Guest guest Posted August 27, 2009 Report Share Posted August 27, 2009 Hi all - I'm new to working with workers' comp, and am wondering how to deal with this. My patient (you may remember as the moxa alternative) had a severe neck injury 13 years ago, and had a cadaver bone graft 11 years ago to stabilize the neck. He's been in severe nerve and muscle pain ever since, even with morphine patches. I've seen him 7 times, just applied for another 6 weeks of treatment and was denied because of lack of documentation (which I can deal with) and because acupuncture 'doesn't appear to be helping'. Huh? are they going to stop his meds because they aren't helping either? (Sorry, gut response.) Can any of you suggest how I manage the appeal on this? k Karen R. Adams, Lic Ac, Dipl Ac 25 - 27 Bank Row Greenfield, MA 01301 413-768-8333 Do or do not. There is no try. Yoda, The Empire Strikes Back __ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 27, 2009 Report Share Posted August 27, 2009 Take ACOEM Occupational Medicine Practice Guidelines, better the last edition, and make a refrence to corresponding pages about treating neck pain. Usually insurance companies, then agree with necessity of acupuncture. Yuri Ovchinnikov, L.Ac turusachan <turusachan Chinese Medicine Thu, Aug 27, 2009 7:20 am workers comp question Hi all - I'm new to working with workers' comp, and am wondering how to deal with this. My patient (you may remember as the moxa alternative) had a severe neck injury 13 years ago, and had a cadaver bone graft 11 years ago to stabilize the neck. He's been in severe nerve and muscle pain ever since, even with morphine patches. I've seen him 7 times, just applied for another 6 weeks of treatment and was denied because of lack of documentation (which I can deal with) and because acupuncture 'doesn't appear to be helping'. Huh? are they going to stop his meds because they aren't helping either? (Sorry, gut response.) Can any of you suggest how I manage the appeal on this? k Karen R. Adams, Lic Ac, Dipl Ac 25 - 27 Bank Row Greenfield, MA 01301 413-768-8333 Do or do not. There is no try. Yoda, The Empire Strikes Back __ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 27, 2009 Report Share Posted August 27, 2009 It seems odd to me then that we may not be asking the right question here. If they are claiming that documentation is lacking, then it appears that this needs to be the place to start, no? Courses that come to mind here might include the IME course for physicians (in CA), insurance billing seminars, etc. I think that until you improve this aspect, you may see this more and more. FYI, as LAc's we often suffer from not knowing this important information. Michael W. Bowser, DC, LAc Chinese Medicine ovchin Thu, 27 Aug 2009 16:58:14 -0400 Re: workers comp question Take ACOEM Occupational Medicine Practice Guidelines, better the last edition, and make a refrence to corresponding pages about treating neck pain. Usually insurance companies, then agree with necessity of acupuncture. Yuri Ovchinnikov, L.Ac turusachan <turusachan Chinese Medicine Thu, Aug 27, 2009 7:20 am workers comp question Hi all - I'm new to working with workers' comp, and am wondering how to deal with this. My patient (you may remember as the moxa alternative) had a severe neck injury 13 years ago, and had a cadaver bone graft 11 years ago to stabilize the neck. He's been in severe nerve and muscle pain ever since, even with morphine patches. I've seen him 7 times, just applied for another 6 weeks of treatment and was denied because of lack of documentation (which I can deal with) and because acupuncture 'doesn't appear to be helping'. Huh? are they going to stop his meds because they aren't helping either? (Sorry, gut response.) Can any of you suggest how I manage the appeal on this? k Karen R. Adams, Lic Ac, Dipl Ac 25 - 27 Bank Row Greenfield, MA 01301 413-768-8333 Do or do not. There is no try. Yoda, The Empire Strikes Back __ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 27, 2009 Report Share Posted August 27, 2009 Mike - I agree with you; I need to know more about what was lacking so am waiting for official notice. When the decision was read to me over the phone, it was the last thing