Archive for the ‘Billing’ Category

Random Thoughts Episode #136: Chiropractic Audits, Business Building & Success

by Tom Necela on July 20th, 2010 in Audits, Billing, Business, Chiropractic Audits, Coding, Collections, Documentation, Medicare, chiropractic billing, chiropractic business, chiropractic coding, chiropractic collections, chiropractic documentation, compliance

Reading time: 5 – 8 minutes

I’m on the road for the next couple weeks traveling for a number of on-site consultations with clients so this blog post will be a summary of random thoughts on the most common questions that repeatedly brought to my e-mail inbox.

1)  Chiropractic Audits: a few months ago I received a lovely piece of hate mail to accuse me of trying to disproportionately scare well intentioned, upstanding chiropractors in regards to the possibility of an audit. My latest “tweet” included a post to the most recent findings from Medicare reviews for the states of Nevada and Hawaii.  In those two states, chiropractic documentation failed to meet requirements 60 to 70% of the time.  Similar posts from other review results in the past were even higher than that and OIG reports even higher still.

I might not be the greatest mathematician, but it seems to me that the majority of chiropractors are not scared enough!  If 60%+ of chiropractic documentation is substandard, that means most of you are in trouble or headed down the wrong road. It’s not a great picture for me either.  There are roughly 50,000 chiropractors in the United States, so that it would be physically impossible for me to help roughly 30,000 of you get your documentation in order, teach you proper billing and coding, or come to your assistance in the case of an audit.  I wish that I would live long enough to be able to help, but with those numbers, some of you are just going to have to suffer the consequences.

For those of you who think slightly more highly of me or take the potential of audits more seriously, now is the time to take action. It is obvious to all that audits are a big business for not only cash-starved government entities like Medicare, but also for insurance companies looking to expand profits by taking your money back.  The audit numbers and amounts recovered in post-payment demands are so large that they are virtually beyond comprehension for the average chiropractor.

Since I don’t know most of you personally nor do I care to manipulate the facts to scare you, let me just share a few recent scenarios that came by my desk.

Chiropractic Audit case #1:  Medicare audit, six patient, 94% error rate determined; post-payment demands made for 18 months (legal limit for that state).   Total bill amounts to only a little over $2000.  Big pain in the patootie is that this doc failed a previous audit and now has to submit all claims for “pre-payment review” which means that Medicare doesn’t pay him a dime until they receive and approve all notes and every treatment.

Chiropractic Audit case #2:  Auto insurance carrier, handful of patients who were treated for the last 3 yrs on claim (bad state, no limitations statute).  Total repayment demand is approx $56,000. Legal expenses totalled $8000 so far.  Doctor may also face civil fines.

Chiropractic Audit case #3: Commercial insurance.  Re-payment demands made by insurance company after extrapolation (process of configuring an error rate to apply across the board).  Demand total was close to $95,000.  Insurance in error on reviews in some instances and doctor’s repayment will be significantly less, but she will still have to re-pay. Doctor will likely be kicked off insurance provider list as well. Legal fees approximately $17,000.

Maybe this is all chump change to you and you have a life of leisure that can afford the time and hassle it takes to wrestle with the insurance companies, hire attorneys and formulate your audit defense. The rest of you, take note.

2)  Business Building:  Don’t chase your customers or patients. Find out where they are going and get yourself or your information in front of them.  This simple advice (not mine but I can’t remember who I heard it from) is full of wisdom and potential applications.  For example, people who are sick or hurting often go to the medical doctor.  How can you get the MD to route them toward your office?  Most people work.  Which of your patients has a position in human resources or is the owner of a small business with a fair number of employees?  Rather than try to come up with some fancy high-powered presentation that you will likely work on for the next four years until you’ve whittled it to perfection, why don’t you just approach people who already know and trust you as patients and see if they can help you make inroads into their company?  People surf the Internet. First off, that means you need to have a website too.  While the chances of catching random visitors that become patients are slim, but you can stack the deck and give them a reason to come to your site by writing articles, posting videos, and providing other informative content for your community.

Obviously if you are busy enough, you may not need to employ any or even all of these strategies. But for the rest of you, instead of spending time surfing the net do something tangible to improve your web presence. Rather than whining that referrals are down, take a concrete step towards leveraging your patient relationships to increase your referrals on your patience. Instead of sitting in your office hoping patients will come to you, reach out to where they are and bring them in.

