New Jersey Chiropractic Assistant Education and Continuing Education

• Define common terminology used in the Chiropractic office
• Identify terminology associated with specific conditions and their treatment
• Describe locations on the body using appropriate anatomical terminology
• Describe the four procedures that constitute vital signs
• Identify normal values for pulse, blood pressure, temperature and respiratory rate in the adult

• Discuss a brief history of Chiropractic
• Describe the basics of Chiropractic Philosophy
• Discuss Chiropractic, Adaptation and Innate Intelligence
• Review how Chiropractic is built upon the basic sciences of anatomy (structure), physiology (function) and the clinical sciences (patient application).
• Understand how Chiropractic affects specific conditions

• Explain the basis of chiropractic, as taught by DD Palmer
• Recite DD Palmer's definition of disease
• Explain the Founder's concept of subluxation
• Using DD's words, justify the statement: Spine straightening is not chiropractic
• Compare and contrast spinal manipulation with chiropractic adjustment
• Define intelligence
• Describe the process of falsification and how it is applied to science
• Explain why intelligence must precede energy/matter
• Explain why the placebo effect cannot exist in a mechanistic world view
• Explain why adaptation is the basis of chiropractic research

• Utilize the Official Disability Guidelines for Low Back Pain.
• Apply the Official Disability Guidelines for the chiropractic treatment of low back pain.
• Use the CCGPP Guidelines for the treatment of low back pain.
• Integrate Outcome Assessments for clinical justification of chiropractic treatment low back pain.

• Utilize the Official Disability Guidelines for Neck Pain.
• Apply the Official Disability Guidelines for the chiropractic treatment of neck and upper back pain.
• Use the CCGPP Guidelines for the treatment of neck and upper back pain.
• Integrate Outcome Assessments for clinical justification of chiropractic treatment for neck and upper back pain.

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• Utilize the Official Disability Guidelines for Shoulder Pain
• Apply the Official Disability Guidelines for the chiropractic treatment of shoulder pain
• Illustrate sensitivity and specificity of orthopedic tests for the shoulder
• Integrate Outcome Assessments for clinical justification of chiropractic treatment for neck and upper back pain

• Utilize the Official Disability Guidelines for Headaches.
• Apply the Official Disability Guidelines for the chiropractic treatment of headaches.
• Use the CCGPP Guidelines for the treatment of headaches.
• Integrate Outcome Assessments for clinical justification of chiropractic treatment for headaches.

• Interpret compliance advice and regulations directly from the Federal Office of Inspector General (OIG)
• Identify and become compliant with other requirements from the state level through third-party payer contractual obligations
• Review existing policy and procedure for compliance, including OIG compliance, HIPAA compliance, and other federal and state programs

• Apply guidelines for accurate coding and compliant billing practices
• Install monitoring to ensure standards are met
• Self-audit for compliance purposes
• Create internal policy and procedure to improve compliance

• Identify risk areas in the claim adjudication process and apply learned knowledge to prevent missteps
• Discuss federal, state, and payer guidelines that govern billing activities
• Avoid behaviors that violate the carrier contract and ensure compliance with regulations
• Evaluate provider contracts and payer policy for complete clarification on claim process

• Utilize self-auditing methods to identify high risk areas of patient finance in the office
• Develop systems for accountability and transparency in patient accounting
• Apply appropriate fee schedule measures to ensure validity in account posting
• Address federal and state guidelines for discounting to ensure compliance

• Apply the process for setting your fees legally and compliantly and according to Federal regulation
• Know the policies of ALL your carriers to be compliant
• Properly administer desired discounts without running afoul of the Federal and State regulations
• Implement legal hardship discounts, if desired, using the Federal guidelines to appropriately verify hardship

• Develop an appreciation of the impact of culture group, minority group and racial group on the health care relationship
• Increase sensitivity, knowledge and skills to promote effective intercultural interactions
• Identify the professional's own cultural identity/judgments /biases and their impact on their behavior and how they are perceived by clients and patients
• Recognize cultural variables that appear in verbal and non-verbal communication
• Examine the influence of culture in our patient population
• Differentiate the provider's culture

