Chiropractic Billing Compliance | Can you reduce your audit risk?
Ben was forced to put all of his plans on hold. After paying the $30,000-fine to Blue Insurance they would have to cancel their Euro trip for another couple of years. He hated disappointing his wife, Carmen, and their baby boy, Jonathan. It seemed like failing that audit last month would have a ripple effect on his financial situation for a long time. He was still trying to figure out how to return the money he had already received for his failed claims without bringing his practice cash flow to a screeching halt. Although he was concerned about the future of his chiropractic clinic, he held on to the hope that he could emerge from this audit risk nightmare with a better way to stay compliant. He just had to come up with a plan for making his chiropractic billing and documentation audit-proof. “Have you been worried about compliance since you got audited last year?” Ben asked his friend,Tom, whose chiropractic clinic was thriving after last year’s brush with disaster. “I am trying to figure out how I can improve my compliance so that I can avoid another failed audit.” Tom smiled and said:”Yes, of course, but I have learned that we really can’t avoid an audit and the audit risk. So I decided to cut down my error rate to reduce my audit risk. Chiropractors can absolutely not afford to have any unsigned notes, unbilled visits, missed re-exams, or denied claims as number one rule. So you have to find a way to track these meticulously.” “Ok, but it seems impossible to even remember all the different insurance protocols for each patient,” countered Ben. “It is so confusing to keep track of all the requirements, and just when you think you get it, they change everything again.” “That’s true,” Tom admitted. “And many of those so-called compliance experts give advice that is really difficult to implement, not to mention that they all tell you something different.” “So how can we get it right then?” Ben asked. “I can’t gamble with the future of my clinic and need a bulletproof process to stay compliant.” How do you manage your: Unsigned notes Unbilled visits Missed re-exams Claim errors
Can you afford to fail an insurance audit?
It seemed like things might get worse for Ben’s chiropractic clinic before they got better. Sure enough, he received another letter from Blue Insurance. This time they wanted him to pay back the money he had already received for the claims that failed the audit last month in addition to paying a hefty penalty of $30,000. “Why don’t you contact a chiropractic compliance expert,” Carmen suggested. “He might be able to help you figure out this audit fiasco without losing your clinic.” Ben was trying to appear calm as he responded: “I guess it’s worth a shot.” He did not want his wife, Carmen, to know how worried he really was. The truth was, he doubted that anyone could help him make it through this audit-nightmare in one piece. But at the same time he did not want to give up on his dream of having a chiropractic clinic so he could save as many people’s lives as possible. When he met the compliance expert, David, later that week, he did his best to stay composed as David prepared him for the worst case scenario. “You should be aware that Blue Insurance might blacklist you,” David warned. “And once they do that, all the other insurance companies will come after you like a pack of wolves. Then you will have to deal with even more audits and disruptions of your chiropractic billing cycle.” “Something tells me that’s not even the worst outcome,” said Ben. “Unfortunately, it’s not,” David admitted. “You could also lose your license, not to mention the legal fees you would incur if Blue Insurance takes you to court. In case you are convicted for fraud, you could also serve time.” Ben swallowed hard. He started thinking about his patients. Would his patients stay loyal throughout these fraud accusations? It’s not like they would understand how difficult the insurance companies made it for chiropractors to stay compliant with ever-changing regulations for chiropractic billing and documentation. His professional reputation was clearly taking a big hit. Would anyone still think of him as a stand-up guy who was not interested in cutting corners? “Is there any way to minimize the damage from this failed audit so that I don’t lose my entire patient base?” Ben asked. “I can’t blame people for not giving me any referrals until this is over. But I can’t afford to lose my current patients, too.” David sighed. He felt Ben’s pain and wanted to reassure him. But he had to avoid giving him false hope. Ben had to be ready for an uphill battle, no matter how ugly it might get, if he wanted to prevail. Have you ever been audited or do you know anybody who was audited? What was the worst part about it?