3)  Success.  Keep in mind that your business should be there to serve you and not vice versa. I’ve run into too many chiropractors whose primary purpose seems to be providing jobs for their employees. Worse, I’ve seen too more “successful” chiropractors whose drive to succeed left their spouses, children, health and sanity by the side of the road.  A few fortunate ones can come back and retrieve it. But for many once these items are lost, they are gone forever.  Take a day off and go play while the weather is nice.  Spend the afternoon with your children, the evening with your spouse.  Your bank account may not look immediately better for it, but in the long run it is cheaper to stay married, stay healthy, stay sane and not have to pay for years of therapy for your screwed up kids!

As for me, I intend to practice what I preach both working and playing.  If you have an Audit or business issue to discuss, feel free to drop me an email. That’s the beauty of the internet, it can be checked anywhere.  On the other hand, if you see a bald man not acting his age on a wakeboard at a lake near you, it just might be me :-)

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Selling Chiropractic Products and Billing Insurance

by Tom Necela on July 13th, 2010 in Billing, Coding, Collections, chiropractic billing, chiropractic coding, chiropractic collections, chiropractic practice management

Reading time: 2 – 4 minutes

Many chiropractors have realized the benefits of offering products for sale to our patients.  Whether it’s the convenience factor for the patient, our ability to control quality or brand use, or the fact that we want to be able to help our patient’s outcomes, products make sense.

Unfortunately, some chiropractors have a difficulty in making the sale of products make financial sense.

Worse, if you are the type of DC to stock your office with every “hot” new product that catches your fancy, only to quickly lose interest in it a few weeks later, product inventory and sales can become a financial drain on your profitability.

Furthermore, some chiropractors to fail to tap into the full potential of product sales, particularly those that fall into the category of Durable Medical Equipment (DME).

While most insurance companies do not provide coverage for patients to purchase nutritional supplies, analgesic gels and other OTC topicals, many insurance companies do reimburse DME.  In other words, that cervical pillow or that lumbar back brace you just sold your patient may have been covered by their insurance benefits, if you correctly billed for this supply.

If this is old news to you, that’s a good thing!  If not, you should begin checking out your patient’s DME benefits when verifying their coverage to see if their insurance covers such items.  A quick glance through ChiroCode or other coding resources will give you some common HCPCS codes used for such supplies. Note:  the bed of nails is not a recommended supply or product and does not have a HCPCS code :-)

Finally, some of you who have been doing this a while may have noticed an “extra” hoop lately that insurance companies are requiring before processing payment.  In other words, your claims may be rejected or delayed due to missing modifiers in connecting with your billed HCPCS code.

If this happens to you, the three basic modifiers most insurance companies are looking for are as follows:

  • RR Rental
  • NU Purchase of new equipment
  • UE Purchase of used equipment

In most cases, chiropractors will sell their patients a new product, in which the appropriate modifier attached to that product’s HCPCS code would be –NU.   But, if you rent or sell used equipment, you should report the –RR or –UE modifiers, respectively.

From the email inquiries I have been getting about how to get paid for DME, this should clear up the basic problems I see many chiropractors facing.  If you want the “advanced” course, you will have to check out one of my seminars this fall – the new schedule and full details are coming soon!

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Still Free? The Word on Co-pays, Coupons & Discounts

by Tom Necela on July 6th, 2010 in Audits, Billing, Business, Chiropractic Audits, Collections, Medicare, chiropractic billing, chiropractic business, chiropractic collections, compliance

Reading time: 1 – 2 minutes

Last year, I posted an article on co-pays, coupons, and discounts –  essentially what to do and what not to do.

This subject remains one of the most popular questions I still get asked.

As we recently have celebrated the freedom of the USA with Independence Day, I thought it fitting to re-visit the “freedoms” (or lack thereof) that we are challenged with inside our chiropractic practices.

Unfortunately, when freedoms are abused, trouble sets in.  Keep your nose clean and re-visit the post

Chiropractic Co-Pays, Coupons and Discounts – When Free Isn’t

(click the link above to see the post)

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2010 Health Insurance Report Cards

by Tom Necela on June 29th, 2010 in Billing, Business, chiropractic billing, chiropractic business

Reading time: 4 – 6 minutes

The results of the annual Health Insurance Report Card are in and, as usual, the AMA’s yearly check-up on health insurance companies and their claims processing trends is not pretty.

