Chiropractic Software | Dr. Brian Paris | Practice of the Month | Advanced Spine & Wellness Center
“I learned about a workflow system versus a reporting system,” says Dr. Brian Paris, Advanced Spine & Wellness Center in Rockville, MD. “So it really allowed me to say, ‘Hey, there’s a software out there. I mean, we’re in the 21st century here. We’ve got to apply this stuff to healthcare and what I’m doing in my business.” Genesis chiropractic software, powered by Vericle, helps providers at Advanced Spine & Wellness Center control and optimize their workflows to achieve better teamwork and stay compliant – not just in scheduling emergency appointments, but in virtually every aspect of practice management. “It allows us, from a quality perspective… we are able to control the services from an internal perspective,” says Dr. Paris. “I am able to control what is going on with the practice.” At a dream practice, there is no room for loss of control, no matter how unpredictable the patient flow on any given day. Advanced Spine & Wellness’ approach to health focuses on spine and posture regeneration beyond the resolution of symptoms. The practice has helped hundreds of Montgomery County residents through state-of-the-art chiropractic, physical therapy, and acupuncture, as patients work to achieve optimal body function, performance and efficiency. “I quickly, when moving over to Genesis software, I was able to see the holes real quick with my Dream [Practice] Analysis,” says Dr. Paris. “And it’s very, very difficult to look at your own weaknesses, especially in something that you built from the ground up.” The professionals at Advanced Spine & Wellness go out of their way to make patients feel comfortable with not only the chiropractors, but also with the office and with the entire staff, before you ever walk through the door. It is the Rockville chiropractor of choice for patients of all ages and genders due to their unique, safe approach to pain relief and injury treatment. “By implementing this workflow system, and in pointing out my weaknesses in revenue and staff management and quality control and compliance, I’m now able to create a vision, accomplish it, and have a space of creation,” adds Dr. Paris. Utilizing a multi-specialty approach to healing, Advanced Spine & Wellness Center does not exclude the known benefits of the medical, surgical, and orthopedic disciplines. They desire and intend to see these philosophies work together to provide patients with the best healthcare. “I [have] learned about a lot of different areas in my practice — primarily three: staff management, revenue and compliance,” explains Dr. Paris. Now, it’s about two or three years later, where I have a very, very transparent picture. I have more time available for myself, and for developing the business, marketing, creating new revenue streams. As this healthcare industry changes, the revenue streams are changing.” Genesis features that simplify staying compliant, while also shoring up the revenue stream during the chiropractic EHR process include: Diagnosis linking to help providers use the right codes. Automated notifications and alarms, such as modifier selection and re-exam due. Compliant SOAP checklists make it easy for providers to create a set of tickets for routine services to make sure they never miss a documentation step. EHR (xDocs and XMR) technology to eliminate errors by auto-populating fields for patient data and reduce documentation time.
Who’s in Charge?
Credit cards are a necessary, but often expensive part of doing business. Could Ben handle credit cards better at his chiropractic practice? “It seems like things are going a lot better at the practice,” Carmen said, turning slowly so Ben could admire the dress she was trying on. Ben was seated in the dress shop, trying to keep their son quiet and still while Carmen found just the right dress for a friend’s wedding. “Yes — but where’d that come from? I thought you were completely focused on the important question of the sarong skirt versus the trumpet skirt.” “Tulip, actually, and yes, I’m very interested in that question. However, I also want to make sure you’re in a good mood before I start using our credit card.” Ben laughed. “I am in a good mood, actually,” he admitted. “The changes we’ve been making at the practice are really paying off. And that dress looks great.” “Good!” Carmen stepped back into the dressing room for a moment and returned with another dress. “Speaking of credit cards…” “I like that dress even better,” Ben offered. Their son ducked under a dress rack. Ben hauled him back out. “Speaking of credit cards?” Carmen was back in the dressing room, but she called through the door. “I’ve been thinking we need a change in our card processor at the pizzeria. The fees seem really high. How about yours?” Ben agreed that he felt his processing fees were high, too, admiring yet another dress. “That blue thing is very nice,” he said as his wife disappeared into the dressing room again. “But, you know, it’s better to pay the fees than not to get paid, and sometimes a patient has an outstanding balance that’s just too high for him to handle in cash.” Carmen stepped out with her arms full of bright fabrics and grabbed Jonathan’s hand. Ben joined her in the line to the cash register. “I guess it’s different at the restaurant,” she said. “We use a point of sale system the same way the store here does. If your transactions are mostly about getting old debts off your books…” “We have some payments through our POS system, both for treatment and for things like back supports and exercise equipment,” Ben said, “but there are also times when we call a client about a bill that didn’t get paid by insurance, and they ask us to put it on a credit card. Those get posted manually, so it’s easy to make mistakes or to miss them.” “I don’t think we have many mistakes in our credit card transactions,” Carmen said consideringly, “but sometimes a card is declined — and the customers have already eaten.” She reached the front of the line and placed her stack of dresses on the counter with a credit card on top. “We’ve had credit cards declined, too,” Ben said. “And as you say, we’ve already provided the services at that point. It’s a hassle to follow up, and I think maybe sometimes we don’t follow up. You can always make them wash dishes, right?” The kids laughed much more than the joke deserved, but Ben hardly noticed. “Hey, how many dresses do you need for one wedding?” “I couldn’t pick just one,” Carmen explained. “Plus, there are other dressy events in our future.” “Like what?” “I don’t know yet, but now that I have these dresses, I promise you there will be some.” Ben didn’t argue, but he was thinking about credit card transactions at the practice. Just how much were those transactions costing him? Could Ben handle credit cards better at his chiropractic practice?
