Is Your Chiropractic Office Secure?

by Tom Necela on May 18th, 2010 in Business, HIPAA, chiropractic business, compliance

Reading time: 4 – 6 minutes

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Today’s post is a back-to-basics reminder of something that we all should not need to be reminded of, but….it is likely than most chiropractors could use improvement in this area.

The topic: security.

Specifically, I’d like to say a few words about the security of information, finances and records in your office.  Some of this pertains to HIPAA; some of this pertains to good old fashioned common sense.  Both are needed.

In case you were not aware, business accounts are the most vulnerable to hacker attacks and the least protected by the law. This is bad news for all chiropractors who do not hold their money under their mattress, which I suspect is most of us.  Here’s why:

Hackers are much more inclined to break into a six-figure business account than a consumer account with a few thousand dollars, according to the article “Could Online Hackers Steal Your Cash” published on the financial website Bankrate.com.  And there’s more bad news: if your bank determines that your money vanished because of something you did, they may not be liable for your disappearing cash!  Sound a bit subjective and risky to you?

With online transactions and banking opportunities increasing daily, chiropractors need to be especially vigilant of protecting their accounts not only to protect their money, but need to take extra steps towards data security in general.  A breach in a health care office may not only be financially damaging, but also has potential to cross lines and expose patient’s personal health information, which could lead to HIPAA privacy violations and fines as well.

While all of this may sound like the plot line to a new conspiracy theory thriller, a quick reality check in your own office may reveal that you are either well protected or unnecessarily exposed so such dangers.

Here are a few items that I would recommend for your to-do list so you can sleep a little more soundly:

  • Make sure all patient files (and x-rays) are kept in locked storage.  This is not only required via HIPAA regulations, but is a good idea to prevent theft.
  • Utilize tougher passwords online.  “1234” just won’t cut it.  Use multiple passwords – not the same one for every site to avoid a widespread breach.  Mix upper and lower case numbers, letters, symbols, etc.
  • Protect yourself against malware (viruses, spyware and other online threats).  While most computers come with a free trial, many chiropractors let them lapse and/or never upgrade to the full version.  Check out the June 2010 issue of Consumer Reports magazine for the latest ratings on effective free and paid security software.  The most expensive fee of any of their recommended options is $70 – hardly a matter for debate when you consider the amount of time, money and effort that will be expended if something bad happens.
  • Pay to have a security system with monitoring installed in your office.  In terms of banking, your greatest theft threat may be online.  But fire, break-ins and other hassles can effectively be monitored via a security system.  I know several DC’s whose offices were destroyed by the elements and many more who suffered break-ins.  Even small town DC’s are not immune to crime and certainly not safe from the elements.
  • Don’t Let Employees Take Laptops Home.  One of the biggest data breaches in health care history occurred when a Blue Cross employee took a laptop to do some work from home.  Unfortunately, the laptop was stolen in a parking lot while the employee was busy running errands.  So not only did the employee NOT get any work done at home, the employee inadvertently caused a data breach that involved over 100,000 physician records – including Social Security numbers and EINs.  Certainly, an accident like that would not be of the same magnitude for your office. But how many patients do you want to notify and inform them that your employee’s conduct caused their personal information to be stolen? Although that would certainly not be fun, it would be required per HIPAA regulations and failure to do so would result in major fines!

Lock up. Protect your business. Sleep well.

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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Chiropractic Audits — What To Do When You Receive THE Letter!

by Tom Necela on April 19th, 2010 in Audits, Business, Chiropractic Audits, Documentation, compliance

