Starting into Practice

Are you willing to pay the price?

2012-05-21T07:00:00-05:00

Do you arrive at the office committed to do the right thing in every call for action?

Do you strive to deliver your clinical knowledge and skill at a higher level than yesterday?

Do you and your staff strive for a zero defect in being error free in matters relating to patient communication and procedures?

Do you and your staff work for the purpose of embracing the mission of the office?

Are you driven by quality, patient-centered care?

At the end of the day do you feel a warm sense of satisfaction for making a difference in the lives of the patients you have touched?

If the answer to these questions is "yes" you are experiencing the rewards from a commitment to excellence. If your answers have been less than positive, you are experiencing frustration and mediocrity and your patients are being denied what they deserve.

You MUST be willing to pay the price!

Audits Increase for Medicare and Its Subcontractors

2012-05-16T07:00:00-05:00

By contractual obligation with the Centers for Medicare and Medicaid Services (CMS), the local Medicare carriers routinely perform post-payment medical review/audits of services rendered by selected providers. Through statistical analysis, the carrier determines if the utilization of CPT codes 98940, 98941 and/or 98942 exceeds that of our peers throughout their jurisdictions.

In addition to the Local Carrier Audits, the Zone Program Integrity Contractors are also increasing
audits. In 2010 and 2011, the Zone Program Integrity Contractors (ZPICs) provided a report for education to the top 8% of providers in 2010 and then the next 8% of utilizers in 2011. Those that received a report in 2010 did not receive another report in 2011. The ZPICS chose to educate the next tier of top providers in 2011, rather than re-audit the same tier of providers.

In ZPIC audits, the request for records may come with a CD that has an Excel spreadsheet included. The column titles included in this spreadsheet are as follows:

Column A – Medicare Beneficiary
Column B – Beneficiary Date of Birth
Column C – HICN
Column D – Date of Service
Column E – Diagnosis Code
Column F – Amount Paid
Column G – Document the precipitating event initiating change in diagnosis and/or new onset of symptoms. Identify objective clinical information which supports the diagnosis.
Column H – Identified Overpayment

In the event you receive a request for records, you will have 30 days from the date of the letter. You must notify the requestor if you are unable to meet this target date. If they do not receive the medical records by the indicated date, or have not received notification of your inability to meet the target date, they will proceed with the review without the documentation. The services will be
considered non-documented, which will result in an overpayment determination. When no documentation has been received, the service(s) will be denied.

Authorization to release medical records to the Medicare carrier is granted by each patient, or their
designee, as a condition for payment of services rendered by Medicare certified providers. Patients authorize the release of any medical or other information necessary by signing either the CMS 1500 claim form (Box 12) or a “Statement to Permit Payment of Medicare Benefits to Provider” release form. Furthermore, the Health Insurance Portability and Accountability Act (HIPAA), effective April 21, 2003, does not prohibit the release of individual beneficiary medical records to the carrier for medical review of billed services.

Each of us must keep in mind that it is illegal for a chiropractor to opt out of Medicare. If you see a Medicare patient, you must choose to become a participating provider or non-participating provider. In either classification, you must still file a claim to the carrier for active care. If you choose not to submit claims to Medicare, you may be subject to audits and possible fines.

Your Most Important Date

2012-05-11T07:00:00-05:00

When we need something done we usually make a date/appointment. Think about it...we make a date to have our car serviced, to go to the dentist, to see a new movie, to get a haircut. An appointment is a mutual agreement to meet with someone at a specific time. You write it on your calendar.

When you have an important task to complete do you "make a date" with yourself? My guess is the answer is "no."

Good planners make a calendar date with themselves to complete office tasks.

Here is how it works...and it is simple. Mark the time into the office appointment calendar at a time when you can have a solid block of uninterupted time. Note a deadline of when the job needs to be completed. So if you put down an hour of time and at the end of that hour you find you need 30 minutes more, reschedule another block of time in the calendar to complete the task.

You can be flexible, but do not get into the habit of "breaking your appointment" with yourself to do some other task. Hold yourself accountable!

It may not seem so in the beginning, but there are great benefits to this type of planning. You know exactly when you are going to tackle and complete a project. Keep your promise to yourself...you will feel good when the project is completed and you can cross another item off of your "to do" list.

Where Does the Money Go?

2012-05-03T07:00:00-05:00

When I stare out over the faces of so many new doctors in our Starting into Practice seminars, I often wonder if any of them really understand the consequences of borrowing so much money to finance their educations.

