When I lecture on chiropractic billing, coding and documentation, I always get asked questions on fees.  Doctors want to know how much they can charge, how much they can discount and what types of discounts, fee systems and plans are legal or not.  Obviously, states differ in their opinions on some of these items, but here is my “top ten” list of FAQs on fees:

Q1. Can I charge different fees for different types of patients?
A. In general, the answer is “no”. In most states, the law prohibits you from “dual fee” schedules or charging higher fees to insurance payers, even though the cost of billing to insurance carriers is certainly more.

Q2. Is there a “legal” way to offer patients discounts off of my regular fee?
A. As above, you should have one “regular fee.” However, most states do permit some sort of “time of service” (TOS) discount. The other prevailing discount that is allowed in most states is a reduced fee due to a financial hardship.

Q3:  How much of a cash discount am I legally allowed to give to my patients?

A:  First, strike the word “cash discount” from your vocabulary.  You do not have two fees – one for cash and one for insurance.  You may, however, offer a TOS discount for prompt payments for services rendered that day.  Secondly, the question of how much discount is too much is the subject of much rumor and fuzzy logic.  I have yet to run across a state that has a law that specifies exactly how much one may discount their services in the TOS scenario.  However, if your discount is considered too steep by your state board, you can certainly be in trouble.

Q4. What about reducing fees for patients who can’t afford care?
A. Believe it or not, most states and most payer contracts permit you to offer a hardship discount on an individual basis to your patients. Generally, this requires written documentation of what constitutes your hardship criteria, but there is no universally accepted determination of such criteria. However, on the flip side, if you deem that every one of your patients (or even every non-insurance patient) is a hardship, your “criteria” would be suspect.

Q5. Are pre-pay plans legal?
A. In general, most states allow some form of pre-pay plans but the legalities vary widely from state to state.  In some states, it is legal to offer pre-pay plans as long as you fully refund the patient’s money upon request.  Other states allow a pro-rated refund, as long as the patient has been informed of such.  Still others demand that you keep pre-pay funds in an escrow account until they are all used up and that you offer a refund plus interest if the patient cuts their care short.

Q6. Can I offer family plans or discounts for families?
A. Family plans and other payment options that are unlimited in treatment visits are dangerous in two aspects.  If you are offering unlimited care at a fixed fee, many states view this as an insurance product since you are accepting the risk of your being able to provide ongoing unlimited treatment for your set fee. Even if this option is legal in your state, family plans can also be a bad deal for the doctor who offers anything other than basic adjustments.  For example, a family of 4 paying $200/mo for unlimited care may get 4 adjustments in a month which gives the doctor an average of $50/visit.  If the family comes in more, the average fee goes down. If they get additional services (exams, xrays, modalities, rehab, massage, etc) the fee goes down even more.

Q7. Can I offer “free” services to patients, but bill the insurance carrier?
A. You can’t have your cake and eat it too.  “Free” is free. If it is offered to patients at no charge, then don’t bill the insurance.

Q8:  Can my patients pay me cash/TOS discount and then have their insurance billed so they can be reimbursed?

A:  Remember, that one of the reasons TOS patients receive a discount is that your paperwork in reduced in exchange for that discount. If you turn around and bill the insurance, what have you gained?  Secondly, if you do decide to bill the insurance on your patient’s behalf, do not bill your regular fee, but your bill must reflect the TOS discount.  This is the correct way to do this and, on the odd chance, the insurance reimburses well, you don’t want your patients making money on the visit!

Q9. Can I offer discounts to various groups, such as military, clergy, seniors, etc?
A. Be careful here.  If you deem uninsured members of the clergy or military personnel to be part of your hardship discounts, then you may be safe in offering that discount to all members of those professions.  However, seniors who have Medicare represent a different group, as Medicare has specific provisions prohibiting “inducements” or enticements you may offer Medicare patients to come to your office.  In general, you are prohibited from offering Medicare patients more than $10 per incident, or $50 aggregate annually.  If your fee discounts exceed these amounts, you may be violating Medicare regulations and subject to penalties.

Q10:  How are UCR fees determined?

A:   Most payers use a proprietary blend of fee schedules to come up with the Usual and Customary Fees (UCR) that they will quote.  Some payers will actually give you the source for these fees but many will not.  In some states, fees are based on your Worker’s Compensation fee schedule.  No matter what the route payers may choose, you should understand that all insurance fees are regional, as opposed to local or national.  In other words, it really doesn’t matter much what the DC down the street charges, as your regional fees likely are comprised of a much greater geographical area than that.  So, setting your fees by calling neighboring DC’s is somewhat silly.  Set your fees according to regional standards (as available in fee product software such as ChiroCode), according to what your highest payers reimburse or according to state standards (such as Work Comp fee schedules).  On the other hand, if you are practicing in Arizona, it also matters little what your cousin Lou is charging in New Jersey, as fees are not nationally based either.

Top 10 Chiropractic Fee Questions: How Much Can I Charge For…?

Among the worst myths/excuses out there in chiropractic is the “I am just not good at the business side of chiropractic” line…

Sorry, if I’ve already offended those of you who have stated this (out loud or in your head). But, as chiropractors, we cannot continue to limp along with this mindset.

First, take a look at Mark Zuckerberg of Facebook fame. What did a twenty-something year old guy know about running a billion dollar business? Nothing – at least initially!  Few people are born with an innate business sense.  Most, like Zuckerberg, learn as they went along.  You can do the same, doctor!

Second, the “business side” of your chiropractic practice is inseparable from the clinical side.  I have met far too many chiropractors who are brilliant clinicians who suffer financially and emotionally because their practice consistently teeters on the brink of financial solvency.  On the other side of the coin, DC’s who are totally anc completely inept will not have a bankroll big enough to stay afloat no matter how proficient their business savvy.  Witness the endless trail of brilliant ideas that fail due to poor delivery.  The concept applies to chiropractors in the same manner.

The good news is, today, we are going to dissect this monster so you can begin to address it. “Poor business skills” usually rears its ugly head in one of several areas.  My hope is that if you can identify what is wrong, then you are at least on the right path to solving the problem.  Unfortunately, too few chiropractors take the time to seriously address these areas, tackling them one at a time.  Our business side, for the most part, is a finite skill set that can not only be tackled but MASTERED in a relatively short time period.

