Chiropractic Office – Billing Precision Building a Successful Practice – Dr. Troy Dreiling
A lot of doctors ask questions like why is growing a practice so hard? Why is taking care of patients so hard? And there are three things you really got to focus on. Number one, we got to focus on treating the patients. Number two, we got to focus on growing the practice well, how you do that; marketing and different things like that to grow the practice. And then lastly is getting paid and being in compliance. We love treating patients. As doctors we just love to treat patients; that’s why we got into chiropractic what we got into this profession to take care of patients. We don’t care if it’s hard. We love to serve the patients but there are some skills we’ve got to work on and focus on and develop so we can continue doing what we love. So growing your practice is a learned skill, you just don’t come out of school open the doors and patients flood to you. You’ve got to develop how to grow and how to focus on implementing and growing your practice. Getting paid, that’s a challenge in today’s economy and market, getting paid for your services. Some of the patients don’t want to pay; they don’t want to pay your full fee your full service. Insurance companies don’t want to pay. Well speaking of that, insurance companies make money on the float, meaning, you’ve taken care of the patient, you’ve provided services and if you’re billing insurance they get paid or they make money on floating the money that they owe you and, you know, the game is interesting. It’s stacked towards the dealer, meaning the insurance company, they do different things to help them hold on to their money so that they don’t have to release it to you, after you’ve provided the service, you’ve worked hard, you’ve taken care of the patient, the patient is satisfied, but yet they’re floating the money they owe you. That’s why if you want to succeed, if you want to save more lives, if you want to help more sick people get well in your office, we have to have the documentation system, that’s no nonsense, that’s fast, it’s compliance. Secondly, we have to have a scheduling system that can keep patients on track, that can help you see what people are missing. And then lastly, we want to level the playing field and at the end of the day know and rest assured that that billing is going to be taken care of and that check’s coming in the mail sooner than later, not on the float, not on the time that they send you paperwork to try to, you know, slow down the claim but you know you’re on top of your game. – Dr. Troy Dreiling
Chiropractic SOAP notes – Audit Risk and Billing Management – Dr. Troy Dreiling
I want to talk about why SOAP notes and your documentation is so critical and why we need it fast. In a high volume busy office, it’s important that you’re on top of your documentation. You know, so many doctors spend more time documenting than the visit takes, which can delay the process of submitting your claims, actually can even throw you into an audit or a compliance risk, and so being able to document fast, effectively, and efficiently is key. A third of all doctors in our profession will be audited this year and so it’s important to be on top of your documentation every single day so that you don’t delay your payments, you don’t set yourself up for an audit risk or a SOAP notes compliance violation. So Billing Precision solved this huge problem by eliminating reading and writing. So when your patient comes in to the adjusting room it comes up on the dashboard, you just hit a few buttons touch screen everything’s eliminated, reading, writing, it’s all there, so now your documentation takes ten to fifteen seconds. You can bill at the table, stay compliant, and stay on track. The billing’s done right there at the table. This changed my practice; better yet, the documentation has audit, proof, notifications built-in. Did you bill this diagnosis for a number of visits, have you billed the same procedures, have you changed things, are you in compliance with different insurance companies, it’s all built-in into the system. So if you’re interested in documenting on the fly fast being compliant, keeping on track with your patients, making sure the money’s there, go ahead and check out Billing Precision, go to their website, schedule a consultation and meet with a Billing’s specialist to see if Billing Precision is right for you.
