The Loss that Led Me to Focus on Patient Experience in Chiropractic
In chiropractic school, we are taught to examine, identify problems, create care plans, and to adjust patients. A lucky, or more prepared, few of us may have taken outside seminars to learn about strategies to bring more patients into our office, billing tactics to increase revenue, or practice management techniques. Yet, for all that we learn, the hours and years we put in to become Doctors of Chiropractic, we are never taught the most important part of having a truly successful business. We’re never taught to focus on the patient experience. Just out of chiropractic school, I was no different. I was running what I believed was a successful practice. I was helping a lot of patients and making a lot of money.. At the same time, I was trying to wear too many hats – business owner, staff manager, doctor. Things were falling through the cracks without me knowing until it was too late. I will never forget the day one of my patients came in and told me he was thinking of killing himself. No doctor is every really prepared to hear something like this, much less, a young doctor, still learning. My patient’s name was Chris and he had come to see me for low back pain, something chiropractors see every day. He had received his report of findings, had proceeded with care, and was getting great results and relief from the pain. At his words, I felt shock. I asked what had happened. The story he told me was incredible. After coming to the class that I held for new patients, he had decided to turn his life around. Hearing the chiropractic message and learning how his health affected every aspect of his life as well as his family’s life, he had made a life-changing decision. He quit drinking. He quit drugs. He was going to get healthy for his wife and children and he was going to do it cold-turkey. But now, he felt like taking his own life. After listening to Chris’ story, I was amazed that he had been affected so deeply by the chiropractic message and thankful that he had truly understood it to the point that he was determined to change his health to improve the future for himself and his family. And, I’ll admit, I was proud that my class, my words, had been good enough to change a man’s life. Yet, how could someone who had understood the message on such a deep level now think of killing himself? Chris and I spoke about what he was feeling and how, after the years of punishment his body had been through, it was natural to have difficulty trying to achieve homeostasis again. I explained how the chemicals in his system had been affecting his whole life, including his thoughts and how things were now trying to balance out as his body fought to move toward health. He understood. He got it, just like he did the chiropractic message, and we continued care. Then came the day when I realized that Chris had not been in for a visit in a while. Chris had understood the chiropractic message so completely that he should have been a patient for life. I pulled his chart to find out what had happened. That is when it became clear that once again, something important had fallen through the cracks. Chris had missed appointments, yet we had not followed up with him. His care plan had expired and his billing was not in order. These things that are so vital to patient retention had been missed. I immediately called Chris to find out how he was and to set up an appointment for a follow-up. That is when I found out that Chris was dead. He had taken his own life, just like he had talked to me about. That is when I knew with complete certainty that the systems we had in place were not enough. We tried to call patients who missed appointments, follow-up on care plans, pre-arrange billing with patients, and so many other tasks every single day. Yet, sometimes, my staff became overwhelmed or simply forgot. Other times, they would give up calling a patient who had not responded. And, so many of our systems relied on memory, leaving my staff and I to juggle all of the responsibilities, hoping no one dropped the ball. We only knew to follow-up with patients when I or one of my staff realized someone had not been in to see us for a while. We only knew to check on insurance claims when someone remembered we had not been paid. I knew that other industries used different technologies and software to manage the customer experience. Yet, the Chiropractic profession had no software to manage the Chiropractic patient experience effectively. There were many chiropractic software companies and practice management softwares available. However, not a single one broke down the patient experience into manageable tasks. And, not one offered one simple daily report to let the doctor know whether the necessary tasks had been performed. Instead, they all forced the doctor to wade through piles of reports, to check each individual aspect of the practice, an ineffective and time-consuming chore, at best. To find a solution, I had to go outside of the chiropractic profession, to find out what big businesses use to manage the customer experience. Since that time, I have dedicated myself to finding a better technology to break down and manage every aspect of the patient experience and making it available to chiropractors. And, so that I would never forget the man who first opened my eyes to the necessity of managing the Chiropractic patient experience, I named my son Christian in his honor.