Play Time’s Over
By Kathleen Casbarro Clinicians need to keep coming coding changes in mind How can Ben get on track for the ICD-10 changeover when it comes to clinical documentation? “Ben!” called Carmen, “You’re going to be late for work!” Ben swung Jonathan down to the floor and settled him with crayons and paper. The time he spent with his son in the mornings helped him start his day in a great mood, but it was easy to lose track of time. “Thanks!” he said to his wife, taking the strong, hot coffee she offered. “You don’t have to go in to the restaurant at all today?” “I have an actual day off,” she beamed. “It’s kids’ clinic at your place today, isn’t it?” “Yes, it is, and I think it’s my favorite day of the month.” Ben’s chiropractic office provided monthly well kid checkups for patients, and it worked out best to bunch all those appointments together. “Unless we have an emergency, it’s all happy, healthy kids.” “You can just write ‘Great kid!’ on each chart and skip the paperwork,” Carmen said with a smile. Ben finished his coffee quickly and headed to the clinic, with Carmen’s words ringing in his ears. He had been focusing on getting billing and scheduling systems in place in preparation for the ICD-10 changeover in October, but he knew he was also going to have to make changes in his clinical documentation. What changes, though? Once again, Ben thought, he was facing a possible problem without knowing just what he was up against. He knew he did a good job with clinical documentation, but he also knew that the documentation would be key to success with ICD-10. There would be different codes for the two sides of the body, for various levels of severity of each condition, and more — and payment decisions would be riding on making the right choices. Ben added “clinical documentation” to his list of issues to think about. The list never seemed to get any shorter, but he felt fairly sure that he had no choice with this issue. How can Ben get on track for the ICD-10 changeover when it comes to clinical documentation?
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.
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?
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 EHR software | Improve patient retention with Care Plans
Does paying your monthly overhead stress you out because your chiropractic clinic is plagued by patient no-shows? It is impossible to predict your clinic’s cash flow when your patients are non-compliant with your prescribed care plans. Needless to say, patients who miss their appointments won’t get better. Inconsistent patient flow also hinders practice growth and profitability. But your clinic’s cash flow can take an even bigger hit when you have to return payments for unfinished care plans. Not to mention the possible compliance issues resulting from this. You can figure out how much your chiropractic clinic might be losing due to unfinished care plans when you replace the assumptions below with your own numbers and complete the calculations. For example: Assumptions: 1 visit = $30 1 care plan = 30 visits Average number of no-shows per care plan: 15 Calculations: Potential income and losses from unfinished care plans per patient: Potential income from 1 care plan: 30 visits x $30 = $900 Potential loss from no-shows per care plan: 15 visits x $30 = $450 Conclusion: You risk losing half of your income when patients don’t finish their care plans! Just how can you identify patients who don’t understand the need for multiple visits to achieve their health goals? First of all, you need to know what the entire care plan looks like in order to track multiple visits. All patients go through a traditional treatment step-down ladder, such as four visits per week for the first four weeks, then three visits per week for the next three weeks. Such unique nuances on many patient schedules are difficult to track manually, and this difficulty grows dramatically with each added chiropractic care plan. Tracking the respective discounts given for each care plan is nearly impossible without a tool. Thousands of care plans are created for new patients every month, to schedule multiple appointments and then track all payments and visits in your Genesis EHR software. When patients don’t show up for their appointments you can receive automated notifications in form of tickets on your Genesis chiropractic software workbench. When patients don’t have a future appointment scheduled or when they cancel their existing appointments you can receive alerts via tickets. That way you can assign your staff the task of scheduling the next appointment. Another useful tool for helping your patients stay on track with their care plans are appointment reminders sent via phone, text, or email. Genesis chiropractic software has integrated several apps which serve this purpose. To set up chiropractic care plan when your patients come into your clinic, simply go to the Genesis Scheduler and click on the “More” tab to open the wizard. You can also create a full care plan from the patient account. Make sure you turn on the settings in your Genesis chiropractic software for Patient Relationship Management and Reminders.
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.”
