Injunction Against Horizon Is Denied

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					                                            •   Practice Expense Calculator Tool
                                            •   List Topics for ANJC's 2007 Convention
                                            •    Q & A: Waiving or Reducing Co-Pays
                                            •   United Healthcare Bulletin
                                            •   ANJC's Women's Council
                                            •   2007 Medicare Physician Fee Schedule
                                            •   Dan Rodis's Application for a Preliminary
                                                Injunction Against Horizon Is Denied.
                                            •   Research Updates: DC's and Work Injuries


Practice Expense Calculator - http://www.list-hosting.net/calc.asp


Survey: Topics @ ANJC's 2007 Convention: Next convention will be built around topics
of greatest interest. Here are some suggestions. What other topics spin your top?

Some Include: Cash Practice, Sports Medicine, CA Training, Whiplash, Nutrition, Technique
(Graston, Activator), Therapeutic Modalities (Cold Laser, Decompression, Electrotherapy),
MUA, Philosophy, Running the Office, Woman in Chiropractic

Email sig@anjc.info and let us know what other topics you’re interested in.


Waiving or Reducing Co-Pays - Q: Can I waive or reduce my patient’s co-pay or
deductible payments without getting in trouble?

A: It is improper to waive co-pay, co-insurance, or deductible payments by patients unless
the patient has a proven financial hardship. The CMS Medicare regulations require the
patient and/or family be at or below the federal poverty level to qualify for a financial
hardship waiver. The federal poverty level is presently set as follows: 2004 HHS Poverty
Guidelines

                          Size of          48 Contiguous
                        Family Unit        States and D.C. Alaska        Hawaii
                              1                 $ 9,310       $11,630 $10,700
                              2                 12,490         15,610    14,360
                              3                 15,670         19,590    18,020
                              4                 18,850         23,570    21,680
                              5                 22,030         27,550    25,340
                              6                 25,210         31,530    29,000
                              7                 28,390         35,510    32,660
                              8                 31,570         39,490    36,320
                     For each additional
                                                 3,180          3,980     3,660
                     person, add
              SOURCE: Federal Register, Vol. 69, No. 30, February 13, 2004, pp. 7336-7338

Thus, if your patient meets these guidelines, you may have them sign a financial hardship
form certifying that they qualify for a financial hardship waiver.
United Healthcare Bulletin: Physical Medicine & Rehabilitation - New reimbursement policy for
2 supervised therapy modalities to be introduced in early '07. In alignment with the
reimbursement guidelines established by the Centers for Medicare and Medicaid Services (CMS),
United Healthcare will implement a new policy for reimbursement of CPT codes 97010
(application of hot and cold packs) and 97014 (unattended electrical stimulation) early in 2007.
This policy will apply to physician and non-physician claims only; facility claims will not be
affected. Application of hot/cold packs (97010) is a modality that is no longer reimbursable
separately in accordance with CMS policy. The application of hot/cold packs is incorporated into
the primary procedure and separate payment will not be allowed, whether billed alone or in
conjunction with another procedure/service. When unattended electrical stimulation is delivered,
97014 is no longer considered the most appropriate code to describe treatment being delivered.
Instead, practitioners utilizing this modality should submit an appropriate HCPCS Code (G0281-
G0283) which better describes the service being rendered.


ANJC Women's Council is reorganizing to better serve your needs. We are looking for
regional representatives to help coordinate networking get togethers. Contact Maureen at HQ
(908-722-5678) if you are interested in helping to plan and schedule events in your area. We
also need to assemble a core group of women to help direct the Council and serve the women of
the ANJC. If this interests you, contact HQ by October 27, 2006 and we will set up a conference
call for all interested.


2007 Medicare Physician Fee Schedule - The 2007 Medicare Physician Fee Schedule (MPFS)
will be posted on our Web site after the Final Rule is published in November. Similar to last year,
the 2007 Participation Announcement and Participating Physician/Supplier Agreement will be
mailed to providers on CD-ROM. This will also occur once the 2007 regulation is put on display.


Dan Rodis's Application for a Preliminary Injunction Against Horizon Is Denied.
On Friday October 13, 2006, Judge De La Cruz of the Bergen County Superior Court denied Dr.
Dan Rodis's application for an order preliminary enjoining Horizon Blue Cross Blue Shield of New
Jersey from recapturing an alleged overpayment from Dr. Rodis's current claims. Judge De La
Cruz's decision was based upon two primary conclusions. First, the judge concluded that Dr.
Rodis could be adequately compensated for his losses by monetary damages at a future trial.
Second, Judge De La Cruz noted that because Horizon disputed a number of material facts,
injunctive relief was inappropriate at this time. While Dr. Rodis and his attorneys are extremely
disappointed in the decision and are presently contemplating a motion for reconsideration, the
judge's ruling has absolutely no bearing on Dr. Rodis's lawsuit against Horizon, which is
proceeding apace. For more information on this lawsuit, or on responding to post-payment
audits, contact John W. Leardi, Esq., of Buttaci & Leardi, LLC at jwleardi@buttacilaw.com.


STUDY LOOKS AT WORK-RELATED INJURIES AMONG DCs - Doctors of chiropractic suffer a
high prevalence of work-related injuries. These findings are from a survey of 1000 chiropractors
in the United States, who were asked to record their 3 most serious work-related injuries. Of 397
returned usable surveys, 40.1% reported enduring an injury while working. “Most injuries were
classified as soft tissue injuries and occurred while either performing (66.7%) or positioning
(11.1%) a patient for manipulation. Body parts most commonly injured were the
wrist/hand/finger (42.9%), shoulder (25.8%) and low back (24.6%). Most injuries occurred
during side-posture adjusting. Most commonly, injuries occurred in the first to fifth year of
practice (37.3%). Because most injuries occurred early on in the career and required a change in
technique, greater efforts toward injury prevention education should be aimed toward
chiropractic students,” urge the study’s authors. JMPT – September 2006;29:518-23.
http://www.mosby.com/jmpt

Provided By: The Chiropractic Health Research Information Service -
www.preventicare.com