Cayman Islands Chiropractic Continuing Education

• Demonstrate The ability to communicate clearly and concisely with current and future patients 
• Describe ways to establish and maintain relationships and facilitate constructive interactions with individuals and diverse groups.
• List strategies to align personal and organizational conduct with ethical and professional standards that include a responsibility to the patient and health care community. 
• Demonstrate an understanding of the healthcare system and the environment in which healthcare managers and providers function.

• Discuss the theories of why aging is now seen as a disease, characterized by chronic inflammation, which could potentially be stopped or even reversed. 
• Share how persistent, low-level inflammation (inflammaging) contributes to the deterioration of cellular and systemic functions, driving the aging process and the development of age-related chronic diseases.
• Examine the role of mitochondrial dysfunction in aging, exploring how improving mitochondrial health can promote longevity and reduce age-related decline.
• Identify clinical strategies to integrate mitochondrial health and anti-inflammatory practices into patient care to enhance healthy aging and mitigate the impact of chronic diseases.
• Introduction to low-level laser therapy, its core principles, and its mechanism of action for healing and optimizing cellular function.
• Explain the role of the mitochondria in cellular energy production and overall health.
• Review evidence-based applications of low-level laser therapy in promoting mitochondrial health via evidence-based research findings and data.
• Discuss practical approaches for integrating low-level laser therapy into clinical practice to enhance patient outcomes in managing mitochondrial dysfunction and promoting cellular rejuvenation.
• Share the global impact of metabolic dysfunction and discuss the effects of obesity driving chronic inflammation and its link to chronic health conditions.
• Discuss the mechanisms through which excess body fat and underlying metabolic dysfunction contributes to inflammatory processes and hormonal/endocrine dysfunction.
• Elaborate on clinical insights into effective interventions for combating obesity, improving metabolic health, and reducing inflammation, including dietary changes, physical activity, and sleep.
• Explore emerging therapies and technologies aimed at improving metabolic function and reducing inflammation, focusing on their potential applications in clinical practice.
• Discuss mechanisms of aging and how the aging process is being challenged by both conventional and alternative medical communities. 
• Provide a comprehensive analysis of nutritional, dietary, and lifestyle-based interventions that have shown promising outcomes for improving longevity and quality of life outcomes. 
• Overview of major concepts, themes, and discussions about the importance of diet, nutrition, and controlling blood sugar to optimize metabolic capacity to maximize aging. 
• Examine emerging research on cellular regeneration and mitochondrial function as critical components in slowing the aging process and enhancing longevity.

Hour 1

• Define standard of care.
• Examine the requirements of Chiropractic documentation.
• Evaluate Chiropractic care and the functional relationship.
• Review state specific examples of documentation requirements.
• Discuss what is mean by episode of care.

 Hour 2

• Establish the baseline of care.
• Identify the inadequacies of intake forms.
• Comply with the requirements of the initial encounter report.
• Review the consultation documentation in various case scenarios.
• Apply appropriate medical decision-making processes and documentation.

 Hour 3

• Examine the Documentation Requirements of a SOAP Note.
• Utilize PART in documentation.
• Utilize outcome assessment tests in documenting medical necessity of care.
• Identify Assessment and its relationship to medical necessity.
• Solidify elements of the treatment plan to support medical necessity.
• Apprise utilization management and review analysis of documentation.

• Recognize the common pitfalls that can put your clinic at risk
• Review the difference between a mandatory ABN and a voluntary ABN
• Identify the appropriate time to initiate a mandatory ABN
• Implement customized and compliant ABNs for your clinic by following the rules

• Demonstrate understanding of the key elements of revised E/M services
• Determine the elements that count as Time-Activities and how to calculate appropriately
• Establish protocol to determine Medical Decision Making element of E/M encounter
• Apply the new algorithm to appropriately code for E/M services under the 2021 model
• Discover how to still demonstrate Medical Necessity with the revised E/M codes
• Determine why history and examination are still needed

• Know how to document exactly what’s required for initial visit treatment plans including physical medicine procedures
• Apply sample language to include in each daily visit note that will meet documentation guidelines for these modalities and procedures, including properly recording time for timed services
• Command the mechanics of how to authenticate documentation for services provided by auxiliary team members
• Tie the patient’s diagnosis to the treatment plan for tissue-specific, physical medicine solutions
• Tell a complete and coherent account of the patient’s daily visit journey, outlining the crucial language necessary to justify medical necessity for all services rendered

• Evaluate the necessary elements to properly document established patient re-evaluations of all types
• Deliver appropriate evaluation and management services to justify continued care, assess progress, and discharge from this active care when the time is right
• Report the necessary components of documenting the transitional diagnosis and treatment plan after a periodic re-evaluation
• Complete the fundamentals of documenting the assessment of change since the last evaluation as it applies to federal regulations in Medicare

• Discern Part B from Part C and know the rules for each
• Discuss mandatory enrollment necessary for Chiropractic specialty
• Master the definition of medical necessity vs. clinical appropriateness and who pays in either case
• Recognize the differences between acute, chronic, and maintenance car
• Locate and understand the Medicare Local Coverage Determination (LCD) for your state including all the rules and guidelines
• Identify CMT coding and how it is differentiated from maintenance in Medicare

