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The Impact of Medicare Fee Cuts on Your Chiropractic Practice
The Impact of Medicare Fee Cuts on Your Chiropractic Practice avatar

Written by Tom Necela, DC, CPC, CPMA, CCP-P on March 30th, 2010
Topics: Billing, Business, Medicare, chiropractic billing, chiropractic business, chiropractic practice management

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Despite the best efforts, lobbying and protests of every major physician association (including the American Chiropractors Association and the International Chiropractors Association), the 21% Medicare fee cuts are still scheduled for April 1, 2010.

For those of you who hope to lessen the blow of this bad news by taking comfort in the fact that a relatively small portion of your practice consists of Medicare patients – think again.  This fee cut (which by the way, is scheduled to be a nice, round 20% reduction for Chiropractic fees) will impact all of your third party reimbursements in time!

This is due to the simple fact that most third party payers use the Medicare fee schedule as a basis to calculate their own reimbursement decisions.  Read the fine print in your contracts and you will find that ABC Insurance pays 150% of the Medicare allowable or XYZ Insurance’s fee schedule is set at 175% of Medicare.

So, yes, at this point, there is no good news to report about this Medicare situation, which will go into effect April 1 or as soon as the carriers can get to the business of revising their reimbursement calculators to ensure that the screws on our Medicare torture chamber are nice and tight.

If you can find your state representatives and senators (you may have to watch some MTV programming or track them down in some tropical paradise, as it is spring break for most), be sure to let them know how disappointed you were in their inability to block this legislation and take 20% out of your already dismal Medicare paychecks.

In the meantime, my other recommendation is to consider this slap in the face a brutal wake up call that it is high time for you to start improving your practice.  Take a look under the hood and see what needs tuning up.  Then, promptly get to work on tweaking for additional performance.

If you need some guidance in the area of what’s going wrong, what to fix or where you stand, fill out my free, no obligation Practice Analysis Questionnaire and I will take a look with you.

Unless we get some sort of last minute reprieve, making no changes in your practice whatsoever will likely result in a 20% loss of your income in the near future if these Medicare fee cuts reach their full impact.  I don’t know about you, but I am not willing to let anyone – whether it is the government, Goliath or any goon bigger than I am – take 20% of my income without a fight and some definite activity on my end to make up for the difference.

Contact your political reps.  Start formulating Plan B.  And let’s get to work on making lemonade out of lemons!

In the meantime, keep these words of Alistair Cooke in mind:

“In the best of times, our days are numbered. And so it would be a crime against nature for any generation to take the world crisis so solemnly that it put off enjoying those things for which we were assigned in the first place: the opportunity to do good work, to fall in love, to enjoy friends, to hit a ball and bounce a baby.”

To Your Success!

Tom Necela, DC

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Solutions to Your Chiropractic Billing Problems
Solutions to Your Chiropractic Billing Problems avatar

Written by Tom Necela, DC, CPC, CPMA, CCP-P on March 23rd, 2010
Topics: Billing, Business, Chiropractic Seminars, chiropractic billing, chiropractic business, chiropractic coding, chiropractic practice management, chiropractic webinars, seminars

blind leading blind

Solutions to Your Chiropractic Billing Problems

Warning: this post may be offensive to some (not because of language or explicit matter) but because those who it irritates are probably most in need of hearing it.

The subject matter: your billing department and its problems.

Because I don’t see your statistics here in front of me, I can’t say for sure which problems your chiropractic practice is facing due to your billing department.  But for many of you, I can venture a guess that it is either poor collections, delayed payments, denied claims, labor intensive systems or a combination thereof.

And unlike the glaring problem of not having any new patients, billing challenges tend to dwell suspiciously beneath the surface until one day you notice you are $10K , $20K, $30K or more off your collection goals.  At that point, you are painfully aware that there is a problem and you begin to scramble for a solution.

Flawed from the Start

Many of you will scratch your head and wonder how this happened.  After all, in many (if not, most) chiropractic clinics, the billing person is the most trusted employee of all.  This is because  it is typically the spouse of the doctor who does the billing.  And this person has been handpicked, trained and has a vested interest in the success of the clinic.

While this may be true, let’s analyze that a little closer.

Handpicked? Certainly, because the budget did not permit a person of adequate skill or experience to fill the position and the spouse is willing to work “for a while” until things get off the ground.

