By Dr. Tom Potisk

Doctors of chiropractic appreciate respect as do patients. When a doctor acknowledges and recognizes that the patient may have limited time and money, a mutual respect develops and the situation becomes win-win. For example, when making a recommendation to a patient, ask “May I explain the tests that need to be performed today?”, and then “These will take approximately ____ minutes. Do you have time today?”

After explaining the results, a good follow up is: “Are you ready to start treatment today?” Then explain the treatment.

Far too often doctors get into a routine and they begin to assume that the patient wants what you’re about to perform. Asking their permission to proceed not only relaxes the patient but lowers your liability because you’ve gotten their consent.

Never assume that permission has already been obtained by staff. Ask “Has the receptionist explained our procedures and policies?”

For gaining referrals, avoid the harsh “Bring in your spouse and child for a spinal exam.” Instead ask, “Many of my patients bring their family here for preventive check-ups. Would you be interested in how that works?” The best time to ask this is when the patient has praised your treatment. As Doctor Sid Williams says, “Breed them while they’re in heat!”

For building a wellness care practice, a great question is “If there were a way of preventing this problem from reoccurring and avoiding new problems would you be interested?”

At the end of your practice day, reflect upon it and take notice of how many times you asked questions versus issued advice and orders. The ratio should be about 50:50. Don’t be afraid to ask your staff for their perspective of your performance. They are your best source of input and will feel honored by your inquiry.

In this era of managed health care and busy lifestyles, asking for the patient’s permission goes a long way in gaining their respect and building a joy filled successful practice.

Dr. Tom Potisk has been a client of PM&A for nearly all of his 25 year multi-doctor practice. He now works with PM&A and is soon publishing a book titled Reclaim The Joy Of Practice.

“A client recently asked us ‘What can I charge Medicare patients for wellness care?”  The answer, as is often the case with insurance, is ‘it depends’. There are several factors that must be considered and a few Medicare regulations that have to be reviewed”

Medicare has covered and non-covered services, as you know.

Non-covered services for chiropractic are easy. Exams, x-rays, extremity adjustments (98943), and therapies are all non-covered services and you may charge the patient whatever your fee is or whatever you have worked out. (WPS Medicare Fraud & Abuse Manual, pages 18-19; Sect 1862(a)(1), Waiver of Liability). Any of these services may be billed with a –GY modifier (indicating they are billed for denial purposes only), but they will be denied regardless (http://www.medicarenhic.com/providers/pubs/Chiropractic%20Billing%20Guide.pdf , page 21-22).

Non-covered services are never paid by Medicare. These services are not considered a benefit of the Medicare program. Because of this, there are no restrictions on what you may charge for these services or what a supplemental insurer may pay (ibid). You do not even need to bill them to Medicare except that you may want them to be denied or to be forwarded to a secondary.

Covered services for chiropractic included spinal adjustments (98940-2) when billed for a covered diagnosis (L30328, http://www.wpsmedicare.com/part_b/policy/active/local/_files/l30328_chiro001.pdf ). A covered service can be paid or can be denied as not medically necessary.

If you are a participating provider, and you bill an adjustment (98940-2) with the correct diagnosis and with the –AT modifier, it will generally be paid by Medicare at 80% of the par fee amount. The fee schedule is published annually (http://www.wpsmedicare.com/part_b/fees/physician_fee_schedule/) and is mailed to you on a disk near the end of every year.

If a covered service (98940-2 -AT) is paid, no problem.

If a covered service is denied as not medically necessary, AND you have notified the patient in advance that Medicare may deny the claim (with your ABN form), then you may collect from the patient.

If you have had the patient sign the ABN, and you are doing an adjustment for an acute or active problem as defined above, then you are billing with the 9894x – AT – GA code and modifiers to indicate it was acute care and that the patient signed the ABN (L30328),
(http://www.chirobase.org/19Insurance/CR3449.pdf page 3, http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM3449.pdf ).

If you are doing a maintenance or wellness adjustment, and you have had the patient sign the ABN form, you are billing without the –AT modifier but with the –GA modifier (9894x – GA) indicating you are billing a covered service and notified the patient in advance that Medicare will deny the claim. You must still bill Medicare for the service, as it is a covered service (http://www.cms.hhs.gov/MLNMattersArticles/downloads/SE0749.pdf , page 4, point#6).

