In business and in life, it is helpful to go back and review the basics, to take a look at where you’ve been and where you want to go.
Today’s blog post feature’s 3 links to our most popular columns of the past – in case you missed them – or in case you need “a refresher course.” (pardon the Fletch reference)
Here they are (in no apparent order):
Enjoy!
Tom Necela, DC, CPC, CPMA
“You keep using that word,” Inigo Montoya says to Vizzini in the cult-classic comedy The Princess Bride. “I do not think it means what you think it means.” The word that Vizzini so frequently misuses in the film is inconceivable. Unfortunately, it’s a term that seems to be floating around in the heads of too many chiropractors as well. As we near 2010, many chiropractors are now painfully aware that their coding and billing activities are being scrutinized more closely than ever before.
(Inconceivable? Read on…)
If you have been following recent legislative developments, you will have noted increasing overpayment recovery efforts by Medicare and its contractors. The current administration has declared that health care fraud enforcement will be a top white-collar crime priority for the Department of Justice (DOJ) and the various investigative agencies. Moreover, additional funding to fight health care fraud has recently been proposed in the Senate. Senator Ted Kaufman (D-DE) has sponsored the Health Care Fraud Enforcement Act of 2009, which, in addition to increasing the criminal penalties for health care fraud, allocates an additional $20 Million per year for health care fraud detection and investigation.
($20 Million extra for fraud detection? Inconceivable!)
While universal health care coverage may remain controversial, there is widespread support for additional legislation aimed at reducing health care fraud. This is not an attack on chiropractic per se (that would be inconceivable!) — these guys are going after every health profession at large!
Though I hesitate to get involved in all manners of political wrangling, there are some major issues creeping our way which can vastly affect our profession of chiropractic. We need to be aware of these not only on a profession-wide political level, but also in terms of how they affect our everyday practice.
If you haven’t already heard, here’s what’s coming unless someone puts a stop to it:
That last proposed provision in Senator Kaufman’s bill should scare the bejeebees out of all small physician practices, including (and perhaps) especially chiropractors. Here’s why:
Unlike the big entity hospitals who have a fleet of attorneys to defend their every move, this provision puts the small timer at a big mechanical disadvantage.
To make matters worse, we have another problem related to the meaning of the word fraud. For many physicians, Inigo Montoya’s clarification is again applicable: “I do not think that it [ in this case, the word fraud] means what you think it means.”
For many of us, we have heard lawyers argue that the fine line between what constitutes fraud and good old fashioned red blooded ignorance (oops I made a mistake) is intent.
This definition makes sense to me, as a non-lawyer type. If I repeatedly conduct my business or an aspect of it (say documentation, billing or coding) in a way that is deemed illegal, substandard or just plain wrong and despite my knowing better, I continue to do so for financial gain, this seems like a reasonable definition of fraud. On the other hand, if I don’t really know what I am doing, I may be wrong but it is out of ignorance not bad intentions. Consequently, the ignorant (but well meaning) doctor who is reprimanded, fined or otherwise correct then proves that his intent was always good by doing one thing: he corrects his actions.
Again, I am not an attorney, but if this provision passes through, I believe it sounds like the word fraud may not mean what we think it means. Or at the least, the lines of intent will be sufficiently blurred to be inconsequential. It won’t matter whether you acted honestly but erroneously; you will still be guilty of health care fraud.
The Bottom line: I see a few action steps here:
1. Now, more than ever, is the time to support your local (state) AND national association to help fight these battles on our behalf! No excuses. Most state or national memberships will cost you the equivalent of one adjustment per month to join. Membership in both will run you two whole adjustments per month. The safety of your livelihood is certainly worth that much regardless of your political persuasions, philosophical differences or nitpicking with their ability to fulfill your agenda. Get over it and support these associations now!
2. Training in compliant billing, coding, documentation should be a priority for both doctor and staff. The only way you can adequately defend yourself, prevent fraud and screen for errors is to know what you are looking for. Unfortunately, chiropractors are either woefully inadequate at detecting their own problems or unwilling to address the issues. Both can have devastating effects on your practice and the profession.
3. Encourage each other to rise to a higher level. Many states are requiring billing, coding or documentation education as a part of their CE requirements. State Boards need to be proactive in teaching doctors on how to comply with the requirements of their state before the docs get in trouble. Unfortunately, I have seen many docs disciplined for things that are “grey areas” such as exam documentation, SOAP note requirements, cash or TOS discounts, etc. If we fail to meet local standards, it’s practically a sure bet that we will fail nationally as well. So we need to go to our state Boards and associations with our challenges and work to find solutions so they don’t become national problems on public display.
Certainly, I am not proclaiming that better billing, coding and documentation will solve all our chiropractic problems (that would be inconceivable!) but a lack of proper systems in these areas will definitely put us at risk for failure in a variety of different forms.
The Wall Street Journal recently reported that a flawed payment database produced by a UnitedHealth subsidiary (Ingenix) and distributed to other major insurance companies has led insurers to underpay millions of claims. The result: patients have been forced to pay amounts they truly were not responsible for to make up the difference of fees that should have been paid to us, the providers.
