A Federal Judge’s Ruling: CMS & The Maximum Improvement Standard

On the one hand, a new DHHS OIG report concludes that chiropractic care is medically unnecessary after the first 30 treatments. By that point, DHHS insists, maximum improvement has been reached. And on the other? Hmmm…

In 2011, a class action suit (Jimmo vs. Sebelius) was filed by a combination of Medicare beneficiaries & national organizations in Vermont federal court. The suit alleged that DHHS “imposed a covert rule of thumb that operated as an additional and illegal condition of coverage, resulting in the termination, reduction, or denial of coverage for thousands of Medicare beneficiaries annually.”

The lawsuit contended that an “Improvement Standard” was universally applied to deny coverage if a patient’s condition hadn’t improved. It further contended that, as a consequence, Medicare contractors & claims adjudicators were denying coverage given the expectation that the patient was deemed unlikely to improve further – even though care might be necessary to prevent further deterioration and/or maintain the patient’s current condition.

What prompted this class action lawsuit? One plaintiff needed long term physical therapy following a series of mishaps that began with a broken femur. After months of therapy, the patient’s daughter received a letter stating her mother “has reached her highest practical level of independence.” But the family believed she needed continued therapy to maintain the progress she’d already made.

Does this sound familiar if you’re a chiropractor? Chiropractors nationwide should recognize this as a denial based on “medical necessity” – which is just one of many phrases that allude to the same concept:  the patient isn’t going to further improve. So, a dichotomy. The new DHHS concept of 30 maximum treatments vs. a ruling in federal court about “maintenance care.”

In January 2013, as part of a settlement agreement in Jimmo vs. Burwell, (that’s Department of Health & Human Services Secretary Burwell), the Court required that DHHS educate its frontline contractors & providers that the “Improvement Standard” was illegal. However, as time passed, it appeared that CMS wasn’t upholding its part of the bargain. Plaintiff’s attorneys returned to the courts to seek enforcement of the original agreement. In August 2016, Chief Judge Christina Reiss of the United District Court in Vermont ruled that CMS did have to launch an improved educational campaign. You can read the CMS fact sheet here.

Now, this suit wasn’t filed by chiropractic patients. Regardless, as the 2013 class-action lawsuit settlement specified: Medicare must cover skilled care and therapy when they are “necessary to maintain the patient’s current condition or prevent or slow further deterioration.” This is not a narrowly worded opinion that specifies ongoing physical therapy in a specific instance. Instead, it defines a generic concept of ongoing therapy to maintain Activities of Daily Living.

So, we have the settlement agreement & most recent ruling by a federal judge. And then we have the new OIG report. According to the report, Medicare spent $359 million covering “unnecessary” chiropractic care. I’m not sure who defined what “unnecessary” refers to in this context, but I’d bet it wasn’t the same context applied by the federal court in August 2016.

Patients have always had the right to appeal coverage denials. And they also have the same odds of prevailing they’ve always had: virtually non-existent. Is there room to get further, necessary care approved? We don’t know until someone starts to push back against these barriers. For further reading on these topics:

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DHHS OIG Targeting Tactics for Chiropractic Audits

While you were making last minute preparations for ICD-10, the Department of Health & Human Services Office of the Inspector General published a new report on 9/29/2015. The report makes specific recommendations to CMS with regard to curbing “questionable and inappropriate payments for chiropractic services.”

Why should you care? Well, if you know what OIG considers questionable and inappropriate, you can make adjustments (no pun intended) to your documentation, use of CPT codes & modifiers, and visit frequency to avoid trouble — the kind of trouble that may eventually land you in a position of oversight (including pre-authorizations for services), not to mention fines and return of funds previously paid.

You undoubtedly have a computer in your office & can generate all sorts of reports that provide information about patients. DHHS has computers too. OIG did a great deal of data analysis on chiropractic services performed in 2013. And their data mining techniques helped them pinpoint those of you who don’t seem to follow the rules — and outliers. So… what are they looking for and what can you do to stay off their radar?