If you are doing a maintenance or wellness adjustment or if you are doing services that are not medically necessary (98940-2), and Medicare denies the claim, AND you did NOT have the patient sign the ABN form, the patient should not be billed for the claim, not even for the deductible or co-insurance (Sect 1862(a)(1), Waiver of Liability). The secondary may or may not pay the claim and Medicare does not have any problem or jurisdiction if the secondary or supplemental insurance pays the claim.

Now, hopefully that is all clear. If not, you can go to the references I hyperlinked for further clarification. I always suggest you go directly to the sources on these.

So the simple question is, IF you bill for the adjustment (98940-2) without the –AT modifier, but with the –GA modifier, indicating it is maintenance care and you notified the patient in advance, what can you charge?

Here is what Medicare states:

“The only situation in which non-opt-out physicians or practitioners, or other suppliers, are not required to submit claims to Medicare for covered services is where a beneficiary or the beneficiary’s legal representative refuses, of his/her own free will, to authorize the submission of a bill to Medicare. However, the limits on what the physician, practitioner, or other supplier may collect from the beneficiary continue to apply to charges for the covered service, notwithstanding the absence of a claim to Medicare.”

“If an item or service is one that Medicare may cover in some circumstances but not in others, a non-opt-out physician/practitioner, or other supplier, must still submit a claim to Medicare. However, the physician, practitioner or other supplier may choose to provide the beneficiary, prior to the rendering of the item or service, an Advance Beneficiary Notice (ABN) as described in the Medicare Claims Processing Manual Chapter 30. (Also see §40.24 for a description of the difference between an ABN and a private contract.) An ABN notifies the beneficiary that Medicare is likely to deny the claim and that if Medicare does deny the claim, the beneficiary will be liable for the full cost of the services. Where a valid ABN is given, subsequent denial of the claim relieves the non-opt-out physician/practitioner, or other supplier, of the limitations on charges that would apply if the services were covered.”

(http://www.cms.hhs.gov/manuals/Downloads/bp102c15.pdf , Medicare Benefits Policy Manual)

Read the whole section. I have underlined the key point. Medicare does not reprice your normal fees in this case and you are free to charge the patient accordingly.

I know that was a long way around to the answer, but this was not just a yes or no question, as you have to understand Medicare and the factors that are involved.

Dave

This article was sent in to us by one of our clients. We felt it was a great suggestion and thought it might help your office when faced with the same situation.

“I just wanted to pass something on that may benefit your other offices.  If we have families that we treat where only two or three of them need to meet their deductibles, we choose the family members that are incurring the most charges and send those in right away.  The other family members we hold the charges until the family deductible is met.

“For instance, we have a family of about 8 people that we are treating that have to meet two deductibles to make their family deductible.  We are only sending CMS-1500 forms on two of those patients until the deductible is met, then we will submit all the bills from the other family members so that we don’t have bits and pieces being eaten out of everyone’s claims unnecessarily”

Filing in this manner, simplifies the collection of the patients out-of-pocket at the front desk, reduces the number of claims affected by the deductibles and overall increases the efficiency of the accounting for these patients.

Thanks Laura D from Family Chiropractic

(Lucas County, Ohio)  2010 (it’s called twenty-ten, by the way) has started out pretty cold this side of the Rockies. Won’t get above freezing all week for many of the Midwestern states. Even Florida is below freezing in some parts.

But it is a New Year.  So, let’s heat it up!

Old Mongol saying: “Ride fast, move fast, stay warm.”

Here are some chiropractic ads and other action steps you can take in your chiropractic office to heat things up:

[Read more →]

T`was the day before Christmas, but there was no cheer.

No jingle bells jingled, no sound of reindeer.
The word had got out that Santa was sick.
There`d be no friendly visit from jolly St. Nick.

The people were sad; no gaiety sounded.
For Christmas had come, but Santa was grounded.
He walked down the street, and what should he see?
On a small sign was printed, Chiropractor, D.C.

Now, Santa was not one to like a new tactic,
But all else had failed, so he`d try Chiropractic.
He entered the office and saw at a glance
In a place such as this illness hasn`t a chance.

[Read more →]

In this short article you will learn a new disease and how to prevent it, how to not lose money, and a special offer for a free drink in Las Vegas.

I love snow days.

