CHIROS LOSE WITH SOAH ACTION:

The Texas State Office of Administrative Hearings (SOAH) overturned a ruling by the Texas Workers’ Compensation Commission (TWCC) pertaining payment for chiropractors, finding that chiropractors cannot collect additional payments for joint mobilizations immediately followed by chiropractic manipulation to the same body area. The ruling was made in a case in which Texas Mutual Insurance Co., a workers compensation insurance provider, denied a bill from Curtis Adams, D.C. for joint mobilization because he had billed for manipulations to the same body area on the same date of service. Texas Mutual’s decision was based on information from chiropractic experts. After Adams filed for medical dispute resolution, TWCC ruled in his favor. In the SOAH appeal an expert witness, another chiropractor, called by Texas Mutual explained that when a chiropractor manipulates a body part, the manipulation includes a preliminary joint mobilization. Texas Mutual Insurance Co. also provided a 15-minute videotape demonstration of a mobilization and manipulation performed to the same body area. The expert went on to say that chiropractors view the joint mobilization as part of the manipulation for billing purposes. Adams did not attend the hearing. SOAH found that the joint mobilizations in the context provided were not separately reimbursable as provided by law, and that Texas Mutual had correctly reimbursed Adams. SOAH also ruled that a chiropractor cannot manipulate a body area without first mobilizing the body area, and could not bill for both services because it would be double-billing for the same service.

Topics Texas