Trained?  Ah yes, the billing person is under the careful tutelage of the doctor who received…absolutely zero training on billing or coding in chiropractic college and whose continuing education credits in the matter curiously blend in with advice from would be know-it-all colleagues who are likely just as clueless in this department, however good intentioned they may be.

Truly, this is a case of the blind leading the naked (sorry for the warped 80’s reference).

Vested interest?  This certainly is accurate. The spouse is probably the most motivated employee in the clinic.  I have seen cases where I would even replace the doctor with the spouse, would it be possible.  But the Olympics provide you with an excellent example of why this is not enough.  Every Olympian is obviously motivated enough to win; they would never had made it their without superior powers of motivation.  But in the end, skill prevails.

My Billing Stinks – What Next?

For those of you who did not need the brutal awareness that you have sent your well-meaning spouse to dine with the wolves, you too may be cognizant of the fact that, well, your billing is less than stellar.

Certainly, it is still possible for your billing person to be a slacker, inept or just not quite as effective as they could be or should be – even if they are not related to you and/or may have impressive looking credentials under their belt.

The good news is that (hopefully) you don’t go to bed with this person and are not bound by marital ties.  Because of that, they are much easier to replace, if necessary.

Before You Give Them the Boot…

Regardless of who your billing person is, if you find yourself in a huge mess, or if you would rate your employee as an “F,”  let the first letter of that rating be a clue as to what you should do.

But for everyone else, there is hope.

After all, a good employee can only rise to the level of the training and the expectations they receive.

Unfortunately, doctor, this means YOU need to get to work!

How to Rescue a Poorly Performing Billing Department

The first steps to rescuing your billing department’s deplorable performance is in your hands and here is what I would recommend:

  1. 1. Monitor the Money. If you were to chart your monthly collections and the results look like a roller coaster ride, likely you have internal issues that need fixing fast.  But the only way to figure out where to apply corrective actions is to begin studying your collections, your accounts receivable and your revenue cycles.  For more assistance in this department, see How to Oversee Your Billing Staff & Service.

  1. Provide Your Biller With the Tools & Resources They Need. I haven’t tracked it precisely, but I believe there is a direct correlation between the age of your coding book and the amount of billing problems that exist in your office.  Worse, every practice that I have been that does not even own a coding book, has multiple billing issues which can potentially take months to fix.  Quit sending them to work without a tool box.  Get them the latest ChiroCode book, (see here for a link to FREE SHIPPING on the 2010 ChiroCode book and don’t say I never give anything away free).
  1. Commit to Ongoing Training for Your Billing Person. Have them attend the FREE monthly webinars that ChiroCode offers (as they are full of useful info unlike most other “free” webinars that our profession uses for an hour long sales pitch).  This week on ChiroCode webinars is yours truly.  Join your staff for seminars on billing, coding or documentation.  I have two coming up and I guarantee you will BOTH learn enough useful info that it is well worth the trip regardless of your distance.  Ignorance is costing you more than you realize.
  1. 4. Give the biller realistic job expectations. Some offices want their billing person to double as the world’s most friendly front desk person AND the most tenacious collections bulldog a delinquent patient ever had the misfortune to encounter.  Good luck with that.  Rare is the bird that can sing both of those tunes.  If you have one, hang on tightly.  If not, consider re-defining your staff job descriptions so that each team member can excel at some needed roles in the clinic, but is not required to be a superstar at everything to meet your approval.
  1. 5. Leverage Their Time. Some clinics have a broadly defined definition of billing that encompasses everything and anything to do with money. As a result, the billing person is responsible for: sending claims, posting payments, reconciling accounts receivable, sending statements, verifying insurance, handling patient finances, presenting care plans, over the counter collections, depositing funds into the business bank account and making change for the pizza guy who delivers the staff meeting lunch.  While all of these things may technically revolve around money, it may not be efficient (or cost effective!) for your billing person to handle them, particularly if they are the highest paid employee or if their desk routinely resembles Oscar Madison’s apartment (for those of you old enough to remember The Odd Couple).  Instead, delegate tasks that don’t require billing expertise (running the envelopes for the statements through the postage meter is a favorite time waster that I see too many billers involved in) and let them focus on bringing in the money and higher value activities.