  • First, don’t forget to use the AT modifier for chiropractic services. It’s required. CMS realizes that its use doesn’t guarantee the service was actually reasonable & necessary, but the modifier is required. In 2013, 96% of all claims included this modifier.
  • Think twice before using CMT code 98942 for the majority of your Medicare patients. 10% of paid services in 2013 included this code and OIG believes that almost half of these were upcoded. Why? OIG computes your RVU’s (Relative Value Units). They identified 1450 chiropractors who were being reimbursed at higher levels than their colleagues. (Outliers.)
  • High average numbers of claims per beneficiary by your practice indicates to OIG that you’re providing maintenance therapy. OIG believes that 16% of chiropractors received questionable payments and that almost half of these were probably for maintenance therapy. To be specific, 96% of chiropractors averaged 8 services per beneficiary. In contrast, the remaining chiropractors averaged 25 services per beneficiary. This is where your documentation becomes critically important.
    1. If you use an electronic kiosk system where patients enter their own subjective data and have the ability to indicate: “No change. Same as last time” regarding subjective symptoms, and use this option regularly, you will have a problem when your documentation is reviewed.
    2. With CMT codes, make sure you separately document each region you treated.
    3. Active/corrective manipulative treatment is expected to be an improvement in, or arrest of progression, of the patient’s condition. When further clinical improvement cannot reasonably be expected from continuous ongoing care, and the chiropractic treatment becomes supportive rather than corrective in nature, the treatment is then considered maintenance therapy. Your documentation must chronologically reflect the active nature of the care you are providing. If you’re unable to document changes in a patient’s subjective complaints & objective findings over time, a CERT audit won’t help you.
    4. Document exact bones (e.g. C5, C6) and/or area (e.g. lumbo-sacral). Documentation must support the symptoms and have a direct relationship to the subluxation. You must have a treatment plan that includes: recommended level of care (duration and frequency of visits), specific treatment goals, and objective measures to evaluate treatment effectiveness.
    5. Be familiar with your Medicare carrier’s LCD (Local Coverage Determination) and use the tables.
    6. You can attest to signatures & plan of care when you get audited, but ideally your documentation should be electronically signed / locked, and your care plans should be reflected in your locked notes.
  • Getting back to those RVU’s, OIG also looked at chiropractors whose paid services indicated the possibility that they were working 16 hour days, which OIG labeled an “unlikely # of services per day.” As you apply CPT codes, you must consider them within the context of other codes you used that day. Make sure you have a sign-in sheet that can back up the fact that those patients were in your office.

Finally, let’s distinguish behavior characteristics considered questionable vs. average by OIG in 2013:

  • Average amount paid per chiropractor: $45,313 vs. $10,303.
  • Average # of paid claims per chiropractor: 1,604 vs. 407.
  • Average # of beneficiaries per chiropractor with paid services: 101 vs.47.

Where do you fit in?

Fortunately, if you’re using the ECLIPSE Encounter to document your Medicare visits, you have everything you need to help you establish each patient’s progression of care.

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ECLIPSE vs. ChiroTouch

Competition is healthy. It improves products. People too. From classrooms to sports fields to tradeshow floors. Even to the moon. But there are rules – and laws – about how far is too far. Suppose the chiropractor down the road starts rumors that you broke the ribs of several patients as you adjusted them? How would you feel if you subsequently ended up on the defensive during conversations with your own patients?

Though defamation is against the law, proving the harmful effect of words isn’t easy. So… we generally ignore such transgressions. In this case, we’d heard rumors. Then, finally, a single email to a chiropractor in Minnesota – signed by the ChiroTouch NorthWest Territory Sales Manager (according to his LinkedIn profile) – came into our possession. It enumerated a variety of “facts” about ECLIPSE that were pure fabrications.

So, our attorneys got involved. ChiroTouch insisted it had only happened once. But our attorneys were uncomfortable. Eventually, we filed a lawsuit in federal court.  ChiroTouch did their best to dismiss it and you can read the judge’s decision here (which has since been cited in multiple cases by other federal judges as a precedent). We figured we’d made our point. And so we dropped the lawsuit and that was the end of that.

