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.