Billing | The Strategic Chiropractor

How to Interpret Your Chiropractic Comparative Billing Report

Written by Tom Necela, DC, CPC, CPMA, CCP-P on November 2nd, 2010

Topics: Audits, Billing, Business, Chiropractic Audits, chiropractic billing, chiropractic business, chiropractic documentation, compliance, Documentation, Medicare

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

How Do Chiropractor Salaries Compare to Other Health Professionals?

Written by Tom Necela, DC, CPC, CPMA, CCP-P on October 26th, 2010

Topics: Billing, Business, chiropractic billing, chiropractic business, chiropractic practice management

Wondering if the recession has hit your practice and your wallet as much as other DC’s or even MD’s?

Let me be the first to tell you that spending time calling up your DC friends or commiserating at your local seminars on how bad things are due to the current economy can not only be potentially depressing, it is almost always completely useless!

First, hate to say it, but your “friends” lie. If they are doing fine and think you are not, they lie to make it seem like things are tougher than reality. After all, why kick a man when he’s down? By the very fact that you ask the question, it’s obvious you’re hurting. I will admit – at least your friend is a nice person and they want to spare your feelings. But, you probably won’t get a truthful response.

Other friends lie because they too are in the toilet but they don’t want to admit it. Instead of actually doing something that is revenue generating for themselves, they will give you a handful of advice that didn’t work for them and act as if their practice is fine. This gives them the air of superiority. In reality, their practice stinks and the advice they gave is either terrible or may in fact work, but they wouldn’t know. They didn’t try it. Again, their response is less than truthful.

So now that we have established that there really is no reason to have the “are things bad in your office too?” conversation, why compare at all?

The answer is this: to study trends and glean insight from businesses that ARE thriving. Read More

How Do Chiropractors Protect Themselves From Wrongful Discounts?

Written by Tom Necela, DC, CPC, CPMA, CCP-P on October 5th, 2010

Topics: Billing, Business, chiropractic billing, chiropractic business

Beware: pirates are attempting to steal your insurance checks!

If you have recently opened the mail only to realize that you seem to be a “participating provider” with insurance companies that you never heard of, you are certainly not alone. While it may seem silly to complain about being paid, the fact is that you are paid a contracted rate (which is sure to be less than your billed amount) for a contract that never existed. In other words, the payer has given you a “Wrongful Discount” because you never agreed to a discount in the first place!

This phenomenon – known as a “Silent PPO” – is just one of the latest in third party payer’s bag of pirate tricks aimed at reducing your payments. Unfortunately, it is becoming an increasingly common occurrence in the field of medical billing. (Yes, that means that it’s not just the chiropractors that are being picked on!) Read More

Medicare Issues Chiropractic Software and Documentation Alert

Written by Tom Necela, DC, CPC, CPMA, CCP-P on September 21st, 2010

Topics: Audits, Billing, Chiropractic Audits, chiropractic billing, chiropractic documentation, chiropractic EHR, chiropractic EMR, Coding, Documentation, EHR / EMR, Medicare

Medicare carrier Noridian Administrative Services (which administers Part B claims in Alaska, Oregon, Washington, Arizona, Montana, North Dakota, South Dakota, Utah and Wyoming) recently updated and reprinted a notice on Chiropractic Software-Generated Documentation that I think can serve to educate us as a profession.

Incidentally, although your specific carrier may not be Noridian, you should take note that most Medicare carriers generate the exact same news releases, alerts and notices each week so I wouldn’t be surprised if you don’t receive a similar “reminder” from your carrier. Even if you don’t the information contained and summarized below can be crititical towards getting claims paid as well as avoiding denials and postpayment audits.

Apparently, the piece was generated because Noridian has seen an increase in the use of software-generated documentation for chiropractic services. In and of itself, there is certainly nothing wrong with using EMR or even any form of computerized notes. So what’s their beef? Read More

Is Medicare PECOS Enrollment Required for Chiropractors — Or Not?