But the rumors persisted. Last December, we received email asking us to clarify comments about ECLIPSE attributed to a ChiroTouch representative. (They weren’t true and we chose to ignore the incident.) Then, last week, we began receiving calls on our recorded lines from multiple clients. These ECLIPSE clients had apparently received calls from ChiroTouch / Future Health. The callers stated that ECLIPSE wasn’t “ICD-10 ready” and went on to suggest that ChiroTouch / Future Health could provide software that was. At least one of the recipients of these calls – even though she was familiar with the ICD-10 capabilities in ECLIPSE – still needed some reassurance from our HELP Desk that this was untrue. Another insisted on calling them back and getting more information. And so she did.

An especially interesting tidbit was that our clients were often left with the distinct impression that these calls were coming from *us*. According to at least one client (who questioned the caller) this seemed intentional.

So, we thought we’d tell you the same thing we told our clients last week:

“Please do not believe such obvious attempts to steal your business and please consider the integrity of any company that would stoop to fabrications in order to win it. If *you* receive one of these calls, we urge you to take the time to go online and review these companies (there’s nothing they can do to contest truthful reviews), share their behavior in forums, and report it to your state associations. Perhaps such action will dissuade them from future attempts to get you to throw away thousands of dollars & hundreds of hours of your time.”

Of course, we think you should ask ChiroTouch or any company you plan to do business with for information about their own products – not products from other companies. And any negative information they provide should be deemed suspicious. Right?

Since 1985, thousands & thousands of chiropractic offices have used ECLIPSE. At one time or another, presidents of many state associations, the ACA, and other organizations have relied on our chiropractic software. It’s topped independent polls, reviews, and surveys for years. Large & small practices nationwide depend on it and benefit from our decades of experience running a successful multi-disciplinary practice  in myriad ways (here’s one). If you want to grow your practice as efficiently as possible, ECLIPSE is the only time-tested chiropractic solution running in the largest practices nationwide — practices with 10, 25, 50, 100 and more employees. And auditors love our unique documentation formats. (Any software that uses a similar format is simply copying data driven designs we created.)

We love competition. Without it, we’d never have grown the way we have. But please get your information about ECLIPSE from us – not from ChiroTouch or any other company. And again, consider the integrity of the company you choose. That’s one reason we’ve never paid for product endorsements. To some extent, this simply reminds me of the late 1980’s — when one company’s reps routinely assured potential clients that all our claim forms get rejected. They did their best to turn a positive into a negative regarding an innovative feature we had & they didn’t. Was it true? Absolutely not. Yet, they succeeded by forcing us to be on the defensive as we attempted to make each sale. We’ve been here for 30 years now.  And that company, like so many others, is no longer recognized by chiropractors — though they were nationwide well into the 1990’s. Sometimes, you need to figure out when to turn on the B.S. meter.

Fun with Advertising

Now, just for the fun of it, let’s take a look at a current ChiroTouch ad. According to the ad:

“A random sample of 500+ practices running ChiroTouch experienced an average of 56% revenue growth year over year.”

Let’s assume a $50,000 annual practice gross when you buy ChiroTouch. In 10 years, you’re grossing $2,735,844 annually. In 15 years, you’ll be grossing over $25,000,000 annually, (Time to consider a corporate jet?) Hmmm. I’d ask for a written guarantee!

From another perspective, if you’re seeing 25, 50, or 100 patient visits weekly right now, in 10 years you’ll be seeing 1368, 2735, or 5261 visits per week respectively. Wow!

Some facts about ECLIPSE

  • ECLIPSE was ICD-10 ready in January, 2014.
  • Dr. Karen Walters, DC FACC has lectured on ICD-10 for C.E. credit. Her March 2015 NYSCA lecture & PowerPoint Presentation are available to anyone free of charge on our website.
  • We have never charged additional fees for updates. If you have a subscription, you can simply download it.
  • We have always avoided outside financing and venture/investment capital. This allows us — with a successful multi-disciplinary practice of our own — to better determine our future. And we have carefully attempted to minimize YOUR out-of-pocket software expenses for decades. As part of that process, we’ve helped thousands of practices realize their full potential.
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Chiropractic Audits & Malpractice: Backups to the Rescue

Irony? I was well into editing this blog entry before being contacted last week by a DHHS Special Agent involved in a NYC investigation. One of my final suggestions — during a conversation that stretched past an hour — was that backups could verify whether data had been falsified. DHHS suspected that data was changed after they notified the office of their interest in specific bills and accompanying clinical documentation. Those backups (which DHHS has) may save this practice from trouble that ranges from fines to jail time.

