Address 3 Areas of Concern For Chiropractic Care in Work Comp

For some time, chiropractic care has been a mainstay in workers’ compensation systems. While there are many benefits to this form of care, members of the claims management team should use caution when managing claims involving a chiropractor.

Are Chiropractors Real Doctors?

Chiropractic care is an alternative form of mainstream medicine used to treat a variety of disorders impacting the musculoskeletal system. By using the spinal cord as a reference point, chiropractors use various manipulations in order to treat not only neck and back pain but also other conditions that have their origins in the central nervous system.

The requirements to become a chiropractor vary in every state. In some instances, a chiropractor receives more medical-based training than the average medical doctor (MD). The main difference in training is chiropractors concentrate their focus of study on physiology and body mechanics.

Areas of Concern for the Work Comp Professional

Chiropractors should be treated with the same professionalism as any other healthcare professional. Like anyone else who provides medical care and treatment, a majority of chiropractors are professionals in every sense of the word.

Claims handlers do need to educate themselves on how chiropractors operate. Unlike most medical doctors who work in or associate with larger groups, many chiropractors operate in a solo practitioner setting. They also offer additional services such as massage and aromatherapy. When managing claims involving chiropractors, claims professionals should employ the following techniques to ensure the injured worker is receiving quality medical care and treatment:

• Review of Billing Practices: Every claims professional should review all medical bills submitted for payment with integrity. When an employee sustains a work injury and is seen and examined by a chiropractor, it is important to review it under the same standards one would from a medical doctor specializing in orthopedic and neurological care. This will include identifying billing codes that are consistent with an initial examination.

• History of Chiropractic Care: It is important for every member of the claims management team to obtain a complete set of medical records for a claimant. This can be difficult when a person has received previous chiropractic care. Any billing statement from an injured worker’s initial visit should indicate if they are an existing patient, have received chiropractic care in the past or are new to this form of treatment.

• Reviewing Treatment History: While chiropractors use medical terminology in their records, it differs from what you would typically find in reports from a traditional medical doctor. It is important to note the frequency of care and how long it is recommended. One should also take note of “flare-ups” listed in medical records and determine if they coincide with the employee’s recollection. It is also important to scrutinize any medical care with applicable state medical treatment parameters.

Managing Claim Costs

The claims management team members will need to take additional steps to address out-of-control treatment with a chiropractor. There are steps that can be taken to address this form of medical mismanagement.

• Independent Medical Examination: The IME is the easiest but sometimes most expensive cost containment method in claims involving chiropractic care. Given the restrictions most states place on such exams, it is a decision that cannot be taken lightly.

• Record-Only Medical Review: This is also known as a “paper review.” From a cost perspective, this is an excellent method to obtain an expert opinion regarding the reasonableness and necessity of care. They can also address whether the chiropractic care is consistent with medical treatment parameters. A paper review is also less expensive when compared to a full-blown IME.

Conclusions

Members of the claims management team and other interested stakeholders must understand the benefits and dangers of chiropractic care. Part of this includes methods and techniques to analyze the care received and make sure it is consistent with workers’ compensation guidelines. It should also be taken care of to treat the effects of a work injury and make the employee whole.

Michael Stack, CEO of Amaxx LLC, is an expert in workers’ compensation cost containment systems and provides education, training, and consulting to help employers reduce their workers’ compensation costs by 20% to 50%. He is co-author of the #1 selling comprehensive training guide “Your Ultimate Guide to Mastering Workers’ Comp Costs: Reduce Costs 20% to 50%.” Stack is the creator of Injury Management Results (IMR) software and founder of Amaxx Workers’ Comp Training Center. WC Mastery Training teaching injury management best practices such as return to work, communication, claims best practices, medical management, and working with vendors. IMR software simplifies the implementation of these best practices for employers and ties results to a Critical Metrics Dashboard.

Contact: [email protected].

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.