Web page link

https://pennchiro.org/

Membership Fees

Member benefits

• Discounted CEUs
• Online resources: practice management forms, coding tools, CEUs
• Coding and compliance training program
• Classifieds
• Strategic business partners
• Networking support
• Advocacy efforts
• Some levels of membership include specials for conventions, including registration

Website to apply for license:  https://www.pa.gov/en/agencies/dos/department-and-offices/bpoa/boards-commissions/chiropractic.html

• License fee: varies by licensure type, typically $225, but read here further: https://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/049/chapter5/chap5toc.html&d=#5.6.
  • $25 application fee
• Fingerprinting and background check NOT required

NBCE Requirements:

Parts I*, II*, III* and IV*: Required – PASSING SCORE IS 375

PT accepted or 100 hours in adjunctive procedures.

NBCE Acupuncture NOT accepted.

NBCE SPEC used at the discretion of the board for lapsed cases.

STATE SCOPE OF PRACTICE:

Contact State for precise definition by state law.

A branch of the healing arts dealing with the relationship between the articulations of the vertebral column, as well as other articulations, and the neuro-musculoskeletal system and the role of these relationships in the restoration and maintenance of health. The term shall include systems of locating misaligned or displaced vertebrae of the human spine and other articulations; the examination preparatory to the adjustment or manipulation of such misaligned or displaced vertebrae and other articulations; the adjustment or manipulation of such misaligned or displaced vertebrae and other articulations; the furnishing of necessary patient care for the restoration and maintenance of health; and the use of Board approved scientific instruments of analysis, including X-ray. The term shall also include diagnosis, provided that such diagnosis is necessary to determine the nature and appropriateness of chiropractic treatment; the use of adjunctive procedures in treating misaligned or dislocated vertebrae or articulations and related conditions of the nervous system, provided that after January 1, 1988, the licensee must be certified in accordance with this Act to use adjunctive procedures; and nutritional counseling, provided that nothing herein shall be construed to require licensure as a chiropractor in order to engage in nutritional counseling. The term does not include the practice of obstetrics or gynecology, the reduction of fractures or major dislocations, or the use of drugs or surgery.

Synopsis taken from FCLB.org

CONTINUING EDUCATION:

• $241 renewal fee
• Renew: Biennial. September 1 (even years)
• 12 hours per year (24 per renewal)
  • Requires education in child abuse training.
• Accepts PACE

Step by step instructions

https://www.nata.org/sites/default/files/apply_npi_instructions.pdf

Step by step instructions

https://sa.www4.irs.gov/modiein/individual/index.jsp

Note: This is your tax ID number as a practitioner

TYPE OF BUSINESS BREAKDOWN

Note: The difference between an LLC and a PLLC is that all members of PLLC are required to be designated professionals.

What is an Associate?

An associate receives pay from the office by which they are employed. If you are an associate who will be dealing with vendors for selling goods, you should consider getting an EIN.

What is an independent Contractor?

An independent contractor receives pay from their patients and insurance companies directly. If you are an independent contractor, you need an EIN.

• NCMIC – https://www.ncmic.com/malpractice-insurance/how-to-apply-online/

• OUM – https://www.oumchiropractor.com/quote/apply

• ChiroSecure – https://www.chirosecure.com

• PRI – https://www.pri.com/who-we-serve/chiropractors

• General Liability Insurance – https://generalliabilityinsure.com/small-business/chiropractic-insurance.html

• ChiroFuture – https://chirofutures.org/online-quote/

• SDN Insurance – http://sdnins.com/chiropractor.html

• CoverMD – http://www.covermd.com/chiropractor-malpractice-insurance.aspx

• Insureon – https://alliedhealth.insureon.com/resources/cost/chiropractic

• MBS Insurance Services – https://www.mbsinsure.com/solutions/malpractice-insurance/

• USA Business Insurance – https://www.businessinsuranceusa.com/chiropractor-professional-liability-insurance

• CM&F – https://www.cmfgroup.com/professional-liability-insurance/chiropractic-assistant-insurance/

• MACARIO Insurance Group – https://www.macarioinsurance.com/who-we-cover/all-classes-of-business/

• Chiroprefered – https://chiropreferred.com/find-the-right-coverage

Claims Made

A policy providing coverage that is triggered when a claim is made against the insured during the policy period, regardless of when the wrongful act that gave rise to the claim took place. (The one exception is when a retroactive date is applicable to a claims-made policy.)