Two weeks ago, I had a similar conversation with an attorney defending a malpractice case in FL, where the plaintiff’s attorney was accusing the doctor’s office of falsifying data after the doctor was notified of the pending lawsuit.

You see, when documentation supports your version of the story, an investigator’s next step is to simply wonder whether you falsified information. It’s virtually impossible to become bulletproof. But it’s very much within the realm of possibility to seal potential cracks.

One of the most overlooked ways to ensure you can prove you didn’t modify records, believe it or not, is your backup system. Just as a sign-in sheet containing a physical signature can demonstrate that a patient was actually in your office, backups can provide forensic evidence when you’re accused of falsifying records during a malpractice suit or audit. We’ve always suggested a rigorous backup schedule with multiple backups that extend to at least a year. However, it seems that extending this to include backups at 6 month intervals for 7 (or so) years is neither difficult nor expensive in today’s environment.

These days, the digital audit trail within your EHR may help protect you. However, audit trails can only go so far. An audit trail in your software may show that data was modified without tracking how that data was actually changed, or what it was changed from. There are myriad reasons for this, but the bottom line is that it’s always better to be prepared.

Backups of your data protect you from mishaps that affect your cash flow & daily office routine. As it turns out, they also present another way to prove your case when an unexpected audit or malpractice suit lands on your desk.

If your backup is maintained by a third party (e.g. cloud based), this will help build an unassailable wall of evidence to support your position. For ECLIPSE users, we recommend DataHealth, which is HIPAA accredited by URAC.

The ECLIPSE Encounter and your backups – when you take proper advantage of them – can help you prevent audits from turning into nightmares. The smart way to avoid problems is simple: lock your notes within a reasonable period of time (e.g. not more than a few days after the patient visit) & certainly never attempt to modify documentation – especially after you’re notified of an audit. (You can always add dated addendums.) Investigators may seize your files and will certainly attempt to forensically determine whether or not you changed existing data after you were notified that the payer or agency wanted more information.

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The Growing Chiropractic Practice: Stop Losing Existing Patients!

It’s amazing how easy it can be for major practice management features within ECLIPSE to fade into obscurity as the decades roll by — even when those features are as relevant now as they were way back in 1984. At the time, Karen’s rapidly growing practice was beginning to leak patients. Once she became aware that a patient had stopped coming in for care, too much time might have elapsed to get the patient to return.

Though this wasn’t an everyday event, she simply wanted an opportunity to intervene earlier — rather than weeks or months later. So, when she enlisted my help to evaluate software for her office, she was laser focused on a very specific feature. She wanted software that would answer simple questions such as:

Who came in last week but hasn’t been in since?
Who came in last month but hasn’t been in this month?

She had already learned on her own that she was able to better educate patients when she reached them earlier. Now she wanted software to help track such patients before they were lost to her practice. Yet, none of the nationally distributed (and very expensive) products we looked at provided this feature. She was unwilling to compromise and the companies refused to add the report. ECLIPSE was born as a direct result. The Trace Patient Visits report did exactly what she wanted and became a staple of her practice.

Back in the 1980’s and 1990’s many D.C.’s learned the value of this report and used it to help grow their practices. These days, perhaps its value has been buried amongst other, flashier features. Everyone thinks about social media and how to incorporate it into their marketing. Great idea! But what about keeping the patients you already have? In the past week alone, I’ve advised three doctors — who separately requested we add this capability — of its existence. It’s there just waiting for you to take advantage of it. Because your practice isn’t just about your documentation. Of course, we’ve got that covered too.

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Cloud Casualties & Your EHR Software

Over the past several years, I’ve discussed:

And now comes an attack on a hosting company. The hosting company could have been ANY hosting company. And the data on their servers could be ANY data – your patient data perhaps. The attack wiped out everything – including all the backups. So, if it was your patient data, stored by EHR software on that hosting platform, you would have lost everything.

On June 17th, 2014 the DDOS (distributed denial of service) attack on Code Spaces wiped out their system along with all their backups and put them out of business. They had advertised that your data was safe because they had redundant systems spanning multiple geographic locations.