Here are the “business side” monsters that afflict most practices, in no apparent order:

•  Improper coding. Incorrect coding or using codes that won’t get you paid

• Inefficient billing by employing a biller or service that doesn’t perform and wastes money.
• Poor fee schedule that eats away your profits
• Incorrect collections:  Failing to collect for services that you have rendered – whether due to poor internal systems, misunderstanding of the rules or both.
• Ineffective tracking of Accounts / Receivable: If you fail to track A/R and solve its problems, it grows.  End result = you are not paid for the work that you do and you are still paying overhead = impending cash flow crisis or lots of wasted efforts
• Inadequate Documentation Codes are correct, bills are appropriate, but nothing substantiates your care so you are not paid – or payers want $$ back
• Illogical Spending – you don’t need every new gadget to be successful.  Really. No matter what the vendors tell you! It’s simple: too much going out, not enough coming in = bad business
• Overhead too high – which usually means your fees aren’t enough for your practice style/location and/or you have chosen the wrong business model to deliver your services. Example: Doc practices low volume and charges low fees – not going to work financially!
• Low Referrals Usually due to inconsistent or no systems in place. Example: Doc practices low volume and charges low fees – not going to work! Or high volume, with high fees and can’t figure out why no one refers!  Or nothing is consistently done in the office – one week lots of new patients, next starvation.
• Doc must spend lots to get NP’s Again, likely a systems problem and a positioning problem. You can advertise to the wrong market all day and end up with no patients. Unless you are new in practice (<3 yrs), if you are doing a good job, your New Patient problems are more likely the result of your poor internal systems than a lack of marketing or advertising
• No Passive Income Streams. This will ensure that you work harder than you should.  Check out our FREE Passive Income Test to see what strategies would fit best in your office!  Face the facts – you need additional income streams other than your two hands.
• Inefficient Use of Time.  Doc is a procrastinator. Disorganized. Dabbler. Micromanager. Control freak. Internet junkie. iPhone Apps addict. Or perhaps just lazy.(Note: most are not lazy, but poor time management skills will eventually hamper all clinics if unaddressed!)

All is Not Lost

If any of these “poor business skills” represent how you run your practice, take heart – all is not lost!

In fact, out of these major categories, my consulting services focus on the development of sound billing, coding, documentation, collections and business systems.  You will notice a curious lack of “New Patients” or “Marketing Wizardry” from the list of my areas of expertise.

That is because, in my experience, if you have developed solid systems in your clinic, learn how to properly get paid for what you do, and run your clinic profitably — there is no need to worry about new patients!

Truthfully, they will be coming in anyway, but your focus will be on maximizing the revenues for services you are already performing, thus lessening the need for constant “new patient addiction.”

If you need assistance in these areas, I am confident that I can help you.  And while I can’t control your spending or overhead, I can suggest ways to streamline your practice and make it more cost-efficient.  Now that you know that help is readily available, you don’t have much of an excuse to whine to your friends about suffering from “poor business skills.”

You do have a choice. You can continue to limp along and try to figure out a route towards practice success.  Or, you can realize that you don’t know it all and be willing to invest a little time and money to enjoy the practice you’ve always dreamed of under the guidance of some expert assistance.

Either way, I wish you success and I do hope our paths cross soon!

Tom

P.S.  If this article helped you realize that your practice is suffering some sort of chiropractic illness — be it low income, low profits, high overhead, high burnout, poor systems or no systems at all — I would suggest you download a copy of my Practice Analysis Questionnaire and send it to me for a FREE review.  There’s absolutely no obligation and my assessment of your questionnaire is absolutely FREE – so you have nothing to lose!

P.S.S.  If it’s “live” learning you need, check out one of my upcoming SEMINARS

P.S.S.S. — Ok, last line.  What did you identify as your problem?  Billing, collections, passive income strategies, office protocols? Check out our products section – we’ve probably got something to address your needs! Don’t worry, I won’t cry if you don’t buy my stuff — fix the problems yourself and we’ll still be friends because I will be happy to here that there is another successful DC still in business!

“I’m Just Not Good at the Business Side of Chiropractic”

In case you haven’t heard, several deadlines have been detoured lately – some pushed back, some here, some coming who knows when….  Here they are, followed by some commentary:

HIPAA 5010 Format Conversion “Non-Enforcement Period” Extended

If you bill electronically, you must convert to the 5010 format in order to have your claims “read” properly and to receive insurance reimbursement.  This rule went into effect January 1, 2012 with a grace period (known as the non-enforcement period) through March 31, 2012.  The non-enforcement period has now been extended to June 30, 2012.  During the non-enforcement period, payers are instructed to accept claims in the old 4010 format and the new, required 5010 format.  After that period is now over, payers no longer have to accept claims in the 4010 format; nor do they have to extend you the chance to resubmit your claims in the correct format.  If you haven’t converted to the 5010 format yet – you still have a chance!

Dr. Tom’s comments:  Do it before you risk non-payment! It is not complicated and you have no reason to resist as it is eventually going to be required – soon. For more info, see 

ICD-10 Deadline

The Department of Health and Human Services (HHS) announced a proposed rule that would set October 1, 2014 as the new compliance date for the International Classification of Diseases, 10th Edition diagnosis and procedure codes (ICD-10).  This date is in response to the previous deadline of October 2013, which was announced as delayed, but a new deadline was not proposed at the time. For the entire ICD-10 Press Release.

Dr. Tom’s comments:  As predicted and stated in my previous posts, ICD-10 keeps getting pushed back for years now.  It probably will happen at some point in the future.  Whether that is 2014 remains to be seen.  I would caution against training your staff and sending them to ICD-10 seminars at this juncture because the deadline may be too far away for them to retain the information. This means you will have to repeat the seminar – good for the instructor or the entity putting on the seminar, not so good for you.

EHR Incentive Deadline Extended

CMS is extending the deadline for eligible professionals (EPs) to submit eligibility appeals under the Medicare Electronic Health Record (EHR) Incentive Programs 2011 payment year. The new deadline is April 30, giving EPs an extra month to file their appeals.

An eligibility appeal allows a provider to show that all the requirements for the Medicare EHR Incentive Program were met and that he or she should have received a payment but could not because of circumstances outside of the provider’s control.

CMS affords providers with a two-level appeal process: an informal review and a request for reconsideration. Within the two-level appeal process, there are three types of appeals that can be filed in the Medicare EHR Incentive Program: eligibility, meaningful use and incentive payment appeals.

Detailed guidance on the appeals process and additional information on all of the appeal types are available on the CMS Office of Clinical Standards and Quality Web site.

Dr. Tom’s comments:  If you are on EMR already and see more than a handful of Medicare patients per week, this may be worth looking into and getting your $$ for 2011 claims while you can. It is not that complicated and may be worth your time spent.

Facebook Deadline!

Our FREE giveaway of Secrets of the $1250 Per Hour Chiropractic Practice ebook is ending soon as the web designers are working on a new design to our Facebook page.  Don’t miss your chance – download it now (click the link above)!