Although the data generated from these Report Cards is derived from MD practices, the big picture perspective is one that is still relevant for us to view as chiropractors. Here are a few interesting tidbits from this year’s Report Cards:

  • 1 out of 5 claims are processed incorrectly by health insurance companies
  • More than $777 million in unnecessary administrative costs could be saved if health insurers could improve claims processing accuracy by just 1%
  • Increasing claims processing accuracy to 100% would save US healthcare costs up to $15.5 billion annually
  • Physicians spend as much as 14% of their revenue to ensure they receive proper payments from insurers

What to Do Next

While the size and magnitude of these numbers are startling, I have yet to speak where seminar attendees were surprised by such revelations.  However, what I do commonly see is a sort of “analysis paralysis” where DC’s feel there is nothing they can do about such things.

While the parallel to the Biblical account of  David and Goliath may be an accurate representation of the battle scenario, the end result is also possible: David won and so can the rest of us “little guys.”  Apart from getting on your knees in prayer and appealing to the man upstairs (not a bad idea given the current sad state of the healthcare marketplace), here are three quick tangible actions to take in light of the recent report card results:

1.  Pay Attention! If 1 in 5 claims are processed incorrectly, odds are that yours will be among them sooner or later.   In the absence of a unified effort against a particular insurance company, you need to track your reimbursements to ensure that you are being correctly paid.  This involves a working knowledge of fee schedules, accurate balance posting, and an eye for detail on the part of whoever is doing your billing.  Without this, you will allow insurance companies to slowly extract the profits from your pockets to theirs.

2.  Do the Math on ROI Externally: Let’s face it.  Not all insurance companies are worth the time or effort give the number of hoops they require you to jump through and/or their pitiful fee schedules.  Sometimes, you just have to do the hard math and give them the boot.  But do it by the numbers and not by emotions.  If you haven’t read my article on “The Annual Payor Survey or How to Drop an Insurance Company” – read the report cards and then consider it for any big “offenders” who are stealing the life and profits from your practice.

3.  Demand ROI Internally: Knowing that the average doc spends 14% of revenues trying to bring in the money, as a business owner you should be acutely aware of where your billing service/department stands as a revenue generator.  In other words, don’t assume they are doing a good job, but track their performance and hold them accountable so that you can mitigate losses the insurance companies are trying to force feed you.  For more specific details on the how, when and whys, see How to Oversee Your Chiropractic Billing Service or Staff.

Those of you who can’t quite figure out the mess you are in, suspect you are leaving too much money on the table, or know that some directed effort in this area would produce tangible returns in your practice may wish to complete a no-obligation Practice Analysis Questionnaire and get an objective opinion on what’s going on in your business.  There’s no obligation and no cost, but great potential to gain from realizing potential strategies for improvement.

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Chiropractic Medicare Mess Sort of Fixed (For Now)

by Tom Necela on June 22nd, 2010 in Billing, Medicare, chiropractic billing

Reading time: 3 – 4 minutes

Three important details emerge as the bottom line from the recently passed legislation:

  1. The 21% Proposed Fee Cuts are Delayed Until November 2010
  2. Medicare Claims will begin processing with a 2.2% fee increase from June 1 to November 30, 2010
  3. The House will vote on the finalization of this increase on 6/22/2010

Obviously, this creates some logistical mess in the present and to anticipate in the future regarding exactly what fees one should anticipate being paid.  To access your fee schedule directly, you should go to your Medicare carrier’s website because that is who will ultimately be responsible for processing your claims.  The American Chiropractic Association also has a helpful page with some Q&A’s and additional Resources on this subject matter.

Personally, I am sure I am not alone in saying that I can’t wait for all this mess to be over and done with.  The volume of email confusion hitting my inbox is astounding and, although  I certainly can see the importance of dedicating space and time in this blog to the subject matter, I’d love to move on!

With that, I am going to encourage all my readers to sign up with Twitter and “follow me” so that I may continue to keep you informed of news related and important items such as this.  And so we can use the blog for a format of discussing other topics of your interest apart from the latest rules and regulations thrust upon us by Medicare or other entities.