As a kid, if you lived in the Northern climates, or mountains, or parts of the world where you can get a ton of snow dropped on you every now and then, you know what I mean. No school. Sleeping in, snow men, sledding, or just cuddling up with a game and watching the snow blow around.

But when you are in the business of providing chiropractic care, snow days can cause the opposite reaction. Snow days aren’t fun, they cost. Sometimes a few thousand dollars in one day and momentum can be lost for a week.

Have you ever known anyone who got really agitated and complained when they were delayed in their travels by a traffic jam?  I always wondered about this. WHY? Why complain? Do something constructive about it, and if you can’t,  then shut up. Why be negative?

Same with snow days. Or any natural work stoppage.  Snow days are a great time to “Sharpen the Saw.” It is a time to work on important things that are not urgent, as Dr. Covey talks about.

Jimmy Parker, D.C.,  always talked about turning your lemons into lemonade, another way of saying the same thing. (Speaking of Parker, come to Las Vegas and hang with us on January 15 & 16. Free drinks for all. Oops. Wait, I got carried away. First 10 that respond to this! See you there.)
[Read more →]

2010

What does that mean to you?

More money?
More time off?
Better service and care for your chiropractic patients and community?

Does it mean a new opportunity to pursue your special projects: the song you meant to write, the trip you planned to take, project with your family, the good deed you hoped to do?

It’s out there.  A New Year, another package of 12 months, 52 weeks, 365 days. It is your playing field, your sand box, your canvass – it’s yours.

But it’s yours ONLY if you take it. Only if you grab it and get busy creating the life and practice and business you want. Otherwise, it will go by quickly while you aren’t looking.

It is a gift, really.  We take so much for granted, particularly us Americans. It is no wonder immigrants who start small businesses do better. They appreciate the gift of Opportunity.

If you don’t seize this year, guaranteed, the world will seize you… like it does to so many. Soon, you will be more concerned about the “economy”, “health care” “reform”, wars, and a million other distractions rather than on creating your own life. Or, you will just bury your head in work, and in a few years when you look up, you will be 55 years old, or 65, or 75, and wonder what the heck you did with your life.

So, our recommendation is to seize 2010, and each day it offers. Set goals and make plans to achieve them.

This is what we are doing. Our newsletters have been a little thin lately only because we have been putting together what we feel is the best program of chiropractic practice building services ever for 2010. All to help you achieve your goals faster.

We are grateful for this chance to help you and we appreciate your trust. We admire the service and care you provide as doctors of chiropractic and chiropractic professionals. But, to be honest, we don’t do it just for you. We do it so that you can help more people become healthy through chiropractic care. And perhaps even more, so that they can be healthy by adopting a chiropractic lifestyle and getting their family and friends to do likewise.

So, here it comes.                                                                        2010.

Go seize the year and make it your own.

Carpe Annum
Marketing through the Holidays and into the New Year
A number of doctors wanted to get the notes from our teleclass on marketing. Here is the link.

Due to popular demand,  I am posting notes from our October teleclass on marketing over the Holidays.  The teleclass is also available on CD for a small fee and available on the new PMAmembers site. ( Opening 12/8)

Teleclass Outline with Ed Petty  — Notes

All marketing is broken down to:

1.    Procedures. These are either special, one time events, or standard recurring. Some have the purpose of immediate results (direct marketing), some more long term (indirect marketing).

2.    Motivation. Desire. Wanting to implement these procedures. (Discipline.)

3.    Marketing management.  Review, Planning, Implementation.

Motivation: You are listening (or reading this) so you are motivated.  But you have to get others motivated as well. You have to get and stay inspired.  It is Ok to be a cheerleader.  What’s wrong with a little cheer? And the more you cheer.. the more you find to cheer about!

The  Marketing Manager System:

• Meeting weekly: Review/make plans/Implement (assign steps/dates)
• Who is responsible and responsible for what
• Calendar Special Promotions/Events
• Checklist of Recurring Procedures/Events

Procedures: Special events/promotions

NOVEMBER

Holiday Turkeys (Care to Share) (Ham for Christmas)
Donation Programs: Shelters, Toys for Tots, Coats for Kids, Food for Families
Scheduling Patients over the Holidays. (Plan ahead so they keep up with their care.)

