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.