If you are not familiar with Twitter, you are obviously one of the few citizens who are not following the every move of Ashton Kutcher or Brittany Spears (and this is a good thing).

Twitter is a online “micro-blogging” site that allows users to contribute short (limited to 140 characters) messages to each other.  It’s great for exchanging newsworthy items, reminders and has a host of potential business related applications.  It’s also famous for being used (mis-used?) as a sort of online diary by which a person can literally blog about one’s every move, meal or madness.

For our purposes, I use Twitter exclusively to keep chiropractors updated on the latest newsworthy occurrences, regulatory changes and other pertinent info that you need to know.  I typically give links to the stories or sources where you can find the needed info.  And the best part is, it’s FREE and if you aren’t interested in the days topic, there’s nothing to do or delete.  Since it doesn’t get emailed to your inbox, you are not overwhelmed with…um.. stuff  you don’t need.  Just check your Twitter account on your own time and it doesn’t cost you a dime!

So, sign up and “follow me” today so we can keep you informed of these items and so we can continue to use blog space to dedicate towards the other topics of your interest!

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3 Quick Tips for Slow Times in Chiropractic

by Tom Necela on June 7th, 2010 in Billing, Business, Collections, chiropractic billing, chiropractic business, chiropractic collections, chiropractic practice management

Reading time: 4 – 7 minutes

knock out

(Reading Time = 5 mins)

Today’s blog post will give you three quick strategies to fix slow times…fast!!

We Can’t Help You

Recently a chiropractor contacted me to ask for help with getting his practice to be more profitable.  He loved my tagline “work smarter, not harder” and wished to move his business in that direction. Without being able to point a finger on a particular problem, he stated that he felt he was working harder than ever and seeing less in the way of financial rewards and personal satisfaction.

The chiropractor submitted a Practice Analysis Questionnaire and took me up on my offer to conduct a FREE, no obligation review of his practice.

I called the doctor at our scheduled time in the morning and was immediately put on hold, during which another call came in that the receptionist needed to take. (It wasn’t a “Would you mind holding for just a minute?” either – it was a “HOLD!” and then nothing!)  After several long minutes on hold, our call was disconnected.

I called again a few minutes later and was put on hold…again…for nearly 10 minutes before I hung up in frustration. Out of curiosity, I dialed the doctor again later in the day and got a recorded message saying they were out to lunch.

In addition to a myriad of billing blunders, coding issues and a sizable A/R that could sink a small town, guess what this office also listed as one of their chief challenges?  Getting new patients!  Sure – there are hundreds of ways to get potential new patients to call your office. And none of them will work if no one is answering the phone properly. Often the first step to working smarter is to make sure what you are doing is working at all!

What if…
Let’s go the other route and throw out a question…

What if you woke up tomorrow morning and there were absolutely NO NEW PATIENTS available anywhere in the world for chiropractors. That’s right, no matter what you did, you could NEVER get another new patient into your chiropractic practice. So the deal would be… for the life of your practice, you only had your existing patients. What would you do differently?

This question is not only a great topic for a team meeting, it may also provide you with some interesting thoughts and observations towards developing variable income streams for your practice.  There’s no “right” answer here – but a lot of potentially good ones!

The Collections Knock Out

Many of you have heard me rant about the futility of sending an endless round of statements to your patients in an attempt to collect past due balances.  While the alternative of sending everyone to a collections agency is not exactly a viable solution either, we’ve been “beta-testing” a solution for the past several years that has proven to be a winner. It is a “statement of delinquency” form that was developed to get slow paying patients to pay.  I will admit that I was initially suspicious of its simplicity. But thousands of “beta-testing” trials later have proven one fact:  simple works!  In fact, several chiropractic clients using them has found that they work particularly well even in stalled economies such as the one we are in now.

The Delinquency Statements are very simple and inexpensive to produce. Here’s the
“recipe” if you’d like to make your own: include a big fat heading reading “Statement of Delinquency” that catches anyone’s attention.  Then include the name of the responsible party, services rendered and, of course, the amount due.  Finally, be sure to add a couple lines that mention what you will do if the balance is not paid and how the delinquency will be cancelled if payment is received in 10 days.