Regardless of the company you contract with for your patient data, realize that they in turn have contracted with a company to provide storage space in the “cloud.” A company that – no matter how safe they claim to be – can be targeted.

With ECLIPSE, where your data resides is up to you. And where your backups reside is determined by you as well. ECLIPSE based practices often maintain backups at several locations, making it difficult or impossible for third parties to hold that data hostage. So, before you succumb to “Cloud fever” — please don’t assume you can leave all your worries behind. At the very least, use a 3rd party tool to create data backups that you can download on a regular basis.

Addendum (8/20/2014):

Since this article was posted, here are just two (of many) additional events that occurred in subsequent weeks…

  • According to various news sources, up to 35% of Practice Fusion customers (i.e. doctors & staff who use the Practice Fusion EHR) lost access for up to two days due to problems with a data center.
  • Community Health Systems, which operates 206 hospitals across the United States, announced on 8/18/2014 that hackers recently broke into its computers and stole data on 4.5 million patients. Anyone who received treatment from a network-owned hospital in the last five years — or was merely referred there by an outside doctor — is affected. The company’s hospitals operate in 28 states… and the lost personal information is protected by HIPAA. That means patients could sue the hospital network for damages.
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Auditors Are Actively Looking For Documentation Shortcuts

Technology can make clinical documentation faster & more efficient. But beware the temptation – even when the means are at hand – to take these time saving ideals too far. There may be consequences.

The Department of Health & Human Services (DHHS) has narrowed their EHR focus over the past few years to specific concepts. First, let’s review a quote from congressional testimony in July, 2011:

“The very aspects of EHRs that make a physician’s job easier—cut-and-paste features and templates—can also be used to fabricate information that results in improper payments and leaves inaccurate, and therefore potentially dangerous, information in the patient record.”

So… who said that and why should you care? That was part of 11 pages of testimony from the Chief Counsel for the Office of the Inspector General (OIG), DHHS. Interestingly, it’s echoed in a newly released OIG report that was the subject of a January 8, 2014 NY Times article.

When I occasionally explain to clients that – for their protection – we won’t provide the means to copy their Encounters (SOAP) between patients, they’re rarely happy. And often, they don’t recognize the danger that lurks just around the corner – a danger we endeavor to protect them from.

Perhaps… if they’d been aware of the above 2011 testimony, they might have second thoughts. When you copy documentation between patients to save time, it’s likely that you’re copying more than you actually need. Then, you go back & fix the new note by deleting or updating irrelevant information. However, multiple studies – and your own experience – should help you reach the conclusion that you’re not perfect in this regard. Mistakes happen, especially when you’re in a hurry and/or multi-tasking. At one time or another, most of us have read back over older prose and found mistakes that escaped our original edits.

The new report released Wednesday simply emphasizes OIG’s focus on “copy & paste” along with its potential for fraud. Good documentation habits can save you from myriad problems – or just one. And this is the type of issue which is unlikely to be noticed unless or until someone else reviews your documentation.

ECLIPSE helps you maintain smart, audit safe habits. If an investigator even brings up the issue as a possibility, you can simply point out that your software specifically disallows it. Yet, ECLIPSE makes it easy to move forward appropriate aspects of a patient’s prior visit on an individual basis. By the way, if you think a narrative based computer program that juggles phrases to make the exact same information look different to auditors is fooling anyone, you’re delusional. Ask anyone who reviews documentation.

And don’t forget… DHHS uses computers too. Just like you. They’re doing their best to expose fraud and protect patients on multiple fronts, as well as help combat potential security issues. And one goal is to step up the volume of reviews:

“We recommended that the Department conduct compliance reviews to ensure that Security Rule controls are in place and operating as intended to protect personal health information”

So, with a higher emphasis on reviews and given the potential downfalls, there are likely myriad ways to speed up your documentation without resorting to copy & paste or as they’ve come to be called: “cloned notes.” ECLIPSE helps you reach performance oriented objectives using government preferred “structured data” while saving you from some of the pitfalls that other documentation software may be exposing you to.