Know When To Fold ‘Em

While I don’t routinely promote Kenny Rogers as a source of wisdom, sometimes you have to just take his advice and “know when to fold ‘em.”  That is, give up the goat and outsource.  Examples:

  • Recently, a doc approached me about opening a new clinic with wife as biller and mom as office manager.  Neither have worked in chiropractic before. Neither have any training.  This is a nightmare waiting to happen.  Why would you want to start your business with your most ignorant foot forward for all the world to see?  They should outsource.
  • A marginal clinic has a poorly trained CA doubling as a billing person manning the ship.  They have no money to hire a decent person, nor can they afford to send the CA for training since she wears all the hats in the clinic. Their practice is spiraling downward since the CA can’t figure out why their collections are in the toilet, mainly because she has no clue where to even start.  My two cents: outsource & pronto!

When To Get Help

There is another option available for those of you who are unwilling to throw in the towel or for those would benefit from guided expertise.  Quite simply, it may be in your best interest get some professional help.

For a free, no obligation look at how I may be able to assist you, complete the Practice Analysis Questionnaire and send it in for my review.

And while you may think that getting professional help can be cost prohibitive, consider some scenarios I encountered while working with my consulting clients who hired me for this purpose.

  • During a recent office consult, I provided a solution for one issue that the billing person (who is excellent at her job) was struggling with.  We analyzed a handful of claims that all were denied due to this problem and unsurfaced approximately $8000 worth of reimbursable services that she will correct and get paid for.  The savings will be further capitalized multiple times over when she applies this same correction to the dozens of other claims with the same situation.
  • Another client (again, with an excellent biller) had repeatedly made one innocent coding mistake to the tune of $60,000 per year in botched income and services.
  • A struggling office was able to increase its billable services from an average of $39 per patient to $64 per patient within 2 months of my consulting, which will yield a $90,000 increase this year – even if they do nothing else!

Bottom line:  billing IS a major factor in your bottom line.  It is too big to ignore and too critical to be left in the hands of an unskilled employee.  Get a handle on your billing and you will be able to steer your practice in the right direction.  Let it go adrift and you will likely sail into dangerous waters.
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The Power of Reciprocity & The Price of Indifference in the Chiropractic Office
The Power of Reciprocity & The Price of Indifference in the Chiropractic Office avatar

Written by Tom Necela, DC, CPC, CPMA, CCP-P on March 16th, 2010
Topics: Business, chiropractic business, chiropractic practice management

reciprocity-logo

Today’s topic: reciprocity.  Or more specifically, how to harness the powers behind this principle to help you improve patient relations, your business and your bottom line. And how to avoid the price of indifference on the part of your patients.

Let’s begin:

First coined in 1766, Webster defines Reciprocity as:

  1. the quality or state of being reciprocal : mutual dependence, action, or influence
  2. a mutual exchange of privileges; specifically : a recognition by one of two countries or institutions of the validity of licenses or privileges granted by the other

In chiropractic terms, both are entirely accurate.  As doctors, we sometimes fail to realize that there is mutual dependence going on within our business: our patients depend on us for our expertise in restoring their health; we depend on patients to pay us for our skills.  Additionally, this mutual dependence is a privilege – again, for both parties involved.  The patient is privileged to have access to our health care and the ability to pay for it.  As chiropractors, we are privileged to have paying patients who need our services.

Since we have now established that there indeed exists Reciprocity within the very nature of our patient-doctor relationship, the question is: what are we doing to enhance, improve or encourage the development of this relationship with our patients?  Here’s the key: our ability to engage the power of reciprocity enables us to irresistibly build our business and magnetically attract patients.

In fact, it is what much of the astounding success of entities like Facebook, Twitter, LinkedIn and other various social media sites have captured that has enabled them to exponential grow their businesses.  Not to mention the countless other examples of reciprocity that cause you to somehow be irresistibly attracted to whatever site, service or sale that is being offered.

Facebook, Twitter, LinkedIN all use it – why can’t you?

And you can use these same principles in your practice! Sound enticing? Read on!

Here’s a common example:  You receive an “invitation” from a long lost acquaintance, not quite a friend but at least neutral enough not to be an enemy.  It’s begs you to “friend” them on Facebook. Bizarre as it may seem, and even though you know the game, you go ahead and accept the invitation even though you may not really have much interest in re-kindling what was never much of an acquaintance or friendship in the first place.

