Archive for the ‘Collections’ 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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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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National Legislative Changes (or Non-Changes) Affecting Chiropractors

by Tom Necela on June 1st, 2010 in Business, Collections, Medicare, chiropractic business, compliance

Reading time: 2 – 4 minutes

Changes_next_exit

In case you haven’t heard, two recent legislative changes have been passed that will affect you as a chiropractor:

Because these changes (or non-changes) happen quickly, I typically alert chiropractors of these via my Twitter page. But for a change of pace and because I know 14, 238 of you reading this are NOT following me on Twitter I thought it might be useful here as well.

(BTW: If you are on Twitter, no worries. I won’t send you tweets about what a great lunch I am eating or give you my reaction to the latest celebrity gossip in 140 characters or less.  If you are not on Twitter, it’s a quick way to stay updated on changes in chiropractic that you need to know. Plus, as a special bonus, you can re-tweet them (sort of like an email forward without the bad jokes) to friends and impress them with you ability to stay in the know on current events!)

So, here’s the news:

Medicare Fee Decrease

The long-anticipated (dreaded?) 21% Medicare fee decrease is scheduled to go into effect June 1, 2010.  While hopes have been high for a delay, no final Congressional action has yet been taken.

Medicare recently released a notice indicating that they would hold claims for the first ten business days of June to provide Congress with additional time to consider this issue.

Chiropractors should be aware that this hold will only affect claims with dates of service June 1, 2010, and forward.

Claims paid prior to June 1 should still be paid at the zero percent (0%) fee increase proposed by other recent legislative activity.  Translation: claims paid with dates of service Jan 1 through May 31 will be paid at the same fee schedule as your 2009 rates.

Red Flag Rules Delayed

Again, the Federal Trade Commission (FTC) has delayed implementation of the Red Flags Rule. The next date is set for January 1, 2011.  Although it has been a subject of much debate whether this ruling even applies to chiropractors, no worries – you still have time.  Meanwhile, Congress intends to determine the scope of entities who are covered by the rule. We will just have to wait and see how that turns out.

Hope you had a great holiday weekend!

I will be back next week with my usual fare of musings on all things related to the business of chiropractic.

Tom

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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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Medicare Fee Cuts Update for Chiropractors

by Tom Necela on March 2nd, 2010 in Business, Collections, Medicare, chiropractic billing

Reading time: 6 – 9 minutes

file_6

In the usual right up to the wire, last minute fashion common amongst government entities, Medicare (CMS) issued the following statement regarding the proposed Medicare fee cuts that were supposed  to go into effect Monday, March 1, 2010:

“CMS is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare physician fee schedule (MPFS).  The Department of Defense Appropriations Act of 2010 provided a zero percent (0%) update to the 2010 MPFS effective for dates of service January 1, 2010, through February 28, 2010.

We believe Congress is working to avoid the negative update that will take effect March 1, 2010.  Consequently, CMS has instructed its contractors to hold claims containing services paid under the MPFS for the first 10 business days of March. The holding of MPFS claims will only affect claims with dates of service March 1, 2010, and forward.  This hold should have a minimum impact on provider cash flow because, under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt.”

In other words, Medicare still doesn’t know whether or not there will be a fee cut.  And in the meantime, they will hold your claims and do nothing.  But, no worries, by law they have 14 calendar days (for electronic) and 29 calendar days (for paper billing) to get their act together and decide what you will be paid.

Presumably, you have nothing better to do than check the Medicare website (or that of your carrier) for the moment when the decision is finalized.

For an organization willing to slap a fine on you for “inducements” of any gift in excess of $10, they are not worried in the slightest on how their financial sloppiness affects our patients.  Sure, Medicare claims their indecisiveness “should have a minimal impact on cash flow” because they have the grandest of intentions of still paying you on time. (The failure of which will likely be the subject of a future statement released by CMS.)    However, notice the conspicuous lack of advice on matters of over-the-counter fee collection whilst we all wait in limbo.

Should we collect based on the 2009 fees, the anticipated fee cut, the negotiated slightly reduced compromise fee cut or anything in between?

