These days, it’s tough to tell where problems start.  Some of you know you, doctor, are the primary contributor.  For others, it’s the staff.  Still others feel it’s insurance or even healthcare at large.

You all may be correct – which is why this article may help point you in the right direction…

Recently, I saw an interesting graphic that depicted the impact of identity theft on healthcare fraud. The graphic illustrated a little mentioned problem in the hunt for fraud and the audit frenzy that is occurring in today’s healthcare:  thieves can steal a person’s (or doctor’s) identity and bill for services to receive reimbursement.  And it’s happening all the time. Witnessed the millions recovered by Medicare for fraudulently billed DME (for example, wheelchairs provided and paid for by Medicare to dead people).

Before you think chiropractic is immune, think again of a larger issue that enables fraud to happen: patient’s no longer understand their health insurance.  And if they don’t understand insurance, they are not only more apt to be victims of crime but also to not reap the full benefits due them.  They are more likely to encounter problems that may get them upset at you.  And, in turn, less likely to want to use their insurance for your care, thus, reducing your income.

With that in mind, below are a few vital, proactive strategies that chiropractors can employ to minimize our audit risk and to preserve good patient relationships:

1. Verify Insurance the Modern Way:  Gone are the old days when one could leave verification to the patients because either their cadillac plan was so good that they didn’t much care or because we already knew what benefits to anticipate.  These days, each payer has umpteen variations of their benefit packages so that we can no longer anticipate that if they have X-insurance, they will have Y-chiropractic benefits with a Z-co-insurance or deductible.  To make matters worse, how a plan will administer benefits is no longer clear either.  Some plans will count the extremity adjustment (98943) as two visits (and two co-pays) when performed with a spinal adjustment.  Others will lump chiropractic and rehab together, while still others have them as a separate package (same goes for massage).  Worse still, many plans define services and procedures differently; for example, if you perform traction (97012), some plans count this as a modality adjunct to your chiropractic, while others count it as a rehab procedure which may pull from those benefits and accrue an additional visit or co-pay!  How in the world can you keep track of all this?  You can’t!  Unless you verify and even that is admittedly an imperfect science, but it is still far superior to leaving it up to your patients. So throw away your 80’s mindset, your forms that were created in the 90’s and step into the new millenium,finally. (For more tips on how to upgrade your verification procedures, see my article 5 Verification Mistakes That Chiropractors Make).

2.  Explain Benefits to Patients.  If most chiropractors can barely navigate the verification maze, how we expect our patients to do so?  Put simply, we can’t.  If you want a surefire way to cause billing messes, increase A/R, frustrate patients and shorten your care, allow patients to muddle their way through the verification mess.  On the other hand, if you want to maintain good patient relations, minimize the number of statements your biller sends, reduce outstanding Accounts Receivable and maximize utilization, then clearly and simply explain to the patient how their insurance works and what benefits they have in your office.  Do not assume – even if they have been to 37 chiropractors prior to your office – that they understand the process or their benefits.  Delegate a well-trained staff member to spend a few minutes explaining this and answering questions.  It is well worth the investment in time and will go a long way in paying dividends.

3. Create a FAQ Page.  Have your billing person sit down and spend an hour writing out answers to the most common billing questions that he or she receives.  Then have them take a sample EOB (or two) where you have billed for your full range of services (chiropractic, exams, PT, massage, etc) and clearly label what each section on that EOB means in plain English.  Then, create a list of the procedures you bill for and explain them in plain English as well.  For example, few patients know what manual therapy is (97140) and even fewer doctors preface their work by saying “Now we are going to perform a little manual therapy.”  So it’s no wonder that when the 97140 code appears on their EOB and isn’t paid correctly, patients get cranky. Be proactive and explain how you bill for what you do. This will go a long way to prevent messes.

4. Use Your Biller’s Time Wisely: At a staff meeting, go over those answers from your FAQ documents with the rest of the staff so that you may minimize the distractions your biller gets and use his/her time wisely instead of answering the same 12 questions over and over again.   In most offices, billers are the highest paid staff.  Why chiropractors let them repeatedly do low-return tasks like verify insurance or answer every billing question (no matter how simple) is beyond me.  It’s just throwing away money.  Allow your biller to focus on the tasks that no one else can do and work to their expertise.

5. Audit Yourself.  Have your staff look through claims to make sure things are going out correctly.  Depending on your volume, it may not be possible or prudent to have them check every single one.  But even a random selection will help weed out preventable errors that will cause audits, post-payment demands or denials later.  Again, an ounce of prevention here pays big dividends.

6.  Consider a Documentation Review or “Preventative Audit” by a Professional.  Let’s face it.  Most of you see very few – if any – notes other than your own.  And we all know how much billing, coding & documentation training we received in chiropractic school.  The results? Many chiropractors repeatedly fall short in their documentation, thus exposing themselves to audits, denials and post-payment demands.  Worse, many of us know we fall short (from reading blogs like this one or attending seminars or by some intuition that just tells us our documentation stinks).  But we fail to do anything about it.  Take action and get a “Preventative Audit” of what you are billing, coding and documenting before disaster strikes.  For a minimal investment, you can save six figures, as many of the audits I am seeing are in that range.  I only have a limited amount of “Preventative Audits”that I perform each quarter for non-clients, so it’s first come, first served.  If you are interested, go to www.strategicdc.com/docreview for more info.