• Discern Part B from Part C and know the rules for each
• Discuss mandatory enrollment necessary for Chiropractic specialty
• Master the definition of medical necessity vs. clinical appropriateness and who pays in either case
• Recognize the differences between acute, chronic, and maintenance car
• Locate and understand the Medicare Local Coverage Determination (LCD) for your state including all the rules and guidelines
• Identify CMT coding and how it is differentiated from maintenance in Medicare

• Understand the difference between clinically appropriate and medically necessary care
• Identify the clinical indications of when to initiate therapeutic withdrawal
• Execute the components of a final discharge evaluation with proper documentation and recommendations
• Learn how to transition a client from an active phase of care to maintenance as a part of your treatment plan

• Demonstrate why each and every digit of the DX tells the payer something important Distinguish the nuances of specialized DX coding rules for carriers such as Medicare.
• Discover the importance of DX pointing, and which CPT codes are an absolute MUST to point to DX
• Illustrate how to diagnose with a higher level of specificity and through proper hierarchy Identify the role of the diagnosis in the documentation process'

• Identify the expected standards of a compliant and complete patient record
• Audit documentation to ensure the most important details are present
• Demonstrate how to conduct a complete baseline audit of record documentation

• Demonstrate the components of recognizing Medical Necessary Care vs. Clinically Appropriate
• Identify CMT coding trends and indicators as they relate to medical necessity
• Properly manage treatment effectiveness for exacerbations and reoccurrences
• Determine Proper Diagnosis and Assessment for Federal Patients
• Acknowledge and audit CMT coding ratios to evaluate the potential risk

• Demonstrate the components of recognizing Medical Necessary Care vs. Clinically Appropriate
• Identify CMT coding trends and indicators as they relate to medical necessity
• Properly manage treatment effectiveness for exacerbations and reoccurrences
• Determine Proper Diagnosis and Assessment for Federal Patients
• Acknowledge and audit CMT coding ratios to evaluate the potential risk

• Identify the key players in the patient provider relationship
• Recognize the key documentation requirements and components required to be eligible to treat Veterans
• Compose documentation that meets  required VA elements
• Locate key resources for successful referral management
• Determine key factors known to be often missing, and understand what to do to correct the deficiency
• Demonstrate the proactive steps to take in treating VA patients from clinical and financial submission

• Identify missing components before they become critical issues for your practice
• Determine the basic requirements of documentation for all payer classes
• Learn to identify payer requirements as part of your documentation standards
• Understand the key documentation components that boards, auditors and reviewers expect

• Apply the changes in the 2022 ICD-10 code set to the clinical diagnosis process
• Compare examination findings, couple with history, to select the most appropriate written diagnosis
• Document within the clinical record your thought process of selecting diagnostic codes
• Classify diagnoses in order of severity and hierarchy to match projected treatment plan

• Properly document “doctor thinking” daily in routine patient visit documentation
• Recognize the role of the PART documentation process in Routine Office Visit notes
• Identify and execute the key components of written assessment in daily documentation
• Recognize aspects of documentation and coding of Route Office Visits (ROV) whether active treatment, preventative maintenance, or wellness care.
• Distinguish the unique components of Subjective, Objective, Assessment and Plan

Hour One: Documentation and Compliance Overview, Rules and Regulations

• Recognize and avoid or correct behavior that is contrary to the rule of “no opt-out for chiropractors”
• Apply compliance rules set forth by governmental agencies that apply to providers of service to Federally insured patients
• Demonstrate day-to-day application of guidance on Federal Program and state requirements for coding, billing, and finances
• Differentiate between active and maintenance care, according to the official Medicare definitions and other third-party guidelines
• Interpret the four types of risk the Office of Inspector General (HHS) expects providers to focus on with Policy and Procedure, per the OIG Guidance for Small Practices
• Recognize the limitations of experimental, investigational, and unproven technologies

 Hour Two: Documentation of Initial Visits-New Patients, New Episodes, and New Conditions

• Identify and apply concepts that differentiate types of initial visits, from new patients to updated episodes
• Produce documentation of initial visits that comply with board requirements for chiropractors
• Summarize documentation requirements as they apply to the new initial Evaluation and Management guidelines set forth January 1, 2021
• Establish medical necessity for your care and know with surety that initial visit documentation is complete
• Rank complicating factors and contraindications according to priority and include with initial assessment
• Populate a required treatment plan for care, whether for short- or longer-term care

 Hour Three: Documentation and Case Management for Routine Visits, Preventive Maintenance, and Wellness Care

• Differentiate between requirements for medically necessary services vs. maintenance which is self-pay
• Apply primary subluxation vs secondary compensation logic to mitigate risk for the full-spine adjustment
• Reproduce the key elements of routine chiropractic visits in documentation as set forth by third-party, State and Federal guidelines
• Interpret functional data to determine stages and levels of care
• Demonstrate the ability to implement therapeutic withdrawal and to document its results
• Recognize maximum therapeutic benefit (MTB) and properly document discharge from active treatment