Note-Worthy
Staff and Office personnel have to work together to make transition easier. Can Ben’s self-improvement plans cause trouble for his staff? Pam looked up as Ben bustled into the office. “You’re energetic today!” “I’m feeling inspired,” smiled Ben. “We’ve made some smart changes in the practice, and we have more coming up, so I think I’m ready to tackle changes in documentation.” “I’m impressed,” said Pam, “but I hope you’re not going to make too many changes. I feel like I’ve had just about all the change I can stand.” Ben was surprised. “I don’t think this is going to be a problem, Pam. We know that the new ICD-10 codes that go into effect in October are going to require more detailed documentation. I’m just going to get a handle on the new requirements.” “I understand that,” Pam sniffed, “but I feel like I have just gotten to where I can completely understand your notes and pick out the important keywords for coding. If I have to get used to a whole new system… well, if it’s not essential, I’d rather we didn’t make any more changes, that’s all.” Ben took a seat. “You know there are a lot more codes in the ICD-10 system than with ICD-9 codes–” “Don’t I know it! Almost 70,000 total.” “And one of the reasons there are so many more is that the codes have to be a lot more specific. If you don’t have very specific clinical documentation, it’ll be easy to get the codes wrong.” Pam said nothing. “If we have too many coding errors, or inaccurate documentation, it becomes a compliance issue.” Pam frowned. “I see what you’re saying. We could face non-payment issues, or even be audited. That would be a lot more trouble than getting used to a new style in documentation.” “Exactly.” Ben stood and stretched. “Tell you what, I’ll work on my handwriting and punctuation at the same time.” Pam laughed — or, thought Ben, maybe it was a snort. Either way, he was ready to get on top of the new demands for documentation. It felt good to have a clear goal. Can Ben’s self-improvement plans cause trouble for his staff? See our ICD-10 page for more information and more blogs on the diagnosis codes.
ICD-10 | 100x More Complicated | Q&A
As your practice is preparing for the impending ICD-10 changes, you might have many questions concerning chiropractic billing procedures and software requirements. To help you get the answers you need, we have compiled all questions that were asked during our recent webinar ‘ICD-10 | 100 Times More Complicated,’ along with the presenter’s responses. Feel free to add any new questions in the comment section below. Q: I have a question about the top 50 ICD-9 codes we use, and doing the crosswalk to ICD-10. Where is the best resource for being able to do that? A: CMS GEMS would be one website that you can use; that’s CMS’s GEMS System, which is the General Equivalent System that they use — the General Equivalent Mapping System that they use to translate ICD-9 to ICD-10. Another good site for you is AAPC.com. Click on their ICD-10 link and they have a feature where you type in our ICD-9 and it returns the equivalent ICD-10 code. GEMS prompts you to choose the lateralities and origins, whereas AAPC is more one-to-one, but GEMS is really what most systems are basing their crosswalk from, and GEMS is built and maintained by CMS, the CDC, and AMA. Q: I’ve done all my conversions from ICD-9 to ICD-10 and I’ve done the left and right conversions. We’ve changed some of our chiropractic documentation so it’s more specific about mechanism of injury — the when, where, the why and the how. What else is there really to do? A: You really want to make sure that how the practice is supposed to document the guidelines for chiropractic documentation are clearly outlined in your policies and procedures manual. And that means adding in specificity and laterality. The manual should also have references as to where you seek the information; your reference point would be to CMS. Q: If I want to take a coding course to get certified, do I need to be certified on ICD-9 and ICD-10? A: Right now, you have to certify for both, but after October 1, you only have to certify for ICD-10. Q: Are you able to come out and help us train our staff? A: We can give you the tools that you need in order to train your practice. For chiropractic documentation, have them listen to our webinar in March, but they can also take external classes — specifically from the AAPC, because their classes on physician documentation are extraordinary. In terms of crosswalking, we will work with you. View our ICD-10 page that has a collection of information about ICD-10.