Let’s go one step further:  another person, less than an acquaintance, sends you a request to  “follow them” on Twitter.  Again, you accept, not really knowing why but not wanting to refuse either.

And one last example:  someone you don’t even know sends you an invite to become LinkedIn.  You see from their circle of colleagues that they have friends or business associates in common.  And even though you may not know them personally, you accept.

All of these web 2.0 invitations work on the power of reciprocity and you gave in to it each time.  But this principle is certainly not limited to the web and, in fact, has been tapped quite effectively by scores of other businesses, charities and individuals who succeeded for the very same reason.  And here it is.

It is part of our natural instinct to want to give back to someone who first gave something to us.

It doesn’t even matter whether it is something so small as a web invite. Or a flower from a Hare Krishna (for those of you old enough to remember them).  Or an envelope in the mail that contains a free gift (the most microscopic pin with an American Flag and return address labels) and asks you to donate to the Veterans of the ABC War Fund.

And now you are swept in by the Principle of Reciprocity and you suddenly find yourself doing exactly what they are asking you to do.

Reciprocity in the Chiropractic Office

So how does this relate to our patients?

Quite simply, how are you giving back to them?  In challenging economic times, many chiropractors are foolishly cutting back on their budgets to make room for more “necessary” items.  Gone are the dollars spent on advertising. Gone are the dollars spent on new patient welcome kits, thank you cards and little gifts for being a patient or referring a new one.

And with it, gone is the understanding of what these items do for your practice and your patients. Gone is the power of reciprocity.  Gone are its tangible benefits because your patients no longer feel like “they owe you” but instead they feel like you don’t even care.

Here are a few ideas for harnessing the power of reciprocity in small, concrete ways which will stimulate your patient to give back to you in return:

  • Say “thank you” to every patient on every visit and train your staff to do the same
  • Distribute a “welcome kit” to all new patients that gives free samples of products you may use or recommend in the office
  • Give an educational book about chiropractic instead of just a pamphlet or brochure, as it has more value and is more likely to be read rather than thrown away. (Certainly, I recommend Beyond Back Pain for this purpose!)
  • Offer to spend time at local schools or performing corporate ergonomic evaluations
  • Have your massage therapist do short, promo chair massages
  • Have patients bring in their current medications, vitamins so that you can review them and see if what they are taking is appropriate and in their best interest
  • Ask if there is anything else you can do to help them.

Certainly, if you don’t express other ways of showing care or concern, a little gift or a new patient welcome package won’t make up for your lack in other areas.  But consumer research shows that one of the greatest reasons your patients (or any customer leaves) is rarely for what we think it is.

In fact, here is the breakdown from a recent survey polling healthcare offices of different disciplines.  Patients leave because:

  • 1%          Die
  • 5%          Move away
  • 6%          Financial concerns
  • 14%        Unhappy with service
  • 16%        Left due to lack of convenience (too far to drive, etc)
  • 58%        Displeased with attitude of indifference on the part of staff/doctor

Obviously, the power of reciprocity was not at work.  The patients didn’t feel they owed you anything because they didn’t even feel that you cared.

The take home message is quite simple:  do everything in your power to show your patients you care and use the power of reciprocity to engage them to reward you for that care by giving back to you in the form of loyalty, referrals and the ongoing support of your business.

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Chiropractic Compliance Concerns, HIPAA Hassles and Practitioner Paranoia
Chiropractic Compliance Concerns, HIPAA Hassles and Practitioner Paranoia avatar

Written by Tom Necela, DC, CPC, CPMA, CCP-P on March 9th, 2010
Topics: Audits, Business, HIPAA, compliance

hipaa compliance

Just in case you were actually focusing on your practice and not glued to the news, HIPAA television and the endless assault of compliance related emails that cross your desk, we had three significant deadlines in February that seem to have rattled a significant number of you.

Even though I may not know you personally, I am going to extend you the grace of assuming that you are not normally paranoid, panicky or otherwise possessive of a peculiar tendency to “snap” when confronted with the politics of change that besets our profession.

So, let me first gently remind you of the deadlines of which you may or may not be aware.  And then, I’d like to put your mind at ease over a few items that repeatedly hit my email inbox and drip with panic-driven sweat and media-fueled fear.