Chiropractic Billing Compliance | Can you avoid getting audited?
The audit of his chiropractic documentation a few weeks ago did not go well for Ben. Now he had to pay $30,000 as penalty, according to the letter he just received from Blue Insurance. Ben felt angry as he crumpled the letter in his hand and said: “Where am I going get this kind of money?” His wife, Carmen, stopped feeding their 8-month old baby boy, Jonathan, for a moment to look at Ben. The dark circles under his eyes were a testament to his many sleepless nights this month. She was concerned, but did not want to add fuel to the fire. He was already stressed out enough. This fine came at the worst time possible since she was still staying home with the baby and wasn’t able to alleviate her family’s financial burden with an additional income. In spite of her MBA she had no helpful business advice to offer either. She felt helpless and powerless as she watched her husband struggle with this new burden. It all started three weeks ago when Ben received a notice from Blue Insurance to review the notes for chiropractic claims that he was paid in 2012. Apparently some of his patients had received inaccurate information due to sloppy accounting and complained, which raised red flags with the insurance company. Next thing he knew, the auditor was knocking on his clinic’s door to inspect the notes for those claims in question. Carmen suddenly had an idea:”Why don’t we meet your friend, Tom, who had to go through an audit last year? Maybe he can give you some pointers on how to deal with this situation.” Tom owned a chiropractic clinic in the same neighborhood and was happy to meet them for lunch. “I’m sorry you have to go through this, too, Ben,” he said. “Being audited and fined is no walk in the park, but don’t beat yourself up over it. I have learned that the insurance companies come after all chiros because they simply do not want to pay us. In fact, the fewer providers they have to deal with, the better. So they just try to blacklist as many of us as possible.” Ben was taken by surprise:”Seriously? Are you saying that anyone can get audited?” “That’s exactly what I’m saying,” Tom responded. “Audit penalties are pure revenue for the insurance companies. And just like every other business, they want to increase their profits. I read in this recent article by Palmetto GBA that chiropractors have a high error rate of 84.41 percent. That makes it easy for the insurance companies to come after us.” “So audits are pretty much a fact of life,” Carmen said flatly. “I just wonder if there is any way Ben can reduce his audit risk so that we still have money for diapers and the electric bill after the next audit,” she added half-jokingly. What do you think? Can audits be avoided, or is there at least a way to reduce your error rate as chiropractor?
Dr. Sandy Haas wins Best Patient Story Contest
Congratulations to Dr. Sandy Haas for winning our Genesis Best Patient Story Contest in October. Check out her inspiring story below. “There’s been so many impactful stories. One story is a story of a young lady that happens to be in the office right now. Her name is Jenny and she is a remarkable young lady. When I first met her and she came to our office, a patient actually brought her in and said I’d like to take care of this patient and I’d like to help her get care and she wanted to help financially support this particular patient get care. She was on so many meds that she could hardly look me in the eyes. She could hardly communicate with me. She looked broken. She looked sad. She looked like nothing about her life was enjoyable. To know Jenny and what she’s done today, she did the work and we just provided her the pathway to get there. But, she’s done probably over forty I.V. nutrients to detox her off of over a dozen plus medications that was just creating such toxicity in her which was shaping the way she thought, the way she felt and shaping her emotions. Now she’s out there and she just laughs, she assists other patients, she’s almost kinda like a volunteer. Even though she’s still coming in for treatments. It’s a remarkable story. She’s lost 125 pounds. Her spine does not look remotely like it did on the very first day. Her story is huge! All I have to ever think of when the day gets, can get stressful and there’s a lot happening in one day, all I ever have to do is just remember a Jenny story.”