Something for the Pain
By Kathleen Casbarro Simplifying coding issues can relieve practice tension How can software make a difference in the ICD-10 changeover? “Doctor!” The box on Ben’s desk squawked. Pam always sounded professional, but Ben knew her well enough to hear the tension in her voice. Ben hesitated for just a moment over the stack of paperwork he’d been plowing through, but decided he should respond to Pam’s obvious stress. As he neared the front desk, he heard raised voices. “You’ve already been to the doctor!” a young woman shouted at an older man whose face was set in pain… or perhaps in stubbornness. “He’s already been to the doctor!” she repeated in Pam’s direction. “Maybe I can help,” Ben offered. “I was in a car accident–” the older man began. “My dad has been to the doctor and to the hospital,” the young woman said firmly, “and they told him it was back pain and it would get better in time. They gave him pain medication to take and he won’t take it. Now he’s insisting on coming here, and I don’t think his insurance will pay. I just want to take him home.” Family altercations weren’t as common in Ben’s chiropractic clinic as they were in hospitals, but he recognized the situation. The daughter was worried that her dad wouldn’t be able to pay, the old man was still in pain, and their worries were showing up as anger. “Let me take these good people back and have a little chat,” he said calmly to Pam. Getting the shouting out of his waiting room was the first priority. He’d get them calmed down, explain the situation, and then bring them back to Pam for intake, and the paperwork — well, it looked like he’d be working late again. It was hours later when Ben had a chance to discuss the event with Pam. “I’ve been thinking about the man who’d had a car accident,” she said. “We’re always careful to avoid using the ICD-9 code 724.5 for back pain because it tends not to get paid. We make sure to use the most specific code we can so the patient’s insurance will be able to pay.” Ben nodded. “I realized that I don’t have that knowledge about the new ICD-10 codes,” Pam continued. “We’re always focused on the people we treat, but the paperwork is what allows us to keep the doors open and take care of those people. I’m worrying that the new insurance reporting codes will get in the way.” “I think we may have a solution,” Ben said. “I’ve been talking with the people at Genesis — the new practice management software. They had a really sensible approach to it. Three things: assessment, documentation, and implementation. That’s better than focusing on the 70,000 new codes, right?” “It might be,” Pam said uncertainly, “If I knew just what that meant.” Ben laughed. “Fair enough,” he said. “What I get is that the software will cluster the codes into groups so we can drill down to the right one, instead of trying to memorize everything. We’ll be able to see the relevant ICD-9 and ICD-10 codes on the billing screen, along with which payers are using each set, and we’ll have a crosswalk that will let us learn and train before the deadline.” “All on the billing screen?” Pam sounded excited. “That sounds workable.” “Workable,” Ben repeated. “That’s it exactly. It’s like when we get a patient having a meltdown in the front office — we may feel a little stress, but we have workable systems in place to handle it, and it turns out well.” How can software make a difference in the ICD-10 changeover?