mentioned. The first one was that acupuncture wasn't working. I'm sure it's a language thing, I speak a different language. I'm just not sure how to address the impression that ac isn't working, esp since the beginning is sometimes subtle. btw, did a really simple treatment today that brought him some relief. a nice lesson to me: KISS. k Karen R. Adams, Lic Ac, Dipl Ac 25 - 27 Bank Row Greenfield, MA 01301 413-768-8333 Do or do not. There is no try. Yoda, The Empire Strikes Back ________________________________ mike Bowser <naturaldoc1 Chinese Traditional Medicine Thursday, August 27, 2009 5:04:28 PM RE: workers comp question It seems odd to me then that we may not be asking the right question here. If they are claiming that documentation is lacking, then it appears that this needs to be the place to start, no? Courses that come to mind here might include the IME course for physicians (in CA), insurance billing seminars, etc. I think that until you improve this aspect, you may see this more and more. FYI, as LAc's we often suffer from not knowing this important information. Michael W. Bowser, DC, LAc ovchin (AT) netscape (DOT) net Thu, 27 Aug 2009 16:58:14 -0400 Re: workers comp question Take ACOEM Occupational Medicine Practice Guidelines, better the last edition, and make a refrence to corresponding pages about treating neck pain. Usually insurance companies, then agree with necessity of acupuncture. Yuri Ovchinnikov, L.Ac turusachan <turusachan > Thu, Aug 27, 2009 7:20 am workers comp question Hi all - I'm new to working with workers' comp, and am wondering how to deal with this. My patient (you may remember as the moxa alternative) had a severe neck injury 13 years ago, and had a cadaver bone graft 11 years ago to stabilize the neck. He's been in severe nerve and muscle pain ever since, even with morphine patches. I've seen him 7 times, just applied for another 6 weeks of treatment and was denied because of lack of documentation (which I can deal with) and because acupuncture 'doesn't appear to be helping'. Huh? are they going to stop his meds because they aren't helping either? (Sorry, gut response.) Can any of you suggest how I manage the appeal on this? k Karen R. Adams, Lic Ac, Dipl Ac 25 - 27 Bank Row Greenfield, MA 01301 413-768-8333 Do or do not. There is no try. Yoda, The Empire Strikes Back __ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 27, 2009 Report Share Posted August 27, 2009 I have worked on IME panels with MDs. There is a certain lingo they are used to seeing. Usually they want to see stuff that resembles PT evaluations, 1.How much improvement was achieved so far? " After the initial treatment course consisting of 8 treatments, the client reports a pain reduction of 40% 2.How much improvement do you expect to achieve, with how many treatments? " Clients with similar injuries usually progress to 80% improvement with a total course of 20 treatments. " 3. Always give the pain scale and frequency. " The client reports the pain as always present, on a scale from 4 to 8, (1-10 scale). Always use SOAP, make it explicit what is the client's appraisal and what is yours, and always quantify everything. If the client does not progress towards a specified therapeutic goal but just feels better after the treatment, they will usually not approve treatment. Good luck. Regards, Angela Pfaffenberger, Ph.D. angelapfa www.InnerhealthSalem.com Phone: 503 364 3022 - mike Bowser Chinese Traditional Medicine Thursday, August 27, 2009 2:04 PM RE: workers comp question It seems odd to me then that we may not be asking the right question here. If they are claiming that documentation is lacking, then it appears that this needs to be the place to start, no? Courses that come to mind here might include the IME course for physicians (in CA), insurance billing seminars, etc. I think that until you improve this aspect, you may see this more and more. FYI, as LAc's we often suffer from not knowing this important information. Michael W. Bowser, DC, LAc Chinese Medicine ovchin Thu, 27 Aug 2009 16:58:14 -0400 Re: workers comp question Take ACOEM Occupational Medicine Practice Guidelines, better the last edition, and make a refrence to corresponding pages about treating