Chiropractic EHR Software | Symmetry Spine and Wellness Center Dream Practice of the Month
Dr. Cynthia Boyd knows how to build a chiropractic dream practice: it takes hard work, a concerted team effort, and the expertise of Genesis chiropractic software and billing staff. “I have my dream practice,” says Dr. Boyd. “There are not many areas that need improvement.” The key to success for Dr.Boyd is balancing all aspects of practice management using Genesis cloud-based chiropractic software: “The [Genesis] system is amazing. I was 3,000 miles away for a month and I knew exactly what was going on.” Dr. Boyd doesn’t have time to micromanage her staff. With Genesis, she can easily track everyone’s individual performance anytime from anywhere. Dr. Boyd can also keep an eye on vital Key Performance Indicators, such as chiropractic billing, with the Genesis Radar. Best of all, Dr. Boyd does not have to change the way she runs her practice to optimize her workflow, complete her patient SOAP notes, and control compliance. As Dr. Boyd keeps growing her practice, she uses Genesis workflow engine to help manage teamwork among her staff and Genesis support team. The staff at Symmetry Spine and Wellness Center keeps the AR past 120 days low at 8 percent by consistently clearing the claims workbench while the weekly phone communications with her Practice Success Coach Heather Miller ensure her practice gets paid in full and on time. Coach Heather Miller: “Dr. Boyd is passionate about what she does and her business. She has found a balance with her practice and all of the other projects that she works on. Dr. Boyd trusts her employees to do their jobs without having to micromanage them. She has a great staff that works well together to get the job done and continue to grow the practice. In the end it all comes down to teamwork.”
Chiropractic Compliance | Check exclusions list to avoid denied claims
Dr. John Davila explains the importance of checking the LEIE or list of exclusions of individuals or/and entities for all staff members at your clinic to avoid chiropractic billing issues such as compliance risks and denied claims. Dr. John Davila talks about the significance of the List of Exclusions of Individuals and Entities for your chiropractic clinic in the video below: Cystic Fibrosis Services: $308,000.00. Radius Hospital Massachusetts: $334,000. Susony Hospital Puerto Rico: $382,000. Saint Francis Hospital Connecticut: $80,000. In a 6-week period of August 2013 the Office of Inspector General, recouped $1.2 million from these hospitals for one simple reason: someone on their staff was excluded from serving Medicare patients. My name is Dr. John Davila of Custom ChiroSolutions and today I want to talk to you about something very, very important that you should be looking at as far as compliance goes in your office. It’s the LEIE or list of exclusions of individuals or/and entities. Now, the reason this story is important is for a very simple reason, a couple years ago I had a client and he had a problem getting his Dr. his associate Dr. Registered with all these different insurance companies, and he couldn’t get the insurance companies to pay even out-of-network benefits and then he tried to get Medicare to register this Dr. and that didn’t work either. Next thing you know, he’s calling me going “Hey listen, I have all this money outstanding. I have these different issues.” We went in and looked and guess what– the first thing you do when you get a compliance manual is, check your employees. He didn’t know that. He didn’t know how. And that’s what we did for him. We came in and checked all of his employees and low and behold, the Doc he was trying to get registered was excluded about two years earlier from the Medicare program. Now the Dr. was cleared of all charges, he got his license back to practice, but Medicare didn’t let him back in. Major, major problem. So, what I want to do today was just bring this up because I think it’s really important for you understand that you need to check your employees. Now this Dr. didn’t know how to do it, we did. What we had to do was get him set up with a compliance manual and get this process going for him and that way he checked his employees. So if you’d like to know more about how to get a compliance manual in your office, especially to go ahead and check your employees on a regular basis, especially if they’ve been excluded from Medicare and if they’re on this LEIE list, let us know. You can give us a call at (800)-974-3479. If you dial extension 2 and ask for Stacy, she’ll go ahead and set you up for a free 30 minute consultation and we’ll get on the phone together, me and you and we’ll talk about how to get a compliance manual in your office. Now remember, call us now 800-974-3479 ext two.