Trouble Brewing
By Kathleen Casbarro ICD-10 spells a major adjustment What will Ben’s chiropractic office face with the changes in insurance reporting? Carmen sat on the sofa next to her husband and pulled her feet up under her. “Ben,” she said, taking his hands, “I want to know what’s going on. You picked at my homemade manicotti, you provided no challenge at Wii Bowling, and you didn’t even do the voices for Jonathan’s bedtime story.” Ben smiled ruefully. “You’re right. I’ve got something on my mind,” he admitted. “Remember I told you about the new codes for insurance reporting?”“ICD-10 codes?” Carmen thought back to the previous week, when Ben had told her some government changes would affect his chiropractic clinic. “I remember you didn’t seem to know just how they would affect you.” “Ignorance might have been bliss! I just found out that the effects are going to be significant. The AMA estimates that complying with the changes will cost a practice like mine in the neighborhood of $83,000.” “That’s not a neighborhood we’d feel comfortable in,” Carmen protested. “Things have been rough with the practice already–” “I know,” Ben agreed. “It’s already so stressful dealing with uneven cash flow, I don’t know where I’m supposed to come up with the funds to cover this kind of investment, but it’s not optional. We have to complete these changes by October 1, 2014, or we won’t get paid at all.” Carmen frowned. “Are you sure it has to cost that much? I’m pretty good at pinching pennies.” “I know you are, but this isn’t like negotiating with your suppliers at the pizzeria. I can’t negotiate with the government, and the the new ICD book has 1,107 pages of non-negotiable changes. We’ll need software upgrades, changes in billing practices, training for all the staff… that’s all going to cost.”Carmen and Ben both stared glumly ahead. “Even if you figured out some way to do everything yourself, you’ll have some opportunity costs,” Carmen said. “You’d have to cut down on the patients you see or the other work your team is doing. I’m at your place a lot and I never see people sitting around doing nothing. You’re already running efficiently, so extra time is the same as extra money.” “Exactly. Plus, any change increases the risk that we’ll be audited or that the insurance companies won’t pay claims. We don’t yet know what will be considered medically necessary under the new system, but we’ve heard that there’ll be opportunities for cherry picking. That means that our choice of words in the notes we write up could affect whether or not we get paid.” Carmen shook her head. “You’re already dealing with non-payment of claims, aren’t you?” Ben nodded. “I just don’t see how we’re going to get through this.” “Things are good at the restaurant. And, as I said, I’m good at pinching pennies.” Ben forced a smile. He was lucky to have Carmen, and he knew she’d do what she could, but the stress was getting to him. This was definitely not what he had dreamed of when he had set up his practice. What will Ben’s chiropractic office face with the changes in insurance reporting? Visit our ICD-10 page to see everything we’ve published about ICD-10 diagnosis codes.
Code of Conduct
By Kathleen Casbarro New coding regulations: A major adjustment for chiropractors What will the new ICD-10 codes mean for Ben’s practice? “I’m a lucky man,” said Ben. His wife Carmen had brought an envelope full of family photos to his chiropractic office. The two of them had taken their son Jonathan for a photo shoot in a community park, but the pictures looked as though they had been taken in a pristine forest. “That photographer has skills.” “True, but she also had some great material to work with,” Carmen teased him. “We are a photogenic family,” Ben admitted with a wink. “I want the one with Jonathan on my shoulder for the office. We look so happy!” “That’s because we are happy,” Carmen pointed out. “But you didn’t actually look very happy when I came in. I thought things were going well with the practice.” “They are,” Ben assured her. “But now that I’m getting control over things in the practice and feeling happier at work, I’ve had time to notice an upcoming change in reporting requirements that feels a lot like… hmm… maybe a giant wave coming at me.” Carmen took Ben’s hand. “A trouble shared is a trouble halved. Tell me about it.” “Well, you know we use codes when we file insurance claims. By October 1, 2014, we have to change them all.” “Sounds like some extra work for your staff, but not exactly like a huge wave about to crash over your head.” “It’s kind of hard to know… We don’t know right now which codes for chiropractic will be identified as ‘medically necessary,’ for example, and we know that it won’t just be a question of renaming. We can’t just find all the 724.3 codes and change them to the single new code that will cover it. There are a lot more ICD-10 codes than ICD-9 codes, and there won’t be a one-to-one correspondence. We might need to make some judgement calls about what’s the best new code for a given procedure. If we make the wrong choice, we might not get reimbursed. And that’s just one thing. I don’t really know how many more things there are like that.” “Okay, I can see that you’ll need to be involved in the change. But is it mostly just about learning the new codes?” “I know that the new ICD-10 codes have seven digits instead of five, like the current ICD-9 codes. That could mean all new forms.” Ben frowned. “I guess I just don’t know what’s involved, to tell you the truth. But the government notices have said that it’ll affect scheduling as well as billing, and the way doctors make notes, and — well, pretty much everything we do.” Carmen started putting the photos back into the envelope, leaving out the one Ben had chosen for his office. “It sounds like you don’t have enough information right now,” she said. “I’m not saying don’t worry — it does sound like something to worry about. But it doesn’t sound as though you know the size and shape of the problem yet. It’s like at the pizzeria–” Ben laughed. “Everything reminds you of pizza!” “Okay, that might be true. But when we know we have big parties coming in, that’s very different from just feeling like it’s going to be a busy night. When it comes to this reporting change, you basically don’t know how much pepperoni you need to have on hand.” “Pepperoni sounds good. Let’s grab some lunch and I’ll worry about this stuff later.” “Just don’t leave it too late — October will be here before you know it.” What will the new ICD-10 codes mean for Ben’s practice?