 Hour Four: The Risks Associated Billing and Financial Compliance Regulations

• Give examples of billing and financial compliance that cross the line of False Claims Act and Anti-Kickback Statute violations
• Apply billing and financial compliance regulations to the day-to-day operations of the practice, including payment and prepayment plans
• Execute random auditing of charges and collections to meet OIG compliance guidelines
• Recognize and apply the rules of offering financial hardship discounts
• Produce advertising that falls within the guidelines of board and federal rules

• Label the main driver is for “Medical Necessity”, how and why you must communicate this to 3^rd party payers
• List the foundation of coding and be able to apply pertinent ICD10 coding guidelines
• Discover how correct coding may dictate our strength to 3^rd parties and have national implications for our profession.
• Discuss critical questions of the benefits and risks of our Chiropractic diagnosis codes in the insurance industry.
• Identify red flags, complicating factors, and have awareness of Risk management when documenting and coding.
• Identify how insurance companies rank the importance of various diagnoses and its effect on claims’ coverage and processing

• Distinguish the meaning and implications of many important terms pertaining to the clinical practice of filiform needling therapies.
• Categorize the most common types of trigger points.
• Incorporate myofascial stress patterns into previously learned myofascial frameworks.
• Compare & contrast the legal, theoretical & practical commonalities & differences associated with the filiform needling therapies of dry needling & acupuncture.

• This contains all courses with the educational objectives listed from Dry Needling 201 through 206

• Demonstrate Clean & Safe needle handling, application, & disposal
• Recognize and reduce risks To Dry Needle Providers
• Recognize and reduce risks To Dry Needle Patients
• Integrate Dry Needling into an Existing Practice
• Document Dry Needling Diagnosis & Treatment

• Identify common filiform needle sizes and types.
• Select appropriate filiform needles for various applications.
• Integrate trigger point releasing concepts & practices.
• Apply effective trigger point releasing needle techniques.
• Outline common myofascial stress patterns.

• Identify Common Myofascial Stress Patterns.
• Discuss the differences commonalities & differences associated with myofascial stress patterns and traditional acupuncture meridians.
• Palpate & Locate Primary Points for Releasing Posterior Myofascial Stress Patterns.
• Palpate & Locate Primary Points for Releasing Anterior Myofascial Stress Patterns.
• Palpate & Locate Primary Points for Releasing Lateral Myofascial Stress Patterns.

• Diagnose & Treat Posterior Myofascial Stress Patterns & Related Trigger Points.
• Diagnose & Treat Lateral Myofascial Stress Patterns & Related Trigger Points.
• Diagnose & Treat Anterior Myofascial Stress Patterns & Related Trigger Points.
• Diagnose & Treat Head & Neck Myofascial Stress Patterns & Related Trigger Points.

• Integrate information from previous 5 classes to efficiently diagnose painful myofascial conditions, create effective treatment plans, and locate effective trigger points in the head & neck regions.
• Integrate information from previous 5 classes to efficiently diagnose painful myofascial conditions, create effective treatment plans, and locate effective trigger points in the Traps & Upper Back.
• Integrate information from previous 5 classes to efficiently diagnose painful myofascial conditions, create effective treatment plans, and locate effective trigger points in the Shoulder, Arm, Chest, Elbow, Wrist, Hand.
• Integrate information from previous 5 classes to efficiently diagnose painful myofascial conditions, create effective treatment plans, and locate effective trigger points in the Mid-Back, Lower Back, Hip/Thigh, Knee/Leg, Ankle, & Foot.

• Develop an understanding of the physiologic principles involved in nerve depolarization and the propagation of action potentials as they relate to Motor and Sensory nerve conduction studies
• Identify the physiology and nerve pathology in clinical conditions presenting in Chiropractic practice, and how they present on electrodiagnostic examination
• Classify the utilization of electrodiagnostic testing in the process of differential diagnosis
• Develop a working clinical knowledge of the setup and recording of Compound Muscle Action Potentials, Sensory Nerve Action Potentials, F-Responses in all major peripheral nerves, as well as H-reflex testing
• Demonstrate a practical knowledge of the neuroanatomy, as well as clinical applications of EMG and Somatosensory and Dermatomal Evoked Potentials

• Know how to prepare for a medical emergency
• Review four emergency medical conditions: Stroke, Heart Attack, Difficulty Breathing, Diabetic Emergencies
• Recognize the causes, symptoms and signs for these emergencies
• Understand how to provide the appropriate emergency treatments

• Gain the knowledge to develop an Emergency Preparedness Manual for your office
• Define crisis management procedures in advance for fires, child abduction, workplace violence, bomb threats and other situations
• Explain the importance of an emergency continuity plan
• Recognize why CPR was changed and compare the new rules
• Perform more effective CPR even before you refresh your certification

• Recognize Altered Mental Status and apply the appropriate emergency response
• Distinguish types of Burns, their mechanisms of injury and pathophysiology
• Plan for the treatment of burns and the appropriate emergency response
• Apply and use the Rule of Nines
• Recognize Allergic Reactions, discuss their pathophysiology and the proper emergency response