a powerful tool to bring pressure on an insurer that misbehaves. 

5 – Grievance Letters and Law Explained.pdf: Force insurers to abide by Arizona insurance laws. This explains the history of the law and is fairly technical.

6 -- Health Care Appeal Request Form.pdf: There is a legal process when a claim is denied as not medically necessary. This is a sample request form. #7 contains complete instructions.

6.1 – Health Care Appeal Request Form for Expedited Medical Reviews.pdf: Use this form when you need approval of a denied service immediately.

6.2 -- Health Care Appeal Process Consumer Guide: From the Arizona Department of Insurance, this is a complete description of the Health Care Appeal Process.

7 -- Health Care Appeals Process.pdf: A three level process. The third level involves review by an independent party chosen by the Arizona Department of Insurance and paid for by the insurance company. This process should be used every time you have a claim denied.

8 -- Workers Comp -- Procedure To Deal With Workers Comp Medical Necessity Denials.pdf: This document explains how to deal with denials of workers' comp claims.

9 -- Medical necessity appeal letter.pdf: An excellent general appeal letter to document medical necessity.

9.1 -- Guidelines for Chiropractic Care: ACS has developed guidelines based on what is advocated by the ACA, ICA and scientific literature.

9.2 -- Template Appeal Letters for Specific Types of Claims Denials

     a. Template Appeal Letters Instruction Sheet

     b. Template Appeal Letter Aetna CPT 97140 Manual Therapy

     c. Template Appeal Letter CMT Level Authorized

     d. Template Appeal Letter Denial Manual Therapy CPT 97140

     e. Template Appeal Letter Denial of Pediatric Chiropractic Care

      f. Template Appeal Letter Denials E&M Codes with CMT

     g. Template Appeal Letter Denials for Medical Necessity

     h. Template Appeal Letter Denials Level of E&M Authorized

     i. Template Appeal Letter Denials of Massage CPT 97124

     j. Template Appeal Letter Denials Physical Medicine Services by DCs

     k. Template Appeal Letter for CCI Edits

     l. Template Appeal Letter Hot and Cold Packs CPT 97010

10 -- Small Claims and Justice Court Instructions.pdf: Sometimes the only solution when an insurance company does not pay is a lawsuit. Here are instructions for suing an insurance company. Use this document in conjunction with #10.1 below.

10.1 – Small Claims and Civil Suits Instructions Simplified.pdfOne counter argument from insurance company lawyers is that any dispute over medical necessity is governed by the federal law ERISA and so belongs in Federal Court, not state court, and so he may file a motion to remove the case to Federal Court. Here is your counter letter: Why ERISA Does Not Apply to this Medical Necessity DisputeYou will need to cite the ERISA Savings Clause which says that state insurance laws apply to ERISA plans. Include it with your letter.

11.1 – Post Payment Audit Demands Information.pdf: Comprehensive position paper on refund demands.

11.2 - Letter to Fight a Refund Demand.pdf and Word version: The most powerful and effective letter to combat refund demands available to chiropractors.

11.3 - Must Insurance Company Payments Made In Error Be Returned by William Sturm: Accompanies #11.3 above and thoroughly explains the legal arguments. 

11.4 - Full journal article which more completely explains the Innocent Third Party Creditor Rule. Accompanies #11.3 above and additionally explains the legal arguments.

11.4a - U.S. Department of Labor amicus brief stating that post payment audit reviews are adverse claims determinations

11.5 - ASH Claims Denials Center: 

Complete information about how to use ASH documents to defeat ASH claims denials. With each ASH claims denial, reference is made to three key ASH Clinical Practice Guidelines and the Mercy Guidelines. The CPGs state that you should be allowed to treat up to 30 days for an acute condition, 60 days for a chronic condition, and up to 4 months for a condition requiring supportive care. Mercy is even more liberal.

The CPGs also state treatment should be approved in 30 day blocks. They criticize the use of passive modalities past the acute phase, but we have provided the rebuttal arguments needed to overcome this position. Included is thorough 15 page analysis Dr. Immerman has written on these issues to help you overcome your ASH problems. Here are all of the key documents you will need to combat any unfair ASH claims denials: 

Dr. Immerman’s Analysis of Three Key ASH Clinical Practice Guidelines: How to use them to support 30 days of care for an acute condition, 60 for a chronic condition and up to 4 months for a condition requiring supportive care

Key ASH Clinical Practice Guideline (CPG) #1

Key ASH Clinical Practice Guideline (CPG) #2

Key ASH Clinical Practice Guideline (CPG) #3

ASH Tier Levels and 6.5 Visit Benchmark Document

BCBSAZ Letter to Arizona Senators with Key ASH Statistics

GO TO TOP 


ERISA and Self-Insured Health Plan Tools to get Claims Paid

12 -- ERISA Claims Procedure DOL Rule 29 CFR 2560.503-1.pdf: Key section of the law which you need to know to get results with your appeals. Here is the key clause with the language to use in every appeal: ERISA Key Clause -- ERISA Claims Procedure 29 CFR 2560.503-1. You should include this language in every appeal letter.