The Deadlines

  • New requirements for “Business Associates” – Deadline: February 17, 2010 HIPAA rules were strengthened by extending the responsibility for protection of PHI to “Business Associates.” Under the new law, the “Business Associates” have the same responsibilities for any breach of private health care information as do the provider of the services. “Business Associates” would include Attorneys, Consultants, Accountants, Third-Party Billing Companies, Computer Vendors or maintenance companies, etc. For a more detailed description of this requirement, see my previous blog entry on “Mandatory HIPAA Updates.”

  • Disclosure Agreement Provision – Effective: February 18, 2010
    Patients have the right to pay in full for out of pocket expenses for health care services and request that your practice not disclose his or her medical information to a health plan or other entity. Your practice must comply with this request. Make sure that all your employees are informed about this provision and modify notification or follow-up procedures where applicable. This is information that will have to be shared with all employees in the medical practice that is involved in health information and insurance processing.  This one is not likely to happen too often, but regardless, you are still required to follow the rules should it occur.  Essentially, if you have a patient that is under- or non-insured and pay for services in cash (or credit card, check), they have the right for their info to remain silent.
  • Information Breach Notification – Effective February 22, 2010
    New provision requiring that HIPAA covered entities such as physicians notify patients (and Business Associates notify the partnering entity) of any breach of health care information. If a breach involves 500 people or less, the responsible party must notify each affected individual by written notice. This notice must contain the details of the breach, the information disclosed, and the steps being taken by the practice or entity to avoid any future breaches, as well as explaining the rights of the patient(s) in protecting their private healthcare information. If the breach involves more than 500 persons, the Act requires that the Department of Health and Human Services be notified as well as the local media outlets.  Hopefully, this one will never happen, but you should be aware that if it does, there are required steps to take.

The Reality of the Situation

Of those three new HIPAA requirements, I do not see any as the reason to hit the panic button.  Rather, get your Business Agreement in place and train the staff on the other two, should the need ever arise.

As for other recent news affecting our practice (and for which I received a lot of email),  the President did signed into law a bill that delays Medicare Fee cuts until March 31, 2010.  Hopefully, this delay will be prolonged at least until 2099 or until the government gets its Medicare act together, in which case the 2099 date may happen first.  On this item, continue to make your voice known through your state and national associations and hope that we make enough collective noise to stop the feds from cutting our paychecks.

Again, no need for panic, but action may be helpful.

Some FAQs About Chiropractic Compliance Measures

The one interesting byproduct of chiropractors who begin to get their compliance act in gear is that more questions begin popping up over everyday matters.   Suddenly, policies and procedures they have utilized for years become the subject of much questioning, much needed revision and, in some cases, not so needed fear.

To set the record straight, here are a few items that I would like to clarify for you so that you can fully understand your responsibilities and which side of the compliance fence that you stand.

  • Q. Our practice confirms patients’ insurance coverage by contacting their health plans the day before their appointments to verify coverage and patients’ financial responsibility. Do we need their consent or authorization to contact their health plan? A. Patient consent or authorization is not necessary to disclose PHI for coordination of benefits, which is considered part of your treatment.  Per HIPAA [45 CFR | 164.501] the full definition of treatment includes: “the provision, coordination or management of health care and related services by one or more health care providers, including the coordination or management with a third party
  • Q:        Are sign-in sheets or calling out the next patient’s name in the waiting room – allowed or not allowed? A: Yes, they are allowed. Believe it or not, if you actually sit down and read through the HIPAA regulations (sick and twisted) one of the intentions behind HIPAA that you will repeatedly see mentioned is “administrative simplification.”  To this extent these activities result in other people learning a patient’s name or other information, the disclosure would be considered “incidental” to your of the patient, and therefore acceptable under HIPAA.  (7.6.2001, OCR HIPAA Privacy TA 164.000.001 FAQ) Chiropractors should still take appropriate precautions to limit the amount of information that might be incidentally disclosed in this manner. For example, you may not want to ask patients to list “reason for visit” on a sign-in sheet. With respect to placing charts outside of your adjusting rooms, you should take precautions such as turning the front of the chart towards the wall so others do not have the opportunity to read the front page while walking past the room.
  • Q:  What about billing electronically, EMR and all these new proposed regulations? Am I going to be required to do all of this? A:  While it may make sense for many individuals to move as much as their practice as possible to an electronic format, you have two reasons to rest easy.  1)  Several proposed requirements for electronic communications are still in the future and so there dates may be delayed or never quite arrive.  2) You may be an exception to the rule anyway.  For example, back in 2003, providers were supposed to be required to bill Medicare electronically.  However, this requirement does not affect many chiropractors, as there are exceptions to physicians with fewer than 10 full-time employees. [42 USC | 1395y(h)]

Keep informed so that you know what you are required to do, but don’t get paranoid. Focus on your practice and your patients. Sleep easy.

