Continuing Education

North American Consultants is currently registered with the Texas Department of Insurance to conduct five separate Continuing Educational (CE) courses. We conduct these courses in your office. If you are interested in providing any or all of these courses for your adjusters please contact your North American Consultants, Inc. Sales Representative or our office.

Course 1 - Practices & Procedures of Retrospective Review

Course 2 - Standards of Care - Chiropractic & Physical Modalities

Course 3 - Multi-Provider Care - Standards & Practices

Course 4 - Retrospective Reviews & Protocols

Course 5 - Chiropractic Red Flags & Unusual CPT Codes

Course 6 - Introduction to Medical Affidavits

Course 7 - Epidural Steroid Injections


Course #1 Outline

Practices & Procedures of Retrospective Review - TDI Course #6213
Review Process Orientation/Education

  1. Chiropractic Laws/Rules in a State of Flux.
  2. Role & Value of the Review Process in Health Cost Containment.
  3. Documentation Required for the Review Process.
  4. Documents Frequently Overlooked by Carriers in the Review Process.
    1. Doctor's daily notes.
    2. ER records.
    3. Photos and other evidence that may suggest the force incurred in the MVA.
    4. Documentation of missed work.
  5. Items Which Should Trigger the Review Process.
    1. Documentation of only sprain/strain injury (soft tissue) with treatment greater than six weeks.
    2. Daily care.
    3. Exam to the comprehensive level.
    4. Unusual or unproved diagnostic tests.
      1. Paraspinal Surface EMG
      2. CPT (Current Perception Threshold)
      3. ROM Testing (as separate procedure)
      4. Muscle Strength Testing (as separate procedure)
      5. Repeat of X-rays
  6. Unusual or Unproved Therapeutic Procedures.
    1. Intersegmental Traction
    2. Acupuncture
    3. Herbs/Vitamins
    4. Extensive use of Passive Modalities
  7. Therapeutic Exercises Vs Kinetic Activities.
    1. Neuromuscular Reeducation
  8. Treatment of Children.

Course #2 Outline

Standards of Care - Chiropractic & Physical Modalities - TDI Course #6217

  1. Scope of Chiropractic Practice
    1. Texas Legislature - Statutes
    2. Attorney General Opinions
    3. Texas Board of Chiropractic Examiners
      1. Rules, Regulations & Provisions
  2. Questionable practices in all health care professions
  3. Types of Medical Practices
  4. Types of Patients
    1. Attorney Referral
    2. Age Consideration
    3. Previous injuries and pre-existing conditions
    4. Accident staging
  5. Necessity of Adequate Documentation
  6. Establishment & Support of condition and diagnosis
  7. Establish the necessity for care rendered
  8. Types of Treatment Procedures
    1. Emergency Room Care
    2. Daily Care
    3. Types of Modalities
      1. Active modalities
      2. Passive modalities
    4. Length of Treatment
    5. Number of Modalities
    6. Questionable Procedures
      1. Intersegmental traction
      2. Acupuncture
      3. Neuromuscular re-education
    7. Re-Examinations
    8. Duplicate x-rays
    9. Necessary Referrals

Course # 3 Outline

Multi-Provider Care; Standards & Practices - TDI Course #6211

  1. Layering care between Specialty Groups
    1. Standards for Physical Therapists & Physiatrists.
    2. Standards for Chiropractic Physicians
    3. Chiro - Ortho - Neuro (some treatments are not known to other specialists)
  2. Pain Treatment
    1. Not appropriate within 6 weeks. Why? (explain subjective pain)
    2. After six weeks -
      1. frank neurological signs
      2. loss of deep tendon reflex
      3. loss of bladder & bowel control
  3. Orthopedic (Spinal)
    1. Disk protrusions & Disk Desication (MRI)
    2. Drying - takes 3-10 months to occur
    3. Osteofication - old or cronic condition
      1. Aggravation does not = Accident caused
    4. Subligamenus disk herniation = bulge (no anomaly)
    5. Watch how words are being defined in diagnosis
  4. Referral to Ortho. Bone or Joint Concern?
    1. Records need to establish objective perspective
    2. Rotator cuff tear = ligament not for sprain/strain
    3. Self serving - makes referral back to chiro
  5. Referral to Family Practitioner - also self serving
    1. OK for evaluation of medications
    2. Self serving - makes referral back to chiro
    3. Watch for the patterns
  6. Referral for MRI Studies
    1. Early MRI abuse.
    2. Frank neurological signs (head, etc.)
    3. Abnormalities and subjective complaints
    4. Have there been needle EMG'S?
    5. Myleogram
  7. Rehabilitation
    1. Passive modalities
    2. Active modalities
    3. Therapeutic exercises
    4. S/S is self-limiting but all are not equal
  8. Daily Care
    1. Higher impact
    2. Patient sought care immediately
    3. Documented high pain component
    4. 2-4 Weeks max then watch for need of higher treatment specialist
  9. Treatment of Children

