To Grow, You Have to Let Go
By Garrett B. Gunderson How to Escape the Job Trap & Build a Real Business | Part 1 Are you a business owner or an employee? Think that through carefully. Let me put it a different way: What would happen to your business and income if you were to leave today and take a three-month vacation? If your business would fall apart and your income would stop, you’re an employee—even if you technically own a business entity. The truth is that the vast majority of professionals, and even many entrepreneurs, think they own a business but in fact it owns them, as what they really have is a job. They have to be physically present and doing the work or the income stops. They spend their time working in the business, rather than on the business. They don’t have the right people or systems to duplicate themselves. They couldn’t sell the business because it wouldn’t survive without them. Robert Kiyosaki explains the difference between a job and a business in a parable: There was once a village with a problem: It had not water unless it rained. To solve the problem, the village elders decided to solicit bids to have water delivered daily to the village. Two people volunteered and the elders awarded the contract to both of them. The first, Ed, immediately bought two buckets and began running back and forth along the trail to the lake, which was a mile away. He immediately began making money as he labored each morning hauling water from the lake. Each morning he had to get up before the rest of the villagers awoke. The second man, Bill, disappeared and was not seen for months. Instead of buying buckets to compete with Ed, Bill had written a business plan, created a corporation, found four investors, employed a president to do the work, and returned six months later with a construction crew. Within a year his team had built a large pipeline, which connected the village to the lake. Bill’s pipeline delivered cleaner water than Ed’s and it supplied water 24 hours a day, 7 days a week. Bill was also able to charge 75 percent less than Ed. Of course, Ed ran ragged while Bill was able to enjoy life—making money even while he was on vacation. So the question is: Are you hauling buckets or building pipelines? Now, let’s be authentic about this: Building a business is no small task. It’s incredibly difficult, particularly for trained professionals and personality-based operations. When you know as much as you do, you’re as skilled as you are, and you care more than anyone, it’s very challenging to replace yourself. But it is possible. The most common thing I hear from FastTrack members in this regard is that “it’s different for chiropractors and dentists.” I realize that there are some differences between highly-trained and skilled professionals and McDonald’s, but it’s still possible to build a business. It’s a classic case of hard/easy, easy/hard. It’s easy to just show up and do the work every day, but that makes your life much harder over time. It’s hard to build a business, but it makes your life way easier over time. But doing so requires a totally different mindset. It requires that you do things that don’t immediately pay off. Running a business means to be efficient and quick, but building a business is methodical and slow. Freedom FastTrack is a similar business to professionals, in that it is highly-technical and personality-based. But over time I’ve been able to escape the job trap. And trust me, it hasn’t been easy. For me, it was much easier to do a coaching call myself than to train a new coach. But I knew I could only be in one place at one time, and I wanted to impact more people. I’ve had to be committed to building a business. There is still progress to be made, but I rarely do coaching, and I have the time to go on trips, work on the business, and focus on the things I love doing most. Here’s how you can do it, too: 1. Build the Foundation of Culture First, you want to be very clear on who you are, what you stand for, what you stand against, what you really want to define your organization. Write down your non-negotiables and never allow anyone in your organization to stray from them. For example, we have everyone that works with us read our style guide, which details our values, vision, and culture. We also do several interviews before hiring, and we emphasize values over talent. 2. Hire the Right People, Train them Meticulously, Treat them Right There’s an informal debate in the business world right now between Michael Gerber, the author of The E-Myth Revisited, and Seth Godin, the author of Linchpin. Michael Gerber says that building a business is all about systems. He teaches to make your systems so simple that you could insert pretty much any warm body to run them. Seth Godin says it’s all about finding the right people—what he calls indispensable “linchpins.” Linchpins are proactive, responsible, and smart. They see needs and fill them. They’re full of ideas for improving your organization. My take is that any business needs both, but I side with Seth when it comes to hiring. You don’t want the lowest common denominators that will be the cheapest to pay. You want the best and the brightest who can adapt to change and proactively improve your organization. You want people who think like trusted stewards upon whom you can depend to make good decisions. The way to find the right people is to first create the position you need filled. Understand the mindset and skills that will be required to fill that position. Then hire someone whose Soul Purpose fits that position. Be willing to allow other people to express their Soul Purpose by building Soul Purpose networks and teams. There are some
PQRS | How These Four Letters Affect Your Practice | Webinar Q&A
Unless you are billing the right set of PQRS codes on 50 percent of your qualifying visits, then you will lose 2 percent of your allowed reimbursement in 2016 and forward. As a result, you may have concerns about the changes that this reporting system brings to your chiropractic clinic. To help you get the answers you need, we have compiled all questions that were asked during our recent webinar “PQRS | How These Four Letters Affect Your Practice,’ along with the presenter’s responses. Feel free to add any new questions in the comment section below. Q: Is Genesis powered by Vericle an eligible registry? A: Right now, the only way to submit a PQRS code to CMS is claim-based. Vericle is working on becoming a registry. It’s a very long process. Right now, we are working on Stage Two Meaningful Use. This is another way for users to avoid the 2016 penalty. Q: Does pain and medication measure have to be reported on every visit? A: Whatever measurements you choose to report, the documentation has to be in your chart. Q: What is Genesis powered by Vericle doing to maintain compliance with Medicare? A: In terms of compliance with Medicare, Vericle does keep up on the rules. In some cases, if you need a different secondary diagnosis when you’re submitting your claims to Medicare, Vericle is C-CHIT. Vericle completed EHR Meaningful Use Stage One and is preparing for Stage Two, which is Medicare compliant. PQRS codes have been available in the Vericle system.
