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?
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?
Win $500 for Telling Your Best Patient Story
Win $500 for Telling Your Best Patient Story! Have you had any funny situations with your patients? Would you like to share them with us? We would love to hear your stories. Tips for Your Story What made this patient so special? How has this experience affected you as a Chiropractor and/or your practice? How does this story inspire you, your practice, and other Chiropractors Watch Dr. Brian Capra’s patient story video: Entry Qualifications Must be a Genesis user Like us on our Facebook page and simply post your patient success story with the hash tag #Genesispatientstorycontest Feel free to add video and pictures ( no more than 5 min. video) 300 – 400 words If you are not active on Facebook, e-mail us at marketing@vericle.com.
Improve chiropractic clinic profitability by increasing PVA
What is PVA and how do you use it? An increasing number of chiropractors have been experiencing anxiety about the future success of their practice. Their concerns span a gamut of issues– from lack of patient feedback about their patient relationships to lack of control of practice management processes to unpredictability of patient flow and cash flow to low profitability. Shrinking practice profitability is a result of five forces that conspire for a “perfect storm:” Rising costs of doing business, from rent to payroll to insurance Shrinking insurance reimbursements Increasingly stringent regulations and growing frequency of audits Delays and underpayments of insurance claims Patient flow fluctuations 3 steps to gain control over your practice’s profitability: Regaining your peace of mind and taking control back into your hands requires a methodical approach consisting of three steps. Measure your case profitability and set a goal for it: Profitability or case profit margin is a ratio of case fees collected minus case costs, divided by case fees collected. Case fees collected is the money spent by the patient in your office over the lifetime of that patient. Measure your patient visit average (PVA): The sad thing about profitability is that there is no way to control it directly. But the good news is that it grows in step with your Patient Visit Average (PVA). In other words, you can control your case profitability indirectly by controlling your PVA. Increase your PVA: Figure out ways to have your patients commit to more than one visit and keep implementing new ideas until your practice’s profitability meets your goals. How to determine case fees collected? The case-fees-collected statistic can be calculated by dividing total collections by the number of cases. This approach has a major shortcoming because it requires the chiropractor to wait until all cases have terminated. For a reliable approximation of the same number without waiting for termination of every patient, follow the two-step approach below: 1. Calculate all collections for a given time period. 2. Divide that figure by the total number of new patients for the same time period. For instance, if Dr. Joe treated 20 new patients last month and collected $10,000, then his case-fees-collected last month were $500. In other words, the average patient last month spent $1,000 before terminating care. How to determine case costs? You can use the same approach to calculate your case costs: 1. Compile total overhead for the same time period used to calculate case fees collected. 2. Divide your total overhead by the total number of new patients for the same time period. For instance, if Dr. Joe treated 20 new patients last month and his total overhead during the same month was $10,000, then his case-costs last month was $500. In other words, the care of average patient last month cost Dr. Joe $500. What does Profitability mean? If your fee to cost ratio is greater than one then you have a profitable practice. Otherwise, you are losing money. Common sense dictates that a profitable practice that takes care of its owner manages a 3:1 ratio of fees to costs, or about 67% profit margin. A common fallacy among many practice owners is the belief that increasing the number of new patients positively impacts profitability. But this may not necessarily be true since increasing the number of patients also increases the overhead, potentially decreasing profitability even further and defeating the purpose of increasing the number of patients. How to compute Patient Visit Average? PVA is a measure of your retention, or your ability to retain patients. In other words, it is a relationship quality indicator. The higher the PVA, the better is your relationship with your patients. As in an earlier calculation, the Patient Visit Average statistic can be calculated by dividing total visits by the number of patients. This approach has the same shortcoming as above because it requires to wait until all patients have terminated. For a reliable approximation of the same number without waiting for termination of every patient,simply divide your total visits for a given time period by the total number of new patients for the same time period. For instance, if Dr. Joe had 300 patient visits last month, including 20 new patients, then his PVA would be 15. In other words, the average new patient returns 15 times to see Dr. Joe. 5 steps for improving your PVA The way to increase PVA is to create a lifetime-maintenance practice. Maintenance patients have a greater understanding and appreciation of what chiropractic has to offer. Create customized treatment plans: Give your patients a customized plan that is tailored to their specific problems at the end of their first session. Block schedule the entire plan in advance: Help your patients understand that you are offering them a complete treatment plan – not a session by session experience. Train your team: Practice “role play,” including specific verbiage and intonation. Without practicing in advance, you leave it to your staff to come up with the right things to say on the spot. Every mistake they make can keep a new patient from coming back and even more importantly – prevent them from benefiting from your treatment plan. Set goals and display results: What you can measure, you can manage and on the same side of the coin what you measure will improve. Go the extra mile: Send thank you letters for referrals. Acknowledge special events like anniversaries, graduations, weddings, or funerals. Thank your patients for being on time, complying with your treatment plan, and meeting payment deadlines.