We all know that Uncle Sam is very generous in giving most students the funding they need to complete such a worthy degree. But maybe, Uncle Sam is a little too generous. Or maybe students are not looking at the whole picture. I'll give you an example of a friend's doctorate college output and the amount of accessible money she had available to her from Uncle Sam.

Tuition for 4 years at a doctoate level $92,427

Government funds available to her (for 1 year) $224,000

Difference is $131,573

Even considering that she needed to pay room and board, (she roomed with a friend, they split costs, she worked a part-time job and lived frugally,) she managed to only need an additional $31,573. She sent back $100,000 to the government, reducing her loan repayment to $124,000.

Now you wonder why is this important?

Again, I picture myself back in the Starting into Practiceprograms where we often hear about the enormous debt students will be leaving school with. Everyone complains about it! Yet, rarely - and I mean rarely - do I ever see a student without a new iPhone, iPad, decent car, etc., and they are talking about their spring break trips to Mexico and Europe, new cars, flat screen TVs, etc.

I know most students are not working, so where is this money coming from? You got it! Uncle Sam!

Instead of putting money back for a possible rainy day, or just taking what is needed to survive school, students are taking and using the maximum amount allowed and buying unnecessary things that will, in the long run, costs twenty times more with the interest they'll have to pay over the next 10 or 20 years. That iPhone that costs $300-$400 becomes $3,000 to $4,000 dollars with student loans.

So think about it before you continue to borrow as you start into practice. Borrow only what you need, not what you want! It's the wise way to begin a profitable practice.

Any of you have stories about what you did with your school loans? Were you wise with your money? Share your successes or failures, won't you?

Are You Involved?

2012-04-26T07:00:00-05:00

The Florida Legislature is currently meeting for its annual 60 day session. By statute, the legislature has only one required task each year: to provide a balanced budget.

Every 10 years, following the national census gathering, the legislature is also required to recommend reapportionment of federal and state voting districts to reflect altered population areas and variances.

Like most years, along with these duties, several other bills have been proposed and are being considered. One is of particular interest to chiropractors and involves individuals who have been involved in automobile accidents and PIP [Personal Injury Protection] insurance.

Under the guise of reducing fraud within the system, many alterations to this plan have been proposed. While all citizens should be in favor or rooting out fraudulent practices, some of the proposals do not seem to be directed at this goal.

Currently, a bill proposed in the House deletes chiropractors from providing care within the system. Obviously, this makes no sense, is bad public policy and will not be beneficial to our citizens if the proposal passes.

This bill has certainly gotten the attention of the profession and its allies. Over the years we've had many good friends in the legislature but these have been relationships which have been nurtured and developed over time. As term limits of representatives has occurred and as different players occupy different seats, times change as do opinions.

Presently, chiropractors, patients and public citizens are attempting to alter this harmful bill but it does not happen overnight and requires that each chiropractor be involved in some way and in an ongoing fashion.

ARE YOU INVOLVED ... and if not, why not? It's your profession and livelihood. Happy Days!

Be Prepared - Create a Contingency Plan

2012-04-24T07:00:00-05:00

A contingency is something that might happen, but then again, it might not. Believe me, if it DOES occur it will be when you least expect it. A power failure, a broken water pipe, an unexpected resignation by a staff member?

The good news is that a contingency plan does not have to be elaborate. Just follow the old Boy Scout motto and "be prepared."

Set aside 30 minutes now and list some contingency plans you have in place and those that you need to develop.

One good thing about having a contingency plan is that by its very existence it helps guarantee that you will never need it! Your awareness of potential problems will keep you "ready" and hopefully help you avert the need for using the plan. It an also help you come up with some creative solutions to the problems they may present.

Eliminate crisis planning by having an ongoing and updated contingency plan.

The Saving Power of an Umbrella Policy

2012-04-20T07:00:00-05:00

I was in Las Vegas this past weekend for a chiropractic event. On the way from the airport to my hotel, my cab came to a standstill for quite some time. As we inched forward, I could see that there was a significant, multi-car “fender bender” in front of us.

It didn’t appear that there were any major injuries, but there was extensive damage to the cars and, without doubt, some sore necks and backs. I did wonder if the person responsible for the accident had enough insurance for all of those affected?

Once fault is established, that person will be legally and financially responsible for the medical bills and property damage for all those involved!