• Examine the historical background of the various Latino/Hispanic groups in the U.S.
• Develop the skills needed to care for people from Spanish speaking parts of the world
• Increase our understanding of the cultural traits of Latino/Hispanic groups in the U.S.
• Summarize specific traits of various Latino/Hispanic groups
• Recognize how we can narrow the gap between us

• Develop the skills for medical documentation record keeping for proper patient care and adherence to insurance protocols
• Summarize informed consent, Mercy guidelines, Medicare guidelines and NCQA guidelines
• Identify common treatment procedures and modalities used in a chiropractic practice And recognize contraindications to them
• designate specific items to consider when interpreting and/or taking plain film X-rays
• Summarize the value of laboratory and diagnostic testing.
• Recognize the importance of patient communication skills in order to assist in the diagnosis and treatment of patients
• Modify procedures and forms to prevent the possibility of a legal malpractice action against the doctor

Hour 1

• Utilize improved patient communication skills with Medicare Patients 
• Apply appropriate risk management procedures to enhance patient communication
• Identify the four elements of legal malpractice and recognize the key components to avoid a malpractice action  
• Utilize key components of good documentation and record keeping
• Integrate the legal requirements of informed consent in your informed consent process 

Hour 2

• Summarize why doctors are held to higher standards
• Discuss the Do’s and Don’ts of record keeping
• Use the 21 NCQA guidelines for appropriate medical record keeping and integrate the 3 key components of Evidence Based Practice (EBP)

Hour 3

• Assess Medicare’s mandatory Electronic Health Records (EHR) requirement        
• Discuss key items related to the Office of Inspector General (OIG) reports regarding Medicare and chiropractic services
• Summarize Executive Order issued by the White House titled reducing improper payments and eliminating waste in the Federal Programs

Hour 4

• Determine what triggers an audit and key items to consider if audited
• Utilize a step by step approach to meet all Federal Medicare Documentation guidelines 
• Summarize Medicare’s guidelines for necessity of chiropractic care and its covered services
• Prepare treatment plans per Medicare’s regulation requirements
• Recognize Medicare’s policy requirements pertaining to x-ray/diagnostic reimbursement
• Determine if ordering vs. referred services meet Medicare’s policy when performed by a chiropractic physician

Hour 1

• Demonstrate the key elements pertaining to Medicare’s documentation requirements for initial and subsequent patient encounters  
• Describe the three categories of chiropractic care covered through Medicare and the one category exempt from Medicare coverage
• Apply Medicare’s x-ray requirements for documenting a subluxation
• Utilize Medicare Advance Beneficiary Notification (ABN) form and its guidelines 
• Use Medicare’s PARTS system to document a subluxation
• Summarize the transformation of Medicare’s PARTS system utilizing the AIR S & M method               
• Include proper Medicare documentation for daily progress notes (SOAP), in order to meet insurance guidelines and meet medical necessity 

Hour 2

• Integrate a 4 step approach to meet E/M (Evaluation/Management) coding requirements to meet Medicare’s guidelines

Hour 3

• Review Medicare Access and CHIP Reauthorization Act of 2015 (MARCA) aka Medicare Quality Payment Program (QPP) and the Merit Based Incentive Payment Program (MIPS)                                                                    

Hour 4

• Apply the critical components of Chiropractic Manipulative Treatment (CMT) coding and Medicare’s requirements for documentation
• Use diagnostic codes ICD-10 (primary subluxation M-codes biomechanical lesions and secondary medical codes) to meet Medicare’s diagnosis requirements
• Recognize Current Procedure Terminology (CPT) codes and how it relates to the Medicare system
• Utilize Medicare modifiers   
• Identify some of the key items with regards to completing the Center for Medicare and Medicaid Services (CMS) 1500 claim form   
• Summarize Medicare’s mandatory claims submission policy                                   
• Explain the five levels of Medicare appeals process
• Distinguish between Medicare participating vs. non-participating provider requirements

• Differentiate between active and maintenance care in clinical documentation
• Execute the use of advance notice in third party patients correctly and accurately
• Identify and implement strategies to clarify the difference between active and maintenance care in documentation
• Recognize and adopt best practices in proper notification about maintenance care vs. active treatment