ERISA requires insurers to tell you what is missing when they deny a claim, and exactly what information you need to supply to them in order for them to justify paying the claim. This document provides the exact pertinent ERISA language for you to use.

13 -- ERISA Letter to File an Appeal.pdf: Use this letter today to get results when claims are denied. Click here for a second letter you can use to file an appeal.

14 -- ERISA Letter to Request for a Copy of the Summary Plan Description (SPD), Claim Appeal Procedure, EOB.pdf: The first step in an ERISA appeal is to get a copy of the plan document. This is the letter to send. Click here for a second extremely effective letter you can use. The SPD explains exactly what the Plan covers.

15--ERISAPatient Authorization Form.pdf: Your patients must sign this form so that you can file appeals and request a copy of the Summary Plan Description on their behalf.

16 -- Understanding ERISA.pdf: Complicated subject, simple explanation of ERISA.

17 -- Understanding ERISA Detailed.pdf: Complicated subject, detailed but understandable explanation of ERISA.

GO TO TOP 


MD-DC Practice and Referrals

18 -- The path to medical referrals.pdf: Key information about how to get referrals from MDs and DOs.

19 -- MD-DC Alignment in Practice.pdf: An entire book by a DC who once was a drug representative and knows exactly how to get into and talk comfortably with MDs and DOs. This is a blueprint with detailed plans. Costs less than $40 from Amazon and is an indispensible resource for every DC.


Record Keeping and Documentation Compliance Guidance

20 -- Record Keeping as Mandated by the Arizona Chiropractic Board.pdf: Detailed instruction complied and updated by ACS over many years.

21 -- Record Keeping and Documentation Course.pdf: Outline of course given by lead auditor retained by the Arizona Chiropractic Board.

22 -- Record Keeping 2005: Full course notes given by former Chiropractic Board chairman. Click here to open this 56 page document with complete instructions on record keeping.

23 -- Medicare Documentation Requirements 

24 -- Office Financial and Clinical Forms:

  1. Assignment of Benefits and Payment Agreement Form (Short Form) and Version Two (Comprehensive Long Form -- Use This One)
  2. Informed Consent
  3. Nordhoff Patient Intake Form 2000A
  4. Nordhoff Patient Intake Form 2000A Updates
  5. Nordhoff Patient Intake Form 2000B
  6. Update to Nordhoff Forms
  7. Pain Drawing 2011
  8. Medicare Records 2011
  9. Pain Intensity and Disability Graph for Documenting Recovery
  10. Progress SOAP Note and SOAP Note Version 2 with Instructions  
  11. Outcome Assessment Tools for Neuromusculoskeletal Conditions including Numeric Rating Scale, Visual Analogue Scale, Oswestry, Roland Morris, Neck and Extremity Disability, Fear Avoidance, Patient Health Questionnaire and more.
  12. Examination Forms For Multiple Body Regions

Lawrence S. Nordhoff, Jr., D.C., is the preeminent author of chiropractic office forms today. Forms #3-9 above were created by him. 

24.2: Functional Capacity Questionnaire and Examination Forms

BCBSAZ requires that you show functional improvement in your patients with changes that can be objectively measured or they will not pay for chiropractic care. Simply treating pain and subluxations is not sufficient justification for coverage under current BCBS contracts. Click here for the BCBS response to a Small Claims Court lawsuit filed by a doctor over a denied claim which explains the BCBS requirements clearly. The following are the tools you need to objectively document functional deficits. Questionnaires and evaluations should be redone at least once every 30 days.

1. Functional capacity questionnaire

2. A Critical Review of Functional Capacity Evaluations: full text journal study

3. Functional capacity as a Evaluation as a Performance Measure: full text journal study

4. Short-Term Functional Capacity Evaluation with Low Back Disorders: full text journal study

5. The Interrater Reliability of a Functional Capacity Evaluation: full text journal study

6. Outcome Assessment Tools for Neuromusculoskeletal Conditions from BCBS: 12 different questionnaires, indexes, scales, etc.

GO TO TOP 

 


Miscellaneous

24.3 -- License Renewal Begins October 1, 2020 Every YearYou need to have a Medical Records Protocol on file in your office.

25 -- ACS Medical Records Protocol: Arizona Chiropractic Board requires you have this on file in your office at all times. ACS updates the Protocol whenever the law changes and sends the updated version every year to members. The Protocol is required by various state laws which you can read here and here.