Best wishes for continued success!

Tom Necela, DC


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Low Cost, High ROI Strategies for Maximizing Chiropractic Income (Tip #148)
Low Cost, High ROI Strategies for Maximizing Chiropractic Income (Tip #148) avatar

Written by Tom Necela, DC, CPC, CPMA, CCP-P on March 9th, 2010
Topics: Uncategorized

piggybank-phone

Today’s blog post is a quick tip for all of you looking for practical ways to maximize your income that fall into the “low cost, high ROI” category.

For those of you already utilizing this tip, congratulations! Now keeping looking for other ways to improve your business.  For those of you who are not, make the small investment in time and money and get going!

As you know, most of our best patients come to us from referrals from our existing chiropractic patients.  But even though we often stress the value of this to our team and to our patients, after a while we (meaning you and/or the team) forget to ask or introduce the concept of referrals.

Here’s a low profile, non-pushy solution that I have found very helpful…

Most chiropractic offices have background music playing throughout the office and on the phones when you place a patient on hold. Many even play a local radio station which can potentially advertise for another practice down the road!

Instead, why not use a Message on Hold service that can create an “automatic referral generator” for your practice by announcing services, specials, promotions or features of your practice for you in brief, 30 second “commercials.”

If you are using an iPod connected to speakers to pipe in your own tunes, why not go one step further and load a pre-recorded commercial (of the same type that you use for on-hold music) into your iPod mix?  Then, every x number of songs, you have a short commercial break – with you as the feature!

Topics for your commercial may include:

  • Unique or new features of your office (Spinal Decompression, Massage Therapy, Cold Laser, Nutritional Counseling, etc)
  • Announcements welcoming new staff
  • Promotions or upcoming events
  • Invitation to refer family and friends

Particularly if you are busy, that last message can go a long way towards bringing new patients into the office.  In my own practice, I have never stopped accepting new patients, but because of a busy schedule, it is amazing how many patients may assume that you no longer see any new patients.

15 seconds of a pre-recorded message played over the phone and/or when they are in treatment rooms can serve as a gentle reminder or plant a seed for referrals.

And here’s the best part.

It requires no scripting for the staff, doesn’t need to be remembered, is non-aggressive enough for even the most timid doctors and keeps going 24/7 (or for as long as you choose to use it.)

These little audio commercials may only last 30 seconds but you will be surprised how many patients comment about them – which means they are listening to your message.  Which is exactly what you want!

Once you have your audio message personalized and professionally recorded, simply put it into use and you are ready to go.  Change the message every few months to keep it fresh and interesting and that’s about all you have to do.

Costs are minimal and the return on this type of ongoing marketing is typically exponential in increased services, new patient referrals and patient education.

Become the “star” of your own practice and utilize audio messages to promote your practice and maximize your income today!

To Your Success!

Tom Necela, DC

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Medicare Fee Cuts Update for Chiropractors
Medicare Fee Cuts Update for Chiropractors avatar

Written by Tom Necela, DC, CPC, CPMA, CCP-P on March 2nd, 2010
Topics: Business, Collections, Medicare, chiropractic billing

file_6

In the usual right up to the wire, last minute fashion common amongst government entities, Medicare (CMS) issued the following statement regarding the proposed Medicare fee cuts that were supposed  to go into effect Monday, March 1, 2010:

“CMS is working with Congress, health care providers, and the beneficiary community to avoid disruption in the delivery of health care services and payment of claims for physicians, non-physician practitioners, and other providers of services paid under the Medicare physician fee schedule (MPFS).  The Department of Defense Appropriations Act of 2010 provided a zero percent (0%) update to the 2010 MPFS effective for dates of service January 1, 2010, through February 28, 2010.

We believe Congress is working to avoid the negative update that will take effect March 1, 2010.  Consequently, CMS has instructed its contractors to hold claims containing services paid under the MPFS for the first 10 business days of March. The holding of MPFS claims will only affect claims with dates of service March 1, 2010, and forward.  This hold should have a minimum impact on provider cash flow because, under current law, clean electronic claims are not paid any sooner than 14 calendar days (29 for paper claims) after the date of receipt.”