ICD-10 | 100x More Complicated | Q&A
As your practice is preparing for the impending ICD-10 changes, you might have many questions concerning chiropractic billing procedures and software requirements. To help you get the answers you need, we have compiled all questions that were asked during our recent webinar ‘ICD-10 | 100 Times More Complicated,’ along with the presenter’s responses. Feel free to add any new questions in the comment section below. Q: I have a question about the top 50 ICD-9 codes we use, and doing the crosswalk to ICD-10. Where is the best resource for being able to do that? A: CMS GEMS would be one website that you can use; that’s CMS’s GEMS System, which is the General Equivalent System that they use — the General Equivalent Mapping System that they use to translate ICD-9 to ICD-10. Another good site for you is AAPC.com. Click on their ICD-10 link and they have a feature where you type in our ICD-9 and it returns the equivalent ICD-10 code. GEMS prompts you to choose the lateralities and origins, whereas AAPC is more one-to-one, but GEMS is really what most systems are basing their crosswalk from, and GEMS is built and maintained by CMS, the CDC, and AMA. Q: I’ve done all my conversions from ICD-9 to ICD-10 and I’ve done the left and right conversions. We’ve changed some of our chiropractic documentation so it’s more specific about mechanism of injury — the when, where, the why and the how. What else is there really to do? A: You really want to make sure that how the practice is supposed to document the guidelines for chiropractic documentation are clearly outlined in your policies and procedures manual. And that means adding in specificity and laterality. The manual should also have references as to where you seek the information; your reference point would be to CMS. Q: If I want to take a coding course to get certified, do I need to be certified on ICD-9 and ICD-10? A: Right now, you have to certify for both, but after October 1, you only have to certify for ICD-10. Q: Are you able to come out and help us train our staff? A: We can give you the tools that you need in order to train your practice. For chiropractic documentation, have them listen to our webinar in March, but they can also take external classes — specifically from the AAPC, because their classes on physician documentation are extraordinary. In terms of crosswalking, we will work with you. View our ICD-10 page that has a collection of information about ICD-10.
Hanging In
By Reuven Lirov Office unease leaves practice owners dangling Are the problems in his practice Ben’s fault? Ben sighed contentedly and rested his chin on his wife’s head. Their son was sitting on her lap and she leaned against him on the sofa so that he could hug her and their little boy at the same time. They had a cartoon movie on the TV, but Ben wasn’t paying attention to it. At times like these, their family seemed like a perfect unit, and his life seemed as though it was completely under control. So why didn’t it feel that way at the office more frequently? Carmen had problems at the pizzeria sometimes, but it always seemed as though she could just tackle the problem and solve it, and it was over. At his practice, it felt like they no sooner solved one problem than another came up. They had high turnover in the front office, and he knew that was part of the reason things slipped through the cracks, but maybe the high turnover was a symptom of the problem. Absenteeism, too — of course that led to turnover when people had to be let go, but it also seemed as though any time one person was missing it created a bottleneck in the office. Then when absent workers returned, it took three days to recover from every one day they’d been gone. Maybe they just weren’t getting the kind of training they needed, Ben reflected. Jonathan was laughing and squealing as the cartoon characters slid down a mountainside. It was funny in the cartoon, Ben thought, but sometimes that’s how it felt at work, and then it wasn’t so funny. The cartoon characters were bouncing from one branch and outcropping to another, their eyes comically huge, and his son couldn’t stop laughing. Ben couldn’t stop thinking that this was just what his workdays were like sometimes, bouncing from one problem to another and barely having time to get one issue cleaned up before another smacked into him. Forget about building and growing the practice — he was always in crisis mode. Ben didn’t really think it was a case of having bad workers. They made every effort to hire smart, competent people. And yet those smart people made mistakes and let things slide. He knew they didn’t provide intensive training to their staff, but where would he find the time to do that? He had always figured that if he hired good people, they could pick most things up on their own. Ben shook his head and Carmen smiled up at him questioningly. He returned her smile and willed himself to get his mind back into the present. He could think about his work problems later — in fact, he’d have to. He sighed again, but this time not with contentment. Maybe it was his fault. Are the problems in his practice Ben’s fault?