The Roller Coaster of Collections | Where is My Money III
By Charles Pritchard The Ups and Downs of Cash flow Give a Chiropractic Clinic Owner Anxiety Which areas of Ben’s clinic are most difficult to track? The roller coaster of collections drove Ben up the wall. He never knew how many of his claims would get paid each month. Some months the money was pouring in like he had won the lottery, and then the payments would suddenly come to a screeching halt. The worst part was the uncertainty. It made him feel sick to his stomach. He felt like he could not even provide for his family’s basic needs, let alone treat them to the long-planned trip to Disney World. It almost seemed ironic that Ben’s wild ride of unpredictable cash flow prevented his wife, Carmen, and his son, Jonathan, from enjoying the rides at the theme park. Not surprisingly, Ben’s revenue issue was slowly killing his joy of practicing chiropractic. Not to mention how his bad mood put everyone at home on edge, too. “I just don’t get it,” Ben said as he helped himself to leftover lasagne. “Back in January, we were averaging around 325 patient visits per month. Over the summer, my clinic literally exploded with 487 patient visits. The last few months we have been averaging around 436, but strangely enough, our collections don’t match that one bit. Although this month’s number is close to what we got in January, I have no way of predicting what we might receive next month. It could be thousands of dollars less…. or we could hit the proverbial jackpot.” “I wish I could use my rolling pin to turn your collections into smooth pizza dough,” Carmen said, jokingly, while placing pepperoni and cheese on her homemade pizza crust. “Your billing issues remind me of a ball of dough. You can’t make pizza with it unless you flatten it out. And at my pizzeria, for example, I have to offer the kind of pizzas my customers like. Otherwise, no one will come back for more.” Ben chuckled and said, “You compare everything to pizza, honey. At least your customers pay you right away. Imagine waiting for two, three months to receive payment for a pizza!” “Hmmm,” Carmen said, while putting the pizza in the oven. “My suppliers might extend me a little credit, but I’m pretty sure I would have to shut down if I was stretched that thin.” “Well, that’s exactly what I have to deal with,” Ben said. “The insurance companies take their sweet time to pay up and I’m left standing in the rain without an umbrella, so to speak.” After dinner, Carmen gave Jonathan a bath and put him to bed. Ben read him a story to help him fall asleep. Then they sat down in the living room to continue their conversation from earlier that night. “You ever come up with a menu?” Carmen asked, as Ben handed her a glass of wine. “Isn’t that your job?” Ben said, sarcastically. “Do you want me to partner up with you in the pizzeria, or are you just out of ideas?” Carmen punched him in the arm, playfully. “Your menu of services, genius!” “What about it?” “OK, let’s look at it this way… how much do you make each time you see a patient?” “Are we talking about cold, hard cash in my pocket? About 30 bucks per visit. Why?” “When I created my bill of fare, I wasn’t just thinking about the kind of pizzas I like to make,” Carmen said. “I had to consider the cost of ingredients, time for preparing the dough, and the likelihood of people ordering it regularly.” “In other words, I should stick to my most profitable options, right?” “Something like that,” Carmen said. “Based on what I know, your services vary in time and equipment needed. Some of them may not even be in high demand. If you take an honest look at your practice, you can probably find some services that are not worth those 30 dollars– especially when it takes forever to get paid.” “So you think I should cater my clinic that way?” “There you go,” Carmen said with a wink. “On that note, I’m dying for a slice of pecan pie. Can I get you one, too?” Which areas of Ben’s clinic are most difficult to track?