Win $500 for Telling Your Best Patient Story
Win $500 for Telling Your Best Patient Story! Have you had any funny situations with your patients? Would you like to share them with us? We would love to hear your stories. Tips for Your Story What made this patient so special? How has this experience affected you as a Chiropractor and/or your practice? How does this story inspire you, your practice, and other Chiropractors Watch Dr. Brian Capra’s patient story video: Entry Qualifications Must be a Genesis user Like us on our Facebook page and simply post your patient success story with the hash tag #Genesispatientstorycontest Feel free to add video and pictures ( no more than 5 min. video) 300 – 400 words If you are not active on Facebook, e-mail us at marketing@vericle.com.
Chiropractic Software | Improve your practice performance by choosing a singular focal point
Can you prioritize the many daily tasks at your chiropractic clinic without feeling anxiety and puzzlement? Getting a singular focal point for you and your staff is necessary for building your dream practice with the right chiropractic software. This focal point basically serves as road map to success while increasing accountability and transparency. It also fosters teamwork and cooperation, which in turn increases predictable profitability growth and control. In order to build your dream practice, you have to set clear goals and balance Key Performance Indicators (KPI) such as Charges, Collections, Visits, No Shows, No Future Appointments and percentage of A/R over 120 days. All the while you have to stay compliant with your chiropractic SOAP notes. But without measuring your practice performance and tracking how each staff members contributes to the chosen goals you will never achieve your dream. In order to solve any practice performance problems that block your path to long-term profitability you need to be able to see the big picture at a glance and look up the necessary, detailed practice stats. Improving your practice performance requires diligent measuring and tracking of each chosen KPI. Only when you know how your practice is doing today, a reliable prediction of how it will perform tomorrow is possible. And by removing the factor of unpredictability from your practice performance you can gain much needed peace of mind. Of course, you don’t have time to search for and analyze multiple reports, let alone track your practice stats. Moreover, this kind of information overload can prevent you from being decisive about allocating resources. The only way to manage your practice effectively is to choose and balance the right KPI so that you can make progress in the selected areas and shift your focus as needed. At the same time this allows you to keep an eye on your overall practice performance. But without the right tools this approach is merely wishful thinking. Genesis Chiropractic Software, however, makes it a reality by providing you with a Radar to track KPI as well as automatically generated, detailed reports on all areas of practice performance, such as chiropractic billing. When you first log on to the home page of your Genesis Chiropractic Software, you can get a quick overview of your practice performance simply by looking at the Radar. It displays selected, vital stats on a single chart across two time points so that you can quickly see where you are right now and discover any trends before they turn into huge problems. You can also drill down into a particular KPI for a comprehensive sense of practice performance. If you want to get to the root of a performance problem you can look up any stats down to the lowest claim aspect and action taken for the appropriate KPI in a detailed, interactive report. For example, you might notice that your chiropractic billing stats are off and discover that the amount for ‘Insurance Collected’ is much lower than ‘Insurance Billed.’ This might indicate a problem with your chiropractic billing claims cycle. You can then look at the ‘Claim Status’ report to find out what might be causing any issues and fix the problem. You can access your practice Radar on your Genesis Chiropractic Software home page and click on a specific KPI to open a single graph. To look at any details of a particular area of practice performance, such as chiropractic billing stats, go to ‘Reports’ in the top menu and select the appropriate one from the drop down menu. Drill down into the desired details by specifying the date, provider or location. Genesis chiropractic reports also include: Context Search Department-wide Saved Queries for Repeat Usage Configurable, Sortable, and Drillable Report Layout by Arbitrarily Customizable Criteria Reconciled Error Reporting Within Standard HCFA form Export to Excel Reporting Across Multiple Departments/Sites Contact your Genesis chiropractic software Profitability Manager to configure your practice Radar with the right KPI’s to help you achieve your goals and build your dream practice. Watch Dr. Haas demonstrate the documentation interface.