In reality, for chiropractors the fee cuts – however large or small – may have a relatively minimal impact on our bottom line, especially when compared to other specialties.  After all, even a 20% reduction on a $35 is $7.   Not pleasant, but not likely to break the bank.

What will add insult to injury is the calculation of the difference between what you are collecting now and what you should have been collecting on March 1 and the time differential that Medicare notifies you about what should have been done, had they informed you on time, along with the positive or negative financial accounting and remuneration that goes along with it.

If you can read and comprehend that sentence (and I am not sure I can, even though I wrote it!) you will likely have no problem with the upcoming changes.  Perhaps you should even go to work for CMS as a translator or policy writer.

For the rest of us, here’s the skinny in plain English and my recommendations:

  • For now, there is no Medicare fee cut (nor any fee raise)
  • Continue operations under your 2009 local carrier fee schedule
  • Collect any co-pays or patient portions with no changes
  • That way WHEN Medicare does release their fee schedule, you can accurately calculate whether you owe the patient or they owe you more.
  • Get ready to support your state and national associations to oppose drastic fee cuts
  • Write to your Senator to oppose the fee cuts and tell them what a ridiculous inconvenience these shenanigans are for you and your patients (their constituents)

(Please note, these are my recommendations, not requirements, as there are no new requirements yet!)

If this frustrates you, hey at least you know you are alive.  It is my understanding that the dead do not experience such emotions.  On the bright side, US Citizens are not the only ones subject to the frustrations of their ruling class.  Other countries do, however, formulate protests with a bit of humor which makes the bad news go down easier.  For example:

  • In response to frustrations with city council, the 1959 election in Sao Paulo Brazil featured Cacareco, a five-year-old female rhinoceros, who ran under the platform “better to elect a rhino than an ass.”  She won by a landslide.
  • In 1967, in anticipation of municipal elections throughout Ecuador, the Pulvapies foot powder company launched an advertising campaign that featured the slogan: “Vote for any candidate, but if you want hygiene, vote for Pulvapies.”  Apparently the hygiene of the area had slipped so badly under the current regime that Puvapies won the election, under protest from actual human candidates.
  • The all-time winner of electoral protest goes to Guinness book of World Record holder, Lord Sutch whose platform was “Vote for insanity — you know it makes sense.” He campaigned in a top hat and leopard-skin tail coat. His proposals included bringing back the village idiot, putting joggers on treadmills to make them generate electricity, breeding fish in wine so they could be harvested ready-pickled, converting coal mines into bungee-jumping centers (and making local politicians be the first to test them), and making all dogs eat phosphorescent food so that their poop could be seen at night.

Stay tuned for more details and in the meantime, keep your nose to the grindstone because Medicare may be paying you less money for more work very soon, (maybe).  Your other option is to follow the advice of the “bang head here” group and hope this resolves quickly, though I am not sure I recommend that route.

Keeping you informed (like it or not!),

Tom Necela, DC

P.S.  For those of you who wish to Work Smarter, Not Harder in spite of the wave of regulations, rules and changes Medicare and any other third party payer throws at you, I have two upcoming seminars in Seattle and Portland on Chiropractic, Billing, Coding, and Documentation Mastery (click link for more details an registration)

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Changing with the Times in Chiropractic

by Tom Necela on December 22nd, 2009 in Billing, Business, Coding, Collections, chiropractic practice management

Reading time: 7 – 12 minutes

Changes_next_exit

Although some pundits have declared that the worst of the recession is over, I know that some offices are seeing the pinch of the slow economy and/or the holiday season on their patient’s finances.  And while it may be true that you cannot get “blood from a stone,” don’t take comfort in all the talk of economic doom and gloom by leading yourself to believe that everyone’s practice is down right now.  Those lies are told by those who want others to join them in their own shortcomings.  Plus, it most certainly is not true.

However, this is not to say that chiropractic offices that are thriving in this marketplace by doing the same old thing. For example, my client who called to tell me he was still alive (hadn’t heard from him in a while, so I sent him a search & rescue email!) has been busy adapting new strategies for his office, adding staff and been busy, busy, busy to the tune of a $60,000+ increase in the last three months since he hired me.  His excellent stats are not the result of pure luck, being in the right place at the right time or multiple mantras chanted towards attracting infinite abundance.  Sorry to all you fans of “The Secret” or other similar think and grow rich spinoffs – this fella did the work, made some proactive changes and is reaping the rewards of his smarter strategies.