Tracking the Variables | Show Me the Money II
By Michelle Corrigan — Profitability Coach Chiropractic Clinic Owner Must Address Billing and Payment Delays What variables affect how quickly Ben gets paid? Being in the dark about his chiropractic claims payments was seriously bothering Ben. He never knew when he was going to get paid. His chiropractic clinic seemed to be at the mercy of the payers, regardless of how many patients he helped each week. One thing was for sure — he needed to solve his clinic’s cash flow problem rather sooner than later. “Why don’t you talk to a practice management coach?” asked Carmen, Ben’s wife. “A change in your daily workflow might help you with your chiropractic billing issues.”Ben really needed some professional advice, but wasn’t sure whose expertise he could trust. He scheduled a meeting at his clinic after hours with the profitability coach, Steve, who had helped his friend, Tom, improve his practice cash flow. “Is there a way to figure out what I am doing wrong?” Ben asked after he had given Steve a brief overview of his dilemma. “I am not even sure anymore whether or not my current practice workflow is ineffective or harmful. My payments fluctuate although my practice stays busy.” “Just remember, you’re trained in chiropractic, not business management,” Steve said. “So, don’t beat yourself up over this. The truth is, that you depend on insurance companies for a major part of your revenue and they know how to make it complicated. Without a powerful tool, like chiropractic software, it is almost impossible to figure out what is going on.” Ben took a moment to digest Steve’s comment and asked, “So, it’s not entirely my fault then, right? “That’s right,” Steve responded while flashing a supportive smile. “It’s usually a combination of factors. And trust me, you are not the only chiropractor struggling with his billing performance.” “That’s a relief,” Ben said. “What should I do?” Steve took a deep breath and said, “Now, don’t get overwhelmed. But the best way to get to the bottom of this is by tracking and analyzing multiple variables of your billing performance. Time, for example, is definitely an issue. Since your chances of getting paid for a claim decrease by one percent with each passing day, you need to find out how each variable affects your claims process.” “That does sound complicated,” Ben said flatly. “How am I supposed to track all that and help my patients?” “Let’s look at it from a chiropractic perspective,” Steve offered. “Take a man who hurts his back, for example. What can happen if he doesn’t seek treatment immediately?” Ben pondered the scenario for a moment. “Without knowing the nature of his injury, I would assume that it can affect his gait. Once he starts overcompensating it will naturally lead to more problems than he started out with.” “Now apply the same line of thinking to your chiropractic billing issues,” Steve said, excitedly. “This kind of domino effect can cause a new all-time low for your billing performance month after month when an error is not corrected since it ends up affecting multiple claims.” “Oh, now I get it,” Ben said. “So, once I discover which aspects of my workflow cause payment delays or denials, I can make the necessary changes to improve my chiropractic billing performance.” “Precisely,” Steve said. “And then you can build your dream practice.” What variables can affect how quickly Ben gets paid?
Show Me the Money!
