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Time is Runnning Out for Mandatory Reporting of Medicare PQRS Codes
Time is Runnning Out for Mandatory Reporting of Medicare PQRS Codes avatar

Written by Tom Necela, DC, CPC, CPMA, CCP-P on May 13th, 2013
Topics: Chiropractic Medicare, chiropractic webinars, Medicare PQRS

 

Hopefully, by now, you have heard about reporting requirements for the Medicare PQRS.  Yes they are mandatory and yes, you need to start reporting them this year in 2013 or you will face penalties starting in 2015.

Yes, that’s two years away but the reason time is running out is this:

1) In order to “successfully” report PQRS, you must report the measures on every visit where you have billed a 98940, 98941 or 98942.  In 2013, you must satisfactorily report on both measures at least 50% of the time and perform each measure at least once to qualify for the incentive bonus.

2) The elephant in the room is this:  if your report your PQRS “incorrectly” you may be rolling out the red carpet for a Medicare audit.

If you have no clue about the whole PQRS requirements, don’t know what G-codes I am referring to and obviously haven’t started reporting, here are some quick facts: Read More

Small Chiropractic Documentation Errors That Lead to Big Problems
Small Chiropractic Documentation Errors That Lead to Big Problems avatar

Written by Tom Necela, DC, CPC, CPMA, CCP-P on May 6th, 2013
Topics: Chiropractic Audits, chiropractic documentation

With auditors examining our every move, many chiropractors are growing increasingly concerned about the state of their documentation.  Here’s the really bad news: as a Certified Professional Auditor and Professional Coder myself, I have reviewed countless chiropractic records and many DCs have good reason to worry.

Here’s the good news: this article will teach you how to avoid surprisingly common and easily overlooked mistakes in your documentation that generally spell big trouble during an audit. Read More

Insurance Contract Catastrophes – How Chiropractors Can Avoid Them Before They Happen
Insurance Contract Catastrophes – How Chiropractors Can Avoid Them Before They Happen avatar

Written by Tom Necela, DC, CPC, CPMA, CCP-P on May 2nd, 2013
Topics: chiropractic business, chiropractic insurance, chiropractic practice management

Deceptive-Contracts1-237x300

It’s no secret that chiropractors are all fighting declining reimbursements and a growing portion of fees are being pushed onto the patient by the insurance payers.  In fact, according to Athena Health Payer View 2012, the weighted Provider Collection Burden increased by 7 percent from 2010 – 2011.  In other words, your patients are being forced to foot more of the bill, which then increases the burden on you to collect it.

Because these moves are precisely calculated by insurance companies, chiropractors tend to feel powerless at times. As a result, we often sigh and continue to take the beating. And while reality dictates that we cannot win every battle, we can minimize the damage done to us by insurance payers by learning to recognize which ones will give you the biggest headaches ahead of time.  Certainly, you could easily say that no insurance plan is ideal, but with a little bit of homework, you’ll see that certain plans spell more bad news than others.  Here’s how to spot the rotten apples: Read More

Fasten Your Seatbelt! The Toughest Challenge DC’s Will Need to Overcome (Part 13 of 13 Things Series)
Fasten Your Seatbelt! The Toughest Challenge DC’s Will Need to Overcome (Part 13 of 13 Things Series) avatar

Written by Tom Necela, DC, CPC, CPMA, CCP-P on April 2nd, 2013
Topics: chiropractic business, chiropractic practice management

Of our entire 13 Things You Will Need to Change series, this post will perhaps represent the toughest challenge for many to chiropractors accept and overcome, which is why I have saved it for last. Before I spit it out, let me preface it with three quick thoughts:

a) The old revenue model, purely based on volume, is crumbling. Payers are paying less and less for adjustments and limiting care while expenses continue to increase.

b) Unfortunately, over the last decade or so, utilization has not increased; in fact, the latest stats indicated that the public use of chiropractic has either flatlined or decreased slightly.

c) Simple economics dictate that if the price of your service is decreasing, the frequency of which it is consumed is decreasing and the cost to deliver that service is increasing, you have an impending disaster in the works.

Thus, here is the single biggest change that chiropractors must make: Read More

2 Words Chiropractors Need to Memorize (Part 12 of 13 Things Series)
2 Words Chiropractors Need to Memorize (Part 12 of 13 Things Series) avatar

Written by Tom Necela, DC, CPC, CPMA, CCP-P on March 26th, 2013
Topics: chiropractic practice management

There are two words we need to all memorize and never forget.  When we do, we become small minded about our business and, worse, our own potential.

Most of you know that I’m not quite the motivational speaker type (unless hitting you in the head with a shovel qualifies).  But this one fits the bill, so I’ll keep it short. Read More

The Single Biggest Non-Chiropractic Skill You Need Now (Part 11 of the 13 Things Series)
The Single Biggest Non-Chiropractic Skill You Need Now (Part 11 of the 13 Things Series) avatar

Written by Tom Necela, DC, CPC, CPMA, CCP-P on March 7th, 2013
Topics: chiropractic business, chiropractic practice management

This year, we are starting out with 13 things you need to do.  Quite frankly, I don’t think the number matters. Whether it’s 4 secrets or 7 or 70, there is one absolutely necessary, super vital, umm—ultra important (what else can I say?) thing you need to do with this helpful information. In fact, I was going to wait to put this as #13 of our 13 things series but I’ve received so many whining emails lately about how the economy is killing their practice, I just have to put it forward now.  Here it is: Read More

Chiropractic ICD-10 Training: Too Late, Too Early? (Part 10 of the 13 Things Series)
Chiropractic ICD-10 Training: Too Late, Too Early? (Part 10 of the 13 Things Series) avatar

Written by Tom Necela, DC, CPC, CPMA, CCP-P on February 21st, 2013
Topics: chiropractic coding, ICD-10

I’ve placed this item near the end of our “13 Things series” because, quite frankly, who knows if ICD-10 will actually happen on schedule or at all.

