www.njchiropractors.com I 19 labor intensive for the clinician, and provides the patient with a method they can continue at home. This has the potential to enhance long-term outcomes and free-up the doctor in a busy clinical environment. The exact mechanisms behind the effectiveness of foam rolling is unclear, but it is believed to be mediated through the process of conditioned pain modulation, otherwise referred to as “diffuse noxious inhibitory control” (Vigotsky, 2015), as well as visco-elastic change, possibly related to stress relaxation and tissue rehydration, whereupon the pressure exerted by the foam roller may re-distribute fluid pressures within the tissue, leading to changes in tissue compliance. However, these changes are temporary, often lasting less than thirty minutes. In summary, partner-assisted methods of stretching, including PNF, PIR, AIS, and others, can effectively increase range of motion and tissue compliance, however their exact neurological mechanisms are still undetermined but are not likely to include the processes of autogenic inhibition or reciprocal inhibition. Foam rolling is an efficient and inexpensive option to consider, and has the potential to induce similar improvements in tissue extensibility and decreased pain pressure threshold without the decrements in force production often associated with static stretching. As with any treatment modality, the clinician must exercise proper judgement in the application of any technique to the appropriate patient population, and monitor progression accordingly. Ken Cieslak, DC, LAT, ATC, CSCS, has been in the fields of chiropractic and athletic training for over 28 years. He is a 1989 graduate of Kean College, and completed his Doctor of Chiropractic degree in 1995 at Life University. Since 1997, he has been employed at Teaneck High School serving as the certified athletic trainer in addition to having a practice of chiropractic in Bogota, NJ. He is also a preceptor in the Montclair State University AT program. He is also a Certified Strength and Conditioning Specialist. Medicare Q&A For medical review purposes, Medicare requires that services provided/ordered be authenticated by the author. The method used must be a handwritten or an electronic signature. Failure to meet the signature requirements may result in the denial or delay in the adjudication of the claim. Proper use of the signature options or utilizing signa- ture log or signature attestation statements may help to mitigate these issues. Let’s review some common scenarios in a “self-quiz” format to determine if the signature requirements would be met. 1  If the DC provided only the legible first initial and full last name, would the signature requirement be met? True or False 2  If the DC provided an illegible signature over a typed or printed name, would the signature requirement be met? True or False 3  If the DC states, “Signature on File,” would the signature requirement be met? True or False 4  If the DC submits an unsigned typed note with a typed name, would the signature requirement be met? True or False 5  If the DC places his/her initials over a typed or printed name, would the signature requirement be met? True or False For additional information, please review the Medicare Learning News article, “Signature Guidelines for Medical Review Purposes” MLN Matters® Number: MM6698 Revised, on the Novitas website. Richard C. Healy, DC, CCSP, is the treasurer and Medicare consultant for the ANJC. A New Jersey Medicare Carrier Advisory Committee delegate and a Certified Chiropractic Insurance Consultant, Dr. Healy is a graduate of New York Chiropractic College and has been in private practice in Dumont for more than 35 years. By Dr. Richard C. Healy ANJC Medicare Consultant Answers: 1) True 2) True 3) False 4) False 5) True