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ICD-10: What you need to know now…

So… a guy walks into a lamppost… and it turns out there’s an ICD-10 code to describe his encounter:  W22.02XA! Would you even admit that to the doctor? I did that once as a teen and would never tell a soul. You can read a WSJ article that goes into humorous detail on the subject here.

I decided it was time to discuss ICD-10 after Karen attended a seminar on the subject this past weekend and one of the tidbits they provided seemed incorrect. (It was.) So, what do you (and by “you” I mean small business health care providers) absolutely need to know about ICD-10? Here are the basics:

For claim submission

  • Any services dated on or after October 1st, 2015 must be submitted with ICD-10 codes.
  • Any services dated before October 1st – even if you submit the claim after October 1st – must use ICD-9 codes. 
  • You absolutely cannot use both types of ICD code on a single claim – so make sure you handle September 30th the same way you’d handle December 31steverything gets billed.
  • Though this change is mandated by HIPAA, some non-HIPAA covered entities like Workers’ Compensation agencies have made it clear that they won’t  (or don’t intend to) be ready by 10/1/2015. Check either directly or through your state association to learn whether you’re affected as we get closer to the deadline.

ICD-9 vs. ICD-10

  • ICD-10 codes are much more specific, and there are many, many more of them. So, if you manage to walk into a wall instead of a lamppost, yes, there’s a code for that: W22.01XA.
  • You generally won’t find a 1:1 correspondence between ICD-9 & ICD-10 codes. There are websites where you can look up both codes and descriptions. And there are some that attempt to provide a crosswalk from ICD-9 to ICD-10 – but I would use those (here’s an example) as a tool to help locate more precise codes.
  • Laterality (side of the body affected) has been added to relevant ICD-10 codes. So, the code you use may inherently define left or right.
  • Another difference relates to episode of care. Whereas an ICD-9 code remains the same over multiple doctor visits, ICD-10 codes may change if it’s an injury or there’s an external cause. For example, a patient with a sprained ankle may return for re-evaluation to ensure the injury is healing properly. In the lamppost example above, the ICD-10 code would likely change to W22.02XD. The “A” (W22.02XA) stands for “initial” encounter (but “acute phase of injury” would be an appropriate way to think of it). The “D” stands for “subsequent” encounter. In 2015, “A” was clarified with regard to chiropractic care to refer to “acute,” and may to be used for all/multiple visits.
  • Injuries are now grouped by anatomical site rather than injury type.


Dr. Karen Walters, DC, FACC discusses everything you need to know about ICD-10 in a 60 minute video that you can watch here.

“I just want to let you know how much I appreciate the ease of transition to ICD-10 with ECLIPSE. The “ICD-9 to ICD-10 comparable” option while entering diagnoses into a patient’s file is seamless. While most other offices are stressing, we will be able to continue along, “business as usual” come October 1st. Thank you.”  — Dr. Michael Goldstein, D.C.

ECLIPSE is ready for ICD-10 now. ICD-9 & ICD-10 codes can be displayed together or separately by selecting an appropriate index. (There are separate indexes for ICD-9, ICD-10 and a crosswalk from ICD-9 to ICD-10.) We have prepared categorized ICD-10 databases for import – which include ICD-9 comparable codes where appropriate – and/or you can enter ICD-10 codes directly. These ICD-10 codes can be imported directly to your existing ICD databases and are available in the same two flavors we have always provided: everything or chiropractic specific. The chiropractic table has been carefully categorized by our team of D.C.’s to make it even easier to quickly locate the code you need. ECLIPSE users can review their 1/16/2014 & 7/16/2014 README entries for more thorough information.

This blog entry has been edited to reflect Congressional delay of ICD-10 from 10/1/2014 to 10/1/2015.

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Who sees 10,000 patients per month with ECLIPSE?

The internet is filled with testimonials that rave about the best chiropractic software. Doctors tell you how much they love certain features and perhaps how busy they are… but rarely define what “busy” means to them, or how they’ve actually integrated the software into their offices.

That’s why it was refreshing to see an independent case study that detailed how one busy clinic integrated ECLIPSE into their environment. The 12 location Tuck Chiropractic Clinic has integrated S.O.A.P., scheduling, billing, document management, alerts and other features into their existing setup – replacing multiple programs from multiple vendors in the process. You can peek into this busy 17 physician clinic by reading that case study here on the Software Advice website.