Upcoming Seminars

San Francisco, Las Vegas, Phoenix, Denver – all great places to visit this spring. While you are there, attend one of our upcoming Chiropractic Billing, Coding & Documentation MASTERY Seminars, receive 6 CE credits and get vital strategies to maximizing reimbursements and minimizing audit risks! Click the above links or go to the Seminars page for more info!

Deadline Detours: HIPAA 5010, EHR Incentives, ICD-10 and more!

Related posts:

1. '>Chiropractors Beware: Medicare’s Non-Enforcement Period Ending Soon
   
   In the wake of converting electronic claims submissions from the...
2. '>Medicare States: Mandatory 5010 Conversion Date for Chiropractors Remains, Fines Delayed
   
   On November 17, 2011, the CMS (Medicare) Office of E-Health...
3. '>The Final Word on Chiropractic EHR Stimulus Dollars (For Now)
   
   The recent release (July 16, 2010) of the “Final Rule”...

Medicare has been particularly active lately in attempting to educate chiropractors about errors that we have been making in respect to billing Medicare for chiropractic services.  Over the past month or so, several Medicare carriers (Noridian, Palmetto, NGS, etc) have held training sessions, webinars and teleseminars dedicated to reviewing “the rules” for proper chiropractic billing, coding and documentation in Medicare.  All told – these carriers represent approximately 50% of US Chiropractors – so it may be worth paying attention to what they are saying.

Below are quotes from the auditors conducting CERT reviews for these carriers as to why services were denied, billing was incorrect or documentation was considered substandard. Note: CERT (Comprehensive Error Rate Testing) Reviews are completely random, routine reviews that each carrier representing Medicare conducts.  So, the errors listed below were not found in a specific subset of chiropractors (i.e. those sanctioned, audited for repeatedly bad documentation, etc).  Rather, these are things that Medicare is finding just from a random selection of notes from our profession.  And therefore, may represent errors that “typical” chiropractors may be making (my comments are afterward, in italics):

Treatment Plan Problems:

• Services were billed as Active Treatment (with –AT modifier) for dates of service between December and June (7 months of care).  No initial or subsequent treatment plans were included in documentation given.  Services were denied and determined not reasonable and necessary.  7 months of care with no treatment plans whatsoever.  It’s hard to defend that the treatment is active if there is no plan. An initial treatment plan of 3x/week followed by a subsequent of 2x/week can at least show one element of progress.  It’s also hard to establish that the patient is progressing when there is no roadmap to follow.

• Return PRN is not considered a treatment plan.  Missing treatment plan means dates of service do not meet medical necessity. Service will be denied.  PRN (patient may return as needed) is essentially a statement that “no further treatment is indicated” at the time you are seeing the patient.  While this may be appropriate as you release the patient from active care, there is danger with the PRN statement. If you see that patient again and fail to change the PRN status, the patient now has no new episode registered, no treatment plan on file and no medical necessity for any subsequent care.

Illegible Documentation

Documentation on multiple dates was considered illegible and non-standard abbreviations were not able to be interpreted. Documentation that cannot be deciphered does not support medical necessity and services will be denied.  If this isn’t the biggest commercial going for getting EMR, I don’t know what is.  Essentially, this doctor could have had brilliantly documented notes, meeting all Medicare qualifications – except for the fact that his chicken scratch can’t be read and/or his abbreviations were not clear.  There’s really no excuse to get denied for this error as there are multiple ways to deliver a clear, readable daily note.

Evaluation Items

On Initial Visit, the following were missing: Onset date of symptoms missing. Aggravating or relieving factors missing. Treatment plan missing.  Services should be denied.  This doc failed on three accounts.  The first of which (Onset date) should be a simple part of EVERY history you take with a new patient.  Probably, the doctor also asked the patient about what makes their pain better or worse, but failed to document it.  The treatment plan (or lack thereof) just adds insult to injury.

Daily Notes Goofs:

No documentation of area where chiropractic adjustments were rendered. Yes, Medicare (and every other payer) are a bit picky about this – they want to know where you adjusted your patients.  Since our coding is dependent upon the number of spinal areas adjusted, it is required that you document those areas in your notes, not just bill for them.

Inappropriate ABN

Service listed as “adjustment” with no rationale for why the denial is anticipated.  This doc understood one half of the ABN requirement.  He knew that his adjustment may be denied; he failed to state WHY – i.e. Medicare does not cover maintenance care.

No pricing given advising beneficiary of liability amounts.

The primary rationale behind the ABN is to inform the patient that Medicare will NOT cover a particular service so that the patient may be able to make an informed decision as to whether they want that service or not.  Part of that disclosure is telling the patient the price (or even an estimated range of the costs) for the services listed on the ABN. As with the doc in the last example, this DC knew part of the requirements, but since they didn’t complete a proper ABN, they did not comply with Medicare’s rules.

Final Thoughts

These CERT findings were pretty typical of most of what Medicare finds wrong with chiropractic billing, coding and documentation.  We continue to make the same errors, regardless of our geographic location.

Other than the primary danger of major Medicare penalties for failing to adhere to the rules, each of the above chiropractors (and those of you committing the same type of errors) face the danger of having those services denied or, worse, post-payment demands.

Think about the average chiropractic practice that sees 20% Medicare patients.  That equates to approximately 20 visits per week.  In a year’s time, that could equal 1000 visits per year all done wrong!

Why?  As chiropractors, we are all well aware that Medicare only pays for one service.  Therefore, our documentation should be spot on.  However, the flip side is that if we are in error in our billing, coding or documentation, we are likely making those mistakes over and over again – perhaps to the tune of 1000 visits per year.

Hopefully, some of these “real life” examples will help you think about improving your own billing, coding and documentation – for Medicare and other payers as well.  If you need more “hands on” assistance with these items, consider attending one of my upcoming SEMINARS where we spend the better part of the afternoon going over the specifics of good, defensible documentation.  And, of course, for those of you who just can’t make the trip, despite it’s massive potential to help you maximize reimbursements and minimize your audit risk (yes, I am a little biased)…stay tuned for more articles in the future.  I’m sure Medicare will continue to dig in and take a look at us – and I’ll be here to report the results to you!

7 Medicare Documentation Errors From Recent Chiropractic Audits

Related posts:

1. '>Medicare Audit Letters Hit Chiropractors Starting August 2010
   
   Every Medicare carrier in the country has been assaulting my...
2. '>Medicare Releases 4th Quarter Chiropractic Medical Review Findings
   
   Medicare carrier Palmetto GBA  released their 4th Quarter (2010) Medical...
3. '>What Chiropractic Errors Are Costing You: 2011 Update
   
   Some of you may get tired of hearing how dangerous...

Even for chiropractors who are not quite gadget-geeky enough to have a bathroom like the one pictured above, the writing on the wall is clear: the future of all business, including healthcare, is becoming increasingly dependent on technology.

