Frequently Asked Questions

Osteopathic Manipulation Therapy (hereafter OMT) is a treatment modality identified by the American Medical Association and defined by a specific   CPT ® code when reported as a service on a patient.  In this manner, it is no different than other   CPT ® codes reported for services rendered for a patient on a given CMS claim form. 

During our seminars, you will be educated on certain OMT techniques.  You will recognize that many of those techniques have parallels with what we traditionally do as chiropractors.  This is just the tip of the iceberg on what you will learn, and you will leave with a firm understanding of legality and compliance (along with a bunch of reference materials and documents for your office)...so the answer is an unequivocal YES! 

One of the goals of the seminar is to eliminate the "subjectivity" of what we do as chiropractors.  Chiropractors waste a lot of energy arguing about philosophy or whether or not we move "bones" or "joints" and the like.   This will always have value from an entertainment perspective, but little functional use when communicating with an insurnance company.  We keep discussions and the presentation "objective" with a lot of factual information and legal concepts supporting what we do. 

You will notice that during our seminars, we cite a lot of federal legislation, state statutes, state scope of practice laws, "black letter law," and some case law (even a U.S. Supreme Court decision!).       We do this to show you how supportive the law really is for chiros to perform OMT. 

What may come as a surprise, is that the seminar if more of a coding and documentation seminar than anything else.  One conclusion you may make is that for many of your treatments, OMT is the most prudent code to utilize for your patient treatment!   This is not to discredit CMT!   In many  cases, that may be appropriate as well.  However, all providers agree there is no such thing as a clinical "one size fits all."  Different patient presentations dictate different patient diagnoses and procedures.

 Maybe.... Whenever you make more money, you're automatically a target for audits.   A large part of the seminar is designated for audit defense and a large part of that defense is proper use of ERISA.

 ERISA, stands for Employee Retirement Income Security Act and it became law in 1974.   Basically, it  stipulates how insurance companies adjudicate payments to beneficiaries of a claim.   Recent case law  and some managed care contracts have changed some of the traditional defenses used in Audits.  However, there are some very pertinent clauses in ERISA, that, if utilized appropriately with your patient in certain office forms, can effectively stop an audit in its tracks.   

This shouldn't be used as an excuse to have poor chart documentation.    As you know there was a 2005 Medicare (OIG) report on the vulnerabilities of chiropractors. Two deficiencies chiropractors were noted to have, was 1)  lack of medical necessity and 2)  poor documentation.  As you know Medicare (and most commercial insurance carriers) uses the P.A.R.T. documentation standards for diagnosis of a subluxation.

However, to answer the original question, we have been audited several times, and have passed without owing any money.   

 OMT has specific protocols for documentation, which we will go over thoroughly. There are many similarities you may recognize with CMS documentation of chiropractic manipulative therapy (98940, 98941, and 98942). As you know, poor documentation is a black eye on the chiropractic profession. This is a very important part of the course, because you need to recognize the specifics for documenting an OMT procedure. Another aspect of documentation that will be covered is medical necessity. As you know from the 2005 report from the OIG, medical necessity went on the hit list for chiropractors and has been on the hit list for audits ever since.

 ERISA stands for Employee Retirement Income Security Act of 1974. This is a very important law because it established protocols for how insurance companies adjudicate claims on behalf of patients. There are many protective clauses in ERISA that govern the actions of a Fiduciary (health insurance carrier)  in claims payments.   If you know how to use them and know how to apply those clauses in an assignment of benefits (and designation of an authorized representative). Several of our clients have used these forms to stop insurance company audits in their tracks. However, without this in place, you could be a "sitting duck" when an insurance company comes knocking on your door for an audit.

  There's a specific clause of the Patient Protection and Affordable Care Act, Section 2706(a) which reads, a “group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable state law.”  Section 2706(a) does not require “that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer,” and nothing in  section 2706(a) prevents “a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures.”  Similar language is included in section 1852(b)(2) of the Social Security Act and implementing HHS regulations.

  The American Osteopathic Chiropractor Association (AOCA) is an Independent Physician  Association with goals to support our members professionally.  Independent physician associations have historically acted as "middle men" when contracting with insurance companies to allow  fair and equitable treatment for its providers, and that's certainly something we do.   Look at it this way-attending the seminar gives you a leg up when dealing with insurance companies and contracting for "equitable treatment."  