Written by Tom Necela, DC, CPC, CPMA, CCP-P on September 15th, 2010

Topics: Billing, Business, chiropractic billing, chiropractic business, Medicare

I have been receiving lots of questions lately about these continual PECOS notices that we have all been getting from Medicare. If these enrollment “warnings” have been getting under your skin or just getting you plain confused as to whether these apply to you or not, keep reading.

Here’s a summary of what is going on: Read More

Chiropractic Payment Denials, Medical Necessity Issues and Winning Appeals

Written by Tom Necela, DC, CPC, CPMA, CCP-P on August 25th, 2010

Topics: Billing, chiropractic billing, chiropractic business, chiropractic webinars

For many chiropractors, the phrase “medical necessity” represents a vague, perhaps arbitrary or even precarious invisible standard we are all supposed to meet. It is one that all third party payers require but is surrounded by little in the way of concrete understanding.

I have communicated with many frustrated chiropractors who feel that the concept of medical necessity is often arbitrarily applied or is representative of a reviewer’s opinion. Finally, when our claims – all or part – are denied or reduced due to lack of medical necessity, it creates a feeling of an “us vs. them” mentality with regards to the third party payer, Independent Medical Examiner or other review entity that gave us the denial.

When our claims are denied for other reasons — bundled services, non-covered services, etc — it is equally frustrating. Read More

Medicare Audit Letters Hit Chiropractors Starting August 2010

Written by Tom Necela on August 17th, 2010

Topics: Billing, Business, Chiropractic Audits, chiropractic billing, chiropractic business, chiropractic coding, chiropractic documentation, Coding, compliance, Documentation, Medicare

Every Medicare carrier in the country has been assaulting my inbox recently with “ALERT” emails designed to make chiropractors aware of studies being conducted by the Comprehensive Error Rate Testing (CERT) program. I am not sure if we are at the equivalent of Code Orange or Code Red at this point, but the profession is definitely on Medicare’s “elevated risk” alert system in some fashion. So, in case you haven’t heard, may this post serve to Paul Revere the chiropractic community to be on guard — Medicare is coming, Medicare is coming! Read More

Are Your Chiropractic Revenues Tied to Emotions or Logic?

Written by Tom Necela, DC, CPC, CPMA, CCP-P on August 3rd, 2010

Topics: Audits, Billing, Business, Chiropractic Audits, chiropractic billing, chiropractic business, chiropractic coding, chiropractic collections, chiropractic documentation, Coding, Collections, compliance, Documentation

When faced with decisions on major life purchases – house, car, building purchase, even expensive remodels or repairs – most of us responsible adult chiropractors tend to do some comparison shopping. We may go out and get three or four quotes, make a list of the pros and cons and then pick the best choice, right? Read More

Random Thoughts Episode #136: Chiropractic Audits, Business Building & Success

Written by Tom Necela, DC, CPC, CPMA, CCP-P on July 20th, 2010

I’m on the road for the next couple weeks traveling for a number of on-site consultations with clients so this blog post will be a summary of random thoughts on the most common questions that repeatedly brought to my e-mail inbox. Read More

Selling Chiropractic Products and Billing Insurance

Written by Tom Necela, DC, CPC, CPMA, CCP-P on July 13th, 2010

Topics: Billing, chiropractic billing, chiropractic coding, chiropractic collections, chiropractic practice management, Coding, Collections

Many chiropractors have realized the benefits of offering products for sale to our patients. Whether it’s the convenience factor for the patient, our ability to control quality or brand use, or the fact that we want to be able to help our patient’s outcomes, products make sense.

Unfortunately, some chiropractors have a difficulty in making the sale of products make financial sense.

Worse, if you are the type of DC to stock your office with every “hot” new product that catches your fancy, only to quickly lose interest in it a few weeks later, product inventory and sales can become a financial drain on your profitability. Read More

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