(For those of you who may not wish to “re-invent the wheel” you can purchase the exact template and instructions for printing and use as part of the  Collections Knock Out package – and once you have purchased the template, you can reproduce as many as you like…forever!)

While this represents a definite direct hit to your escalating A/R, coupling the Delinquency Statements with an Auto-Debit Strategy in which you offer patients the ability to pay their balance over time helps you increase your ability to capture an enviable percentage of your delinquent accounts.

In fact, several clients utilizing our Collections Knock Out strategy have remarked that this one-two punch has resulted in better collections performance than their collection calls and collections agencies combined.  And the best part – you can do it yourself at a fraction of the price!!

To Your Success — and may it be quick!!

Tom Necela, DC, CPC, CPMA

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The Best of…Strategic Chiropractor Blog Flashbacks

by Tom Necela on May 10th, 2010 in Audits, Billing, Business, Chiropractic Audits, Coding, Collections, Documentation, HIPAA, Medicare, Medicare ABN, OIG Report, Politics, chiropractic billing, chiropractic business, chiropractic coding, chiropractic collections, chiropractic documentation, chiropractic practice management, compliance

Reading time: 1 – 2 minutes

flashback

In business and in life, it is helpful to go back and review the basics, to take a look at where you’ve been and where you want to go.

Today’s blog post feature’s 3 links to our most popular columns of the past – in case you missed them – or in case you need “a refresher course.”  (pardon the Fletch reference)

Here they are (in no apparent order):

Enjoy!

Tom Necela, DC, CPC, CPMA

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Prompt Payment Headaches, Chiropractors & Mosquitoes

by Tom Necela on May 4th, 2010 in Billing, Business, chiropractic billing, chiropractic business, chiropractic collections

Reading time: 4 – 7 minutes

BullfighterMosquito

While some of the profession is battling post-payment reviews, audits or denials, there is a pest that is all the more common and has the potential (in time) to be just as deadly to chiropractors at large: it is the delayed payment.

The delayed payment is sort of like the mosquito of the billing world.  That annoying little bugger that keeps biting you when you least expect it; and yet, we sort of expect to get bitten, particularly if we live near bodies of standing water, are camping, or anywhere in the great outdoors.  And much like the sting of a mosquito, most chiropractors view delayed payments as a minor nuisance that they only occasionally do something about.  After all, how many folks do you know who slather themselves with mosquito repellent every time they go outside or pass near the waterfront?  Sure, your paranoid friends do, but normal people just don’t walk around wearing DEET cologne 24-7.

This same casual attitude applied to our payment delays, however, can create cash flow problems, minimizes the value of our claims and in general, has potential to make us mucho more cranky than the bite of a mosquito.

These delays also put billions of dollars in the “pockets” of health insurers as they earn cumulative interest on every late claim.  In effect, we allow the insurance companies to be more profitable – at our expense!

How to Manage Late Claims
I realize that there are some people – chiropractors included – who are averse to all technology and willingly stand in the way of progress at every chance they can get.  (I met one of these interesting people at a seminar a couple years back who refused to put his email on a form, not because he feared I was a spammer, but because he “didn’t do computers.”  I never checked, but I am presuming he paid in confederate currency or wampum.)  For those of you who having nothing against the personal computer, here’s what to do:

1)      File electronically. This speeds up the payment process and the tracking tools that virtually every electronic clearinghouse employs enable you to accurately nab the latecomers and unleash your fury upon them.  (Or you can handwrite a manual entry log of each and every claim you submit, and on every fourth bottle of arthritis pills your aching fingers consume, see who is late and who owes you money.)

2)      File Accurately. Technically it’s not the payers fault if they pay you late on the account of an error on your end, so don’t give them the easy way out.  Again, if you file electronically, use “Claim Scrubbing” which is a nifty little technology that essentially checks for errors on your claim before you submit them.  (Technophobes may engage in the same error-checking process at the expense of their eyeballs and manually look over each claim.)

3) Know your state laws. Most states have prompt pay laws to protect you (can you believe it?)  from receiving too much abuse at the hands of a payer.  But you have to actually know what the laws are in order to use them to your advantage.  (Note to those who hate computers: reading is available both online and offline so you are on equal ground on this one.) 

