from the desk of:
Mark Studin DC, FASBE(C), DAAPM, DAAMLP
"NYS W/C Critical Update, Part 5"
NYS Workers Compensation Regulatory Requirement for Research to Certify Ongoing Care
Acute and Chronic Low Back Pain
Disclaimer: This opinion does not reflect any organization, including, but not limited to, the US Chiropractic Director or any state or national organization. It is the sole opinion of Dr. Mark Studin and is intended to be a tutorial for the new NYS WC Guidelines. Each doctor has to base his/her utilization of the guidelines, codes and treatment plans based upon the clinical findings of his/her individual patients.
The New York State Workers Compensation Medical Guidelines require researched evidence as one criteria to approve the necessity for ongoing care for patients. The most prevalent diagnosis is low back pain and a diagnosis chiropractors are confronted with on a daily basis.
Should care be required to go beyond the initial allowable visits and require a variance through filing an MG-2 for low back pain, the following research may be cited as published peer reviewed verification that chiropractic care is beneficial and clinically indicated.
It is also strongly recommended that you attach a detailed narrative in SIMPLE language so that the board or a W/C judge can understand it.
Reference: Hoinis, K., Pfleger, B., McDuffie, F., Cotsonis, G., Elsangak, O., Hinson, R., Verzonsa, G., (2004) A Randomized Clinical Trial Comparing Chiropractic Adjustments to Muscle Relaxants for Subacute Low Back Pain, Journal of Manipulative Physiological Therapeutics, 27:388-398
According to Hoinis et. al. in 2004 concluded that chronic low back pain patients benefit from chiropractic adjustments. In addition, they cite that spinal manipulation for acute low back pain, resulting in both short-term benefits and long-term benefits of 1 to 3 years.
NOTE: I am not a supporter of using manipulation in citing research for chiropractic care as it co-mingles with physical therapy and osteopathic findings, however that is what the researchers reported and is valid to support your care for short and long-term care.
Reference: Wilkey, A., Gregory M., Byfield, D., & McCarthy, P. W.(2008). A comparison between chiropractic management and pain clinic management for chronic low-back pain in a national health service outpatient clinic. The Journal of Alternative and Complementary Medicine, 14(5), 465-473.
Wilkey, Gregory, Byfield, & McCarthy (2008) studied randomized clinical trials comparing chiropractic care to medical care in a pain clinic. "The treatment regimens employed by the pain clinic in this study consisted of standard pharmaceutical therapy (nonsteroidal anti-inflammatory drugs, analgesics, and gabapentin), facet joint injection, and soft-tissue injection. Transcutaneous electrical nerve stimulation (TENS) machines were also employed. These modalities were used in isolation or in combination with any of the other treatments. Chiropractic group subjects followed an equally unrestricted and normal clinical treatment regimens for the treatment of [chronic low back pain] were followed. All techniques that were employed are recognized within the chiropractic profession as methods used for the treatment of [low back pain]. Many of the methods used are common to other manual therapy professions" (p. 466-467).
After 8 weeks of treatment, the 95% confidence intervals based on the raw scores showed improvement was 1.99 for medicine and 9.03 for the chiropractic group. This research indicates that chiropractic is 457% more effective than medicine for chronic low back pain. To say that the medical approach doesn't have a place in healthcare would be inaccurate and irresponsible, but based upon evidenced based outcome studies, research concludes that for chronic low back pain, the path is chiropractic first and drugs 457% second. Chiropractic is clinically indicated by "peer reviewed research" for chronic low back pain patients.
This regulation is directly from the New York State Department of Insurance
and is specific for manage care/indemnity plans
If utilized properly, you will ensure your collections without having to beg and plead
from the desk of:
Mark Studin DC, FASBE(C), DAAPM, DAAMLP
The carriers have 45 days to pay or deny your claim. Anything beyond that will result in a default of the payment of your claim and mandate a 12% penalty to be paid, by regulation. A telephone call will fall on deft ears, therefore create a paper trail with a demand for payment utilizing the law as leverage.