Reading time: 4 – 6 minutes

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  • Don’t Panic and Don’t Ignore It! An audit letter is not an automatic presumption of guilt.  Some audits are completely random and conducted routinely with no suspicion cast toward your billing activities, documentation ability or treatment parameters. So do not panic in the presence of an audit letter. Don’t assume that your documentation is substandard. Don’t automatically determine they will find your records insufficient and make plans to be subversive.  On the other hand, do not ignore the audit letter.  Instead, plan to take action.
  • Can I even be audited?  You do have legal rights depending on the state in which you practice and your specific situation. For example, if you are an out of network provider, there is a possibility that the carrier cannot audit unless they suspect fraud.  On the other hand a governmental entity like Medicare definitely can audit you, so move on to the next step.  Perform your due diligence immediately and research this issue.
  • Determine exactly what the audit letter states. Are they requesting a chart audit where they want to look at your medical records?  Do they want to perform a site visit?  Once you’ve determined which type of audit they’re intending to conduct on your practice, you need to formulate response to that audit or to the request that the audit’s making in a timely manner.  In some types of audits, no answer is the worst possible answer you could give.  So you want to respond in a timely manner to the request for the audit.  Also, provide what is requested: nothing more, nothing less.  The auditors do not want to review a 42 page explanation of your chart notes; they should stand for themselves.  Furthermore, any additional material you provide beyond what is requested can be used against you as well.  One tip: do not respond to phone or fax audit requests.  Get it in writing!

  • Do Not Alter Your Documentation. I get many emails and calls from chiropractors who have received an audit letter.  The most common question is: “what do I need to do to prepare for this audit?” To be blunt: the time to prepare for your audit is not when an audit request letter is in your hands! Never take matters into your own hands and alter medical records to improve what appears to be incomplete or insufficient documentation. Poorly done records are still better than the best records that have been fraudulently contrived.
  • Determine IF You Can Meet Audit Requests.  If the time frame that the carrier is requesting is not reasonable due to some sort of extenuating circumstances, contact the auditor for an extension.  If it’s going to take you more time to produce the information, ask for an extension.
  • Is this something we need to appeal immediately? If your “audit” letter is actually a demand for repayment, your best option may be to start the appeals process.  Do not automatically presume that the payor’s review is final or even correct.  If appropriate, an appeal can save you thousands of dollars in unnecessary repayments and headaches.

  • Is this something for which you will experienced assistance? You may need to obtain the assistance of a certified professional coder or a certified professional medical auditor whose expertise is in chiropractic (such as myself) to help defend you.  A healthcare attorney may also be wise, especially if there are several zeros in your demand or repayment letter. Again, before you hit the panic button or get out your checkbook, it may be critical to the success of your defense or appeal to get professional help.  The reality is that your license, your lifestyle and your livelihood may all depend on it!

I hope that you found this article helpful.  For a more detailed discussion on audits, I suggest you check out my program “How to Prepare Your Chiropractic Practice For Recovery Audits.”  For specific questions regarding your own audit situation or letter, you may contact me per the guidelines below.

Due to the large volume of requests that I receive for audit advice, opinions and requests from chiropractors to “look this over and tell me what this means,” I can no longer respond to phone inquiries on this matter.  If you have need for an opinion or objective discussion on audits or demand letters, the need for attorney/ legal representation or appeals, please contact me via a separate email for this purpose at Audits[at]StrategicDC.com.

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Why do Chiropractors consistently overpay their income taxes?

by Tom Necela on April 13th, 2010 in Business, chiropractic business, chiropractic practice management

Reading time: 5 – 8 minutes

If today’s blog post title has you perplexed – don’t worry.  I am not masquerading as an accountant or tax specialist.  I have plenty to teach in my area of billing, coding, documentation and profitable business strategies to keep me busy for a long time.

But since teaching chiropractors to work SMARTER in their business is my mission, and since April 15 is near, I thought this would be a good opportunity to host a guest column on an issue none of us can afford to ignore – taxes!

A final word.  There are several reasons that I chose Jim Bowen, JD to author today’s blog post.  Because of the tremendous asset he has been to my business and finances, I have the utmost confidence he can help you too. He understands taxes (most of us don’t) and from working with scores of DC’s over the years, he understands the challenges we face as chiropractors.  Listen and learn.  I’ll see you next week!

Tom Necela, DC

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Why do Chiropractors consistently overpay their income taxes?

Here is a sobering thought this time of year: between 89 and 92% of all small business significantly overstate their income tax liabilities.  My work with DCs has me believe that their rate is probably higher.  The average discrepancy between what my DC clients were paying and what they actual were required to pay is over $22,400 a year.  Over a period of time, this contributes to a widening separation in net income between the well-run business and the average business.

What accounts for this?