I have met the rare bird who refuses to use a computer, cell phone or debit card and I am sure they have good reasons.  But for most of us who don’t want to go the route of the dinosaur, we must embrace at least some technology that can make our practices better, more profitable or more efficient.  And there are many tools and strategies available now to help you improve your chiropractic business.

That said, I will also admit that I am NOT in favor of every new gadget or idea that comes sailing over the internet or raved about by the blogosphere.  As a whole, I have found that most chiropractors are actually not on the cutting edge of technology. Fortunately, since our main tools of our trade are our two hands, we don’t have to be.  But we can pick and choose which gizmos can really help us and not just look pretty. Here’s my short list of things you need to consider:

Get Your Stimulus Money While It is Still Available:  The much-talked-about stimulus dollars actually materialized into chiropractic hands at the end of 2011. So, yes, the government did make good on at least one recent promise.  And, if I were you, I would try to catch those dollars while you can.  Not everyone is eligible.  Not everyone should try.  But if you (a) see Medicare patients more than once every blue moon, it may make sense; (b) if you are already using a certified EMR/EHR, you are more than halfway there; (c) if you are considering getting EMR/EHR, now is the time to shop as the potential for government stimulus (i.e. money back for using your EMR/EHR) may ease the burden of that purchase.  If you are in any of these three categories, you should strongly consider taking a FREE Stimulus Webinar to learn more. 30 minutes can help you earn thousands. The webinar is sponsored by ACOM — not me. But since they were the first company to get a chiropractor stimulus money, I will defer to their expertise in this matter.

Check Your Web Presence.  For those of you who actually have a website up and running, congratulations!  Now is the time to make sure it is being put to good use.  Don’t bother answering any of the spam emails that start with “I noticed that your website is not ranking well with Google…” There are many FREE tools and resources to start with.  One is Alexa which will give you your website rank and a few keywords that people are using to find your site.  For a more detailed analysis, look into Google Analytics – its FREE as well. If you notice that when you Google yourself, all kinds of sites except your own come up first, you’ve got problems and may need some advanced help.

Advanced Web Strategies.  If you are prone to write incessantly (like me), getting a blog for your chiropractic website can boost your search engine rankings as you are now viewed as producing new content as opposed to having a static, online equivalent of a business card; Chiropractic Blog Designs makes this quick, easy and painless.  If you don’t like writing (or even if you do), consider incorporating video onto your website which feeds the search engines well. Chiropractic Traffic makes an excellent and simple to use site that incorporates this strategy.  Finally, if Social Media (Facebook, Twitter, LinkedIn, etc) is your thing – or if you want it to be – perhaps a course from Pat MacNamara’s  “Club 365” Chiropractic Social Media Training will bring you up to speed quickly on how to use these strategies.

Cool Tools For Your Patients:  Once patients are in the door, you can also show them that you and the 21^st century have met.  Frustrated with patients who won’t even take a walk? Make it fun (or even competitive) with Fitbit, a wireless activity tracker that allows your patients to track the number of steps they walk, distance, calories burned, stairs climbed and even their sleep patterns.  Even better, they can track their progress online and even compete with friends.  For those patients who exercise on the treadmill some but need a technology boost to make it more fun, also have them look into iFitLive which turns their treadmill into a running excursion up the “crookedest” street in San Francisco or allows them to take a jog in Paris – without the plane fare!

Tech Savvy Tools for You: Let’s face it — we’ve all made some hiring mistakes.  Technology can help us bridge the gap where good judgment seems to leave us in the lurch.  One of my favorites is a basic, inexpensive background check offered by Direct Screening and probably dozens of other companies.  A stellar-looking resume fails to uncover the fact that your newly hired employee is actually an ex -convict who is going to be front and center in your office taking patient’s money, handling credit cards and depositing money into your bank.  Wouldn’t it be nice to know if she were previously found of a crime in her last job?  Similarly

21^st Century Billing Strategies:  Got deadbeats?  Returned mail, no return phone call patients who have appeared to drop off the planet?  It’s amazing how you can find these folks online! For about $25, you can track these folks down and find their current whereabouts using People Finders.  Similarly, if bad checks keep coming your way, get your patient onto autodebit quickly!  Your bank account may allow you to do this or use any number of online tools such as First ACH which I have been using for years now to allow patients to make payments without the hassle of sending checks, making calls, etc.

Extra Credit for the Truly Ambitious:  Want to really impress even the most tech savvy patients in your practice?  Instead of a handout with some exercises on it, have them download your customized i-phone App!  With Bizness Apps, you don’t need any design skills, just tell them what you want and they help build the App for you and it’s amazingly cheap!  Or create an app that makes it easy for patients to schedule appointments or contact you with Chiropractic Apps !

One Last FREE Bonus:  Sometimes you just have to think outside the box (or copy someone else that is) and consider a new angle to promote your services.  Case in point: many of you have been bugging me to get on Facebook for years.  Despite all the rave, I just couldn’t think of a way to make Facebook fun AND productive, without being a time robber.  But what if I could use Facebook to REWARD my loyal readers, web visitors and random web surfers by offering something of value such as a FREE ebook or “secret” offer only available to those who can find it?  Bingo – we have a winner that sounds worth pursuing.  Can you do the same?  Put your creative brain to work, have some fun and build your chiropractic business! BTW, check out my first Facebook fun attempt, now, while it’s still there.  Go to my Facebook page and download a FREE copy of Secrets of the $1250 Per Hour Practice!  (Yes, you need a Facebook account to get it, but maybe this will start that ball rolling for you…)

Whiz-BANG! Increase Income & Avoid Trouble with Chiropractic Technology

Related posts:

1. '>Chiropractic Compliance on the Web: How DC’s Can Avoid Internet Trouble
   
   We’ve all heard what a powerful marketing tool the internet...
2. '>Bad Debt is Killing Good Chiropractors
   
   Too many chiropractors have a lingering problem with debt in...
3. '>How Can You Increase Your Chiropractic Income Without Working More?
   
   At one point in time, virtually every business owner –...

Let’s talk about avoiding what I call the “Chiropractic Skills Trap.”

This may sound odd and perhaps even a bit sacrilegious but the skills trap takes on many forms and produces several varieties of results for those who fall into it — but none of them good.