New Chiropractic Network Members in January 2014
One-hundred-thirteen new members across 63 practices joined Genesis Chiropractic Software and Billing Network in January 2014! There is strength in numbers due to the shared knowledge – we call it the “Billing Network Effect,” as the billing performance of each member practice improves in step with the total volume of processed claims. Each office uses our chiropractic software for their billing. Please welcome our new Genesis network members: Brooke Taylor of Abundant Life Chiropractic, The Woodlands, Texas Tricia Sanders of Active Life Health Center, Atlanta, Georgia Lisa Solis, Amanda Drugmand, Preston Simper and Elizabeth Meagher of Aliante Chiropractic & Integrated Health, Las Vegas, Nevada Santaann Matone of Amboy Chiropractic, Staten Island, New York Rachel Arfstrom of Apex Chiropractic, Eau Claire, Wisconsin Danielle Leffel of Back to Health Chiropractic and Wellness, Winona, Minnesota Lashelle Leckie of Better Health By Design, Cumming, Georgia Stephen Lychock of Bey-Lea Chiropractic, Toms River, New Jersey Dr. Rachel Sorg of Bull City Chiropractic, Durham, North Carolina Jodi Jones of Carolina Chiropractic of Charlotte, Charlotte, North Carolina Madison Vander Well of Cascade Family Chiropractic, Colorado Springs, Colorado Tina Tweeten of Celebration Family Chiropractic Clinic, Celebration, Florida Michelle Bitterman of CBP Spine Center, Windsor, Colorado Lisa Walker of Central Jersey Spine & Wellness, Freehold, New Jersey Lucia Reynolds of Chiropractic First of Rockford, Rockford, Illinois Tim Huang, Angelina Kavvathakis and Millie Watson of Chiropractic Works, Oakland, New Jersey Alisha Meenen of Connected Chiropractic, Johnstown, Colorado Kendall Thomas of Cornerstone Chiropractic, Green Bay, Wisconsin Andrea Verdeyen of Discover Chiropractic, Denver, Colorado Matthew Poorman and Robert Rosania of Drs. Choice, Rahway, New Jersey Diana of Family Chiropractic Center of East Rutherford, East Rutherford, New Jersey Dr Brittany Tinker of Family Healing Chiropractic, Charlotte, North Carolina Heather Steele of Fountain City Family Chiropractic, Kansas City, Montana Amanda Nalley of Giles Family Chiropractic, Napa, California Liz Hartfield and Casey Price of Glen Mills Chiropractic Health Center, Glen Mills, Pennsylvania Sarah Griffus of Great River Family Chiropractic, Moline, Illinois Kaileigh Mclaughlin of Greenleaf Chiropractic, Wichita, Kansas Lakesha of Greenwood Family Chiropractic,Greenwood, Indiana Dr. Scott Reiner and Kesa Marsh of Hedges Family Chiropractic, Durham, North Carolina Dr. Brandon Trujillo and Sarah Bennett of Ideal Spine Health Center, Eagle, Indiana Linda of I Get It Chiropractic, Westminster, Colorado Julia Gilley of Integrative Body Health, Carrollton, Georgia Susan Judge and Kaylyn of James E. Judge, DC, St. Charles, Illinois Dan Scibelli of James Family Chiropractic, Summerville, South Carolina Kelly Cisneros of Jon Scott Chiropractic, Thousand Oaks, California Demetra Lee of Keen Family Chiropractic, Austin, Texas Melissa Tapp of Livingood Family Chiropractic, Cary, North Carolina Carlos Maxwell of Living Well Chiropractic of Central Florida, St. Cloud, Florida Natalie Brewer and Ashley Landof of Lone Star Family Chiropractic, Katy, Texas Jen Couch and Caro Duran of Longmont Spine and Physical Medicine, Longmont, Colorado Caitlyn Loing and Jessica Boll of Minnesota Disc Institute, South Edina, Minnesota Dr. Rebecca Warren, Dr. Kelan Connoly, Dr. Ashley Crampton, Dr. Colin Schulze, Dr. Jake Shuppe, Dr. Christi Shuppe, Dr. Ryan Lutz, Dr. Cassie Major, Dr. Michael Major, Stacy Schulze, Dr. Xavier Counts, Dr. Sarah Williams and Dr. Nathan Warren of MLHC, Celebration, Florida Jayce Watkins, Danny Sigars and Heather Denney of Neck Attack, Overland Park, Kansas Carmen Marascalco of Oxford Chiropractic, Oxford, Mississippi Kristy Sorensen of Ozanne Family Chiropractic, Fayetteville, Arizona Nicole Hardesty of Pacific Spine & Joint Medical Group, Daly City, California Daniel Pitta, Rudjar Good, and Brandt Green of Paris Chiropractic, Rockville, Maryland Dr. Kyle Peacock and Kelsi Peacock of Peacock Family Chiropractic, Fishers, Indiana Traci Jeremiah of Peoria Family Chiropractic, Peoria, Illinois Melanie Gartside and Brad Holtgrave of Planet