Course #4 Outline

Retrospective Reviews and Protocols - TDI Course #6215

REVIEW PROCESS ORIENTATION/EDUCATION

  1. Value of the Review Process in BI Claims.
  2. Documentation Required for the Review Process.
  3. Documents Frequently Overlooked by Carriers in the Review Process.
    1. Doctor's daily notes.
    2. ER records.
    3. Photos and other evidence that may suggest the force incurred in the MVA.
    4. Documentation of missed work.
  4. Items Which Should Trigger the Review Process.
    1. Documentation of only sprain/strain injury (soft tissue) with treatment greater than six weeks.
    2. Daily care.
    3. Exam to the comprehensive level.
    4. Unusual or unproved diagnostic tests.
      1. Paraspinal Surface EMG
      2. Repeat of X-rays
      3. Unbundling of x-rays
  5. Hospital Protocols
    1. Activation of Trauma Team
    2. Ordering of MRI's and CT's
  6. Unusual or Unproved Therapeutic Procedures.
    1. Herbs/Vitamins
    2. Extensive use of Passive Modalities
  7. Therapeutic Exercises Vs Kinetic Activities, what is the difference.
  8. Chiropractic Treatment of Children.
  9. Use of Biomechanical Engineers
    1. Why use Engineer?
    2. Criteria for Engineer
    3. Value of Engineer
    4. Engineers and Court

Course # 5 Outline

Chiropractic Red Flags and Unusual CPT codes - TDI Course #6209

Review Process Orientation/Education

  1. Value of the Review Process in BI Claims.
    1. Documents Required for the Review Process
  2. Standards of Chiropractic Evaluations
    1. Value of SOAP Notes
  3. Documents Frequently Overlooked by Carriers in the Review Process.
    1. Doctor's daily notes.
    2. ER records.
    3. Photos and other evidence that may suggest the force incurred in the MVA.
  4. Chiropractic Red Flags to Look For During the Review Process
    1. Documentation of only sprain/strain injury (soft tissue) with treatment greater than six weeks.
    2. Daily care.
    3. Exam to the comprehensive level.
    4. Unusual or unproved diagnostic tests.
      1. Paraspinal Surface EMG
      2. Repeat of X-rays
      3. Unbundling of x-rays
  5. Unusual or Unproved CPT Codes
    1. 97140
    2. Use of E/M codes with CMT codes

Course # 6 Outline

Introduction to Medical Affidavits

  1. Purpose of Affidavits
    1. What is an Affidavit?
    2. What Rules do affidavits follow:
  2. Medical Necessity Affidavits
    1. Follows Ruling 18.001
    2. How is it used and who signs it?
  3. Cost (Billing) Affidavit
    1. Follows Ruling 18.001​.
    2. How is it used and who signs it?​
  4. Paid vs. Incurred Affidavit
    1. Why use an Attorney to sign it?​
    2. What rules does it follow?
    3. Haygood vs. Escobedo ruling

Course #7 Outline

Epidural Seteriod Injections
Review Process Orientation/Education

  1. What is an Epidural Steriod Injection?
  2. Different Types of Injections.
    1. Translaminar
    2. Transforaminal
    3. Caudal Approach
  3. Who are Candidates for ESI’s?
    1. Prior Conditions
    2. Current Symptoms
  4. Appropriate Coding for ESI’s
  5. Limitations
    1. Results
    2. Risks
  6. FAQ