Last year, I wrote several posts about the rise in several specific audit threats to your chiropractic business and bottom line. (see also “Chiropractic Compliance Bombs You Don’t Want to Explode”)

Unfortunately,  from the number of concerned emails and whispers I get at seminars, payers haven’t given up on using these dangerous tactics.  If anything, they have seemingly increased.

What exactly are these new fangled threats?  Certainly, it appears like auditors have a bottomless toolbox of tricks, but in this article, we will discuss three that are particularly dangerous and increasingly more common:

Three Dangerous Chiropractic Audit Scenarios

1) Payers Posing as Patients — This tactic is primarily used by Auto Carriers on PI patients. A rep from the auto insurance calls your office posing as a prospective new patient.  They typically ask questions regarding your fees — while failing to identify themselves as an insurance representative. Instead, their questions sound as if they are a price conscious cash patient.  The questions frequently ask how much you charge for an adjustment, a massage or perhaps an exam.

When this happens, your ability to collect (or keep) your full fee, your practice’s compliance and your license on completely dependent on the ability of your staff member to answer the reps questions correctly (in their eyes).  As has been painfully demonstrated by chiropractors caught in this trap, any number of answers can be given that can potentially get you in some major hot water.

In some cases, when your staff member has answered incorrectly, the rep springs out of their patient disguise, puts on a judge robe and slams the proverbial gavel to inform you that you are sunk. They will report back to the insurance that you have overcharged the payer and a post-payment demand will be promptly arriving in the mail.  Audit attempted, trial done and over in one fell swoop.

2) Payers Calling Your Patients – a second threatening scenario is when a payer’s audit efforts are routed directly through the patients. The method is simple: a phone call to your patient with lots of questions. Depending on the payer, the payer either adopts a neutral stance and befuddles your patient with a barrage of questions or (and more disturbingly), informs your patients that they are investigating your billing practices.  Either way, the effect is the same.  All but the most trusting patients suspect the worst.

3) Payers Notifying Your State Chiropractic Board — a third assault being waged  by the payers is a complaint lodged against you to your state board.  Payers know that, in most states, every board complaint must be investigated.  So, if the payer thinks you are up to no good, they generously let your state board know their opinion regardless of whether it has merit or not.  Depending on how vigorous the payers in your state are, your board will then notify you of their investigation.  Fortunately or unfortunately, this may not happen for up to one year as in some states the disciplinary board is so backlogged in hearing all these cases that they can’t get around to investigating your case for quite some time.

Obvious Audit Problems Emerge

Regardless of which of the three threats above attack you, several problems typically emerge.

— You find out that while a TOS discount may have been legal in your state, the way you structured it was not bulletproof and therefore, you may be subject to paying back money or being forced into accepting a lower rate for your services;

— You discover massive weaknesses in your staff’s training and ability to accurately communicate your fees

— You begin to lose sleep at night over your admittedly questionable compliance and wonder what other areas your practice may be compromised;

— You are forced to repay money for improper billing or coding;

— You are shocked to discover that your malpractice carrier provides little or no coverage for “billing disputes” (the category most post-payment demands fall under)

— You are not amused to find that there is no definitive laws on TOS discounts in your state and therefore, your discount is in the court of public opinion as to whether it is too high or too low.

The Worst Consequence of All

Perhaps the most disturbing effect of all this nonsense is the fact that the vast majority of chiropractors experience a MAJOR loss of business during ANY investigation or audit.  This is due to the fact that the audit causes them to lose the focus that they would normally devote to their practice and instead shift it to attending to the details of their audit.

For some, the pain and financial loss doesn’t even end when the audit does.  Over the last several years, I have met and worked with way too many “post-traumatic audit victims.”  These are good chiropractors who felt the sting of an audit (whether financially or intellectually) and then they practice in fear.  For some, they under-code everything they do hoping to stay under the radar, losing thousands in the process.  Others give away services left and right – again, losing income.  Some become obsessive about their documentation to the degree that they seriously injure their practice productivity (and income) in the process. And a few are never quite the same – perennially paranoid and always looking over their shoulder, they become chiropractic corpses whose practices and personalities are a thin shell of what they used to be.

WHAT TO DO NEXT

Sorry (again) to be the grim reaper of reality here but there are too many chiropractors whose lives are at stake to let this slide and just pretend to play another happy day in coding land.

If these scenarios are disturbing to you, do something about it.   Here are three suggestions:

1) Review your compliance and office procedures with your staff to see if you have any gaps (no compliance procedures? Go to step 3)

2) If you are uncertain how robust your compliance procedures are, take a compliance test (if you do poorly, go to Step 3)

3) While there is no completely bulletproof solution for all chiropractic compliance and audit threats,  most problems of this nature can be seriously reduced with proper training and procedures, which is exactly what our Chiropractic Audit Armor service offers.  If you’d like to sleep better at night knowing you have avoided unnecessary errors, have crafted a tangible defense and are doing thing right, Chiropractic Audit Armor is for you.

Your other option, as always, is to do none of the above. You can hope that nothing happens to you and continue rolling the dice.