4)      Appeal inappropriately delayed claims. Yes, this last step is going to require some writing (keep those arthritis meds handy) but you don’t have to be Shakespeare to get your point across.  State the facts.  We submitted the claim on X date.  According to Y State Law, you needed to pay me by Z. That’s about the size of it.

5) File a complaint. In a perfect world, this whole blog would be unnecessary and you would be able to stop at step 4.  However, since we are obviously dealing with slightly lower standards among the human kind here, if a claim has not been paid in accordance with your state law and is untimely, follow the requirements for notifying the respective state agency and complaint process for your state. While you are at it, notify your state and/or national association, if you belong to one. (If not, join! Or feel free to file your complaint with any random entity who also does not receive your support for presumably not representing your interests.)

6) Lather. Rinse. Repeat. Even in a less than perfect world, step numero cinqo would work, but – you guessed it – things are just that bad!  If and when this happens again to you (and especially if it’s from the same insurance payer), you need to appeal and file a complaint AGAIN!  This is the stuff lawsuits are made of and even if you hate lawyers and politics, it’s how big things generally get done that take care of the little guys.  If not, I presume you are also the time to sit in the same spot in your backyard whilst being a human blood donor for the dozens of mosquitoes that feed upon your carcass.  And I also presume, you’ve no need for the additional income, as apparently you and the mosquitoes are entertaining each other at this point.  And that kind of fun, money just can’t buy!

Tom Necela, DC, CPC, CPMA

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What the 4th Annual Payor Survey Means to Chiropractors

by Tom Necela on April 27th, 2010 in Billing, Business, chiropractic billing, chiropractic business, chiropractic webinars

Reading time: 4 – 7 minutes

gong show

The 2010 National Payor Survey was recently released much to the chagrin of third party payors; not surprisingly, it doesn’t exactly depict the payors in a flattering light.  The survey, which was conducted by an independent research firm, polled hospital and health care executives from all 50 states to extract data on their daily interactions with a myriad of insurance companies to detect trends, problems, and issues to address from a physician’s or facility standp0int.

United HealthCare gets the stinky sock award for the fourth year in a row as the worst health insurance payer in America, with a 2:1 ratio of negative vs positive feedback. Fellow contestants in the “Insurance Payor Gong Show,” Coventry and WellPoint/Anthem also would have received the big gong for their pitiful feedback ratings that included as much negative as positive feedback.  Aetna ranked as the best payer closely followed by Cigna.

This year’s survey also highlighted some interesting categories  as follows:

  • Easiest to Deal With (BCBS) and Most Difficult (United Health Care)
  • Best Reimbursement Rates (United HealthCare) and Worst (Wellpoint/Anthem)
  • Most honest and candid (BCBS) and Least (United Healthcare)
  • Most Timely and Responsive ( BCBS) and Least (Wellpoint/Anthem)
  • Fewest Claims Denials (BCBS) and Most (Wellpoint/Anthem)
  • Best at Processing Claims (BCBS) and Worst (United Healthcare)
  • Best at Fixing Claims (BCBS) and Worst (Wellpoint/Anthem)

So what does this mean to chiropractors, who are “little fish” in the big pond of healthcare?

1.   Anticipate problems — if the insurance companies are unafraid and willing to mess around with the big guys (hospitals, large medical groups), be assured that they will take the same approach to you.  If your major payor is one of the “worst of the worst” keep a very close eye on your billings, accounts receivable and EOB’s — and watch for shenanigans!  If it’s a minor payor (few patients) that gives major headaches, consider dropping them.  See my article on “How to Drop An Insurance Company” for specific strategies.

2.  Fight back — WHEN your claims are paid incorrectly, know your rights to fair/correct payment and appeal.  If you don’t have a fleet of appeal letters for every situation ready to deploy at a moment’s notice, it’s time you prepare for battle.  Start saving them as you write them so you can re-use your appeal the next time around (there WILL be another time) or consider my Chiropractic Appeals Toolkit as a ready-made resource for this purpose.

3.  Form the Roman Turtle. If you know military history, you may have heard about the “Roman Turtle” formation in which the soldiers would configure themselves tightly together. If the enemy shot arrows at them they would use their shields to surround their bodies and protect themselves from all angles. Even with a small group of soldiers, the benefit to banding together like this afforded them excellent protection.  There is simply no way that you, the solo DC, can battle the big guys by yourselves. Now, more than ever, is the time to join your state and/or national association and fight battles collectively.