Chiropractic Billing Expert Interview – Dr. Brian Capra – Part I
Dr. Brian Capra, a graduate of Life University, has been a practicing chiropractor and office automation expert. He routinely visits chiropractic offices around the nation while receiving raving feedback from his clients. The following two-part interview with Dr. Brian provides a behind-the-scenes look at his work. Yuval: When did you become interested in chiropractic? Dr. Brian Capra: I became interested in Chiropractic just before graduating with a bachelors in biology. I have always enjoyed studying complex systems. I loved learning about how life is formed and how amazingly efficient is the human body. Most business systems are crude approximations of the amazingly efficient systems in the human body. Chiropractic maximizes that innate intelligence to do what it understands infinitely better than any human mind. To think that we can outsmart this intelligence with a pill, potion, or lotion is naive. Removing interference and maximizing the potential of life, relationship, or business is what has intrigued me most about Chiropractic. Yuval: What attracted you to office automation? Dr. Brian Capra: The human body uses automation to manage millions of processes every second. The autonomic nervous system is a good example. Imagine having to memory-manage every heart beat and breath throughout your day. That job alone would keep you so preoccupied you would forget to go get food and water for you survival. On the business side, the insurance companies continuously add things to manage to the practice. If these new things are memory-managed, the efficiency of the practice suffers. Ultimately, patient care, practice capacity, and profitability shrink. I’m concerned about where chiropractic profession is going in terms of profitability. I feel like most practice owners are indifferent and apathetic, while the ship is being steered by people who do not have our best interests at heart — out-of-control payers and incompetent billers, to name two. We are at an absolutely crucial and unprecedented point in our history where technology enables the insurance companies to underpay us, profile us, audit, and take back the little money was paid … But many billing companies do not have the processes, the technology infrastructure, or the talent required to face the challenges posed daily by the insurance companies. And the practice suffers substandard reimbursement, overworked practitioners, burnout. I can’t tell you how many times I have heard a doctor say “how can I keep up with notes, billing, etc.” The answer is simple: use your chiropractic training, use the principles that keep your own body functioning. Yuval: Why did you decide to start Billing Precision? Dr. Brian Capra : The simple reason: I needed a billing solution for my own practice, I experienced second rate service first hand for too long, and I knew of no solution that would be good enough for rapid development of my practice and that I could trust to change as the insurance industry changed. I knew that lots of people feel the same way but I could not wait anymore for somebody else to do it for me. When I graduated, I went to learn from some of the most influential doctors, including Dr. Lerner, Dr. Loman, and Dr. Nalda. In addition to outstanding clinical training I also learned from them how to approach building and managing my own practice. I learned the importance of discipline and the potential of adequate infrastructure. I also saw how frustrated they were with the lack of integrated solutions: everything about running the office seemed to require memory-management, from scheduling the patient, to tracking care plan compliance, to managing outstanding balance. I feel that most practice management solutions are built backwards or incomplete. They just keep reinventing the wheel. Another Scheduler, Custom notes, Automated check in. My feeling on this is SO WHAT??? Is the system checking you for compliance? Is it making sure everyone is billed? Are your notes really going to protect you against an audit? A good system must also manage patient education and community outreach. Part of our mission is to bring an industrial strength billing service and a practice management system, including a patient relationship management system, and help build the overall patient capacity of the practice.
Billing Payment Delays – #1 Payer’s Tactic to Increase Insurance Profits at Provider’s Expense
Q: Do insurance companies benefit from payment delays? A: Yes, they do. Payment delays are directly proportional to profits: the longer is the delay–the higher is the profit. In some cases, half of their profit margin originates on the float, such as Aetna in 2006: Premium 7% Interest on Premium 7% Total 14% Insurance companies have often accused doctors of submitting incomplete and inaccurate claims and justified the delays because of the time needed to discover fraudulent claims. But some states found plans guilty of and penalized them for intentionally delaying payments in order to profit from the “float”. For instance, as early as in 1999, United HealthCare paid Georgia $123,000, and Coventry HealthCare of Georgia (formerly Principal Health Care of Georgia) and Prudential HealthCare Plan of Georgia – nearly double that amount. A quick review of basic insurance financial performance metrics helps understanding the above dynamic. An insurance company offers clients a premium based on the expected cost of caring for them, plus a markup for administrative costs and profit. Accordingly, most analysts use three metrics to measure payers’ financial performance: Administrative Cost Ratio (ACR): The ACR is the ratio of administrative and sales expenses to the total income from premiums. Medical Loss Ratio (MLR): The MLR is the ratio of medical expenses to income from premiums. Investment Ratio (IR): The investment ratio is equal to net investment income divided by revenue from premiums and fees. For example, Aetna showed the following performance in 2007: Premiums and fees $25,500 million MLR 72% ACR 21% Combined Ratio 93% Implied Operating Margin 7% Note that other factors also influence profitability, especially legal fees. But an insurer can actually turn a profit even if the cost of administration and insurance claims exceeds the premiums it collects. It does so by investing income on the float in stocks and bonds between the time when a client pays a premium and the time when the client needs payment for his or her medical expenses. In the above example, adding up MLR and ACR, we see that without any investment, Aetna would earn 7% profit on its premiums alone. Nonetheless, Aetna does take advantage of the float, and earns about 7% net interest income on the premiums, bringing its total profit margin to around 14% (ignoring taxes and other revenue sources). References: Annual financial statements (wikinvest.com/stock/Aetna_(AET) September 24, 2008) Wayne J. Guglielmo, “Prompt-pay laws are finally getting teeth,” Medical Economics, Jan 22, 2001).