When Money Magazine set out several years ago to find out, they came up with a pretty interesting conclusion.  After working with small businesses for over 20 years and hundreds of DC clinics, I can add some additional reasons why the Chiropractic clinic is uniquely positioned to make quite a bit of money every year, but hands over more to the IRS than necessary:

  1. Working within the wrong entity. Almost every chiropractic office would be tax-advantaged to operate as either an S-corporation, or an LLC that is taxed like a corporation.  Partnerships have several disadvantages while the sole proprietor suffers from the highest IRS audit rate there is as well as the lowest ability to operate efficiently.   Most sole props realize a 30-50% decrease in tax liability simply by converting to a corporate form and accounting properly within that form. Accountants and tax attorneys already operate this way, while DCs are left on their own
  2. Not understanding basic and advance tax planning techniques. Once you have your correct entity, you need to know what to do with it, a subject not commonly taught at your Chiropractic College.  There is not one or two things to employ to achieve Tax Nirvana – it is a sophisticated integration of the clinic operation with the individual circumstances and goals of the clinic owner, that results in a low tax liability within the dictates of the Internal Revenue Code.
  3. Not properly characterizing and documenting income and expenses. Think of this as no different from your business.  If you adjust, but do not characterize correctly or document sufficiently, you will not get paid.  The same adjustment characterized and documented correctly will get paid.  The ability to deduct a private school, children’s braces or a new Lexus also depends upon characterization and documentation.  As in health care, learn the rules and benefit from them.
  4. Relying on an accountant. This is where Money Magazine comes in:  Money sent out a hypothetical tax return to 46 accountants and received…46 different amounts due!  Tax liability ranged from $36,320 to over $94,000 – for the same return.  The reason was obvious: during the season, accountants prepare an average of 6.7 returns a day – not much time for careful consideration of your circumstances.  A CPA is vital to preparing and submitting your returns, but they are just relying on the p/l you submit to them and you cannot rely on them for the lowest tax liability and audit rate that you deserve.
  5. Not having a tax advisor or preventative audit. A tax and accounting review prior to sending your material to your accountant (or better yet, earlier in the year) is what makes the difference.  You should be looking for ways to reduce your chance of being audited, as well as keeping more of your earnings.  This takes pro-active planning with an advisor that understands law, accounting, business planning and has a detailed understanding of the Chiropractic business.
  6. Not looking for improvement. DCs are experts in trying new ways to increase patient visits, collect higher fees and extending that PVA, but they do not take even a few minutes to see how they can reduce their taxes.  Inertia and denial are two main reasons, but overall, it is the lack of understanding that something can actually be done about it.  One of the basic rules of business accounting is:  It is not the amount of money you make that determines your tax liability, but how you take and account for that money that matters.

What can you do now about your 2009 taxes?  Plenty, as it turns out.
First: tell your accountant to file an extension.

Second: Give me a call or email your 08 taxes (09, if prepared).

Third: Take advantage of a15 minute, free consultation to see how far off you are and discover out the easiest way to correctly file your returns.

I review hundreds of returns for Chiropractors every year and it is rare that I find one that cannot be significantly improved.  With my background and experience in law, accounting, business planning along with an extensive knowledge of the DC practice, I provide a unique perspective to you and your clinic.

Interested in learning more?  Take a look at www.bowen.us to get a better idea of how I can help you…this year!

Remember, it is not too late to lower your 2009 taxes.  It just takes action.

James M. Bowen, JD, is the owner of Bowen, Inc.: a for-profit corporation dedicated to strengthening the chiropractic community by helping Doctors of Chiropractic become more efficient.  His consulting service provides efficient DC operations, satisfied and energized owners, increased compliance and guarantees increased net income – year after year.

Mr. Bowen can be reached at 406.370.9900, his email is jmb@bowen.us and his website is www.bowen.us

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Medicare Releases Chiropractic Medical Review Findings for the 1st Quarter

by Tom Necela on April 6th, 2010 in Audits, Chiropractic Audits, Coding, Documentation, EHR / EMR, Medicare, chiropractic EHR, chiropractic EMR, chiropractic coding, chiropractic documentation

Reading time: 4 – 6 minutes

detective

Recently, a Medicare carrier (Palmetto GBA) released their 1st Quarter results of Medical Reviews they have been conducting.  Even though Palmetto is only one of several carriers who administer claims on behalf of Medicare, their findings are relevant to chiropractors and, in my experience, reflective of trends across the chiropractic profession at large.