Chiropractic, Romeoville, Illinois Corey Todd Hunter and Elise Miller of Posture Works, San Francisco, California Zenna Graves of Premier Chiropractic, Stockton, Illinois Ivanna Goodman of Redbird Chiropractic, Miami, Florida Samantha of Rosemount Chiropractic, Rosemount, Minnesota Wendy Gallego, Chad Bailey, Karen Correa, Julio Dominguez, Jackie Clason, Cyndee Krantz, Beth Varona, Caryna Fernandez and Carolina Rivas of Shin Wellness, Miami, Florida Laurisa Smith of Smith Family Chiropractic, Austin, Texas Joann Melendez of Texas Sunset Family Chiropractic, Denton, Texas Paula Foster of The Balanced Spine, Issaqua, Washington Suzanne Demers, Caitlin Butler, Brad Montgomery, Isaac Hernandez, Julie Montgomery, Kayla Glover and Eric Harris of Trinity Chiropractic, Naples, Florida Amanda Graham and Jessica Glass of Victory Chiropractic and Wellness, Knoxville, Tennessee Jodie Elliott of Vital Chiropractic, Elburn, Illinois L.J. Campbell and Nikki Teeple of Wickiser Clinic of Chiropractic, Anderson, South Carolina Lorraine Hurst, Angie Helgeson, and Wendy Plaster of Woodbury Family Chiropractic, Woodbury, Minnesota
Mistakes
Office errors can spill over into patient care What are the consequences of mistakes in Ben’s office? “Honey, I’m home!” Ben sang out as he stepped through the front door. His small son ran and tackled his knees, and he was relieved to see that his wife was smiling. Ben swung Jonathan up onto his shoulder and hugged Carmen. “How’d things go at work today?” he asked her. “You were right,” she said. “Once I talked honestly and respectfully with the girls about how much time there were spending on… umm… personal things…” “By which you mean the super-cute delivery guy,” Ben cut in. “Exactly,” Carmen laughed. “Anyway, they saw my point and I think it’ll be okay. It’s just hard to get a conversation like that started.” Ben thought about his own staffing issues. High staff turnover, absenteeism and errors seemed to be a constant problem, and he didn’t feel that he had time to spare to deal with the issues — even if he’d had a good plan for approaching them. Jonathan’s attempts to get down got Ben’s attention away from work, and he set the boy gently on the floor. Jonathan scampered off and Carmen said gently, “Are you worrying about work again?” Ben agreed that he was. “Maybe it’s the upcoming changes in reporting regulations that are making me notice it more,” he said, “but I feel like we make a lot of mistakes.” “Any mistakes in a medical office feel like a lot,” Carmen observed. “Oh, it’s not mistakes in treatment. It’s things like incorrect diagnosis codes, forgetting to collect copayments, incomplete documentation, delayed payments — even overpayments.” “Not things that affect the patients, then?” Carmen asked. “Actually, that kind of mistake can affect the patients,” Ben admitted. “Whether it’s a billing issue that gets uncomfortable and the patient just doesn’t come back, or a feeling that things are falling through the cracks that makes a patient feel less confident about us, we can lose patients because of office problems.” “Plus,” he went on, following his wife into the kitchen as she raced to turn off the oven timer, “Every hour I spend dealing with office SNAFUs is an hour that I’m not seeing patients.” Carmen cocked her head, a steaming pan of baked sausage and eggplant in her hands. “I think it’s always easier to change the circumstances than to change people,” she said, setting the pan onto the table. She began to gather the ingredients for a salad. Ben grabbed a tomato and began to slice it. “The circumstances are pretty settled,” he objected. “We have things we have to do, sometimes by law. There aren’t any points for originality when you’re talking about medical billing.” “I get that, but there must be things that make it easier to make mistakes, or harder. Like lines in the parking lot make it easier to park a lot of cars than it would be if everyone just did their own thing.” Jonathan raced in at that moment with a picture he had drawn, and Ben pushed thoughts of work from his mind, but Carmen’s words came back to him later. It seemed like lots of little mistakes added up to big problems. If his staff couldn’t change, how could he get past the problems? What are the consequences of mistakes in Ben’s office?
