1. When lifting, the largest muscles in the area should perform the task. The larger the muscle or muscle group used for lifting, the lower the stress on smaller, more vulnerable muscles.
2. During any work activities, people should be able to comfortably assume a number of different postures and not remain in one position for an extended time. Muscles will fatigue and be more prone to injury when assuming a particular posture, especially a poor one (e.g., partially bent forward at the waist).
3. When performing tasks, it is important to keep the joints either in their neutral posture or approximately halfway into the range of motion. Working with your joints at the extremes of their ranges of motion for prolonged periods places abnormal stresses on them and can cause repetitive stress injuries.

As the deadline for implementation of the April 1, 2013 regulation looms, and not having heard from the Department of Financial Services relative to the Association’s February 20, 2013 inquiry above, I telephoned the Department of Financial Services and spoke directly to someone in the Insurance Bureau that works on No-Fault issues. After explaining the foregoing ambiguity again, the DFS representative explained that he believed the issue had been addressed in the State Administrative Procedure Act (SAPA) run-up to the regulation and that the Regulatory Impact Statement clearly states that ONLY the portion of a provider’s fee that exceeds the fee schedule will be denied, not the entire fee.

Not content to take the Department’s word, I looked up the Regulatory Impact Statement (RIS) directly and it seems to concur with the DFS statement. Under the rubric: “Preventing Billing in Excess of Mandated Fee Schedule or for Services Not Rendered,” the RIS states as follows:

• Patients under age 35, women, Hispanics and patients whose first provider was a chiropractic physician had reduced odds of lumbar spine surgery
• Approximately 43 percent of patients who saw a surgeon first had surgery
• Only 1.5 percent of those who saw a chiropractic physician first ended up having surgery

• Use of false and misleading Explanations of Benefits relating to chiropractic claims (required under ERISA for informing subscribers of how their claims have been processed), which interferes with the doctor-patient relationship
• Manipulating charge and payment data, allowing ASHN and CIGNA to pass on excessive costs to subscribers, while distorting the amounts providers actually receive in benefit payments
• ASHN's restrictions of care via the pre-authorization process and provider contract provisions that prevent patients from having access to the full breadth of their benefits and in contradiction to their certificates of coverage--a violation of ERISA
• ASHN and CIGNA's imposition of excessive co-pay requirements on subscribers, another ERISA violation
• CIGNA's improper prevention of doctors of chiropractic (DCs) from providing services that fall within their scope of practice, in violation of state provider non-discrimination laws
• ASHN and CIGNA's violation of various state prompt payment laws

• The new fee schedule will be effective as of January 1, 2013, but is not published on the NGS web site at this time. For bookkeeping purposes, you may want to consider holding 2013 Medicare billings until later in the month. Check the website for updates.
• Participation in PQRS is no longer optional as of January 1, 2013. Providers who do not report quality measures beginning January 1, 2013 will see a 1.5% fee reduction penalty starting in 2015.
• EHR incentives are also still in effect with financial incentives available to those who qualify.

President Obama Signs the American Taxpayer Relief Act of 2012
--New Law Includes Physician Update Fix through December 2013--