Having visited well over 500 offices in the last few years, I can tell you that, of the chiropractors who fall prey to the “Chiropractic Skills Trap”,  99% land in one of the following three categories:

1.  Fire-Frenzy.  These docs have developed (or are busy developing) their technical (i.e. clinical) skills while ignoring the “business side” of their practice.  While this would seem the normative pattern for younger docs, they are not uniquely afflicted by this problem. In fact, I have seen some “seminar” junkies who have more initials behind their last name than some people have teeth, who are probably among the most accomplished clinical chiropractors on the planet and, coincidentally, are also near broke. Whether the doc is younger or more experienced, their practices have no visible systems in place and if there are systems, they are woefully inadequate or obsolete.  These docs (and their staff) spend most of the time haphazardly putting out fires only long enough for the next one to erupt.  The one positive aspect of these offices is most are painfully aware of the fact that they are completely disorganized and hope to do something about it someday. They know they are under-producing and feel like they can see more patients, do more services and make better income.  However, the next fire which is just around the corner always seems to prevent them from actually getting around to doing so. In the meantime, the stress level keeps building.

2.  Roller-Coaster. The good doctors of this category have developed adequate skills to serve their patients but have never really developed the “business side” to the same degree.  In their defense, these offices have some systems in place usually in a slightly murky form of a visit protocol (1^st visit = NP Exam, 2^nd Visit = ROF, Visit 3-396 = Random Mush ) or sometimes a front desk system for processing patients or the phone.  Mostly, though, these offices have still not developed systems to adequately train staff, maximize revenues, minimize patient schedule abandonment or efficiently utilize doctor and staff time. There is still too much doctor dependence and, at times, too much on the doctor’s plate. As a result, several things emerge: the doctor is still forced to put lots of time and energy in to keep the practice running smoothly, they are always on the verge of a crisis (and may narrowly miss) and the doctor is destined for burnout (although he or she won’t admit it) because they are deceived into thinking they have systems in place. Life in these practices is like a rollercoaster of endless ups and downs; some months are good and fun, some teeter on not so fun.  This is the most dangerous category because they don’t really have effective systems and because the doctor has so much to lose (and gain) in the way of potential.  Unfortunately, this category is also the most common.

3.  Mine-Filled. These offices are hard to define based upon skills; some doctors in this category are incredibly skilled and busy.  Others are incredibly busy and adequately skilled.  What binds the offices in this category together is that they all DO have some solid systems implemented. The basics are in place and the practice is generally profitable and smooth running. Although this type of practice has obviously achieved a respectable amount of success, landmines that threaten to destroy the practice lurk beneath the surface.  For example, the doctor has good protocols to generate revenue, but he’s not quite sure if his billing or coding is correct or legitimate.  In other areas, he’s found some good ways to streamline processes and utilize staff, but he’s not sure if those methods are exactly compliant. And his notes? Well, he knows that his documentation could use some improvement but he’s hoping that it’s good enough.  If this type of doctor were to tell the truth, they lose more sleep than they are willing to admit and spend a little too much time looking over their shoulder and worrying that some day, their castle may come crashing down.

So, doctor, which category do you think best fits your office?

Now that we’ve identified some problem areas, let’s discuss some potential solutions for each category so you can start working on these issues right away!

Category 1: Your lack of systems will result in continual frustration for you and your staff.  Spend some time trying to identify problem patterns in your business.  Not just the once in a blue moon occurrences, but things that seem to happen repeatedly and/or with annoying frequency. Write a list of these issues down and begin to develop a systematic plan for solving them.  Then, move on to the next item until you have developed a series of systems to really address the problem patterns in your practice.  One shortcut recommendation would be to check out my Chiropractic Office Protocol Book – which addresses many of the challenges and offers solutions for the problems faced by Category 1 and Category 2 doctors.

Category 2: Your systems need to be firmed up a bit and you can probably benefit from the advice for Category 1 doctors as well. However, to take your practice to that “next level” you also need to begin focusing on the business “as a business.” Identify some potential revenue streams that do not depend entirely on you. These may be new to your practice, ones that you are not fully maximizing or even ones that you tried unsuccessfully in the past.  But you need to face the facts: you cannot keep practicing in the same manner and expect different results (Yes, that’s also known as the definition of insanity) In this respect, you need to take ACTION!  Quit percolating on an idea or whining that something is not working as well as you thought and get moving on it.  I don’t care what it is — put it into motion keeping in mind the old saying “nothing happens until something moves.”  My recommendations: take my FREE Passive Income Test to see what’s a good fit for your practice size, volume and geographic area.  It’s FREE and I will be glad to point you in the right direction.

Category 3: There may be an issue or two that you need to specifically address in the manner of those in Category 2, but most practices in this category need to really focus on continuing to increase efficiency, leveraging established relationships and protecting the fortress.  In this manner, the first two items can probably also be helped by expanding revenues not depending on you – take the Passive Income Test, it’s free.  As for protecting your tail, consider taking a Seminar to learn better billing, coding, documentation and audit protection strategies.  At your level, even learning one or two strategies to protect your audit risk, improve your documentation or correct a compliance issue can mean tens of thousands of dollars that are less at risk.  You and your practice have achieved a lot; now it’s time to protect it. My specific recommendations: (of course, I am biased) but one of my upcoming Chiropractic Billing, Coding, Documentation MASTERY seminars will either amaze you at what you don’t know or give yourself a level of comfort of what you have done right.  Secondly, consider an On-Site Visit to have an objective third-party take a look at your practice to make sure it is on par.  Yes, I offer this service as well, as do other compliance professionals or some healthcare attorneys. Finally, pay attention or pay someone to pay attention for you.  Chiropractic payers update their policies, rules and regulations quickly and frequently – you can’t afford to miss them. As with most successful practices, you will not commit one error, one time but you will repeat the same mistake many multiples of times over.    Read the blogs, payer updates, newsletters — or pay your staff to do this for you — or both.

Time to Face Reality

When looking at the issue of profitability and practice success from a big perspective, an honest appraisal of your abilities, habits and motivation will tell you where you stand.  Is your business sinking?  Either get help fast or abandon ship!  It may be noble to be long-suffering, but the question is: can you afford it?

For those of you whose business is adequate but less than stellar, sometimes an objective opinion or outside assistance is needed to get you to that next level, to conquer obstacles and achieve longstanding goals. This is not to say you are incapable, but the often quoted insanity definition comes to mind again. Far be it from me to call you, a perfect stranger, a little nutty but, if the shoe fits….

If you’re not sure where to start or you are sure you need help, download a copy of my FREE Practice Analysis Questionnaire.  There’s no obligation and did I mention it’s FREE!

Hope this article has been helpful, encouraging, eye-opening or just frustrating enough to spur you to do something about avoiding the “Chiropractic Skills Trap!” Our profession needs more great chiropractors; but specifically, to achieve that, we also need your business to be profitable and pleasurable so you don’t take your good skills elsewhere in frustration or because of a tragic loss of your practice.