Into the Fire
Poor Communication Turns Up the Heat in the Office How do staff problems affect Ben’s chiropractic practice? “Ben? Can I talk to you about something serious?” Ben turned to his wife in surprise. Carmen was usually easygoing, taking a relaxed attitude even in serious situations. “Of course. What’s up?” “It’s the girls at the pizzeria.” Like many pizza places, Ben knew, Carmen’s had lots of part-time help, including students and musicians who needed a day job. The work tended to be fun and casual, even though Carmen ran a tight ship. She had a lot of turnover — what restaurant didn’t? — but she rarely had staffing problems. “I’m usually the one complaining about my staff,” Ben said. “You go with the flow.” “I know,” Carmen agreed. “I think we’re a happy workplace, and the systems are organized enough that the people can relax. But we have this new delivery guy…” Carmen hesitated. “Spit it out!” joked Ben. “Well, okay, he’s really cute. Whenever he’s in the shop, the girls hang out near him, flirting, instead of doing their work.” Ben couldn’t help laughing. “That’s your employee problem? Listen, I have staff absences, paperwork backing up, information silos that mean we constantly have questions that can’t be answered because the only person who knows the answer is off –” “You aren’t even listening!” Carmen objected. “I can’t bring this up with the girls without insulting them, and I can’t bring it up with the new guy at all. I can’t fire him for being too cute –” “Sorry, Carmen,” Ben insisted, “you don’t know what staff problems are if your idea of a staff problem is how to avoid hurting somebody’s feelings. My people are competent, but there doesn’t seem to be enough communication among them to keep the paperwork and billing going smoothly. We end up looking bad to the clients because their files can’t be found, or missing out on billings because the paperwork has errors. Those are staff problems.” “Maybe you’re right,” Carmen said. “Those do sound like more serious problems. Are you paying enough attention to your workers?” “That’s part of the problem, I’m sure,” Ben admitted. “I’m in with patients all day. I don’t have time to oversee the staff, and I guess they all have a lot of freedom to set up their own systems…” Carmen laughed. “If everyone just does what he or she wants, you can’t call it a system.” “Well at least I’ve got you laughing,” Ben said. “Listen, just tell your people to get back to work. You’re letting your embarrassment over the situation make it seem more difficult than it is.” As they got ready for bed, though, Ben was wondering. If that was the biggest staff problem Carmen faced in her business, why was he constantly troubled by staff problems in his? How do staff problems affect Ben’s chiropractic practice?