By Reuven Lirov Chiropractic Practice Owner Struggles with Cash Flow What can Ben do to correct his cash flow problems?“You ready for lunch?” Ben looked up from the pile of bills on his office desk to see his wife, Carmen, standing in the doorway. “Only if you’re buying,” he said. “That bad, huh?” Carmen replied, closing the door behind her. “I’m a little surprised. On my way in, Pam told me that you’re booked solid.” “Patients aren’t the problem,” Ben said. “Revenue is. Seems like no matter how many adjustments I do, I’m never sure if I’m going to meet expenses that month.” “I thought you had someone who took care of billing,” Carmen said, perching on the edge of the desk. “Isn’t that their job?” Ben laughed, weakly. “That’s how I looked at it. And if it were just a matter of a few patients with payment issues, I’m sure my staff could handle it.” “Then what’s the problem?” “It’s a combination of collecting from insurance companies and then figuring out what the patient owes. Seems like we have to chase after the insurance companies for every dollar we’re due.” “I don’t get it,” Carmen said. “Your staff files the claims. Doesn’t that mean you automatically get paid?” “I thought so,” Ben said. “But I guess that’s why I’m a chiropractor and not an accountant. Come on, I need to get out of here.” Ben wasn’t really in the mood for lunch, but he needed to clear his head. He and Carmen walked to their usual lunch spot and found themselves a booth. As they slid in, Ben’s phone chimed. “What is it?” Carmen asked. “It’s a tweet from Richard,” Ben said, reading the display. “He says, ‘Life is a series of adjustments.’ Hashtag ‘chiropractics.’” “You spoken to him recently? His practice seems to be pretty successful. Maybe he can give you some advice.” “That’s not a bad idea,” Ben said, sliding back out of the booth. “I’m going to give him a call. If the waitress comes, order me a turkey reuben.” It took a couple of days before Ben and Richard could carve out some time. Finally, they got together on Saturday, when Richard was cleaning out his garage. “It drives me crazy,” Ben said. “Cash flow is so inconsistent. Feast or famine, and I never know which. Sometimes the drought lasts for weeks, no matter how many patients I see.” “You’ve got to get down to brass tacks,” Richard said, hanging his hedge trimmer on the pegboard. “Figure out what your best sellers are.” “My what?” “Your moneymakers. Start by checking which CPT codes, POS items sold, referring physicians and employee productivity generates the highest revenue in the shortest time possible.” “I’m guessing my billing department could help me with that,” Ben said as he coiled up an extension cord. “There are no guarantees,” Richard said, “but that’s what works for me. For instance, you want to avoid using the worst CPT code for the best payer. And trust me; once you’ve gotten your system straightened out, you’ll be better equipped to make vital practice decisions.” Should Ben follow Richard’s advice? What can Ben do to correct his cash flow problems?
Chiropractic Billing Compliance | How to audit-proof your practice
An Audit Proof Practice is what Dr. Ben needs. That was definitely NOT money well spent. Ben felt red-hot anger building up inside him like boiling lava in a volcano right before its eruption. He still had a hard time accepting that Blue Insurance fined him $30,000 for failing the audit and made him refund the payments he had received for all failed claims. He promised himself that he would do whatever it takes to reduce his audit risk from now on. “Given the volume of claims, an automated monitoring system may be the only practical way to detect suspicious conduct or potential flagging for audit,” Ben read out loud from the book Practice Profitability. That made perfect sense to him. He had been racking his brain for ways to implement his friend Tom’s advice of tracking the notorious red flags for insurance companies: unsigned notes, unbilled visits, missed re-exams, and denied claims. An automated monitoring system sounded like a life saver to him. “Does your chiropractic software help you stay compliant?” Ben asked Tom. Tom was a successful chiropractor who had been through several audits, but always seemed to emerge unscathed. “Absolutely,” Tom said. “There are just not enough hours in the day to help my patients and track all potential compliance issues manually.” “But how exactly does it help you?” Ben asked. “I wonder what kind of system would be the right choice for my clinic since I am not exactly a tech whiz.” “Don’t worry,” Tom said. “You just need to find a system with several useful features that are built around your workflow. The idea is to make your life easier, not more complicated.” Ben thought about that for a minute. He had been looking for ways to simplify managing his practice. But the most pressing issue for him right now was staying compliant. “Could it cut down my error rate?” Ben said. “Definitely. Just look for chiropractic software that has automated alerts and built-in claims scrubbing,” Tom said. “Those features will help you fix any mistakes before you submit any claims to the insurance companies.” “So you are saying that your chiropractic software alerts you of compliance issues and helps you manage your entire practice workflow,” Ben said in stunned disbelief. “It sure does,” Tom said “I use the software to assign tasks to my staff with tickets and complete my notes while I’m still with my patients. This makes my life so much easier and saves me so much time. My favorite thing is the Radar on the homepage, which gives me a quick overview of my practice stats so I know what is going on in all areas at all times.” How would you advise Ben? Is there a way to audit-proof his chiropractic clinic?