Aetna, Cigna, WellPoint, and big names in the health insurance field then used the data which was computed by Ingenix to calculate their “reasonable and customary” charges and make them anything but reasonable.
The exact amount of charges deflected to patients remains unknown, but the Associated Press/New York Times reports the number is in the billions, and that two-thirds of the nation’s health insurance industry relied on the flawed payment models.
Of course, UnitedHealth has admitted no wrongdoing in its handling of Ingenix, though it agreed to close the database and help pay for a new one operated by a nonprofit group.”
When you hear about his type of nonsense in the news, certainly it can make your blood boil. After all, insurance companies already make providers reimbursement challenging while raising patient premiums to capture a larger profit margin in the middle. Insurers make promises they have no intention of keeping, they repeatedly flout regulations designed to protect consumers, and they make it nearly impossible to understand – or even to obtain – information we need.
So how can chiropractors level the playing field when we are dealing with such giants? Quite frankly, we can’t. Unfortunately, our numbers are just too small and our pocketbooks even smaller. But that does not mean the battle is lost, that we need to get out of insurance altogether.
I am a big fan of learning from the successes of others. In this respect, I believe we can protect our chiropractic interest by modeling what our counterparts in the medical community have done well.
Here are a few things I would propose:
1. Support Your State and/or National Association. Best is “and” but if you cannot do it financially, you should at least support one or the other. While we are too small to fight most big battles, we can enter class action suits and, if we prove a united front, negotiate contracts like the bigger players. One thing’s for certain, a lack of association support will ensure we lose even the smallest of political struggles.
2. Raise Your Fees Regularly. If you were twisted enough to read the actual details of the Ingenix price fixing fiascos, you would have found out that Ingenix created database calculations that automatically and randomly lowered UCR payments. For example, if you normally receive $35 for a 98940 and an insurer applied the Ingenix database, you would sometimes receive $35 (accurate), sometimes $33 (automatic, incorrectly reduced payment) and sometimes $31 (randomly applied, reduced payment based on a reduced % of your billed charges). So who could possibly win in this scenario? Only docs who raised their fees (to help counteract random fee reductions based on % of billed charges) and/or those who paid attention enough to notice the errors and fight it.
3. Pay Attention to Payment Details. As in the previous example, most docs (or billing persons) who don’t pay enough attention would never have known that they were being underpaid because they don’t track claims carefully enough (and because the database also shifted payments to patient responsibility!). Paying attention also helps eliminate unnecessary denials, and coding or billing errors. Finally, attention to claim detail can also help YOU prevent errors on your part that could trigger audits. Yes, admit you are imperfect too.
4. Appeal Incorrectly Paid Claims. I believe I will have to stop quoting appeal statistics because every time I do, I find another number that is lower. No matter how you slice it, only a fraction of doctors (of any specialty) appeal claims and insurance companies know it.
5. Learn How to Bill, Code and Document Correctly! MD’s know they don’t know how to bill so they outsource it. Hospitals realize that the whole scenario of billing, coding and collections is too vital to neglect, so they outsource everything too. Few chiropractors outsource and fewer take the time to learn how to do things right, even though we admit we were taught none of this in school. Recently, I ran into an owner of a Billing Company that REFUSES to work with chiropractors for that very reason. Unfortunately, the game has changed. For those who refuse to learn how to play by the rules, it will have severe repercussions. Those who wish to master the business side of their practice need to keep vigilantly updated on the changes and they will reap the rewards of increased income and protection from audits.
A few additional suggestions:
Let me challenge you today on a vital issue in regards to the future of chiropractic.
Be forewarned – unlike my usual writings, you will find no specific advice on proper coding or documentation. There are no billing “secrets” shared within the paragraphs below. Nothing will be found that will help you discover find errors you are making in the area of collections. In fact, not a shred of practice management advice will be given.
Despite the curious lack of advice on my part, today’s column may have the potentially BIGGEST IMPACT on your practice – if you act quickly – than any or all of the items above.
Unless your head has been firmly planted in the sand, you are undoubtedly aware of the mysterious frenzy over health care reform that has invaded Capitol Hill. While specifics are a bit lacking right now, one thing is certain: as chiropractors, we must seize the opportunity that has been placed before us to secure our future.
In the wake of upcoming changes, we all now have the ideal moment to voice our opinions to President Obama and our representative politicians.
Do not delay! Do not miss your chance! Most of all, do not stand by while our chiropractic future slips out of our hands.
A simple letter will do, but there is so much more that can be done for those who wish to get involved.
To give credit where it is due, this column was inspired by Dr. Gerry Clum, President of Life Chiropractic College West who has implemented a simple, straightforward, strategic plan to secure our chiropractic future.
Here’s my challenge and your three-step “To-Do List”
That’s it — three easy steps to secure your future, your patients’ future and the future of the chiropractic profession.
Until next time,
Tom
(A special thanks to Dr. Clum for permission to post his plan on this blog)
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