However, we offer many other resources for our providers as well- legal, banking, insurance, advertising, and others.      

Association membership allows us to be stronger together than individually, but ultimately we all benefit individually in our own practices.   In these times of uncertainty for the future of our profession it makes sense to band together for the betterment of our profession.  

In some cases OMT is reimbursed substantially higher than CMT. In some cases there isn't much difference at all. There's a very simple process we can walk you through that can show you the difference in reimbursements based on your geographical region. In many cases, providers with whom we talk with are pleasantly surprised with the outcome, especially when it's extrapolated over the course of a year with all the patient visits they see in that time frame.

  OMT is not a covered service by Medicare for chiropractors. Medicare only covers CMT (98940, 98941, and 98942). This may change with the Medicare Modernization Act.....fingers crossed!

  We think it's wise to incorporate a discount plan concept into your office. We have found the company www.patientoptions.org to be very patient-friendly without patients having to pay membership fees to be entitled to a discount. 

 As you know, in the United States, ICD-9 codes transitioned to ICD-10 codes in 2015,  and we went from 13,000 codes to a whopping 70,000 codes overnight. This was all designed to make diagnosis of a patient more specific. When diagnosing to support the   

CPT ® codes for OMT, there may be a few changes you make, but you will recognize and implement the language very easily.

 Several state boards are on record saying they don't address billing issues or certain CPT codes. It's not their job to say what CPT codes we can or cannot use. Their objective is to enforce the scope of practice laws for licensed professionals and protect the best interests and safeguard the public. Furthermore, you will find no chiropractic statutes or regulations that prohibit a chiropractor from using an OMT code. There's a very specific reason for this!

Additionally, we've had Board members attend our seminars and we've received complements afterwards.   They've requested that they remain anonymous, because they don't want to be on record that the Board necessarily condones Osteopathic Manipulation. 

If you are a board member, I encourage you to give us a call to discuss, in a more candid  and detailed approach, some questions you may have.     

 We have addressed this issue briefly when we've done association-sponsored continuing education seminars, however, most states have strict criteria for presentations from which we have to abide.   Because it is not a common concept that chiropractors are aware of, they are hesitant to host a seminar specifically on Osteopathic Manipulation.   That is changing gradually, but nothing happens overnight.   

If you are a state association, I encourage you to call us to have an open discussion, if you have interest in us presenting.     As stated earlier, much of the presentation is documentation and coding.   We do discuss technique as a formality as well.   

 No.    About 10% of the attendees to our seminars are attorneys.   They find it valuable for their clients in prosecuting and defending personal injury claims, especially when there are questions about medical necessity and in cases fighting Colossus  and Xactimate personal injury software.

(**For those unfamiliar with these terms, they are a type a computer program and artificial intelligence that insurance companies use to mitigate their losses in a given claim.)  

We presently network with attorneys in 23 states with most of them admitted Federally. This is important if there is a claim involving the Patient Protection and Affordable Care Act (PPACA) or ERISA.   Some attorneys find the course so useful, they refer chiropractors with whom they work. 

The AOCA is the American Osteopathic Chiropractor Association, an Independent Physician Association. Collectively, our goal is to represent the best interests and our providers and members who perform osteopathic manipulative therapy as part of their practice model. We are a group of chiropractors demanding parity in health care.  Our goal is to educate, train, defend,   and support like-minded doctors who demand parity and recognition in our profession. Additionally, we have a large network of attorneys nationwide that can facilitate you in contract negotiations, dispute resolution, and audit defense. 

 I've had the privilege of meeting and teaching you at some of my continuing education seminars on ERISA, clinical documentation,  and OIG compliance. Some of the recurring concerns are that we go to school for a very long time, study hard and take out lots of student loans to get where we are today, only to realize our dreams and aspirations developed in school take a back seat to reality.  We may associate or have our own office, but over the course of getting involved in chiropractic, many of us get pigeonholed in thinking our role in health care is very limited and worth very little. 

Most chiropractors are mavericks in the sense that they operate in small clinics.  Our numbers  aren't that large, and they are decreasing every year, because it's increasingly challenging to survive in this healthcare environment. What we don't realize is that collectively we are very strong.  Our education is top notch, and we're doing the public a disservice if we don't learn to collectively flex our muscles. It's time we work together for the betterment of our profession and practice to the full extent of our education and licensure.

-Douglas Luther, DC