The goal of the medical review program is to reduce payment errors by identifying and addressing documentation and billing errors concerning coverage and coding. In their reviews, Palmetto GBA identified ten problem areas for the first quarter of 2010. These areas were as follows:

  1. Split/shared visits
  2. Signatures
  3. Labels/Diagnostic Testing
  4. Hospital & Nursing Facility Discharge Services
  5. Chiropractic Services
  6. Therapy Services
  7. Individual Psychotherapy Services
  8. Evaluation & Management Services
  9. Legibility

10.  Teaching Physician Services.

Please note this is not an all-inclusive list but does reflect the majority of documentation issues discovered during the review process.  Of this list, however, three items have direct application to chiropractic reimbursements in the Medicare program.

So let’s discuss these three “Frequently committed errors”:

  1. Signatures.  Put simply, Medicare requires an “identifier” for services provided or ordered.  That identifier is your signature – either in handwritten or electronic form.  Signature stamps in your documentation are not acceptable per Medicare Signaure Requirements (See section 3.4.1.1 B) Quite frankly, this is so basic that it is ridiculous that it even makes the top ten. Apparently, despite its simplicity, most physicians seem to overlook it.
  1. Chiropractic Services.  As a relatively small profession, we should not even make the top ten hit list.  We did, however, so now it is our responsibility to correct these problems asap as a profession.  Palmetto found chiropractic documentation to be lacking in the area of Treatment Plans.  More precisely, chiropractors were missing treatment plans with specific objective, measurable treatment goals. Follow thru with these specific objective treatment goals on subsequent visits was also often omitted.  Difficult?  Not very.  Documented?  Apparently, not very often.  Can you fix this, doctor?  Definitely!
  1. Legibility.  If this is not the biggest commercial for EMR, I don’t know what is!  Again, there is no reason any physician should be getting dinged for this one.  Alas, I have seen many of your notes and I sadly agree, that they are barely legible, sometimes only to the highly trained eye (yours and that of your longstanding staff) – and sometimes, even you cannot decipher your own notes.  Put simply, if your notes cannot unquestionably be read by a third-party without eliciting a migraine or use of some special telescopic lens, it is high time to get on EMR.  There are plenty of good systems out there.  In fact, ANY system that produces legible documentation is better than marginal handwriting – and I have yet to see an EMR system that fails to product legible documentation!

In summary, we chiropractors need to get our act together pronto – not only for Medicare, but for all third party payers.  The items above are not difficult to fix, but I realize that some of you are overwhelmed by how much work you have to do to bring your documentation, billing and coding up to acceptable standards.  Others may be so consumed with building your business that you literally don’t have time to look up and see the arrow sailing directly at the target on your chest.  And some of you are just plain tired of putting out the fires in all these areas due to a lack of solid systems that both maximize your reimbursements and minimize your audit risk.

The good news is: help is available. And while it is a physical impossibility for me to assist  all of you with these needs let alone answer the truckload of emails I receive per month on chiropractic billing, coding and documentation questions from random chiropractors at large!  But I am willing to offer a FREE, no obligation look under the hood of your practice for those of you willing to invest the time and effort into completing a Practice Analysis Questionnaire.  Download it, complete it, fax it in today and take a concrete step towards improving your practice, your business, your piece of mind and your life.

To Your Success!

Tom Necela, DC, CPC, CPMA

P.S.      Not sure what can be done with YOUR practice?  Take a look at what my clients have to say about the transformations they have achieved in their practice!

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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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Solutions to Your Chiropractic Billing Problems

by Tom Necela on March 23rd, 2010 in Billing, Business, Chiropractic Seminars, chiropractic billing, chiropractic business, chiropractic coding, chiropractic practice management, chiropractic webinars, seminars

Reading time: 8 – 14 minutes

blind leading blind

Solutions to Your Chiropractic Billing Problems

Warning: this post may be offensive to some (not because of language or explicit matter) but because those who it irritates are probably most in need of hearing it.

The subject matter: your billing department and its problems.