If you’re an ICD-10 threat follower, you undoubtedly know that the powers that be have cried wolf before.  But at the time of this writing (Feb 2013), there are some strong indications that ICD-10 will actually go forth.  Here’s why:

  • There already exists a “code freeze” as far as Diagnosis codes go (ICD-9) and, except in cases, for new diseases or new procedures, there will are no new codes planned.
  • After October 2013, there will be no new codes issued on ICD-9 at all.
  • Any planned new additions to the codeset after October 2013 will take place in ICD-10

Recommendations for ICD-10 Training for Chiropractors and Their Staff

Even though it looks much more likely that the ICD-10 will go through, I’d have some serious hesitations about training my staff anytime before June 2013 (at the earliest), just to make sure that the ICD-10 thing will really happen on time.

Unfortunately, coding “experts” have already been holding seminars this and even last year on ICD-10.  I’m sure that is good income for them but I’m sorry –  if ICD-10 gets delayed to 2015, do you really expect your staff to learn it this year, not use the codes AND remember everything in a couple of years?  For some, even learning things in 2013 that won’t be used until 2014 is pushing it.

Wait it out.  You’ll hear the rumbling getting closer.  Then act!

No Hype, Web Un-Marketing For Chiropractors (Part 9 of the 13 Things Series)
No Hype, Web Un-Marketing For Chiropractors (Part 9 of the 13 Things Series) avatar

Written by Tom Necela, DC, CPC, CPMA, CCP-P on February 13th, 2013
Topics: chiropractic business, chiropractic practice management

This post may come as a surprise to many of you as I don’t have any cool marketing names attached as a tagline that brand myself a self-proclaimed marketing “guru,” “genius,” “maven“ rainmaker or even noisemaker.

But, like it or not, our businesses all need marketing in some shape or form. And because of that, I am a student of many in this regard.  Mostly, I don’t look at chiropractic marketing experts because the bulk of them have just borrowed their ideas from each other and a select few, from real marketing heavyweights.

As the healthcare landscape changes in 2013 and beyond, I believe that many chiropractors will be forced to take a more serious look at their marketing efforts.  Some, in fact, who have not given a thought to marketing in a decade or more, will need to begin anew or face the consequences as they watch their numbers slowly take a dive.  Newer DC’s will have to master marketing skills that they were definitely not taught in school, as most materials that would appear in such a classroom are dated by a decade at the least.  So where do we turn? Read More

Avoiding Chiropractic Documentation Slop & the Slap That Follows (Part 8 of 13 Things Series)
Avoiding Chiropractic Documentation Slop & the Slap That Follows (Part 8 of 13 Things Series) avatar

Written by Tom Necela, DC, CPC, CPMA, CCP-P on February 7th, 2013
Topics: chiropractic documentation, chiropractic EHR, chiropractic EMR, compliance

Despite all the warnings, ranting, raving and rumors about audits, there is still a lot of — for lack of a better term — chiropractic  documentation “slop” out there.

I use the term “slop” as opposed to “sloppiness” because I am not simply referring to messy or illegible handwriting on chiropractor’s notes, although there is definitely plenty of that to go around.  Instead by “slop” I am referring to a much more broad-based problem that encompasses a lack of legibility, lack of completeness and a lack of effort.

Yes, sloppy, incomplete and lazy documentation will get you in trouble.  Worse, there is little to no defense on your part.  No auditor is ever going to call you up and ask you to translate your hieroglyphics that are masquerading as your notes.  No nurse who is reviewing your notes (yes, many nurses and few DC’s will ever see your documentation) and ask you to explain exactly what you mean by your chiro-speak.  And unless you are very unfortunately called into court, you will not get the chance to explain your rationale for care, the kinetic chain and why you adjusted the patients big toe when their only chief complaint was neck pain (and if you are, you may be even less fortunate than the DC whose care was just denied in the first place).

Here it is, served up unadorned on a tin platter for your eatin’: like it or not, in 2013, you’ve got to change your documentation “slop” — or else.

Now that we got that big glass of cheer out of the way, here’s how: Read More

Why the Solo Days May Be Numbered for Chiropractors (Part 7 of 13 Things Series)
Why the Solo Days May Be Numbered for Chiropractors (Part 7 of 13 Things Series) avatar

Written by Tom Necela, DC, CPC, CPMA, CCP-P on January 31st, 2013
Topics: chiropractic business, Chiropractic Exit Strategy, Chiropractic Partnership Sale, Chiropractic Practice Purchase, Chiropractic Practice Sales, Chiropractic Transition Planning

Here’s an idea that more chiropractors need to embrace in 2013 and beyond: the days of the solo doc may be numbered.

Why chiropractors fail to embrace the concept of a group practice, shared space, partnership or associateships is beyond me.  For the most part, we are among the only sizable solo entrepreneurs left in health care.  Sure you can still find the occasional massage therapist who practices out of their home gently kneading to the sounds of their Windham Hill cds. And I know there are lonely acupuncturists who would love someone else to share their moxa, but for now they sniff alone.  Certainly, there are still naturopaths brewing their own tinctures in their back closet, happily (or not) by themselves.  But many of these practitioners have tiny businesses and see few patients.

The rest of the healthcare professionals who have significantly broken the 6-figure revenue barrier – they work together. Except that is, for us. Unfortunately, as healthcare dollars get pinched into pennies, we may need to take a serious look at the feasibility of our “solo-ness.”  Here are a few reasons we should consider aligning with similar minded DC’s: Read More

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