Let me make one thing clear: I am not telling you to start to do your own billing, over the counter collections or put a register in your treatment rooms to collect co-pays!  However, I do think that, as the CEO of your business, you need to spend time in consideration of the way your office currently handles finances.

Unless you have been wearing blinders for several years now, $5 co-pays and $250 deductibles are becoming as rare as a monogamous celebrity.  In many cases, the insurance step children have taken their place in the form of $50 co-pays and $5000 deductibles.  Obviously, the clinic who approaches patient finances like it were 1985, 1995 or even 2005 has strategies that either won’t quite fit in today’s environment or ones that don’t even border on reality.

Instead, savvy practices that are succeeding today are coming up with an assortment of ways to make sure that the patients still get the care they need AND to ensure they are paid to deliver it.  Here are a few ideas and tips to think about in this regard:

1. Your Credit Card machine is mandatory. The first line of defense for a patient who doesn’t have cash on hand – be it for a co-pay, deductible or to purchase the bulk of needed care –  is to have a credit card machine.  You are a dinosaur if you don’t.  Those of you who would laugh at the notion at someone practicing without a credit card machine need to meet some of the characters who send me snail mail because they “don’t do internet.”  I bet they “don’t do credit card machines.”  And it is likely, they “won’t do practice” for long either.  Get the machine.  And for those of you who have one, shop yearly for transaction rates, fees and other little ways the companies will suck more of your money than need be.

2. Consider Auto-Debit. Some people don’t like the idea of paying 22.5% interest on their credit card which seems to be the direction many companies are headed.  As an alternative, allow them to make payments.  But whatever you do, refuse to accept payments the old-fashioned way!  In other words, someone owes you $500 and your well-meaning staff member agrees to accept $50/month payments only to find out that 10 months turned into 17, included 19 reminders sent by your staff to get the $500 and in total, you actually lost money by spending more in staff time than you received.  Instead, use auto-debit through your bank or a processing company such as FirstACH.com or PaySimple.com.  Patients are used to having their bills paid this way, and with a simple form, they can pay you the money over time without having it be a headache and a financial nightmare on the back end.

3. Make Sure Your Hardship Agreements are in Writing. Some of you are too easy on what constitutes a hardship in your clinic and you waive co-pays at the drop of the hat.  Not only is this potentially dangerous for legal and/or contractual reasons, it may make little business sense.  Certainly, if someone is in need, you want to get them the care because you have a good heart.  But be sensible about this.  DEFINE what a hardship is and stick to it.  I get way too many emails from staff that complain about their doctors being all over the map in this regard.  Get the poverty levels for your area and see what your state says about who doesn’t have any money and who should qualify for your generosity.  That way, when someone approaches you with what seems like a legitimate financial challenge, you have some concrete criteria to see if they meet the definition legitimately.  One final note: your hardship agreements should be in writing and be temporary (put an end date in which the hardship ends or must be re-qualified).

4. Beef Up Insurance Savvy, Cash Friendly Services. Even though much of the coding, billing and documentation advice I give slightly favors third party payment systems, it is a wise move to have services that are both reimbursable through insurance and for which patients readily pay cash.  My favorite choice in this category is massage therapy because it costs little to start up, has excellent profit margins, generates quick cash flow, is frequently reimbursed by insurance companies and routinely paid for in cash as well.  My How to Build a $300,000 Massage Practice in Your Chiropractic Clinic program is one of our top sellers for this reason – and it continues to get rave reviews because the program is a simple step-by-step model for how to create a successful massage department.  Certainly, massage is not alone in the insurance savvy, cash friendly category; but I do believe it outweighs the other choices by a large margin.