Because I don’t see your statistics here in front of me, I can’t say for sure which problems your chiropractic practice is facing due to your billing department.  But for many of you, I can venture a guess that it is either poor collections, delayed payments, denied claims, labor intensive systems or a combination thereof.

And unlike the glaring problem of not having any new patients, billing challenges tend to dwell suspiciously beneath the surface until one day you notice you are $10K , $20K, $30K or more off your collection goals.  At that point, you are painfully aware that there is a problem and you begin to scramble for a solution.

Flawed from the Start

Many of you will scratch your head and wonder how this happened.  After all, in many (if not, most) chiropractic clinics, the billing person is the most trusted employee of all.  This is because  it is typically the spouse of the doctor who does the billing.  And this person has been handpicked, trained and has a vested interest in the success of the clinic.

While this may be true, let’s analyze that a little closer.

Handpicked? Certainly, because the budget did not permit a person of adequate skill or experience to fill the position and the spouse is willing to work “for a while” until things get off the ground.

Trained?  Ah yes, the billing person is under the careful tutelage of the doctor who received…absolutely zero training on billing or coding in chiropractic college and whose continuing education credits in the matter curiously blend in with advice from would be know-it-all colleagues who are likely just as clueless in this department, however good intentioned they may be.

Truly, this is a case of the blind leading the naked (sorry for the warped 80’s reference).

Vested interest?  This certainly is accurate. The spouse is probably the most motivated employee in the clinic.  I have seen cases where I would even replace the doctor with the spouse, would it be possible.  But the Olympics provide you with an excellent example of why this is not enough.  Every Olympian is obviously motivated enough to win; they would never had made it their without superior powers of motivation.  But in the end, skill prevails.

My Billing Stinks – What Next?

For those of you who did not need the brutal awareness that you have sent your well-meaning spouse to dine with the wolves, you too may be cognizant of the fact that, well, your billing is less than stellar.

Certainly, it is still possible for your billing person to be a slacker, inept or just not quite as effective as they could be or should be – even if they are not related to you and/or may have impressive looking credentials under their belt.

The good news is that (hopefully) you don’t go to bed with this person and are not bound by marital ties.  Because of that, they are much easier to replace, if necessary.

Before You Give Them the Boot…

Regardless of who your billing person is, if you find yourself in a huge mess, or if you would rate your employee as an “F,”  let the first letter of that rating be a clue as to what you should do.

But for everyone else, there is hope.

After all, a good employee can only rise to the level of the training and the expectations they receive.

Unfortunately, doctor, this means YOU need to get to work!

How to Rescue a Poorly Performing Billing Department

The first steps to rescuing your billing department’s deplorable performance is in your hands and here is what I would recommend:

  1. 1. Monitor the Money. If you were to chart your monthly collections and the results look like a roller coaster ride, likely you have internal issues that need fixing fast.  But the only way to figure out where to apply corrective actions is to begin studying your collections, your accounts receivable and your revenue cycles.  For more assistance in this department, see How to Oversee Your Billing Staff & Service.

  1. Provide Your Biller With the Tools & Resources They Need. I haven’t tracked it precisely, but I believe there is a direct correlation between the age of your coding book and the amount of billing problems that exist in your office.  Worse, every practice that I have been that does not even own a coding book, has multiple billing issues which can potentially take months to fix.  Quit sending them to work without a tool box.  Get them the latest ChiroCode book, (see here for a link to FREE SHIPPING on the 2010 ChiroCode book and don’t say I never give anything away free).
  1. Commit to Ongoing Training for Your Billing Person. Have them attend the FREE monthly webinars that ChiroCode offers (as they are full of useful info unlike most other “free” webinars that our profession uses for an hour long sales pitch).  This week on ChiroCode webinars is yours truly.  Join your staff for seminars on billing, coding or documentation.  I have two coming up and I guarantee you will BOTH learn enough useful info that it is well worth the trip regardless of your distance.  Ignorance is costing you more than you realize.
  1. 4. Give the biller realistic job expectations. Some offices want their billing person to double as the world’s most friendly front desk person AND the most tenacious collections bulldog a delinquent patient ever had the misfortune to encounter.  Good luck with that.  Rare is the bird that can sing both of those tunes.  If you have one, hang on tightly.  If not, consider re-defining your staff job descriptions so that each team member can excel at some needed roles in the clinic, but is not required to be a superstar at everything to meet your approval.
  1. 5. Leverage Their Time. Some clinics have a broadly defined definition of billing that encompasses everything and anything to do with money. As a result, the billing person is responsible for: sending claims, posting payments, reconciling accounts receivable, sending statements, verifying insurance, handling patient finances, presenting care plans, over the counter collections, depositing funds into the business bank account and making change for the pizza guy who delivers the staff meeting lunch.  While all of these things may technically revolve around money, it may not be efficient (or cost effective!) for your billing person to handle them, particularly if they are the highest paid employee or if their desk routinely resembles Oscar Madison’s apartment (for those of you old enough to remember The Odd Couple).  Instead, delegate tasks that don’t require billing expertise (running the envelopes for the statements through the postage meter is a favorite time waster that I see too many billers involved in) and let them focus on bringing in the money and higher value activities.

