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.”