neck pain. Usually insurance companies, then agree with necessity of acupuncture. Yuri Ovchinnikov, L.Ac turusachan <turusachan Chinese Medicine Thu, Aug 27, 2009 7:20 am workers comp question Hi all - I'm new to working with workers' comp, and am wondering how to deal with this. My patient (you may remember as the moxa alternative) had a severe neck injury 13 years ago, and had a cadaver bone graft 11 years ago to stabilize the neck. He's been in severe nerve and muscle pain ever since, even with morphine patches. I've seen him 7 times, just applied for another 6 weeks of treatment and was denied because of lack of documentation (which I can deal with) and because acupuncture 'doesn't appear to be helping'. Huh? are they going to stop his meds because they aren't helping either? (Sorry, gut response.) Can any of you suggest how I manage the appeal on this? k Karen R. Adams, Lic Ac, Dipl Ac 25 - 27 Bank Row Greenfield, MA 01301 413-768-8333 Do or do not. There is no try. Yoda, The Empire Strikes Back __ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 28, 2009 Report Share Posted August 28, 2009 Hi Angela - that's good stuff. SOAP is what, 'symptoms', 'observation' and.... I new this once. I can put things in this format, and will follow your suggestions. And this seems to be largely nerve pain, like the nerves are misfiring or confused (I can bet that observation will go over well). He cries out if I gently touch the skin over his left scapula. the pain causes tension, the tension causes him to stiffen the neck and shoulder muscles, drawing left shoulder and head together, which increases the pain. Deep heat helps (he loves moxa), but the affect doesn't last past the treatment. Dr. Tan's treatments seem to help, though not for very long - so far. How do I come up with a prognosis for treatment for 13 year old nerve pain and probable muscle involvement? k Karen R. Adams, Lic Ac, Dipl Ac 25 - 27 Bank Row Greenfield, MA 01301 413-768-8333 Do or do not. There is no try. Yoda, The Empire Strikes Back ________________________________ " Angela Pfaffenberger, PH.D. " <angelapfa Chinese Medicine Thursday, August 27, 2009 6:56:33 PM Re: workers comp question I have worked on IME panels with MDs. There is a certain lingo they are used to seeing. Usually they want to see stuff that resembles PT evaluations, 1.How much improvement was achieved so far? " After the initial treatment course consisting of 8 treatments, the client reports a pain reduction of 40% 2.How much improvement do you expect to achieve, with how many treatments? " Clients with similar injuries usually progress to 80% improvement with a total course of 20 treatments. " 3. Always give the pain scale and frequency. " The client reports the pain as always present, on a scale from 4 to 8, (1-10 scale). Always use SOAP, make it explicit what is the client's appraisal and what is yours, and always quantify everything. If the client does not progress towards a specified therapeutic goal but just feels better after the treatment, they will usually not approve treatment. Good luck. Regards, Angela Pfaffenberger, Ph.D. angelapfa (AT) comcast (DOT) net www.InnerhealthSale m.com Phone: 503 364 3022 - mike Bowser traditional_ chinese_medicine Thursday, August 27, 2009 2:04 PM RE: workers comp question It seems odd to me then that we may not be asking the right question here. If they are claiming that documentation is lacking, then it appears that this needs to be the place to start, no? Courses that come to mind here might include the IME course for physicians (in CA), insurance billing seminars, etc. I think that until you improve this aspect, you may see this more and more. FYI, as LAc's we often suffer from not knowing this important information. Michael W. Bowser, DC, LAc ovchin (AT) netscape (DOT) net Thu, 27 Aug 2009 16:58:14 -0400 Re: workers comp question Take ACOEM Occupational Medicine Practice Guidelines, better the last edition, and make a refrence to corresponding pages about treating neck pain. Usually insurance companies, then agree with necessity of acupuncture. Yuri Ovchinnikov, L.Ac turusachan <turusachan > Thu, Aug 27, 2009 7:20 am workers comp question Hi all - I'm new to working with workers' comp, and