Alas, here we are in 2014 with changes swirling all around our chiropractic practice. And while most chiropractors will try to keep all our plates spinning as best we can, we cannot forget to avoid the big threats that can harm, maim or even kill our practice. Here’s the what, why and how to avoid these beasties:
- HIPAA Compliance: thanks to the Omnibus Rule (which went into effect in January 2014), too many chiropractors risk being unknowingly out of date with HIPAA compliance. Unfortunately, many DC’s simply believe HIPAA is a bunch of forms that your patient signs when they start care and the “unwritten rule” that you don’t talk about patients outside the office. While HIPAA does require paperwork, it’s more than a simple privacy agreement. And while HIPAA does require you to protect your patients health information, telling your staff not to gossip is not going to cover all the bases. So how does one tell if their “compliance binder” is keeping them compliant? For starters, look at the date. Your binder’s usefulness is threatened if you haven’t made recent updates to reflect the changes in the Omnibus Rule. Worse, your “compliance binder” is long past expired if it was put into to place pre-2009 when HIPAA changed many of its rules. But wait – there’s more bad news. Seeing that our government needs money, the HIPAA “police” are now on the prowl! The Office of Civil Rights gets involved if you have a HIPAA violation that is classified as “abuse” and the Department of Justice gets to investigate potential cases of HIPAA fraud. Don’t know about you, but neither one of those entities sound like anyone I want to dance with.
- Coding Compliance – it’s no secret (hopefully) that ICD-10 will rock the healthcare world in October 2014. But the onset of ICD-10 will only add fuel to the auditor’s fire in the coding world since they have already been setting physicians ablaze for various violations of coding “rules.” Thanks to the big auditing push and chase for fraud, waste and abuse spearheaded by Medicare, coding errors are getting more costly for small practices. Despite the fact that statistics show that <5% of doctors billing ANY insurance entity are fraudsters, it’s big bucks to the payers to go after you anyway. Why? Well, in the witch hunt for fraud, it turns out they find a lot of overpayments and ask for a lot of money to be paid back to the payer. While the legitimacy and accuracy of these overpayments is extremely suspect, it still makes great financial sense for payers to employ professional auditors who work on a commission basis to comb through your records to find some hidden money they can take back. After all, if the auditors are on a commission, it costs the payer absolutely nothing for them to audit you. Even salaried auditors working for big payers are quite the “profit center” for the insurance company. When they can pay an auditor $25/hour and turn around and demand $200,000+ back from you (based on a few hours worth of the auditors time), the payers know they’ve got a good thing going, which, obviously, is very bad news for you and your sloppy coding practices. Oh and the really bad news? It will get much worse in ICD-10 as the specificity of your coding will need to change and improve dramatically.
- Documentation Compliance – most chiropractors will readily admit that either their documentation is one of their weakest areas or that it needs some improving. Despite the glaring obvious elephant in the room, we seem content to throwing him some peanuts and generally tolerating our bad documentation pachyderm friend. As above with coding audits, documentation goes hand in hand to either save your soul or turn up the heat against you. And yes, this too will get more difficult in ICD-10 as well. The time to change is now. In fact, it was yesterday.
- Fee Compliance – perhaps the most devilish trick that the payers have been using over the last couple years is the phony patient call. This little game is creating big wins in the PI arena particularly. Here’s the scenario: the payer calls your office pretending to be a patient. They ask a bunch of fee related questions, typically in regards to your “cash” prices. A week or so later you get a letter from the payer confirming that they have called your office and verified that you are breaking the law via your dual fee schedule or illegal cash discount. While they sometimes threaten legal action (turning you into your state board), mostly they would just like their money back. And when they find that you have been charging their patient $150 for an Exam and another $100 for x-rays, they get suspicious. This is because when they called your office and found out about your $49 “New Patient Special” that includes an Exam, Xrays and a Treatment, they see that there is a math error there and they intend to turn it in their favor. The request? We’d like that $100 or so back for every New Patient we paid you over the last 18 months! Ouch. But it can get worse if they multiple the post-payment demand by exams, treatment, massage therapy and other billable entities that you have reportedly overcharged them for.
The most obvious solution is to tighten your ship and play by the rules. Make sure that your HIPAA compliance is up to date. Read up on the Omnibus Rule, privacy breach and other HIPAA requirements and put them into motion in your office…quickly. Ensure that you are coding and documenting accurately for services rendered. Get ICD-10 training sooner rather than later so you can incorporate that too. And finally, be sure that your fee structure helps you avoid unnecessary headaches with fee hassles by training your staff to answer questions accurately and by creating a compliant fee schedule.
Resources and What to Do Next
Undoubtedly, there is a group of you who can do all of this and get it done well.
On the other hand, many of you know that you don’t currently possess all the pieces of the puzzle to make this work and/or that you won’t ever have the time to get around to finding fixes to all these problems on your own.
If you are in the latter group, you need to seriously check out our Chiropractic Audit Armor program (our interactive compliance training and mystery caller program, which also includes ICD-10 implementation training) so you can get ‘er done and sleep at night.