The emails have been pouring in, my phone ringing constantly.
So many, MANY chiropractors want to know the same thing:
“Why the sudden increase in Medicare denials?”
“What happened? This past week we got flooded with 67 requests for documentation!”
“Are we doing something wrong? We received over 50 requests for detailed notes in one batch!”
Today I’m going to speak to you about a mandatory format conversion for your electronic billing that you must do by January 2012 or you will not be paid! If 2012 sounds like a long way away, you should know that testing for the 5010 conversion starts now — in April 2011!
Specifically this format conversion is called 5010 and you might’ve heard of it as a HIPAA 5010 Format Conversion or “mandatory claims reformatting.” Lots of chiropractors have been emailing me for advice on what to do, where to go for information and what exactly is required for the conversion.
First — a reality check. Do NOT be fooled by the term HIPAA! One reason I told you up front that you will not be paid and I didn’t mention HIPAA is that I know chiropractors by in large ignore lots of things related to HIPAA. They think, “Well in I’ve never seen a HIPAA policeman” or “this is just some low priority compliance items I can handle later.” This is entirely different!
This 5010 conversion is mandatory if you do ANY sort of electronic claims transmission or electronic billing. Read More
As we discussed in my last post, Expedited Agreements and Other Fee Negotiation Scams Waged at Chiropractors, insurance payers are continually rolling out new tactics to avoid releasing claim payments or to minimize reimbursements.
Accordingly, your standard operating procedures may longer be sufficient to get you paid for all the good work you do. One overlooked but vital tool to accomplishing this is your Insurance Verification Form. As such, now may be time to enhance your verification of benefits to insure that emerging claim processing tactics are identified and thwarted.
Unfortunately, most chiropractic offices are employing few, if any, of these tactics. Instead, they are doing insurance verification, “the way we have always done it” and getting the same (or worse) results. Read More
Many of you have probably received a letter similar to the one pictured below offering you “expedited” handling of the reimbursement owed on an outstanding claim.
This scam is being used by a number of different companies who contract with payers to primarily (but not exclusively) target out-of-network providers. These letters, which are often received by fax, propose to “expedite payment and decrease the patient’s responsibility.”
While this sounds admirable in theory, a quick look at the math behind this proposal will illustrate why you should feed such documents to a hungry shredder as quickly as possible. Look at the example below: Read More
By request, we have taken our popular seminar and brought it into your home/office via WEBINAR! Read More
For those of you who did NOT attend my recent seminars in the Northwest, here are a few items you missed!
For those of you who attended, as promised, here are the specific references and places to go for the information that was not included in your notepacket.
Tom
P.S. If you did NOT attend my recent seminar, be sure to read the bottom of this post for a Special Offer!!
P.S.S. Seminar attendees — I used this picture above to stimulate your memory to…stop giving it all away! 
Read More
Too many chiropractors have a lingering problem with debt in their office — and it is literally killing their practice and their profits.
By debt, I am not talking about how much you owe on your student loans, your credit card or even how much business debt you may have due to capital expansion loans, lines of credit, etc.
The debt to which I am referring is bad debt, as in, uncollected accounts receivable. In other words, services you have already performed, but for which payment has not yet materialized. Read More
For those of you who are wondering why I am devoting three blog posts to the Chiropractic Comparative Billing Report, it is this: even if you did not receive a CBR, there is a wealth of opportunity and danger in the data derived from the CBR. Put simply, Medicare has sent the CBR as warning signal (for some of you) that what you are communicating to Medicare (and other payers) may not comply with guidelines and meet the requirements you need to get paid.
While none of your results from the tables or graphs from the CBR should be viewed as a problem in and of itself, there are a few “dangerous” conclusions that you definitely do not want drawn from your practice patterns – whether or not you received a CBR. Read More
In Part One of this post, we discussed how to interpret some of the data from the Chiropractic Comparative Billing Report issued recently by Medicare to 5000 DC’s around the USA as well as made some proactive suggestions for improvement.
In this installment, we will discuss the data from the remainder of the Comparative Billing Report (Figure 2 and 3) as well as how to draw some conclusions from the CBR data about your practice. Read More
This past week or so, 5000 chiropractors nationwide received a “present” in the mail in the form of a Chiropractic Comparative Billing Report (CBR). Even though I had previously reported that this would happen (see my previous post “Medicare Releases Chiropractic’s Comparative Billing Report Pilot”), my email inbox now knows what it must feel like to be a postal carrier during the holiday season.
Although, the CBR is not punitive or an audit per se, the report has certainly stirred up strong feelings in our profession and got a whole lot of people suddenly worried about their billing practices and level of audit risk.
At this point, it is not humanly possible for me to respond to all the emails that I have received on the CBR from the profession at large.
However, I will offer the following blog post to address many of the common concerns and questions I have received from chiropractors wondering what to do about their CBR. Read More
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