Know When To Fold ‘Em

While I don’t routinely promote Kenny Rogers as a source of wisdom, sometimes you have to just take his advice and “know when to fold ‘em.”  That is, give up the goat and outsource.  Examples:

  • Recently, a doc approached me about opening a new clinic with wife as biller and mom as office manager.  Neither have worked in chiropractic before. Neither have any training.  This is a nightmare waiting to happen.  Why would you want to start your business with your most ignorant foot forward for all the world to see?  They should outsource.
  • A marginal clinic has a poorly trained CA doubling as a billing person manning the ship.  They have no money to hire a decent person, nor can they afford to send the CA for training since she wears all the hats in the clinic. Their practice is spiraling downward since the CA can’t figure out why their collections are in the toilet, mainly because she has no clue where to even start.  My two cents: outsource & pronto!

When To Get Help

There is another option available for those of you who are unwilling to throw in the towel or for those would benefit from guided expertise.  Quite simply, it may be in your best interest get some professional help.

For a free, no obligation look at how I may be able to assist you, complete the Practice Analysis Questionnaire and send it in for my review.

And while you may think that getting professional help can be cost prohibitive, consider some scenarios I encountered while working with my consulting clients who hired me for this purpose.

  • During a recent office consult, I provided a solution for one issue that the billing person (who is excellent at her job) was struggling with.  We analyzed a handful of claims that all were denied due to this problem and unsurfaced approximately $8000 worth of reimbursable services that she will correct and get paid for.  The savings will be further capitalized multiple times over when she applies this same correction to the dozens of other claims with the same situation.
  • Another client (again, with an excellent biller) had repeatedly made one innocent coding mistake to the tune of $60,000 per year in botched income and services.
  • A struggling office was able to increase its billable services from an average of $39 per patient to $64 per patient within 2 months of my consulting, which will yield a $90,000 increase this year – even if they do nothing else!

Bottom line:  billing IS a major factor in your bottom line.  It is too big to ignore and too critical to be left in the hands of an unskilled employee.  Get a handle on your billing and you will be able to steer your practice in the right direction.  Let it go adrift and you will likely sail into dangerous waters.
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The Power of Reciprocity & The Price of Indifference in the Chiropractic Office

by Tom Necela on March 16th, 2010 in Business, chiropractic business, chiropractic practice management

Reading time: 6 – 10 minutes

reciprocity-logo

Today’s topic: reciprocity.  Or more specifically, how to harness the powers behind this principle to help you improve patient relations, your business and your bottom line. And how to avoid the price of indifference on the part of your patients.

Let’s begin:

First coined in 1766, Webster defines Reciprocity as:

  1. the quality or state of being reciprocal : mutual dependence, action, or influence
  2. a mutual exchange of privileges; specifically : a recognition by one of two countries or institutions of the validity of licenses or privileges granted by the other

In chiropractic terms, both are entirely accurate.  As doctors, we sometimes fail to realize that there is mutual dependence going on within our business: our patients depend on us for our expertise in restoring their health; we depend on patients to pay us for our skills.  Additionally, this mutual dependence is a privilege – again, for both parties involved.  The patient is privileged to have access to our health care and the ability to pay for it.  As chiropractors, we are privileged to have paying patients who need our services.