The Chiropractic “Skills Trap”

Related posts:

1. '>Overworked Chiropractors, Under-Producing Chiropractic Practices
   
   I guess it happens to the best of us. After...
2. '>What to Do When: Systems & Solutions to Persnickety Problems Chiropractors Face
   
   Ever get the feeling that your chiropractic office is “sweating...
3. '>Un-Stuck-ify Your Chiropractic Practice: Rising to the “Next Level”
   
   Let’s talk plans, protocols, systems and solutions to “un-stuck-ify” your...

If one can judge a year by the amount of changes taking place, 2012 is sizing up to be a big one.

In this, we received word of two significant items for which chiropractors should take note.

THE GOOD NEWS: ICD-10 is DELAYED

If you have followed my previous posts or attended my seminars over the last year or so, you are already aware of my cautions regarding ICD-10. I’ve been recommending that chiropractors avoid preparing for ICD-10 due to the high probability of its implementation being delayed.  Certainly, I am not always right but in this case, my prediction is spot on:  thanks to the many protests received about how major the impact of ICD-10 would have, the transition to ICD-10 has been temporarily delayed to an unknown date in the future.

So, if you registered yourself or staff to attend a ICD-10 seminar, my recommendation would be to cancel and get your money back as it’s not likely that you will remember the materials when/if ICD-10 finally hits years from now.  Surely, you have more pressing problems to solve.

THE BAD NEWS: RECORD SETTING AUDITS!

The bad news surrounds the whole threat and business of auditing.  Many chiropractors ask me where the future of audits may go.  Unfortunately, this week, the news probably revealed that future for anyone that can do third grade math.

Here’s the quick summary.  The “business” of auditing began to boom in 2005-2008 when Medicare began its official experiment in auditing healthcare providers, hospitals and other related entities.  Long story short: in 3 years, the Feds recovered $900Million or so in post-payment demands.  Obviously, this “experiment” — in terms of dollars generated — was successful.

Naturally, the great auditing experiment was given the green light and continued, making chiropractors and other physicians a target.

Fast forward to present day:  the numbers are in and recent press release from the HHS revealed that 2011 was a record-breaking year for audits and the Feds recovered nearly $4.1 Billion!

REALITY CHECK & TIME FOR MATH

Here’s where the chiropractic reality check and math exercise comes in:  chiropractors have not fared so well in the last two OIG reports made on chiropractic services.  Last year (2011) chirorpractors were also the focus of a special review in Medicare.

If the Feds can recover $4 billion in ONE YEAR, certainly audits in general will continue, if not increase in volume.  Even Uncle Sam can do that math.

Unfortunately,  chiropractors will also continue to be a target in those efforts.

There is hope, however.  If we improve our game, chiropractors may be able to better protect themselves than other professions due to, once again, simple math.  Our volume is lower, our claims are smaller, our numbers are fewer.  So, presently, the only reason we are an audit target is due to the facts that (a) through random auditing, everyone is a target and (b) if we do not improve our chiropractic billing, coding & documentation, we are an easy target.

Chiropractors, we CAN change that last part!  You CAN improve your billing, coding and documentation. Take a SEMINAR and educate yourself. Stay updated on the latest trends.  It is possible to both maximize your reimbursements AND minimize your audit risk. For those interested in how your clinic may benefit from this, fill out a Practice Analysis Questionnaire and I will contact you to see how I can be of assistance.

The first step, however, for all of us, is to admit that we MUST do something to improve: for our practice, for our patients and for our profession!

The Feds Giveth & Taketh Away: More Changes Awaiting Chiropractors!

Related posts:

1. '>Are Your Chiropractic Revenues Tied to Emotions or Logic?
   
   When faced with decisions on major life purchases – house,...
2. '>2% of Chiropractors Appear Aware of Mandatory Changes — 0% Appear Ready
   
   I’ve got three news updates for you today – one...
3. '>Random Thoughts Episode #136: Chiropractic Audits, Business Building & Success
   
   I’m on the road for the next couple weeks traveling...

These days, it makes sense – no, in fact it is a necessity – to have other providers in your office who can supplement your income stream and/or help your business earn money apart from efforts you make with your own two hands.  Whether that means having a massage therapist on staff, hiring an Associate Doctor or having an Independent Contractor (of whatever type) in your office depends on the style of your practice, your volume, your available space and your budget.

Although the type or number of providers may differ as may their employment status (employee or independent contractor), the level of risk you incur should NOT be a variable factor.

Unfortunately, some chiropractors fail to take appropriate (or prudent) steps to protect themselves from these other providers and can place their business in great jeopardy in the process.  So today’s column is going to focus on just that: protecting your business from internal provider problems.

1. Beware of Unlicensed and Uninsured Massage Therapists

Many of you who have attended my seminars, read my previous columns or books are quite aware of my biases towards massage therapists. On the positive side, I believe massage is a wonderful complement to chiropractic care, as a simple and proven income stream when structured correctly and for the fact that patients generally love massage.

On the not so glamorous side, I hate the drama that comes along with many therapists.  I majored in English in undergrad and long ago was tired of drama – no matter what medium it takes. So when massage therapists exhibit poor work ethics, entitlement syndrome, a generalized lack of reliability, and more relationship woes in one week than some have had in a lifetime, my fuse is admittedly short.  In fact, I’ve had quite a few humorous “thank you” emails from those who have read my candid thoughts on massage therapists and how to handle them to know that I am not alone in my viewpoints.

That said, I am more than willing to tolerate the potential risks of insane LMT’s for a massive upside benefit to your patients and your bottom line.

BUT — there is one risk that I would not want to tolerate with regards to massage therapists — nor should you.  And here it is…

Unlicensed massage therapists and/or LMTs who are not covered by malpractice can ruin your day far more than any kooky, barefoot, bad juju massage therapist aura.
A brief clarification:  I understand that some states license massage therapists and some do not.  From a billing perspective, I am also very aware that, in some states, therapists bill for their services under your chiropractic license and in some states they may bill out independently.  These factors may play a role in whether or not your therapist needs to be licensed in your state, they do not automatically remove you from the risks associated with the therapists performing their services.

An unfortunately true story:

I received a disturbing call from a chiropractor seeking some advice.  The doc had previously purchased my Build a $300,000 Massage Practice in Your Chiropractic Clinic and implemented a healthy income from his massage therapists.  Unfortunately, he found out that his massage therapist had been performing massages in his clinic without a license for approximately the last 18 months. Of course, he practices in a state where a license IS required for massage and where insurance payers required services to be performed by a licensed therapist to be eligible for reimbursement.  Unfortunately, he also had been billing for the therapist’s services the entire time and receiving reimbursements.