If you don’t have one already, I’d suggest discussing an umbrella policy with your insurance agent. An umbrella liability policy will provide protection beyond the limits of your home, auto and business policies. For instance, if you were the person that caused the auto accident I described above and the collective damages exceeded your auto liability limits, the umbrella would be an extra layer of protection helping to protect your personal finances from becoming at stake.

I think most people either don’t think of an umbrella policy or have the impression they are unaffordable. In reality, the cost for a million dollar umbrella is typically very affordable considering the peace of mind it provides!

As always, please consult your insurance agent to discuss your particular insurance plan. Our NCMIC insurance agents would also be happy to assist you and discuss your options. (Contact them by email at agents@ncmic.com or by calling 800-394-1466.)

Beware of Your Discount Policies

2012-04-17T07:00:00-05:00

The world has become a smaller place with social networking, texting, Twitter and internet coupon organizations. Beware that marketing for new patients has its limitations.

As a method to attract new patients, many offer huge discounts off their services. While this may be a routine occurrence in the department store, it may be a direct violation of Federal law, state law and/or your PPO policies.

In January 2012, Blue Cross Blue Shield of Illinois (BCBS) released a statement pertaining to discounts. In their Blue Review column, BCBS stated that

“Many businesses are offering discounted services through social media and other marketing channels as a way to attract new clients. This strategy does not apply to health care services you provide with BCBSIL members. The offering of any type of discount, such as a waiver of co-pay, is prohibited. Additionally, requesting pre-payment from your patient for covered services is not allowed.”

This may apply nationwide and should be reviewed in the applicable PPO policies.

In addition, Medicare has had a similar policy for nearly 10 years.

“A person who offers or transfers to a Medicare or Medicaid beneficiary any remuneration that the person knows or should know is likely to influence the beneficiary’s selection of a particular provider, practitioner, or supplier of Medicare or Medicaid payable items or services may be liable for civil money penalties (CMPs) of up to $10,000 for each wrongful act. The statute defines “remuneration” to include, without limitation, waivers of copayments and deductible amounts (or parts thereof) and transfers of items or services for free or for other than fair market value.”

When you sign a contract with a PPO organization, you must abide by all its rules and regulations. While these marketing ploys may succeed in attracting new patients, it may also succeed in attracting recoupment proceedings and the Office of Inspector General (OIG). Abide by the policies of the PPO and if in doubt, get clarification, in writing, from their customer service department.

Are You Using Free Publicity?

2012-04-12T07:00:00-05:00

In our Starting into Practice programs, students seemed most interested in marketing techniques. At a recent program a student asked us, "Why does advertising cost so much?"

We explained advertising and marketing don't have to cost anything if you think outside of the box.

For instance, did you know that instead of paying for advertising in community newsletters you might be able to "offer" to write a short feature column on health-related issues such as "Preparing Your Back for Gardening Season."

A fresh face and a fresh idea might be just what they need, plus your name gets a byline!

Or how about writing a press release if you attend a CE program or your Homecoming? Pieces like that usually get noticed in the business section.

What about contacting your local radio station and ask if you can be interviewed "on air" when you volunteer for a community event (remember - it's not about you). For example, one D.C. we know volunteered to be the director for the local hospital's annual fundraiser. His presence there got him noticed by the other volunteers and he was soon added as an "on staff" chiropractor.

How about asking your new clients for "referrals?" That's the best advertising you have!

Overall, think differently. You don't have to always pay for something. Use your head. Share ideas. Ask for help. Soon you'll be paying less and receiving more patients!

Do you have a "free" way of marketing or advertising you'd like to tell others about? Just comment on this blog post and share your ideas.

The patient who knows more than the doctor!

2012-04-09T07:00:00-05:00

I realize that the majority of patients are more educated as to their condition with the help of the internet but sometimes they can also be misled and scared depending on the multitude of diagnosis that come up on the search.

Now, I live in a small town and take care of a lot of strong willed and stubborn Pennsylvania Dutch farmers...talk about old school! A patient once came in with a sore neck from pulling his own tooth out with a pair of plyers!

Just this week, someone came in with a red and swollen hand that he claims was coming from the nerve in his upper back because he caught a cold in it! He refused to listen to me that it could be an infection and he needed to get it checked out.

When I encounter these patients, and believe me it happens more than you would think, I record all the pertinent information in my progress notes, print them out and read it out loud to the patient so they understand what I am recommending and they sign it.

Maybe this is overkill, but I want to make sure that I am covering myself for any liability. Am I the only one with insane patients?!