Outsourced Billing Nightmares – Why Billing Precision? – Part II
by Erez Lirov Part II – How is Billing Precision a Non-Traditional Billing Service? “See, the problem is that traditional medical billing companies are built for traditional medical doctors.” Now the older man was philosophizing. “We’re different in many ways, but one of the most important ways is in our patient visit average. Chiropractors sometimes see dozens of visits for each of their patients. The coding and documentation is almost identical every visit. It’s only if you look at an interval of time – say 12 visits – that you can see large-scale improvements in the patient’s health and treatment.” “That’s why a higher volume practice cannot survive without a powerful in-house system that helps you produce documentation and claims by making minimal changes every visit, and not recreating an entire encounter every time you adjust someone. Now, all of the sudden, you have two systems. One for managing your practice and seeing patients. and the other, for doing your billing. The two systems can’t talk to each other, so everything becomes fragmented and things get missed.” “For example, last week I had a patient walk into the office for a routine adjustment. As soon as he scanned into my front-desk kiosk, an alert came up telling my CA that some of his previous claims had begun failing because his carrier was waiting for an insurance survey from him. If the billing system hadn’t been talking directly to the front-desk check-in system, we would have missed that and could have continued treating him for free for months.” The young man look awed. His current system didn’t do that. He asked the older doctor what system he was using. “Billing Precision,” came the answer. Now the young doctor was confused. Billing Precision? Wasn’t that a billing company? It certainly sounded like a billing company. But, then, what was the old guy talking about? He had to find out. “Do you mean your software is called Billing Precision?” he inquired. “No,” responded the older man. “The software is Vericle. I outsource my follow-up and EOB entry to a company called Billing Precision, and they supply me with the software. Billing Precision is not a traditional medical billing company. Their software is web-based, so it’s really my office software. I use it just like a regular practice management system. But the best part is that Billing Precision accesses it from their location to do their follow-up and EOB entry.” “It gives me the best of both worlds. I get the efficiency and control of an in-house system, without having to continuously hire and train billing staff. My patients’ charts come up automatically at each adjusting station when they scan their key-chain tags. It takes me 10 seconds to document and bill a repeat visit at the table. The data is then automatically pushed to the insurance companies or accrued on the patient’s account if it’s a cash patient. The whole process takes seconds.” “I also get real-time access to my vital stats and all of my financial reports. Not just in the office. I took a trip to Italy last summer. Halfway through, I really wanted to see how my associate doctor was doing while I was away. I logged on to the system from an Internet Cafe, and in seconds, I was able to see reports and stats.” The young doctor was hesitant. It sounded very different from the typical in-house or outsourced setups he had read about or seen in other offices. “Does it work?” he asked. “It worked for me,” mused the older man, “but I knew what I was getting into. I had experienced both traditional approaches to billing and I knew both didn’t work for me. I wanted to focus on building my practice without having to train and manage a team of billers, but I didn’t want to give up control of my billing. This was the only solution that let me have it both ways.” The older man smiled and thought back to the first time he talked to Billing Precision and received a demo of the software. It looked nice, but his stomach was doing backflips at the thought of another outsourcing billing nightmare. Now that everything was up and running, he was glad he made the right decision. He was concerned for the young doctor. Would he appreciate the benefits of Billing Precision’s non-traditional service without first experiencing the pain of traditional approaches? He thought about that for a while. “You have to decide for yourself,” he finally said.
