Today’s column is admittedly lighter fare as I will address the most common questions that fill my inbox on a daily basis in hopes of pointing many of you in the right direction at once.  Here they are, in no apparent order:

How Do I Learn Proper Documentation, Coding, Billing procedures or teach them to my staff? The ACA offers its members a free online tutorial for Medicare, many local Medicare carriers do the same. Some insurance companies even teach “provider workshops” covering principles of coding, billing and documentation. Admittedly I may be biased, but my seminars get excellent reviews (see seminar testimonials to read for yourself). I teach seminars all over the country and offer webinars for the homebodies. My fall schedule should be posted soon.  If your hometown is not on my list, don’t be offended, just ask!  I have several sponsors that are willing to fly me just about anywhere if they can stick their logo on your event brochure.

Is the threat of Audits something I should really worry about? That depends on how much you are willing to give back to Medicare or a commercial payer.  Medicare’s RAC program is now in force everywhere (as of August 1, 2009).  You can go to Medicare’s website and learn more about the RAC program for free. My advice: Start to “self-audit” your records. Pull a few files and see if they would pass scrutiny. Are your records legible? Are they complete? Are they compliant (Hint: Your dusty compliance binder that someone scared you into buying for $1500 isn’t enough to protect you).  If you don’t even know what an auditor would be looking for, I have also just written a non-state specific manual on “How to Prepare Your Chiropractic Practice for Recovery Audits” to assist you in the process of getting ready. (Watch your email inbox for more info on how to purchase the “pre-release” edition soon)

Do You Offer Private Consulting? Yes, I will consult with your office to get practice saving principles in your hands.  You will find that these strategies not only can save you from trouble, but will also improve your bottom line.  I can come to your office or do things via distance (phone, fax, email).  My programs are tailored to fit your practice needs and do not the usual “cookie cutter” offerings where everyone attends the same seminar to learn how to get new patients or how to practice just like me.  I focus on profitability, working smarter, billing, coding, documentation and collections strategies.

Can you give me an example of a “perfect” SOAP note that will meet medical necessity. Yes, I can but I won’t.  Why not? Because you will then copy it and use it for every single one of your patients.  The purpose of a SOAP note (or any documentation) is to communicate what is going on with your patient to someone who is not there.  While there are certain elements that should be part of every good SOAP note, it also should be a document flexible enough to change with the patient.  For example, you have three patients, all have neck pain. One is 5, one is 35 and one is 85.  Shouldn’t something about their documentation look different, even if they have the same presenting problem!  I love simplification, but there is a danger is too much simplification.  In my opinion, to give you a “perfect” SOAP note as a template for all your patients would endanger you for the reasons described above. Then, if you run into trouble with it, you will come back and blame me that my perfect SOAP wasn’t perfect when in fact it might have been just fine, had you not used the same SOAP for the last 93 visits your patient had in your office. Yes, I understand that certainly not all docs would do this, but I have no way of detecting those who would. So the simple answer, again, must be “No.”

What is the best way to transition insurance based patients to cash patients? That depends on the situation.  If you have a patient who has benefits covering 12 visits a year and you anticipate 2 more visits are necessary, this is not a billing issue but an educational one.  In other words, if after 12 visits, they don’t see the value of paying for 2 additional visits to complete their care plan, you have not done your job educating the patient or teaching them about the value of your services.  On the other hand, if you are recommending corrective care plans that far exceed insurance benefits, then you probably need to devise a working model that will allow you to affordably present the remainder of your care where insurance reimbursement is absent.  The biggest mistake I see DC’s routinely make here is not properly calculating the cost per patient visit.  In other words, they set up TOS discounts, case fees, or care plans that are just not profitable (and may may not even be legal  in their state).  When considering your fees, you should always calculate the bottom line: what it costs you, per patient, to deliver your service.  Without this calculation, you may keep the patient, but lose money providing them with care.

Can I buy some of your products on a trial basis to see if I like your ideas before I hire you? Admittedly, I don’t preach the same message as most chiropractic practice management groups, coaches or consultants.  98% of them base success on volume; I believe it is entirely possible for success (financially and personally rewarding) without high volume.  But to do so, you must learn how to properly structure your business, align your model of care, and maximize your reimbursements.  And in today’s marketplace, it makes good sense (financially and in terms of peace of mind) to protect yourself from audit exposure.  That’s my main message. If you like that line of thinking or would like to improve your practice from within on those terms, you will likely enjoy my materials.  If you have the opportunity to see me “live” you will get this message as well as many concrete ideas on how to “tweak” your practice for better performance.  That is another good way of testing to see “if we are a good fit.”

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