Billing & Coding -and- Ethics & Law w/ E. Calkins, CA & W. Coleman, DC (Aug 27, 6hrs)

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Billing, coding and ethics all in one session, for DCs or CAs. Includes 2 hrs ethics & law, 4 hrs billing & coding. 3-9pm


Wayne Coleman, DC
Wayne Coleman, DC, Professor, Ethics and Jurisprudence, Life West
Emma Calkins
Emma Calkins
Emma Calkins, CA


August 30, 2017 - 3:00 pm


August 30, 2017 - 9:00 pm


LifeWest Campus: 25001 Industrial Blvd, Hayward, CA 94545   View map

This course will ensure your practice is getting paid for your services. Bring yourself and your staff for information on how to navigate insurance company contracts, medical policies, claims, processing and of course ICD-10 diagnosis coding. Includes 2 hours Ethics & Law, and 4 hours of Billing & Coding.

6 hours mandatory CE credit PENDING


State CE Available/Approval #
California 6 hours Approved
2 hrs Ethics & Law – CA-A-16-12-13001
(Category A mandatory hours)
4 hrs Billing & Coding – CA-A-16-12-13002
(Category A mandatory hours)

Hour Topic
1: Ethics & Law
  • Ethical concepts that chiropractors are judged by
  • Most common causes for legal actions taken against Chiropractors
  • Limitations on using Laser therapy
  • Record keeping/medical necessity
2: Ethics & Law
  • Proper advertising
  • Scope of practice
  • Internet communications with your patients
  • What unlicensed individuals can and cannot legally do in your office
3: Billing & Coding
  • Introduction
  • Insurance Network Participation – Pros and cons of being a network Chiropractic Healthcare Provider for insurance companies versus cash practice.
  • Credentialing/Contracting – Validation/Re-validation process with Medicare. Credentialing and contracting with private insurance carriers.  How to find out your fee schedules with each company.
  • Electronic Medical Records – How use of EMR assists in choice of ICD-10 diagnosis codes, and streamlines process for Medical Necessity Reviews. Provide brief overview of most used Chiropractic EMR programs, and low cost EMR programs that also meet Medicare’s Meaningful Use requirements.
4: Billing & Coding
  • NEW Changes that occurred to ICD-10 October, 1, 2016.
  • “Unspecified” Codes – and why to never use them.
  • “Acute Injury” Codes – What they are, how they may trigger questions, and how to treat them in your practice without scrutiny.
  • Medical Policies – Being aware of each carrier’s medical policies and what they deem medically necessary should guide diagnosis, not create.
  • How to show through diagnosis coding your adjunctive therapies are separately payable from your manipulation codes.
  • Resources – General Equivalence Mappings (GEM’s) coding sites, Chiropractic specific code books that all practices can use.
5: Billing & Coding
  • Top CPT codes used in Chiropractic
  • Reporting PT and Modality Codes – PT codes are timed How to consolidate your treatments into less line items, maximizing reimbursement potential
  • Multiple Therapy Reductions – Insurance carriers’ rationale/explanation of fee schedule reduction for multiple therapies reported for one date of service.
  • Medicare Specific Coding –Where and how to access region specific Local Coverage Determinations for Medicare to ensure you are reporting “medically necessary” treatment. ABN use in Chiropractic office.
  • PQRS – Physician Quality Reporting System. Top 2 measures Chiropractors can report on and how to report the measures. Stops a 2% reduction on Medicare Fee Schedule.
  • Modifiers – Modifier -59 replacements, ABN and Medicare specific modifiers.
  • Authorization/Medical Necessity Reviews – Navigating the American Specialty Health Plans processes. What records they will require and base their decisions on.  How to communicate the process to your patients (maintenance versus injury care).
  • Workers’ Compensation and “MedPay” cases. What is required on your claim forms.
6: Billing & Coding
  • Insurance Verifications – Importance of verifying patient benefit prior to treatment. Examples of Chiropractic Insurance Verification form and why certain questions are necessary/helpful for the Chiropractic office.
  • Avenues to Verify – Various online tools to verify chiropractic benefits, including with Medicare.
  • Follow Up Phone Verification – Specific questions necessary to ask representatives of the patient’s insurance carrier for Chiropractic coverage.
  • Patient Portion – How to determine a patient’s out of pocket prior to the insurance carrier’s processing of the claim I order to collect at time of visit. How to handle overpayment or underpayment that at times may result.
  • Electronic Billing tips – “Replacement” and “Void” claims and when to use them.



(510) 780-4508