In other words, Medicare still doesn’t know whether or not there will be a fee cut.  And in the meantime, they will hold your claims and do nothing.  But, no worries, by law they have 14 calendar days (for electronic) and 29 calendar days (for paper billing) to get their act together and decide what you will be paid.

Presumably, you have nothing better to do than check the Medicare website (or that of your carrier) for the moment when the decision is finalized.

For an organization willing to slap a fine on you for “inducements” of any gift in excess of $10, they are not worried in the slightest on how their financial sloppiness affects our patients.  Sure, Medicare claims their indecisiveness “should have a minimal impact on cash flow” because they have the grandest of intentions of still paying you on time. (The failure of which will likely be the subject of a future statement released by CMS.)    However, notice the conspicuous lack of advice on matters of over-the-counter fee collection whilst we all wait in limbo.

Should we collect based on the 2009 fees, the anticipated fee cut, the negotiated slightly reduced compromise fee cut or anything in between?

In reality, for chiropractors the fee cuts – however large or small – may have a relatively minimal impact on our bottom line, especially when compared to other specialties.  After all, even a 20% reduction on a $35 is $7.   Not pleasant, but not likely to break the bank.

What will add insult to injury is the calculation of the difference between what you are collecting now and what you should have been collecting on March 1 and the time differential that Medicare notifies you about what should have been done, had they informed you on time, along with the positive or negative financial accounting and remuneration that goes along with it.

If you can read and comprehend that sentence (and I am not sure I can, even though I wrote it!) you will likely have no problem with the upcoming changes.  Perhaps you should even go to work for CMS as a translator or policy writer.

For the rest of us, here’s the skinny in plain English and my recommendations:

  • For now, there is no Medicare fee cut (nor any fee raise)
  • Continue operations under your 2009 local carrier fee schedule
  • Collect any co-pays or patient portions with no changes
  • That way WHEN Medicare does release their fee schedule, you can accurately calculate whether you owe the patient or they owe you more.
  • Get ready to support your state and national associations to oppose drastic fee cuts
  • Write to your Senator to oppose the fee cuts and tell them what a ridiculous inconvenience these shenanigans are for you and your patients (their constituents)

(Please note, these are my recommendations, not requirements, as there are no new requirements yet!)

If this frustrates you, hey at least you know you are alive.  It is my understanding that the dead do not experience such emotions.  On the bright side, US Citizens are not the only ones subject to the frustrations of their ruling class.  Other countries do, however, formulate protests with a bit of humor which makes the bad news go down easier.  For example:

  • In response to frustrations with city council, the 1959 election in Sao Paulo Brazil featured Cacareco, a five-year-old female rhinoceros, who ran under the platform “better to elect a rhino than an ass.”  She won by a landslide.
  • In 1967, in anticipation of municipal elections throughout Ecuador, the Pulvapies foot powder company launched an advertising campaign that featured the slogan: “Vote for any candidate, but if you want hygiene, vote for Pulvapies.”  Apparently the hygiene of the area had slipped so badly under the current regime that Puvapies won the election, under protest from actual human candidates.
  • The all-time winner of electoral protest goes to Guinness book of World Record holder, Lord Sutch whose platform was “Vote for insanity — you know it makes sense.” He campaigned in a top hat and leopard-skin tail coat. His proposals included bringing back the village idiot, putting joggers on treadmills to make them generate electricity, breeding fish in wine so they could be harvested ready-pickled, converting coal mines into bungee-jumping centers (and making local politicians be the first to test them), and making all dogs eat phosphorescent food so that their poop could be seen at night.

Stay tuned for more details and in the meantime, keep your nose to the grindstone because Medicare may be paying you less money for more work very soon, (maybe).  Your other option is to follow the advice of the “bang head here” group and hope this resolves quickly, though I am not sure I recommend that route.

Keeping you informed (like it or not!),

Tom Necela, DC

P.S.  For those of you who wish to Work Smarter, Not Harder in spite of the wave of regulations, rules and changes Medicare and any other third party payer throws at you, I have two upcoming seminars in Seattle and Portland on Chiropractic, Billing, Coding, and Documentation Mastery (click link for more details an registration)

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