The 2010 National Payor Survey was recently released much to the chagrin of third party payors; not surprisingly, it doesn’t exactly depict the payors in a flattering light.  The survey, which was conducted by an independent research firm, polled hospital and health care executives from all 50 states to extract data on their daily interactions with a myriad of insurance companies to detect trends, problems, and issues to address from a physician’s or facility standp0int.

United HealthCare gets the stinky sock award for the fourth year in a row as the worst health insurance payer in America, with a 2:1 ratio of negative vs positive feedback. Fellow contestants in the “Insurance Payor Gong Show,” Coventry and WellPoint/Anthem also would have received the big gong for their pitiful feedback ratings that included as much negative as positive feedback.  Aetna ranked as the best payer closely followed by Cigna.

This year’s survey also highlighted some interesting categories  as follows:

• Easiest to Deal With (BCBS) and Most Difficult (United Health Care)
• Best Reimbursement Rates (United HealthCare) and Worst (Wellpoint/Anthem)
• Most honest and candid (BCBS) and Least (United Healthcare)
• Most Timely and Responsive ( BCBS) and Least (Wellpoint/Anthem)
• Fewest Claims Denials (BCBS) and Most (Wellpoint/Anthem)
• Best at Processing Claims (BCBS) and Worst (United Healthcare)
• Best at Fixing Claims (BCBS) and Worst (Wellpoint/Anthem)

So what does this mean to chiropractors, who are “little fish” in the big pond of healthcare?

1.   Anticipate problems — if the insurance companies are unafraid and willing to mess around with the big guys (hospitals, large medical groups), be assured that they will take the same approach to you.  If your major payor is one of the “worst of the worst” keep a very close eye on your billings, accounts receivable and EOB’s — and watch for shenanigans!  If it’s a minor payor (few patients) that gives major headaches, consider dropping them.  See my article on “How to Drop An Insurance Company” for specific strategies.

2.  Fight back — WHEN your claims are paid incorrectly, know your rights to fair/correct payment and appeal.  If you don’t have a fleet of appeal letters for every situation ready to deploy at a moment’s notice, it’s time you prepare for battle.  Start saving them as you write them so you can re-use your appeal the next time around (there WILL be another time) or consider my Chiropractic Appeals Toolkit as a ready-made resource for this purpose.

3.  Form the Roman Turtle. If you know military history, you may have heard about the “Roman Turtle” formation in which the soldiers would configure themselves tightly together. If the enemy shot arrows at them they would use their shields to surround their bodies and protect themselves from all angles. Even with a small group of soldiers, the benefit to banding together like this afforded them excellent protection.  There is simply no way that you, the solo DC, can battle the big guys by yourselves. Now, more than ever, is the time to join your state and/or national association and fight battles collectively.

4.  Work Smarter. Many DC’s enter battle naked or worse, send in their spouse unarmed and dangerous.  A $50,000 coding mistake (actually a $25 mistake made 2000 times over several years) becomes a dear price to pay for ignorance but in virtually every office that I consult with, I can uncover at least that much in income they are either giving away, discounts they are inadvertently giving to insurance companies and services that they are either not billing for or performing incorrectly.  I don’t care which side of the fence you sit on — whether you are more concerned about potentially losing money by doing something wrong or losing out on money that you could have made for services you already performed.  Either way, you are not working smarter, you are simply working harder and harder for less income and more risk.

If you suspect that you are working harder, missing out on income or unnecessarily exposing your practice to audit risk, join us Thursday April 29 for our upcoming one hour, info-packed webinar  7 Ways to Tighten A/R and Increase Profits! where you will discover profitable strategies to increase income, decrease risk and prevent errors that cause you to lose money or leave it on the table!

Can’t make the webinar?  Order it on CD! That way, you won’t miss out on:

** How to manage your revenue cycles for maximum profit + minimum effort

** The ONE rule that will single-handedly guarantee increased profits…IF you follow it!

** How to obtain maximum value for your efforts + time

**What one strategy you are missing that can provide your clinic with extra income with virtually no extra work on your part

** When to use your “secret weapons” to get payment

** How to increase efficiency + decrease staff costs for collections

** How to effectively collect amidst high deductibles, skyrocketing co-pays and the changing health-care marketplace..

To Your Success!

Tom Necela, DC, CPC, CPMA

Related posts:

1. 2010 Health Insurance Report Cards The results of the annual Health Insurance Report Card are...
2. Prompt Payment Headaches, Chiropractors & Mosquitoes While some of the profession is battling post-payment reviews, audits...
3. Insurers Underpaid 'Billions' In Health Claims: What Can We Do? The Wall Street Journal recently reported that a flawed payment...