4.  Work Smarter. Many DC’s enter battle naked or worse, send in their spouse unarmed and dangerous.  A $50,000 coding mistake (actually a $25 mistake made 2000 times over several years) becomes a dear price to pay for ignorance but in virtually every office that I consult with, I can uncover at least that much in income they are either giving away, discounts they are inadvertently giving to insurance companies and services that they are either not billing for or performing incorrectly.  I don’t care which side of the fence you sit on — whether you are more concerned about potentially losing money by doing something wrong or losing out on money that you could have made for services you already performed.  Either way, you are not working smarter, you are simply working harder and harder for less income and more risk.

If you suspect that you are working harder, missing out on income or unnecessarily exposing your practice to audit risk, join us Thursday April 29 for our upcoming one hour, info-packed webinar  7 Ways to Tighten A/R and Increase Profits! where you will discover profitable strategies to increase income, decrease risk and prevent errors that cause you to lose money or leave it on the table!

Can’t make the webinar?  Order it on CD! That way, you won’t miss out on:

** How to manage your revenue cycles for maximum profit + minimum effort

** The ONE rule that will single-handedly guarantee increased profits…IF you follow it!

** How to obtain maximum value for your efforts + time

**What one strategy you are missing that can provide your clinic with extra income with virtually no extra work on your part

** When to use your “secret weapons” to get payment

** How to increase efficiency + decrease staff costs for collections

** How to effectively collect amidst high deductibles, skyrocketing co-pays and the changing health-care marketplace..

To Your Success!

Tom Necela, DC, CPC, CPMA

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The Impact of Medicare Fee Cuts on Your Chiropractic Practice

by Tom Necela on March 30th, 2010 in Billing, Business, Medicare, chiropractic billing, chiropractic business, chiropractic practice management

Reading time: 3 – 4 minutes

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Despite the best efforts, lobbying and protests of every major physician association (including the American Chiropractors Association and the International Chiropractors Association), the 21% Medicare fee cuts are still scheduled for April 1, 2010.

For those of you who hope to lessen the blow of this bad news by taking comfort in the fact that a relatively small portion of your practice consists of Medicare patients – think again.  This fee cut (which by the way, is scheduled to be a nice, round 20% reduction for Chiropractic fees) will impact all of your third party reimbursements in time!

This is due to the simple fact that most third party payers use the Medicare fee schedule as a basis to calculate their own reimbursement decisions.  Read the fine print in your contracts and you will find that ABC Insurance pays 150% of the Medicare allowable or XYZ Insurance’s fee schedule is set at 175% of Medicare.

So, yes, at this point, there is no good news to report about this Medicare situation, which will go into effect April 1 or as soon as the carriers can get to the business of revising their reimbursement calculators to ensure that the screws on our Medicare torture chamber are nice and tight.

If you can find your state representatives and senators (you may have to watch some MTV programming or track them down in some tropical paradise, as it is spring break for most), be sure to let them know how disappointed you were in their inability to block this legislation and take 20% out of your already dismal Medicare paychecks.

In the meantime, my other recommendation is to consider this slap in the face a brutal wake up call that it is high time for you to start improving your practice.  Take a look under the hood and see what needs tuning up.  Then, promptly get to work on tweaking for additional performance.

If you need some guidance in the area of what’s going wrong, what to fix or where you stand, fill out my free, no obligation Practice Analysis Questionnaire and I will take a look with you.

Unless we get some sort of last minute reprieve, making no changes in your practice whatsoever will likely result in a 20% loss of your income in the near future if these Medicare fee cuts reach their full impact.  I don’t know about you, but I am not willing to let anyone – whether it is the government, Goliath or any goon bigger than I am – take 20% of my income without a fight and some definite activity on my end to make up for the difference.

Contact your political reps.  Start formulating Plan B.  And let’s get to work on making lemonade out of lemons!

In the meantime, keep these words of Alistair Cooke in mind:

“In the best of times, our days are numbered. And so it would be a crime against nature for any generation to take the world crisis so solemnly that it put off enjoying those things for which we were assigned in the first place: the opportunity to do good work, to fall in love, to enjoy friends, to hit a ball and bounce a baby.”

To Your Success!

Tom Necela, DC

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