Wait – it gets worse…

She mentioned the license issue to the office manager about the time it was due to be renewed. The therapist was very happy with her chiropractic employer who was keeping her busy and she enjoyed her working environment.  She wondered if the chiropractor would pay for her license since she was an employee of the clinic.  The office manager promptly made a note to discuss it with the doctor — and never did.

Not done yet — worse still…

Approximately 6 months after this conversation, the massage therapist also let her malpractice lapse because she presumed she was covered under the chiropractor’s policy as an employee of the clinic.  She had no intentions of looking for a job elsewhere so she didn’t feel the need to carry any
malpractice on her own.  And, you guessed it, she failed to inform her employer that she dropped coverage.

2. Painful Partnerships, Associates and Independent Contractors

This same scenario isn’t unique to massage; it could have happened to a chiropractor employing an Associate Doctor or Independent Contractor (of any specialty) as well.

Many chiropractors happily rent space to another chiropractor, an acupuncturist or a massage therapists (you’re probably losing money here – sorry, couldn’t resist!).  What they fail to check out is whether that practitioner is appropriately licensed, insured and/or covered by the owner’s liability policy.

Face it, doctor.  Your name is on the door.  It is you who will be sued when something goes wrong.  Worse, if you are billing for their services, it might be nice to know these practitioners are appropriately licensed or credentialed.  Even if they are billing under your license, they may need appropriate credentials.  At the least your malpractice carrier should know someone else is treating your patients other than you.  In most states, having an employee put an ice pack on a patient is far different than someone performing a massage, assisting with rehab or (especially) sticking tiny needles in a patient’s back.

Make sure your tail is covered or the needle that comes to extract your license and your money will be the most painful blood draw you’ve ever experienced.

How to Protect Yourself from Other Providers in Your Office

In the absence of donning a shield and suit of squirrel armor, here are a few suggestions…

If you are in a state that requires licensure for massage therapists…

• Look up their license status online to make sure there are no disciplinary actions or sanctions against them BEFORE you hire them (call your state licensure board if they do not provide online verification)
• Get physical evidence (a copy) of their current license upon hiring. Make a copy of that license and put it in their file.  You should also have it on display in your office, just like your own license.
• Note the expiration date of their license. Most massage licenses are cheap.  Offer to pay it for the therapist once they have been successfully employed for 90 days or more. This presumes that they are worth keeping and it also makes sure you don’t leave it up to them.
• Get physical evidence (a copy) of their malpractice upon hiring. Make a copy of that policy and put it in their file.
• Note the expiration date of their malpractice coverage. Most malpractice policies for massage are also inexpensive. Comparison shop what they are paying with what your own malpractice carrier may offer as an additional “rider” for covering these therapist. (It may be cheaper that way because you are already insured)
• Offer to pay malpractice for the therapist as an additional form of compensation. Again, if they have proven themselves a stable employee… When they ask for a raise, this is a good thing to contribute to their overall pay package.  If they don’t believe they are being paid enough, they will often drop the coverage and you will be the one endangered.

If you are in a state that does NOT require licensure for massage therapists…

• You can obviously skip the license issue steps above, but malpractice is still a good idea since the therapists are working on your patients
• Check with your malpractice carrier to see if it is necessary to put the therapist on your policy as it is doubtful that the therapist will have their own

If you have Independent Contractors working in your clinic…

• You are probably killing your profitability on massage — sorry, couldn’t resist
• You still need them to demonstrate evidence of a license and/or malpractice coverage
• I would not pay for either but be vigilant in making sure that they are current

If you have other Associates / Independent Contractors (Chiropractors or Other Providers)

• The same rules apply, except they definitely need to be licensed!
• Malpractice coverage should be demonstrated as well!

I hope that this is just an unnecessary reminder for all of you – but it’s better to be pestering you about these things than listening to chiropractors cry on my voice mail.

How Chiropractors Can Avoid Mistakes With Massage Therapists, Associates & Other Providers

Related posts:

1. '>The 6 Figure Opportunity Your Chiropractic Practice is Missing
   
   I was contacted by a chiropractor recently who asked if...
2. '>5 Verification Mistakes That Chiropractors Make That Put Their Income at Risk!
   
   As we discussed in my last post, Expedited Agreements and...
3. '>Chiropractic Compliance on the Web: How DC’s Can Avoid Internet Trouble
   
   We’ve all heard what a powerful marketing tool the internet...

In the wake of converting electronic claims submissions from the old 4010 to the new, mandatory 5010 format, Medicare has granted a grace period whereby carriers are required to accept either format.

This “non-enforcement” period ends on March 31, 2012.  After that time, carriers that receive claims in the old 4010 format will not attempt to repair these claims and process them accordingly.  In other words, chiropractors who submit claims electronically and fail to convert to 5010 Format by then will risk those claims not being paid.

Presently, Medicare contractors are issuing N2226 or N2228 error codes to indicate that the claim has been received in the wrong (old) format.  Chiropractors who submit claims to Medicare and receive these error codes should check with their clearinghouse or billing system to ensure that their claims are properly going out in the 5010 Format.

In a recent MedLearn Matters Alert, Medicare also clarified that providers should not assume that they will receive an error code for every claim billed in the incorrect format.  Furthermore, Medicare emphasized the fact that the practice of sending error codes will discontinue at the conclusion of the 90 day non-enforcement period (ending March 31, 2012).

Chiropractors, the message is clear: if you are going to submit claims electronically to Medicare, you better make sure that they are in the 5010 Format…quickly!  Don’t risk claims denials due to this relatively simple conversion process!!

Chiropractors Beware: Medicare’s Non-Enforcement Period Ending Soon

Related posts:

1. '>Medicare States: Mandatory 5010 Conversion Date for Chiropractors Remains, Fines Delayed
   
   On November 17, 2011, the CMS (Medicare) Office of E-Health...
2. '>Deadline Detours: HIPAA 5010, EHR Incentives, ICD-10 and more!
   
   In case you haven’t heard, several deadlines have been detoured...
3. '>New Rules & Regulations For Chiropractors Anger 39 Healthcare Associations
   
   If you think the pace of all the new rules...

At one point in time, virtually every business owner – chiropractors included – has asked the question “How can I improve my income?”   Today’s post will discuss this mega-dilemma of nearly all entrepreneurs.

Before we discuss potential solutions, allow me to throw another question at you:

HOW do you want to increase your income?

For many DC’s, they will add a caveat: “…without working more!”  This is not because chiropractors (or entrepreneurs in general) are lazy.  Most owners could verify that they work harder and, often, longer hours than any employee would tolerate.  In fact, what most business owners are really longing for is a way to work more EFFICIENTLY and EFFECTIVELY.

Is Raising Fees or Increasing New Patients the Answer?