am wondering how to deal with this. My patient (you may remember as the moxa alternative) had a severe neck injury 13 years ago, and had a cadaver bone graft 11 years ago to stabilize the neck. He's been in severe nerve and muscle pain ever since, even with morphine patches. I've seen him 7 times, just applied for another 6 weeks of treatment and was denied because of lack of documentation (which I can deal with) and because acupuncture 'doesn't appear to be helping'. Huh? are they going to stop his meds because they aren't helping either? (Sorry, gut response.) Can any of you suggest how I manage the appeal on this? k Karen R. Adams, Lic Ac, Dipl Ac 25 - 27 Bank Row Greenfield, MA 01301 413-768-8333 Do or do not. There is no try. Yoda, The Empire Strikes Back __ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 28, 2009 Report Share Posted August 28, 2009 If you are looking for more info on what to do, you might want to check into Dr. Kevin McNamee's DC/LAc courses on physical examinations or those offered by Dr. Fred Lerner DC/PhD. This is a huge area that I think we need to be prepared to get into if we want insurance to pay us for our treatment. This area can be profitable and is closely guarded by the insurance gate-keepers. Glad to hear that you are willing to look more closely at this as it benefits you and your patients. Be aware that the insurance EOB will not define what you are lacking in, only that they deny the claim for a standard reason. Michael W. Bowser, DC, LAc Chinese Medicine turusachan Thu, 27 Aug 2009 15:46:21 -0700 Re: workers comp question Mike - I agree with you; I need to know more about what was lacking so am waiting for official notice. When the decision was read to me over the phone, it was the last thing mentioned. The first one was that acupuncture wasn't working. I'm sure it's a language thing, I speak a different language. I'm just not sure how to address the impression that ac isn't working, esp since the beginning is sometimes subtle. btw, did a really simple treatment today that brought him some relief. a nice lesson to me: KISS. k Karen R. Adams, Lic Ac, Dipl Ac 25 - 27 Bank Row Greenfield, MA 01301 413-768-8333 Do or do not. There is no try. Yoda, The Empire Strikes Back ________________________________ mike Bowser <naturaldoc1 Chinese Traditional Medicine Thursday, August 27, 2009 5:04:28 PM RE: workers comp question It seems odd to me then that we may not be asking the right question here. If they are claiming that documentation is lacking, then it appears that this needs to be the place to start, no? Courses that come to mind here might include the IME course for physicians (in CA), insurance billing seminars, etc. I think that until you improve this aspect, you may see this more and more. FYI, as LAc's we often suffer from not knowing this important information. Michael W. Bowser, DC, LAc ovchin (AT) netscape (DOT) net Thu, 27 Aug 2009 16:58:14 -0400 Re: workers comp question Take ACOEM Occupational Medicine Practice Guidelines, better the last edition, and make a refrence to corresponding pages about treating neck pain. Usually insurance companies, then agree with necessity of acupuncture. Yuri Ovchinnikov, L.Ac turusachan <turusachan > Thu, Aug 27, 2009 7:20 am workers comp question Hi all - I'm new to working with workers' comp, and am wondering how to deal with this. My patient (you may remember as the moxa alternative) had a severe neck injury 13 years ago, and had a cadaver bone graft 11 years ago to stabilize the neck. He's been in severe nerve and muscle pain ever since, even with morphine patches. I've seen him 7 times, just applied for another 6 weeks of treatment and was denied because of lack of documentation (which I can deal with) and because acupuncture 'doesn't appear to be helping'. Huh? are they going to stop his meds because they aren't helping either? (Sorry, gut response.) Can any of you suggest how I manage the appeal on this? k Karen R. Adams, Lic Ac, Dipl Ac 25 - 27 Bank Row Greenfield, MA 01301 413-768-8333 Do or do not. There is no try. Yoda, The Empire Strikes Back __ Quote Link to comment Share on other sites More sharing options...
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