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?
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