Since we have now established that there indeed exists Reciprocity within the very nature of our patient-doctor relationship, the question is: what are we doing to enhance, improve or encourage the development of this relationship with our patients?  Here’s the key: our ability to engage the power of reciprocity enables us to irresistibly build our business and magnetically attract patients.

In fact, it is what much of the astounding success of entities like Facebook, Twitter, LinkedIn and other various social media sites have captured that has enabled them to exponential grow their businesses.  Not to mention the countless other examples of reciprocity that cause you to somehow be irresistibly attracted to whatever site, service or sale that is being offered.

Facebook, Twitter, LinkedIN all use it – why can’t you?

And you can use these same principles in your practice! Sound enticing? Read on!

Here’s a common example:  You receive an “invitation” from a long lost acquaintance, not quite a friend but at least neutral enough not to be an enemy.  It’s begs you to “friend” them on Facebook. Bizarre as it may seem, and even though you know the game, you go ahead and accept the invitation even though you may not really have much interest in re-kindling what was never much of an acquaintance or friendship in the first place.

Let’s go one step further:  another person, less than an acquaintance, sends you a request to  “follow them” on Twitter.  Again, you accept, not really knowing why but not wanting to refuse either.

And one last example:  someone you don’t even know sends you an invite to become LinkedIn.  You see from their circle of colleagues that they have friends or business associates in common.  And even though you may not know them personally, you accept.

All of these web 2.0 invitations work on the power of reciprocity and you gave in to it each time.  But this principle is certainly not limited to the web and, in fact, has been tapped quite effectively by scores of other businesses, charities and individuals who succeeded for the very same reason.  And here it is.

It is part of our natural instinct to want to give back to someone who first gave something to us.

It doesn’t even matter whether it is something so small as a web invite. Or a flower from a Hare Krishna (for those of you old enough to remember them).  Or an envelope in the mail that contains a free gift (the most microscopic pin with an American Flag and return address labels) and asks you to donate to the Veterans of the ABC War Fund.

And now you are swept in by the Principle of Reciprocity and you suddenly find yourself doing exactly what they are asking you to do.

Reciprocity in the Chiropractic Office

So how does this relate to our patients?

Quite simply, how are you giving back to them?  In challenging economic times, many chiropractors are foolishly cutting back on their budgets to make room for more “necessary” items.  Gone are the dollars spent on advertising. Gone are the dollars spent on new patient welcome kits, thank you cards and little gifts for being a patient or referring a new one.

And with it, gone is the understanding of what these items do for your practice and your patients. Gone is the power of reciprocity.  Gone are its tangible benefits because your patients no longer feel like “they owe you” but instead they feel like you don’t even care.

Here are a few ideas for harnessing the power of reciprocity in small, concrete ways which will stimulate your patient to give back to you in return:

  • Say “thank you” to every patient on every visit and train your staff to do the same
  • Distribute a “welcome kit” to all new patients that gives free samples of products you may use or recommend in the office
  • Give an educational book about chiropractic instead of just a pamphlet or brochure, as it has more value and is more likely to be read rather than thrown away. (Certainly, I recommend Beyond Back Pain for this purpose!)
  • Offer to spend time at local schools or performing corporate ergonomic evaluations
  • Have your massage therapist do short, promo chair massages
  • Have patients bring in their current medications, vitamins so that you can review them and see if what they are taking is appropriate and in their best interest
  • Ask if there is anything else you can do to help them.

Certainly, if you don’t express other ways of showing care or concern, a little gift or a new patient welcome package won’t make up for your lack in other areas.  But consumer research shows that one of the greatest reasons your patients (or any customer leaves) is rarely for what we think it is.

In fact, here is the breakdown from a recent survey polling healthcare offices of different disciplines.  Patients leave because:

  • 1%          Die
  • 5%          Move away
  • 6%          Financial concerns
  • 14%        Unhappy with service
  • 16%        Left due to lack of convenience (too far to drive, etc)
  • 58%        Displeased with attitude of indifference on the part of staff/doctor

Obviously, the power of reciprocity was not at work.  The patients didn’t feel they owed you anything because they didn’t even feel that you cared.

The take home message is quite simple:  do everything in your power to show your patients you care and use the power of reciprocity to engage them to reward you for that care by giving back to you in the form of loyalty, referrals and the ongoing support of your business.

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