www.njchiropractors.com I 17 [ REHAB CONTINUED FROM PAGE 14 ] Documentation shall be legible and complete (including signatures) Legible signatures/credentials of professionals providing services •  If signatures are missing or illegible, include a completed signature attestation statement for illegible signatures, include a signature log •  For electronic health records, include a copy of electronic signature policy and procedures describing how notes and orders are signed and dated. Validating electronic signatures depends on obtaining this information. Abbreviation key (if applicable) Any other documentation provider deems necessary to support medical necessity of services billed, as well as documentation specifically requested in the additional documentation request (ADR) letter Copy of Advance Beneficiary Notice of Non-coverage (if applicable) 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. In terms of exercise, the chronic pain patient needs to realize that pain does not equate harm. We need to get them moving to build strength, endurance and flexibility. When starting the chronic low back pain patient on exercises, start with core stabilization and cardio. For core stabilization deconstruct their movement patterns to the point where they can perform stabilization activities properly. When assessing core strength and endurance the goal is for the lumbar extensors to be slightly stronger than the flexors (1.3:1 ratio) yet, the lateral stabilizers need to be within 10% strength. Modified front, side and reverse planks can serve as a baseline for these ratios. Cardio: the best is walking, if possible. Maintain strong posture with a balanced sagittal line, relaxed arm swing and feet straight ahead (less than a 10% foot flare). As soon as possible building up to a brisk cadence is the goal. Start with five minutes and build to 30+ minutes. To build endurance, exercises can be split into segments throughout the day Remember, pain does not mean harm. Just be sure you do not overload the patient too quickly. Yes, adjust your chronic low back pain patients. The location, technique and frequency obviously is driven by the exam findings. In addition, here are a few insights from current literature that can be applied to get better outcomes: •  The highest concentration of peripheral mechano- receptors is found in the feet, SI joints and suboc- cipital regions: Adjusting all of these areas could be important. •  Mobility of the T4 region is essential in back pain management, so be sure to assess motion of the upper thoracic spine and keep it mobile. •  Using Boyle’s concept of mobility vs. stability, be sure the acetabular joints are mobile and not restricted at all, as well as the SI joints. Chiropractic has been ahead of the research curve, and now we need to own it. The multimodal approach to chronic back pain management is supported in the current research and we have been providing it since 1895. Donald DeFabio, DC, DACBSP, DABCO, is in private prac- tice in Berkeley Heights, NJ, and is the team chiropractic doctor for a local university. His exercise protocols can be found on his YouTube Channel. He conducts Relevant Rehab, hands-on seminars to teach the keys of successful integration of active care into the everyday chiropractic office. Chiropractor Programs • Natural Alternative for Pain • ORGANICALLY PRODUCED IN COLORADO Help your patients and add a nice revenue stream! CALL OR EMAIL TODAY! 267-318-6526 Alan Rind info@healthypathllc.com healthypathcbd.com 100% THC FREE