W hether your role as a chiropractic assistant involves patient education, taking dictation during exams, interacting with third-party payers, reading charts and notes, or simply talking intelligently and productively with the patient and the doctor, good communication is vital to your and your practice's success. You didn't learn to speak even your native language overnight, so don't expect to learn to "speak chiropractic" instantaneously. However, building a sound foundation in the profession's most-used terminology is a critical functional skill for chiropractic assistants, and vital to becoming an important asset to the practice. You can and should expect this learning to continue throughout your professional career in chiropractic. If you're like most of us, understanding may come in waves. At first, you may only master the rudimentary meaning of the terms at their most basic definition, and that's okay. But understand that the more you know, the more you can do, and thus the more fulfilling your work will be and the more valuable you are to the team. Take the term "subluxation," for example. In traditional or allopathic medicine, it means an incomplete or partial dislocation. In chiropractic, however, the word is more complex, beginning with a change in the structural or functional dynamics of a joint. That could mean a fixed or partially restricted joint as easily as a hypermobile joint where the bone is moving beyond normal range of motion. Simply put, you can't be a good CA if you don't speak the doctor's language. So if you haven't already done so, ask your doctor to explain what subluxation means to them. The chiropractic vocabulary begins with many acronyms, including CMS (Centers for Medicare and Medicaid Services), the agency that is a part of the federal Department of Health and Human Services (HHS) that administers the Medicare and Medicaid programs; CMT (chiropractic manipulative treatment); EHR (electronic health records); and, for that matter, CA (chiropractic assistant) and DC (doctor of chiropractic), two you may be relieved to find you already know. You'll see more than a few acronyms in doctor notes too, including DX (diagnosis), TX (treatment), ROF (the clinical report of findings, in which the doctor explains his or her clinical findings to the patient and makes treatment recommendations, usually on the first visit); and MVA (motor vehicle accident). One of the acronyms you'll become most familiar with is ICD (International Classification of Diseases) codes. These codes describe the patient's diagnosis, and, right now, are typically three digits with a decimal and one or two digits extending beyond the decimal point. We're currently using edition nine, thus, ICD-9. Over the next year, the entire profession will be readying for ICD-10, a much more comprehensive coding set with longer alphanumeric strings, more specificity, and the ability to more accurately convey the diagnosis and treatment rendered. ICD-10 is due to be implemented in October 2015. When it comes to terminology relative to insurance billing, if you've ever been a patient, chiropractic or otherwise, you know many of the relevant terms already. Such terms include deductible (fixed amount of money paid by the patient annually before insurance will kick in); copay (fixed amount paid by the patient each visit with insurance picking up the remainder); and EOB (explanation of benefits) from the insurance company. Then there's the true insider language of chiropractic-terms and phrases that refer to internal billing and other processes. An example here is the 75/50/25 Scheduling Rule, which is a guideline that suggests that if you have 100 patients on the appointment books this week, next week should already have 75% of them scheduled, with 50% the following week, and 25% the week after that. A hardship agreement is a financial determination established in advance when a patient is unable to pay the actual fees established by your practice. This hardship policy must be applied consistently across the entire patient roster. A TOS is a time-of-service discount offered to patients who are willing and able to pay on the spot. The OIG (Office of the Inspector General from the Department of Health and Human Services that oversees compliance with and looks for fraud and abuse in federal health programs) strongly suggests that these discounts fall between 5 to 15% and are based on the practice's actual savings when compared to billing later. Here's a short list of some of the other vocabulary that's advantageous for you to learn: Atlas-The topmost vertebra of the spine. Some chiropractic techniques follow the philosophy that adjusting the atlas corrects everything else in the body. Big idea (also called innate intelligence) - Chiropractic is founded on this concept, which is that the body heals itself when interference to the proper functioning of the nervous system is removed. Cavitation - A "pop" that happens in a spinal joint when the vertebra are separated by manual adjustment to create a vacuum that pulls in nitrogen gas. Many patients incorrectly refer to this as having their backs "cracked." Cervical vertebrae -The seven vertebrae in the cervical, or neck, area of the spine. Discount medical plan organization (DMPO) - An organization that allows chiropractors to set legal discounted fees for patients who must pay cash for all or part of their service. Dual fee schedule - Usually, charging cash patients less than insured patients. Important to note that this can be illegal. Inducement - Offering freebies, gifts, or discounts in excess of $10 per patient more than five times per year. This is also illegal. Intervertebral disc - The tough cartilage that acts as a cushion between two vertebrae. Each disc has a gelati-nous-like center (nucleus pulposus). When this protrudes, it's called a disc herniation. Lumbar vertebrae - The five bones in the lower-back portion of the spine. Musculoskeletal - Referring to structures involving tendons, muscles, ligaments, and joints. Nerve root - One of the two nerve bundles emerging from the spinal cord that join to form a segmental spinal nerve. PI -This abbreviation for "personal injury" is used in phrases such as "PI practice" and "PI seminar," which focus on patients with auto injuries. Sacrum-The triangular bone that serves as a base for the spinal column and connects the pelvic bones. SMT - The abbreviation for "spinal manipulative therapy." Spinal adjustment - Some chiropractors use the terms "adjustment" and "manipulation" interchangeably, yet others do not. Either way, it refers to a correction of a subluxation. Spinal decay (also called subluxation degeneration) - Calcification and/or deterioration of any vertebrae. Most often seen in the cervical region where it can lead to a reverse cervical curve and the head-thrust-forward posture seen in some elderly people. Subluxation -The medical definition is incomplete or partial dislocation—a condition, visible on x-ray films, in which the bony surfaces of a joint no longer face each other exactly but remain partially aligned. Chiropractors use the term in several ways, as described above. Thoracic vertebrae -The twelve vertebrae in the thoracic, or upper- to mid-back, portion of the spine. Ticklers - A system of reminders to office staff—including you—to stay in touch with patients regarding appointment scheduling, reimbursement, and follow-up. Vertebra - A bony segment of the spine that encircles and helps protect the spinal cord and nerves. The plural of vertebra is vertebrae. Obviously, this is a mere handful of all of the terminology that presents the complete vocabulary of the profession. Read up, study, and, most importantly, keep your ears open and never be afraid to ask for clarification if you don't understand. Sometimes, as in learning French or Italian, the best way to pick up a language is to dive in at the deep end. Just keep swimming! Before you know it, you'll speak fluent chiropractor. KathyMills Chang is a Certified Medical Compliance Specialist (MCS-P) and, since 1983. lias been providing cliimpractorswith reimbursement and compliance training, ad\'ice and tools to improve the financial performance of their practices. Kathy is known as one of our professions foremost experts on Medicare andean be readied at (855) TEAMKA1C or injb'u kniauiiversUy.com