Genesis Chiropractic EHR | New user tip #1 – Practice makes perfect
By Lisa Ogden ~ Profitability Coach for Genesis You can achieve success with the Genesis Chiropractic EHR system and build your dream practice when you and your staff complete the recommended training prior to going live. Chiropractors who wait until they actually see patients to learn the system “on the go” commonly run into the following 4 problems: Frustration: Not being able to use something when you most need it can be very frustrating for anyone. Even more so when your livelihood depends on it. Wasted time: Without establishing a level of comfort, documenting a patient visit can take much more time than Genesis is designed for. Compliance issues: Very similar to the paperwork that might be piling up on your desk, not getting to know your Genesis system can often result in incomplete and/ or unsigned SOAP notes. Unsigned notes are a major compliance or audit risk. Delayed payments: Payers don’t submit payment for incomplete or unsigned notes. The good news is that these four issues do not occur for practices that take the following 4 steps PRIOR to going live with their Genesis platform: Step 1: Participate in live online training session with Genesis staff: Our staff will walk you through proper visit documentation, step by step. Step 2: Create mock patient accounts: Spend time documenting several test patient visits including note sign-off and claim submission. Document the type of visits that are common for your practice. Document initial and follow up visits. Initial visit documentation will obviously take more time than follow up. You should be shooting for under 2 minutes for documenting initial and 10 seconds for most follow up visits. Step 3: Customize your Genesis platform: After you have spent some time getting to know your new platform, you may discover that minor customization is needed to improve efficiency. Schedule a second live training session to learn how easy it is to improve your user experience with customization. Step 4: Practice documenting: Now that you have made some minor tweaks to your documentation platform its time to practice documenting again to ensure you have everything set the way you want it. Your goal should be to document a visit, sign off on your notes, and submit a claim while the patient is still in your office. If you haven’t achieved this level of efficiency yet, it is important to contact your profitability coach and discover what might be holding you back. Take the time to get to know your new platform to eliminate frustration and achieve the top tier performance you are looking for with your chiropractic EHR.
Control Your Claim Flow Visually Using Radar Software
Do you worry about insurance claims payment delays? Lack of control over your chiropractic claims process causes inconsistent cash flow for your practice. If you cannot track and predict your cash flow easily you will have a hard time making your business profitable. You might even drive away patients when you are stressed out, which further hinders the growth of your chiropractic clinic. Ultimately, you cannot achieve any long-term profitability without sufficient growth. Since seeing patients is your priority, you can’t make time to micromanage each chiropractic billing aspect. Addressing the large amount of failing or rejected claims is virtually impossible with limited resources. Nevertheless, you need to follow up on your chiropractic claims to avoid reduced cash flow. Inconsistent and ineffective chiropractic billing performance can have many culprits including incompetent or untrained staff. But no one can adequately keep track and follow up on all underpaid and denied claims without effective chiropractic software. Not correcting these claims causes payment delays and can increase the percentage of your AR past 120 days. That’s why you need to track your active claims backlog and evaluate your chiropractic billing performance. Managing a chiropractic office is a balancing act of multiple Key Performance Indicators (KPIs), though. It can be challenging to prioritize tasks as many chiropractors tackle easy problems first before they focus on more complex matters. You need to keep your eyes on the big picture if you want to improve your claims workflow management and chiropractic billing performance. To accomplish this you need a centralized organization of tasks and performance. It is important to choose the right chiropractic software functionality. You should be able to look at multiple aspects of your practice at once, just like the snapshot Genesis’ Practice Health Monitor (a.k.a Radar) provides. To improve teamwork every member of your staff can also see this Radar chart on Genesis’ Home page every time they log on. You don’t need to waste time on compiling your practice stats, including claims status since data collection is automated. Furthermore, you and your staff can monitor trends to detect any problem areas before they cripple your practice performance. You can track your practice performance over time and measure any improvements with Genesis’ radar. But first you need to customize your workflow KPIs. Your Practice Success Coach then configures your radar to help you reach your goals.