Something for the Pain
By Kathleen Casbarro Simplifying coding issues can relieve practice tension How can software make a difference in the ICD-10 changeover? “Doctor!” The box on Ben’s desk squawked. Pam always sounded professional, but Ben knew her well enough to hear the tension in her voice. Ben hesitated for just a moment over the stack of paperwork he’d been plowing through, but decided he should respond to Pam’s obvious stress. As he neared the front desk, he heard raised voices. “You’ve already been to the doctor!” a young woman shouted at an older man whose face was set in pain… or perhaps in stubbornness. “He’s already been to the doctor!” she repeated in Pam’s direction. “Maybe I can help,” Ben offered. “I was in a car accident–” the older man began. “My dad has been to the doctor and to the hospital,” the young woman said firmly, “and they told him it was back pain and it would get better in time. They gave him pain medication to take and he won’t take it. Now he’s insisting on coming here, and I don’t think his insurance will pay. I just want to take him home.” Family altercations weren’t as common in Ben’s chiropractic clinic as they were in hospitals, but he recognized the situation. The daughter was worried that her dad wouldn’t be able to pay, the old man was still in pain, and their worries were showing up as anger. “Let me take these good people back and have a little chat,” he said calmly to Pam. Getting the shouting out of his waiting room was the first priority. He’d get them calmed down, explain the situation, and then bring them back to Pam for intake, and the paperwork — well, it looked like he’d be working late again. It was hours later when Ben had a chance to discuss the event with Pam. “I’ve been thinking about the man who’d had a car accident,” she said. “We’re always careful to avoid using the ICD-9 code 724.5 for back pain because it tends not to get paid. We make sure to use the most specific code we can so the patient’s insurance will be able to pay.” Ben nodded. “I realized that I don’t have that knowledge about the new ICD-10 codes,” Pam continued. “We’re always focused on the people we treat, but the paperwork is what allows us to keep the doors open and take care of those people. I’m worrying that the new insurance reporting codes will get in the way.” “I think we may have a solution,” Ben said. “I’ve been talking with the people at Genesis — the new practice management software. They had a really sensible approach to it. Three things: assessment, documentation, and implementation. That’s better than focusing on the 70,000 new codes, right?” “It might be,” Pam said uncertainly, “If I knew just what that meant.” Ben laughed. “Fair enough,” he said. “What I get is that the software will cluster the codes into groups so we can drill down to the right one, instead of trying to memorize everything. We’ll be able to see the relevant ICD-9 and ICD-10 codes on the billing screen, along with which payers are using each set, and we’ll have a crosswalk that will let us learn and train before the deadline.” “All on the billing screen?” Pam sounded excited. “That sounds workable.” “Workable,” Ben repeated. “That’s it exactly. It’s like when we get a patient having a meltdown in the front office — we may feel a little stress, but we have workable systems in place to handle it, and it turns out well.” How can software make a difference in the ICD-10 changeover?
Chiropractic Software | New Network Members December 2013
Thirty-five new members across 25 practices joined Genesis Chiropractic Software and Billing Network in December 2013! There is strength in numbers due to the shared knowledge – we call it the “Billing Network Effect,” as the billing performance of each member practice improves in step with the total volume of processed claims. Each office uses our chiropractic software to thrive. Please welcome our new Genesis network members: Maria Douglas, Hannah Zimmer, Paul Stine, and Bethany Pettit of Abundant Life Chiropractic, Woodlands, Texas Paul Willemse of Advanced Healing & Pain Relief Center, Union, New Jersey Eunice Rizo-Tabora of Aliante Chiropractic & Integrated Health, Las Vegas, Nevada Jacquelyn Rose of Brittian Chiropractic Center, Winston Salem, North Carolina Joshua Eddings of Cascade Family Chiropractic, Colorado Springs, Colorado Rosemary Tobias of Central Jersey Spine & Wellness, North Freehold, New Jersey Bethanie Telep of Chiropractic Works, Oakland, New Jersey Gisela Maldonado of City Of Bridges Chiropractic, Brentwood, Pennsylvania Ashley Anderson of Cook Chiropractic, Chippewa Falls, Wisconsin Yadira Puntiel of Drs Choice, Rahway, New Jersey Amanda Salameh of Dr Glen R Burford DC, Collierville, Tennessee Summer Cockayne of Elevation Chiropractic, Boise, Idaho C. Gonzales of Family Chiropractic Center Of Bayonne, Bayonne, New Jersey Myong Ok Om of Family Chiropractic Center Of East Rutherford, East Rutherford, New Jersey Cindy Sulla, Adrianna Natale, and Ashley Sulla of Iannelli Chiropractic Centers, Turnersville, New Jersey Lauren Reilly and Christie Fosina of John P Maher, DC, Carmel, New York Jessica Kiewlich, Tina Dieterich, Brad Grgurich, Chrystal Zavala, and Jeff Meyers of Longmont Spine and Physical Medicine, Longmont, Colorado Karen Schwietering of Lori A. Nuzzi, DC, of Midland Park, New Jersey Joshua Madrigal of Miles Chiropractic, Glasgow, Kentucky Kim Qualls of Natural State Health Center, Little Rock, Arkansas Dametria Farris and Heather Bladel of Next Level Health, Rockford, Illinois Elizabeth M Ruegsegger of Premier Chiropractic, Stockton, Illinois Candice Bierle of Inspired Chiropractic, Sioux Falls, South Dakota John Chevigny of Stability Spine & Wellness, Seattle, Washington Tawny Jenna Mcinstosh of Wickiser Clinic Of Chiropractic, Anderson, South Carolina
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.
