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? See everything we’ve published on ICD-10 on our ICD-10 diagnosis codes page.
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? Learn how Genesis Chiropractic Software can increase your revenue. 7 ways to increase your chiropractic practice revenue.
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? Genesis Chiropractic Software used in your practice will increase your revenue. See 7 ways to increase your chiropractic practice revenue.