5. Clean Up Your Messes. Many of us are willing to point the finger at the patients or the economy for our financial struggles when the real answer is the mess that is in our own backyard. To put it bluntly, you will never achieve high levels of financial success if your Accounts Receivables are too high or inappropriately pushing beyond the 90 day mark.  If your billing person (or system or company) is a mess and can’t get you paid, there is no amount of compensating you can do on the other side to squeeze more profits out of your patients that will ever balance the scale.  Finally, if your documentation and your coding systems stink or were passed down to you by Uncle Louie, DC who was a big roller in the 70’s,   you are in for financial trouble at the least.  In today’s marketplace of heavily scrutinized claims, post payment demands and recovery audits, it makes little sense to bill for anything and everything with little attention paid to proper billing, coding or documentation standards because you will only to pay it back later.  Instead, spend some time cleaning up your own messes.   If you have even an average practice in terms of volume and visits, I can virtually guarantee you are leaving hard-earned money on the table because of your lack of expertise in these areas.  I say this, not to brag, but because this is what I do every day of my consulting business and there is literally that much to improve in most of our practices.

So, which of these steps are you missing in your practice?

Is it all of them?  Can you survive doing business the same way you are doing it now or is it high time to “kick it up a notch” and change with the times.  You may not be able to do much individually about the state of the economy, but you can do a whole lot about how your private practice handles finances.  So, get to work.  And if you don’t know where to start, consider completing my Practice Analysis Questionnaire so I can give you some guidance in this regard.  There’s no charge nor any obligation to utilize my services, but I am willing to give you some candid opinions/recommendations (like ‘em or not!) for those who take the time to fill out the questionnaire.

Happy Holidays!

Tom Necela, DC, CPC, CPMA

P.S.  For those of you who would like more in-depth strategies, check out my Chiropractic Collections & Financing Secrets program which has dozens of different tips and techniques to improve collections.

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Your Toughest Chiropractic Billing, Coding, Documentation Questions Answered – FREE!

by Tom Necela on December 15th, 2009 in Audits, Billing, Business, Chiropractic Seminars, Coding, Collections, Documentation, EHR / EMR, HIPAA, Medicare, Medicare ABN, OIG Report, chiropractic EMR, chiropractic documentation, chiropractic practice management, chiropractic webinars, compliance, seminars

Reading time: 3 – 4 minutes

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You are invited as a guest to Join Tom Necela, DC, CPC, CPMA — Certified Professional Coder, Certified Professional Medical Auditor, former Insurance Claims Analyst, and current President of The Strategic Chiropractor — for a special FREE 60 minute Webinar!

FREE WEBINAR!


Thursday December 17, 2009

– 9 am PST/10 am MST/11 am CST/Noon EST

So…

Bring your TOUGHEST questions on Chiropractic:

  • Billing
  • Coding
  • Documentation
  • Collections
  • Getting Paid for the Work You Do!

And receive the ANSWERS you need that will help you:

  • Maximize your reimbursements
  • Decrease denials
  • Shorten Payment delays
  • Lower Accounts Receivable
  • Reduce your risk of audits

We are hosting this seminar as a special “thank you” to all of our blog readers, clients and customers who have made The Strategic Chiropractor the #1 source for teaching chiropractors how to “Work SMARTER, not harder” for increased profits.

As a sign of our appreciation we’d like to offer you a FREE seat for this webinar and the chance to have your question answered “live” during the event.

(If you cannot attend or would like a CD copy of the webinar, see below for details.)

Historically, this is our most popular event webinar of the year, so you need to act quickly! Previous editions of this webinar resulted in hundreds more questions than we could physically answer in a limited time format.

Space is limited and ADVANCED REGISTRATION is MANDATORY to submit questions (the earlier you submit them, the better chance they have for being included in the presentation material).  So register below, submit your questions and get your front row seat for the ultimate biggest bargain on the subject of chiropractic, billing, coding and documentation!


CLICK HERE TO REGISTER!


Hope to see you there!

Tom Necela, DC, CPC, CPMA
The Strategic Chiropractor

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The Top 3.5 Ways to Save Money in Your Chiropractic Practice

by Tom Necela on November 17th, 2009 in Billing, Collections, chiropractic billing, chiropractic business, chiropractic practice management

Reading time: 5 – 8 minutes

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Many chiropractors today are seeking ways to increase revenue and reduce the costs of practice operations.  In today’s post, I will share with you a few excellent ways that I have found to help curb expenditures so that there can be “more money than month.”