The Law:
|
45 calendar days after receipt of a |
12% per year interest as penalty |
|
12% per year or the rate
established for corporate taxes
under § 1096(e)(1) of the NY
tax law
Language for your complaint:
Dear Claims Examiner:
The services rendered were billed within the New York Insurance guidelines. It has now been beyond 45 working days allowed by New York Prompt Pay Law, § 1096(e)(1) of the NYS
insurance law.
Since you have violated this regulation we can submit this entire claim for summary judgment or arbitration through our legal counsel.
We would like to resolve this issue without using legal counsel. If we do go to court, It will cost you both the amount of the claim and attorney fees with 12% interest annually as mandated by regulation § 1096(e)(1) of the NY insurance law
We request payment within 3 weeks of the date of this letter for the resubmitted bill(s) as prescribed by law. By doing so we will waive the interest due us as described in the regulations previously cited. If we do not receive payment, we will be forced to litigate this matter and also file a complaint with the New York Department of Insurance.
State of New York Insurance Department
1-800-342-3736
In addition, the Prompt Pay Law allows the state of New York, Department of Insurance to fine the carrier $500 per day, per HCFA as additional penalty.
Sincerely,
DC
WHAT IS THE SIGNIFICANCE
As I shared, there are laws and regulations that insurers know all too well, but are banking on that we don't know them and laughing all the way to the bank because we don't invoke the laws and regulations in place to reimburse us as legally required. I have been using these regulations and guiding offices for decades on how to understand and implement these laws allowing doctors nationally to increase their collections by as much as 50% on a consistent basis.
With utilizing the power of the law, insurance carriers are now paying doctors interest for delaying payments as prescribed in most states, which is the deterrent for delaying timely payment of our claims. In addition, we will be supplying language for you to use so that you can collect your fees timely.
It is these regulations that the US Chiropractic Directory will be researching and providing for doctors in your state. We are providing this as a free service; why?
WHY
The answer is research. As of 2011 there is no research that proves the basis of what we do; the true effects of the adjustment/manipulation. When we care for patients in our chiropractic offices, people get better, whether it is musculoskeletal, asthma, digestive issues, reproductive issues, pediatric issues, etc... and there is minimal to no research to certify in the scientific community as what we do as valid. In fact, there is no research that validates subluxation; the basis for chiropractic since 1895.
That doesn't mean chiropractic doesn't work or that we have to make anyone other than our patients happy...but...my goal is to realize 95% of the population under chiropractic care in my lifetime and after 30 years in chiropractic the clear path towards the realization of that goal is "peer reviewed" research. We need more, it is costly and the government is not funding chiropractic anytime soon at a level significant enough to make a difference.
Therefore, I am willing to provide doctors of chiropractic the power to collect more money, the knowledge to be more profitable and the action steps to realize that goal. The rules are the same for chiropractic, medicine, dentistry, etc... for insurance reimbursement and I have been successfully guiding multi-disciplines towards increased profitability for decades.
My ulterior motive (yes I have an ulterior motive) is that when chiropractors become more profitable and I ask for donations to support chiropractic research, there will be enough money to make a difference.
HOW TO GET THE INFORMATION
Although the Directory does offer paid memberships for any doctor who wants a preferred listing, there will be a free level of participation for any chiropractor to join and get the same insurance information. In addition, the free members will have access to the curriculum vitae builder, which is the only place anywhere to build your CV in an admissible, professional format. There are no strings attached, no requirements to spend any money and is not free for a limited amount of time. Basically, there are no games...it is free for those who choose that avenue and easy to enroll.
To get started:
2. Click on "Sign Up Today" on the homepage in the left column
3. Print the fax back form
4. Complete the form and fax it back
Once enrolled, to find the information:
1. Enter your username and password
2. Click on "Doctors" on the top toolbar
3. Scroll to "Doctors Consulting Site"
4. Click on State Collection Regulations..." on the left toolbar
5. Click on "New York"
I look forward to getting your collections up.
Respectfully,
Mark Studin DC, FASBE(C), DAAPM, DAAMLP
Academy of Chiropractic
US Chiropractic Directory
631-786-4253
www.TeachChiros.com
www.TeachDoctors.com
www.USChiroDirectory.com
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