• Properly document findings and recommendations around muscle therapies
• Master the documentation necessary in daily visits to verify medical necessity
• Identify and implement strategies the most important findings and rationale necessary to add muscle therapies to the treatment plan
• Recognize how to differentiate between various manual therapies to meet the requirements of third-party payers' medical review policy

• Differentiate between supervised modalities, constant attendance modalities, and therapeutic procedures
• Properly document the time and service for any physical medicine modality and procedure
• Clearly define the rationale for these services within the patient's medical record

• Recognize the varying specific requirements for documenting unique adjusting techniques in regards to compliant records and risk management
• Properly document patient encounters for medical necessity
• Discuss the Medical Review Policy insurers use in reviewing medical documentation
• Review case studies and examples to identify documentation errors during self-auditing

• Apply best practices for using abbreviations, addressing legibility, authentication of signatures, and managing the day-to-day flow of your patient records 
• Clearly delineate the beginning and end of episodes of patient care, proper recording of these episodes, and boundary discussions with patients 
• Locate and utilize the definitions of medically necessary care, and apply it as a differentiator from clinically appropriate care
• Assess documentation across the life cycle of the patient’s chart from history to discharge and on through maintenance and wellness care based on live examples demonstrated
• Identify the deficiencies that may be present in your documentation through the eyes of an auditor

• Utilize documentation requirements for the most commonly used CPT codes in the profession
• Apply coding techniques and algorithms to ensure the proper code is selected to meet E/M documentation guidelines
• Recognize the codes that carry the highest degree of risk and confirm that documentation meets the code requirements
• Identify the mandatory elements of medical review policy for selected chiropractic codes

• Compose Complete and Accurate Treatment Plans
• Formulate multiple Standard Treatment Protocols for better compliance and efficiency
• Differentiate patient care plans per Patient condition severity
• Propose recommendations based on exam findings, not third party coverage

• Discuss Medicare’s guidelines for documenting quality measures 
• Discuss Medicare’s Merit-Based Incentive Program (MIPS)
• Identify and determine the eligibility requirements for MIPS
• Identify and discuss the 4 categories under MIPS (Quality, Cost, Promoting Interoperability (PI) and Clinical Practice Improvement Activities (CPIA)
• Recognize how Medicare calculates MIPS to determine payment adjustments

• Know how to document exactly what’s required for initial visit treatment plans including physical medicine procedures
• Apply sample language to include in each daily visit note that will meet documentation guidelines for these modalities and procedures, including properly recording time for timed services
• Command the mechanics of how to authenticate documentation for services provided by auxiliary team members
• Tie the patient’s diagnosis to the treatment plan for tissue-specific, physical medicine solutions
• Tell a complete and coherent account of the patient’s daily visit journey, outlining the crucial language necessary to justify medical necessity for all services rendered

• Recognize and document the difference between active and maintenance care
• Use a decision-making matrix to determine the reportability of active treatment, and to be able to help the patient understand the distinction
• Apply the Medicare standard of recordkeeping to intake requirements to establish a baseline for episodes of care
• Determine whether routine visits qualify as active treatment when presented with new and updated complaints

• Describe the need for prognosis
• Summarize what a prognosis is
• Demonstrate the use of prognostic tools
• Appraise your individual patient’s outlook for recovery.
• Measure the progress
• Make evidence based clinical decisions
• Substantiate your opinion for expert testimony.
• Illustrate the evidence for care.
• Prescribe evidence based care plans.
• Properly document and code complicated cases
• Improve the patient report of findings and discharge procedures

• Interpret in documentation, the difference between active, medically necessary care vs. clinically appropriate but possibly maintenance adjustments
• Able to distinguish compensatory vs. primary subluxations and document them properly
• Specify proper documentation techniques as a full spine adjuster
• Demonstrate the ability to classify documentation for each chiropractic technique employed

• Perform functional testing to identify patients who will benefit from active care rehab
• Correlate functional testing findings with a protocol-driven care plan customized to the patient’s diagnosis
• Recognize and document preferred outcomes that result from properly executed active care techniques
• Follow clinical algorithms to best understand the beginning, middle and end points of active care rehab
• Properly document the clinical rationale for active care rehab by linking it to the diagnosis and treatment plan of initial visit documentation