1. Know the costs of providing your services.
At my seminars, I am frequently asked about how to set fee schedules. Specifically, DC’s often want to or how to implement profitable “cash” or time of service fees that don’t give the farm away and are also compliant.  Before any decisions can be made about how to go about this, it is vital that you knows the actual costs of providing the services you render in your practice. Any discussions made without this knowledge are meaningless as they have no context or relevance to you practice. Figure out your “Cost per patient” (or even Cost per Procedure, if you can be that specific) so that you will know exactly what each of the main procedures that you bill out cost your practice to provide. This knowledge will help steer you in the right direction to creating a profitable fee schedule and perhaps even eliminating services or procedures that are a waste of time or money.

2. Setting up a sound budget annually and review it! A budget provides a planning mechanism that forces us to monitor variations in our practice spending, but it also allows us to allocate money towards necessary elements of our business such as marketing. Once cost categories are broken down, I have found very few practices that were not able to save thousands of dollars per year!  The most common item overbudget?  Staffing!  An expense category that frequently surprises doctors? Telephone expense.  I have found lines being paid that were no longer in use by the practice, astronomical cell phone plans, and even the occasional savings be realized with some good comparison shopping.

3. Outsource, Liberate or Just Get Rid of the Dead Wood!
Although I mentioned budgeting in step two, the reality is that most cost savings in the area of comparison shopping and appropriate budgeting pale in comparison to overpaying staff.  Quite frankly, some of you need to take a good hard look at your numbers and get rid of the dead wood around your practice!  Employees that are overpaid and underworked are costing you far more money than you will ever save in watching your spending on pens and paper.  Similarly, employees that are inefficient in their job are costing you big bucks as well.  For example, if you are paying an employee to do your billing who is collecting an unacceptable percentage of your services, that employee may be doing their job, but they are not cost efficient.  Why?  You can outsource your billing to someone who is only paid when they collect, as opposed to your employee who is paid whether they collect well, poorly or anywhere in between.  For some of these staff you need to liberate them so they can find meaningful employment elsewhere in a field in which they possess more talent or interest.  For others, you may need to shift their job description towards tasks that produce a better ROI or for which they possess better skills.  Finally, in this tough economy, there is absolutely no reason to tolerate and pay for any staff member who does not put 110% effort into their job, who does not play well with others or who is a thorn in your side.  In virtually any market in the country, one quick trip to Craig’s List will reveal dozens of job seekers who would love to take their place and give you a bigger bang for your buck.  Save your money by not trying to “save” marginal or mediocre employees.  It almost never works and in the end, your time, money and effort would have been better spent on a new prospect.

3.5  Evaluate the Performance of Your Billing (For all you Jeffrey Gitomer fans, here is reason # 3.5)  While it may be obvious if your front desk CA is a dud, the next questions many of you will ask is…”How can I tell if my billing person is doing their job well?”  Or “How can I tell if I am spending too much money on my billing service?”  Evaluating the performance of your billing staff (or service) is a hard science we were never taught in chiropractic college but can be easily learned.  For starters, I would suggest you look at your Accounts Receivable and Your Collections vs Services.

For most practices, your A/R should be heavily skewed towards the Current-30 day mark and taper off towards the 60,90, and 90+ days of aging marks.  If not, you may have a problem. On the other hand, your Collections should match your Services as closely as possible.  Obviously, collecting 100% of services is the best, but depending on your practice mix (cash, insurance, PI, WC, etc) lower percentages may be acceptable as well.  While it is difficult to give a catch-all formula that works for all practice styles, I can tell you that it is nearly impossible to be profitable if your collections percentage approximates your overhead.  In other words, the average overhead for clinics is 50% and I have met doctors with 52% collections who are puzzled why they are struggling to make money.  If you are in this situation (or getting too close for comfort), I suggest you contact me for assistance.

Incidentally, if you need additional information on how to meaningfully evaluate billing performance, I would recommend my program “How to Oversee Your Chiropractic Billing Staff or Service.”  Sure that’s a blatant commercial, but there is no other resource that I know of in chiropractic that covers this important topic in such detail (which is why I wrote it!).

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