After reviewing the study, consider how ECLIPSE fares in independent surveys and ask competitors why their prices are so high, even when they can’t offer the type of after-the-sale support provided to ECLIPSE users on a daily basis.


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Evaluating Chiropractic Software: Practice Management Expertise

In 2012 & 2013, ECLIPSE once again topped independent surveys by multiple state chiropractic associations. You can read about one of those surveys here. The other was conducted by the North Carolina Chiropractic Association (NCCA) earlier this year. According to the survey, ECLIPSE was the top system preferred (of 21 systems listed). And, according to the NCCA, “ECLIPSE was strongly recommended by 71% of the people surveyed.” (That percentage includes the entire survey group – not just ECLIPSE users. And, for the record, we’re not based in those states.)

So, how does this happen? One factor that few doctors recognize is unparalleled practice management expertise, which we seem to provide as a natural part of “technical support” to clients on a routine basis.  Everyone tends to forget that when you buy software, there’s so much more to it than pre-sales hype and testimonials.  So here are just a few actual examples of the type of scenarios our HELP Desk handles daily.  Please note the variety:

Case #1: Using CMT Codes 98940, 98941 & 98942

This past January, a doctor called our HELP Desk, upset because all his ChiroCare claims were being rejected. He indicated that he was “losing thousands of dollars every week.” He further noted that he is the “chief insurance person for…” a large, well-known Midwest-based practice management firm.  At our request, he provided his clinical documentation. It was immediately apparent that he was improperly documenting & coding his visits. We subsequently confirmed this directly with ChiroCare and provided him with our findings and a solution within two days. We not only explained exactly what he was doing wrong, we explained how to do it right. And this is a doctor who gets paid as an “expert” to provide practice management advice on this specific subject to our colleagues.

This past week, a doctor in MO requested help interpreting his Medicare appeal & denial. He apparently doesn’t have many Medicare patients and was unfamiliar with how to document the 98941 code submitted on his claims. We explained how to document & use CMT (his diagnoses documented 1 region — lumbar) along with Medicare P.A.R.T. We also gave the doctor some relevant links to read on the ACA website.

Case #2 Chiropractic / Physical Therapy Services

An RN called from a client office, gravely concerned that her office would be audited for “committing fraud.” She further noted that she had worked for Medicare’s investigational division, had issued audits as part of her job, and had testified in court.  This all came out while she argued her position – which was that a key provider degree type used in her office needed to be added to ECLIPSE for claim submission. We simply provided the CMS ANSI documentation to the effect that she was mistaken and helped her get her claims out in a timely manner.

Case #3: HIPAA Violation

A doctor called the HELP Desk after a patient had been accidentally deleted from the computer system. It seemed to be a simple problem. And he didn’t realize that he could have set user permissions to avoid it. But it turned out to be a bevy of HIPAA violations. Staff had sat a patient (let’s call him John) in front of one of their computer workstations. And the current user was logged in and apparently had permission to do anything. John, who has Trisomy 21, promptly deleted another patient. And the office was blissfully unaware of the potential violations. Just a decade ago, practice management consultants across the USA were basing many of their seminars on HIPAA. We advised this doctor about proper office procedures, HIPAA requirements, creation of a HIPAA Compliance Manual & appointment of a HIPAA Compliance Officer.


This past week, it became apparent during a conversation that a doctor was unfamiliar with the OSWESTRY formula. We explained the formula and how the scoring of an OSWESTRY form works in detail. (OSWESTRY forms in ECLIPSE are scored automatically.)

Case #5 What does the HELP Desk know, anyway?

Years ago, a doctor in Binghamton, NY called the HELP Desk with questions about Medicare changes in that part of NY. The HELP Desk Director called Mike for a quick explanation (the changes were brand new) and relayed them to the doctor. Hours later, Mike got another call from the #2 at Markson Management Systems (MMS) with the same question. (At that time MMS was one of the largest chiropractic specific practice management firms nationwide.) Curious, Mike asked why. As it turns out, the doctor didn’t believe the “computer guys” and sought an answer from the consultants she paid thousands of dollars to annually for advice. To this day, she has no clue that both responses ultimately came from the same person!

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