Occurrence

An occurrence policy covers claims resulting from an injury or another event that occurs during the policy term. Coverage depends on the timing of the event. A claims-made policy covers claims that are made during the policy period.

Tail Coverage

An addition to a claims-made policy. It extends coverage for incidents that happened during the time you had your policy, but a claim was not filed until after your policy expired or was canceled. Tail coverage is another name for an extended reporting period.

Note: $1 Million/$3 Million is the minimum plan required in order to participate with some Insurance Companies.

As of this writing, most private insurance companies rely on the Council for Affordable Quality Health Care (CAQH) to verify your credentials. You will also need CAQH credentialing for some of the government supplemented participations as well. Others will use Availity for your credentialing, however as of this writing that is becoming less common. Keep in mind, you only need one account on either of these, and then will give permissions to each insurance company you are working to participate with to access your information and to be verified as a provider.

• • Availity: https://www.availity.com/essentials

CAQH: information needed can be filled out here: https://proview.caqh.org/Login/

The following is a quick step by step of what things you should select as a chiropractor and documents/information you may need.

1. NUCC Grouping: Chiropractic Providers
2. Provider type: Doctor of Chiropractic
3. Select your state
4. Social security number
5. Demographics and contact information
6. License number(s) and state(s)
7. Educational information (about your chiropractic school and degree)
8. Board certified: No (chiropractors are not board certified, and do not need to be)
9. You may select directory listings and other searchable tags
10. Practice location(s), including TIN
11. You may add credentialing contact information if you are using a third party, but if you are doing this yourself you may skip this section.
12. Malpractice insurance information: company, expiration dates, and policy numbers.
13. 10 year work history, dates, addresses, etc.
14. Professional disclosures
15. Documents to upload:
    1. Standard authorization release; updated every 120 days
    2. Professional liability insurance verification (proof of insurance)
    3. State license (copy)
    4. W9

Common insurance companies include Aetna, Anthem, Cigna, Geisinger, Highmark, Independence BCBS, UHC (Optum)

Aetna: https://www.aetna.com/health-care-professionals/join-the-aetna-network.html 

Anthem: https://www.anthem.com/provider/credentialing/ 

Cigna: https://www.cigna.com/health-care-providers/credentialing/join-medical-network 

Geisinger: https://www.geisinger.org/health-plan/providers/join-our-network 

Highmark:  https://providers.highmark.com/provider-network/credentialing/professional.html  

Independence BCBS: https://www.ibx.com/resources/for-providers/becoming-a-provider/professional-providers 

As of this writing, chiropractic networks are closed to new providers unless joining an existing, participating group or change in ownership of a participating practice. 

UHC (viaOneHealth) https://www.uhcprovider.com/en/resource-library/Join-Our-Network.html

Medicare Enrollment:
https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/cms855i.pdf

Medicare Revalidation: PECOS:
https://www.youtube.com/embed/PaLEWx0JGPw?rel=0&autoplay=0

Tips For Medicare Audit/Record Request Tips
https://www.acatoday.org/Practice-Resources/Medicare/Medicare-Audit-Record-Request-Tips

Type Of Audit And Record Requests
https://www.acatoday.org/practice-resources/medicare/medicaretpe/

Targeted Probe And Education (TPE)
http://www.acatoday.org/MedicareTPE

Medicare Training For The Chiropractic Office
https://learn.acatoday.org/products/medicare-training-for-the-chiropractic-office

How To Bill Secondary Insurance Plans
https://www.medicare.gov/supplements-other-insurance/how-medicare-works-with-other-insurance

Which Insurance Pays First
https://www.medicare.gov/supplements-other-insurance/how-medicare-works-with-other-insurance/which-insurance-pays-first

• Medicaid coverage for those when providers enroll in the program
• Evaluation by means of examination of the patient
• Treatment by means of manual manipulation of the spine to adjust misaligned or displaced vertebrae
  • No coverage when in a hospital
  • No coverage for physical therapy, traction, physical examinations, or consultations
  • Non-compensable services: orthotics, prosthetics, medical supplies, x-rays, etc.
• Manual (chiropractic chapter): https://www.pacodeandbulletin.gov/secure/pacode/data/055/chapter1145/055_1145.pdf

• Specifically noted for medical coverage for physicians or other health care providers, including chiropractors. 
• For reasonable medical services needed 
• Guide: https://www.pa.gov/en/agencies/dli/programs-services/workers-compensation/state-workers–insurance-fund-home/swif-claims-and-indemnity/coverage-and-benefits.html