Outsourced Billing Nightmares – Why Billing Precision? – Part I
by Erez Lirov The two chiropractors were chatting and billing companies came up. One was an older, experienced doctor. He had tried it at low volume, high volume, cash, insurance, care plans, fee-for-service. And several times, he had tried to outsource his billing — and failed. The younger doctor, having practiced for only a couple of years, had just brought up the subject of billing, and remarked at how time-consuming billing had become for his growing practice. His CA, he estimated, was now spending almost 20 hours per week entering charges, sending claim batches, printing and submitting secondary claims, and posting EOBs. With all her other duties, there was less and less time for claim follow-up, and the younger doctor was concerned that patients were not getting the personal attention they deserved. Worse, he was working harder, but revenues seemed to decrease as claim after claim was simply not paid. He finally said it: “I’m looking at hiring a billing company. Got any ideas?” The older, wiser doctor immediately frowned. His experience with traditional billing companies were complete and utter disasters. Each time, he had had to move the billing back in-house, find and train new staff and recover from financial issues. The billing companies he tried were simply not equipped to handle his volume of claims. Besides, there were lots of other issues. “Such as?” asked the younger doctor, obviously distraught at the prospect of having to hire and train a separate billing clerk for his office. He had hoped there was a simple solution – a silver bullet that he could simply sign up for and that would let him get back to doing what he loved — treating his patients. “Control, for one,” answered the older doctor, still frowning. It was a problem that plagued almost every billing service out there. Billing companies tend to work in their own software systems. It makes them more efficient at follow-up and data entry, since their billers need to learn only one system. It also allows them to monitor and control all employees centrally. But it wreaks havoc on the provider’s office. Few billing services provide any kind of remote access to their billing system. Often, remote access is slow and cumbersome, and the office never utilizes it. It’s hard to run a practice when the vital statistics are so hard to access. Harder still to control the billing and follow-up process when the claims and audit trails are out of reach. And that was just for starters. Lack of efficiency followed lack of control. With in-house billing, the charges flowed from one screen to the next, with no paperwork in-between. Once the process and data were moved out of the office, the staff started spending hours faxing superbills to the billing company. The faxes invariably died in the middle or came back as unreadable, causing no end of frustration. But that wasn’t the worst of it. Continued in Part II…
Expert Chiropractic Billing and Coding Seminars by Dr. Kotlar of Target Coding
Not knowing how to go about proper reimbursement can be very frustrating. For many chiropractors, coding and billing turns into an insurmountable predicament. Billing Precision and Target Coding have pulled together their collective experience of more than fifteen years to help chiropractic offices get paid fairly and properly. Target Coding’s billing compliance, documentation and CPT coding products and services are designed to be educational, enlightening and financially rewarding. Question: Do You Know How To Maximize Reimbursement for EVERY SINGLE patient that walks into your office? After 10 years of experience visiting hundreds of chiropractors across the country, Target Coding found five very important items being overlooked: How to Establish and Document Medical Necessity in the SOAP Notes, Ammunition to Fight for Fair Reimbursement, Compliant Coding, Accurate Fees and Knowing How To Create Proper Treatment Plans and How To Update Those Plans In Order To Justify Continued Care. Proper utilization of these five items can provide an exceptional method to deliver high quality care, offer excellent financial return and help you sleep better at night. Target Coding sees hundreds of chiropractors losing thousands of dollars unnecessarily because of improper and out-dated billing and coding procedures. Stop giving things away for free! Dr. Marty Kotlar is the President of Target Coding. Dr. Kotlar owned and operated a successful chiropractic practice for 12 years and multi-specialty practice for 4 years. Dr. Kotlar is Certified in CPT Coding, Certified in Healthcare Compliance and a member of the American Chiropractic Association, International Chiropractors Association, American Academy of Professional Coders, American Medical Billing Association and The Council on Chiropractic Physiological Therapeutics & Rehabilitation. Dr. Kotlar has written seven chiropractic and physical medicine & rehabilitation books on coding, compliance and documentation. He is a contributing author to Chiropractic Economics, Dynamic Chiropractic and is a featured guest speaker for Foot Levelers Seminars, Parker Seminars, The Coding Institute and at many state association conventions nationwide. Dr. Kotlar has taught coding and documentation courses at Parker College of Chiropractic, Northwestern Chiropractic College and New York Chiropractic College.