Let’s take a look at two common ways to increase income.  First, you could raise your fees.  This almost immediately produces an income boost. The cost to do so is nothing.  Sounds perfect?  And while increasing fees is one thing I believe is critical to your financial success, it does have limits.  After all, in theory you could double your fees and double your profits. You also may multiply the number of patients who head for the door. With insurance allowables, you also know that strategy doesn’t work across the board.   So, although raising fees may be smart, it is a limited strategy by nature.

Now let’s look at the example of new patients.  Most chiropractors would agree that having more new patients is key to increasing income.  Certainly that is often true. But don’t be too hasty in proclaiming new patients as the premier method of increasing income.  Why?  Two words: acquisition costs. If your new patients come from referrals, the cost to acquire them is nearly zero so this can be a profitable venture.

On the other hand, if the new patient walks in as a result of an ad you placed, you need to now calculate the costs of the ad and the potential income the patient will generate for your practice.  In this way, some new patient acquisition methods can certainly be profitable while others less so or not at all.

So, perhaps a better question to ask is:

What’s the most cost-effective improvement I can make to increase income?

In the October 9, 2009 edition of Medical Economics, healthcare consultant Keith Borglum gives the answer, plain and simple:

“The most cost effective improvement is usually in improving your coding.”

Of course, as a Certified Professional Coder and Professional Medical Auditor myself, I agree and admittedly, I am a bit biased.  But here’s the reasoning behind Mr. Borglum’s proclamation, which is both logical and true to my experience as well:

“An extraordinary number of physicians fail to stay current in their knowledge of coding, resulting in reduced reimbursement or delayed and denied claims.  Many physicians purposefully undercode out of fear of penalties for overcoding or unbundling. Others leave their coding to support staff – an inappropriate approach virtually guaranteed to result in errors …”

Chiropractors are No Different

Although this consultant is speaking in reference to Medical Doctors, in my experience, we chiropractors are really no different.  In chiropractic school, we were taught examination procedures based on creating a working diagnosis so we could accurately assess the patient’s condition and create an appropriate plan of care.  In other respects, our exams were also about protecting ourselves from malpractice resulting from potential hazards that could be mis-diagnosed. But I have yet to meet a chiropractic graduate from any school who was taught how to properly document an exam for purposes of correct coding and billing.

As a result, most fall into one of two camps mentioned above.  Conservative chiropractors tend to undercode or underbill, thus denying themselves reimbursement for procedures they actually performed.  More aggressive chiropractors tend to bill for procedures out of some sense of justification for the time they spend performing a service that may not necessarily match up with coding or documentation requirements.  As a result, they overbill or upcode.

Many clients come to me seeking ways to improve income, but most also have some predetermined methods that they believe they need to use to achieve this and hope that I can somehow teach them a new “trick” or “secret method.”  On the contrary, most clinics I see would benefit not from something new, but by returning to the old.

In other words, they can reliably improve income by making sure they are being paid for what they are already doing. They can increase revenues by maximizing reimbursements and minimizing errors that cause them to leave money on the table.  Proper billing, coding and documentation can help you achieve this – without the added expense of new equipment, extra staff or additional funds in the marketing department.

Proper Coding & Billing Makes Sense (and Dollars)

On top of that, if you consider correct coding from an expense point of view, proper coding not only has the potential to increase your income, but also prevent you from losing income –few strategies can ever achieve both.

If you want to get down to pure return on investment, taking a coding class for $100 or $200 could easily find you at least one item that you could improve.  Even if that resulted in a $25 increase for a service or procedure you performed just a few times a week that could result in a $5000 increase over the course of a year or a 50:1 ROI!

Personally, I have had seminar attendees tell me that one of my strategies was worth $25,000 to their bottom line!  Take that one step further and spend a few hours consulting with a coding expert and you could easily turn your investment into a 5 digit return. One of my favorite examples: 20 minutes into a visiting a client’s office, I found one error that cost them $42,000 in the previous year.  I can’t calculate that ROI as the numbers are astronomical, as is the fact that once corrected, that client will reap the $42K per rewards for years to come.  Similarly, I had a recent phone conversation with another client that revealed a $50,000/year coding error being made for no apparent reason that pure unadulterated ignorance. The client was uncertain whether to be depressed (that he lost that money each year for the past 15 years) or elated (that he could earn it with one small change).

Before you mistakenly believe that these things only happen in rock-star practices and that I am discovering only the rarest of gems, think again. I am certainly no superman. And my clients are amazingly human as well.

But here’s the thing:  if you are making $10K/year mistakes on some items, missing $15K/year opportunities on others and uncertain how to capitalize on $25K/year possibilities in other areas of your practice, eventually that money begins to add up to big dollars and little sense if you don’t do something about it.

It’s Not ALL About Audits

Finally, I know that in recent years, there has been much written about audits.  And they are a real, scary possibility for all of us.  May I remind you, however, to keep things in proper perspective.  Although it is possible (perhaps even probable) that many chiropractors are doing things incorrectly in terms of their billing, coding, documentation and compliance, that certainly does not mean that everyone will be audited.

On the other hand, however, if you consistently under-code or fail to bill for your services, one thing is guaranteed: you will ALWAYS be paid less than you should for your work.  After all, no one will pay you, if you don’t ask properly.

So, the next time you are seeking ways to increase income in your practice, remember the following:

1. All income increases are not equivalent – consider return on investment
2. Correct billing and coding can help you prevent income loss
   
3. Correct, billing and coding can help you increase income

Action Steps

One of the most basic steps towards improving your coding should include the purchase of the ChiroCode deskbook.  Quite frankly, no office should be without it.  And EVERY office I have seen without one of these books that is making major coding errors that are costing them money and exposing themselves to audits.  Unfortunately, I can think of no exception to this rule.

Secondly, take an active part in improving your billing, coding and documentation knowledge.  This is for both the doctor and the staff.  Read blogs, articles and attend seminars.

If you are tired of being put to sleep and want more interactive instruction on proper coding, billing, documentation and business development,I have some upcoming seminars you may want to attend as long as your brain can stand 12 hours worth of material stuffed into a six hour format.  Disclosure: I drink too much caffeine, talk fast and we cover a lot of ground. If you can hang (and you can), see my SEMINARS page for more info and upcoming dates and locations.

Now is the time to start planning and investing in success for 2012 and beyond!

How Can You Increase Your Chiropractic Income Without Working More?

Related posts:

1. '>Are Your Chiropractic Revenues Tied to Emotions or Logic?
   
   When faced with decisions on major life purchases – house,...
2. '>Chiropractic Seminar Freebies You Missed! And Your Chance to Profit From Them…
   
   For those of you who did NOT attend my recent...
3. '>Random Thoughts Episode #136: Chiropractic Audits, Business Building & Success
   
   I’m on the road for the next couple weeks traveling...