26 -- DC Power of Attorney directing payments to doctor.pdf: Use when an insurance company refuses to honor assignments of benefits.

27 -- DC Power of Attorney Instructions.pdf: Instructions for #27.

28 -- State Board Investigations and Disciplinary Actions.pdf: Every doctor with a state license needs to read this background document about boards and discipline. Forewarned is forearmed.

29 -- Medicare Advance Beneficiary Notice of Noncoverage ABN: Medicare's most comprehensive statement on the subject.

GO TO TOP 


Personal Injury Tools

Directory to the Complete ACS Arizona Personal Injury Package

30 – Ethics Opinion 98-06 which requires PI lawyers to pay your bill if they know it exists (constructive knowledge) even if there is no written agreement.

30.1 -- PI -- Letter To Get Attorney To Release Settlement Monies He Has In Hand.pdfThis is the letter to use when you have billed medpay or a PI case has settled and the attorney has the money in hand but refuses to disburse the funds and pay your bills.

31 – Balance Billing in PI Cases: Why balance billing to a third party insurer is almost always allowed in PI cases including citations to legal authorities.

31.1 -- LaBombard Case: Legal opinion from ACS health care attorney to send to an attorney who cites the LaBombard  case as a basis for demanding that you pay 1/3rd of your medical bill for legal fees. Click here for a copy. The Illinois Supreme Court just ruled in favor of providers and against attorneys in a case which you should print and send in as support of your LaBombard letter. Click here for a copy: No common fund fee recovery for health care liens --  Illinois State Bar Association.

32 -- Should You Bill Health Insurance in Personal Injury Cases: In most, but not all cases, the answer is yes. Click here to read the full ACS position paper on this important subject.

33 – Sample form for Notice and Claim of Medical Lien: Fill in the blanks with your office information.

34 – Sample form for Release of Medical Lien: Fill in the blanks with your office information.

34.1 -- Who Can An ARS 33-931 Lien Be Enforced AgainstWhen a third party insurer refuses to honor a valid County Health Care Lien, this document tells you what to do to collect your money.

35 – Arizona Department of Insurance Circular Letter 2000-02 mandating fair investigations of low speed impact automobile accidents. Use to combat insurance company fraud in low speed impact cases.

35.1: Letter to Send Claims Adjuster Who Raises Low Speed Impact DefensesDocuments numbers 35.2-35.5 should be enclosed with this letter.

35.2: Threshold Of Injury For Any Single Individual Or Entire Population Not Known: 5 page literature review by Dr. Immerman

35.3: Can The Amount Of Property Damage Predict Injury Likelihood Or Severity: 6 page literature review by Dr. Immerman

35.4: Arizona Department of Insurance (ADOI) Circular Letter 2000-02

36 -- Forms:

  1. Attorney Lien Form: The best in the profession. Read the two articles that explain the lien and an attorney's services to enforce it by clicking here and here. Use this with the Lien Acceptance Policy Form for patients.

36a -- Patient Collection Letters: Letters to send to patients who owe you money with three levels: Friendly, Formal and Harsh.

GO TO TOP 


Lien Forms for Health Insurers that Refuse to Honor Assignments and for Auto Insurers UM/UIM and all Claims

County Health Care Liens are not valid in UM and UIM cases, but the ACS Liens are valid. Be sure to use them in all UM/UIM cases. Also, the ACS liens can be used as assignments of benefits for health insurers, thus forcing them to send payments to your office and not to the patient. The liens must be filed with with the appropriate Arizona governmental agency, see below for instructions.

37 -- Assignment of Health Care Insurance Receivables for Adult Patient

38 -- Assignment of Health Care Insurance Receivables for Minor Patient

39 -- Comprehensive Explanatory Article: "Lien Statute Helps Providers to Collect."

39a -- Model Assignment and UCC Lien Document for Trauma and Health Insurance Cases: Can be used for both automobile accident and health insurance cases

GO TO TOP 


How to Qualify as a Courtroom Expert in Clinical Biomechanics 

ACS has developed a Position Paper documenting how your chiropractic education has provided you the foundation to be a courtroom expert in clinical biomechanics today. Click here to read the Position Paper. Click here and here to read the key supporting documents. Now, get ready to testify!

GO TO TOP 


HIPAA Compliance Center

September 23, 2013 is the HIPAA deadline for compliance with new rules. To comply, members should click on the following links and then use the forms and follow the instructions therein. 

HIPAA To-Do Checklist Updated 09-20-13

HIPAA Sample Notice of Privacy Practices Updated 09-20-13

HIPAA Business Associate Contracts Updated 09-20-13

HIPAA PHI Deidentification Updated 09-20-13

HIPAA FAQs Updated 09-20-13

HIPAA Forms Comprehensive 2011

HIPAA Release Forms Brief 2010

GO TO TOP

602-932-8113.