Dr. Chris Zaino – 2500 Visits Per Week – Implements Billing Precision
Dr. Chris Zaino is currently the highest volume chiropractor in the country. In a practice this size, billing, collections, and compliance can become a major predicament. Billing Precision network helps Dr. Chris meet the challenges and increase the capacity of his practice. Having a single integrated technology, process, and billing service that manages your practice work-flow, is vital at any volume. Because of the growing complexity in coding rules, ever more frequent insurance audits, and busy patient lifestyles, not managing any one component leads to lost efficiency and revenue. Dr. Chris Zaino explains how his practice was “gushing blood” in all areas and how Billing Precision has helped stop the bleeding. Some important aspects of Billing Precision which allow him to do this are Real Time Billing with integrated compliance and coding warnings at the table Table-side documentation that can be updated in real time in under 10 seconds No show management and automated patient check in Web based transparency to all practice, billing and compliance statistics 24×7. Care plan management, including expected collections thresholds and reports. Full audit trail of all actions taken by practice staff and/or Billing Precision teams Integrated credit card and recurring payment tool Email marketing campaign manager. Automated appointment reminders. Many thanks to Dr. Chris Zaino, Whitney Zaino and their amazing team at Abundant Life Chiropractic. We are excited to be even a small part of a mission as big as this.
Chiropractic SOAP notes – Patient Visit Documentation in Billing Precision
Visit documentation is a major compliance requirement. A practice owner who neglects or postpones visit documentation risks failing post-payment insurance audits and severe penalties including license suspension and heavy fines per claim. What’s the best way to stay compliant, see more patients, and reduce your SOAP notes time? Use Genesis Chiropractic Software to complete your notes in 15 seconds like our clients do. Imagine having an all-in-one touch screen computer next to your adjusting table. While with the patient you touch a few buttons to copy the last note, create a new note, update the subjective, objective, CPT codes, ICD-10 codes, sign-off and send it to the insurance company. Everything can be done by touching buttons, not by writing long naratives in your SOAP notes. https://youtu.be/mfYeuqadqA8
Dr. Troy Dreiling Doubles Insurance Collections plus Improves Office Efficiency
Hello, everybody. Dr. Troy Dreiling here from Vancouver, Washington. I’m prepared to do my job today to take care of patients, get sick people well. The beautiful thing about Billing Precision is they do their job. So I don’t have to worry about my chart notes. I don’t have to worry about my appointments if they’re there or not. It’s all done for me by part of the management team of Billing Precision. So when I step into the office, it’s game time, it’s go time, and we’re taking care of patients to help them get well. We doubled our insurance collections, no joke, doubled our insurance collections, and it was amazing. I was like, “Holy mackerel! This works!” – Dr. Troy Dreiling So today what we want to talk about with Billing Precision is the followup. So once everything is entered into the system whether it’s from you or a team member, the insurance information or the patient information, date of birth is correct. If it’s an accident, the accident state, the diagnoses are in there. Once everything is entered, the chart note is entered. Once you hit bill or the really great thing I like is when you hit bill sign off, that means you’ve actually read the chart note. You approve the chart note, and you bill it and you sign it off, so you’ll never have to touch it again. And it has made our life so much easier. So now if we have to go back and get chart notes, we hit print and it’s done because we’ve already signed it off. We’ve done it that day. We’ve done it at the table. Also billing immediately has been amazing. We doubled our insurance collections, no joke, doubled our insurance collections, and it was amazing. I was like, “Holy mackerel! This works!” We had chaos literally chaos before, you know. Imagine seeing 80 new, 100 new, 200 new patients, 300 new, then to 400 new patients in a month. Imagine trying to keep all that organized with staff that’s not quite up to speed on billing and coding, and doesn’t have the software to back it up, doesn’t have a team that really knows what they’re doing. Imagine the mess that could come out of that, and you know I’ve been there. Yeah. So if you actually want to get paid, have faster claims come through, actually, get the claims paid in a timely fashion, have your billing team respond to tickets and claim it immediately, I recommend you go to billingprecision.com or now https://genesischiropracticsoftware.com. You arrive here to the website and schedule a personal review, and then they’ll take you through. Is it right for you? Is it right for your team, for your staff, for your office, for your needs? Probably one of the best things I’ve done in practice for the profitability and ease of use, and its compliance. Everything has just been streamlined and we’re working hard to make sure that all your needs are addressed. I’m glad you took the time to read this entry by Dr. Troy Dreiling on Billing Precision and making your life much easier as a chiropractor. The Billing Precision software has been re-branded as Genesis Chiropractic Software.