DECEMBER

GNO (Girls Night Out/ Shop Before You Drop)
Gift coupons
Saturday with Santa
Poinsettias (with gift coupons)
Planning, training – sharpen the saw.
Do scheduling for new year: “Flexibility Screenings” with gyms,  lunch and Learns with businesses
Gifts for Allies  and those who referred: Box of nuts, organic flowers, cups, pens, caps, t-shirts. Cards.

JANUARY

Lending Library: Supersize Me, Fast Food Nation, King Corn, Sugar Blues, Food Inc. End of Overeating
Workshop on Nutrition and Fitness
Annual Reactivation Program
External Workshops, Screenings, and networking

FEB

Doctor’s With A Heart Donation Program
Have a Heart – Oaklahaven Children’s Chiropractic Center – link
Valentine’s Gift Coupons

MARCH

Leprechaun Appreciation Day (Kid’s Day) link

Procedures: Recurring

Community Education: Talks or Awareness Weeks
Nov: Flu
Jan  Feb Food, Supplements/ Fast food Series –  With  a Dietician and a trainer.February: Heart Heath- blood pressure
March: Headache Awareness Week

Communication Channels
Newsletter
Email Newsletters – NEW SERVICE FOR 2010 – We will do this for all clients on Standard Management Programs or higher.
Press Releases
Ads on other special newsletters: Chamber of Commerce, YMCA, Church Bulletins
Web site/Face Book – Fan /LinkedIn

Internal Recurring:

Morning case management meetings – (include a joke.)
Staff meetings -
Patient Success StoriesAtmosphere:  Take a “vibe Check”, check: seriousness, atmosphere. Where’s the party?
Spinal Care Class
Whiteboard
Brochures
Staff education
WOC (Whip out card)
Mission

Two can play at this game.

If the pharmaceutical companies can use swine flu as an excuse to sell vaccines, you can use it to promote wellness.

The general corporate media, and doctors employed by these corporations, have been pushing the horrors of the swine flu “pandemic” and offering pharmaceutical products – vaccines – as the primary solution. But it makes one wonder what is really going on when there is so much information about the unhealthiness of the vaccines, as well as much common knowledge about many different non pharmaceutical solutions that are healthy.

Dr. Oz, an MD on a major television network, in an interview where he promotes the use of the swine flu vaccination, admits that while he gets vaccinated, his wife and children do not. (Link to video below.)  What does that tell you?

There is a lot of information about this but I know I am just preaching to the choir here on this blog.

The point is, now is your chance to step up to the plate as a Health Leader and help navigate the way for your patients and community through this confusing issue of flu vaccinations.

What I am saying is that this is a great opportunity for you as a  Doctor of Chiropractic.  While only a small percentage of people are actively receiving chiropractic care at any one time, a majority of people are skeptical about swine flu vaccinations. (Consumer Reports 9/30/2009)

By offering information about the swine flu from a natural perspective, you can position yourself as a health leader to this huge market.

Good marketers are always looking for a relevant event to help get their message across. This is a powerful one.

For example, you could you could easily schedule and present a 45 minute basic class on:

The Flu: A Natural Perspective

or

Concerned About Swine Flu, But Uncertain About Vaccinating Your Kids And Family?

or

What You Should Know Before You Get That Flu Shot

You could invite a guest speaker, such as an MD or DO or nurse, anyone really, who is pro chiropractic and subscribes to the chiropractic lifestyle.

The first step, however, is becoming informed and educated yourself. Doctor Mercola has a great deal of information on his site with references to other sites. A fast search will give you tons of info and books to read. Some of the comments posted on these sites by readers are also informative.  I have listed just a few below.

While you do need to know about vaccinations and the swine flu, you really need to understand the level of propaganda drug companies use to promote their products.  This is something you should be able to take issue with as a chiropractor who sees the results of unnecessary back surgeries weekly.   Once you are incensed about these injustices, all else will follow.

For a more radical approach, you can use a poster that shows how MD’s were used to support the use of tobacco and Vioxx, both products which are known toxic killers. [Sample poster below.]

Some things you can do:

• Give a talk with or without a guest.
• Host a community discussion group with a panel.
• Talk to your patients one on one about what you know.
• Educate your staff.
• Place poster or pamphlets around the office.
• Write a letter to the editor.
• Make comments on blogs, face book or other web sites.

Again, you do not have be an expert about the biochemical aspects of vaccinations. The basics are obvious enough and will allow you to swing any discussion around to general health, nutrition, exercise, and of course,  subluxations, nerve interference, and chiropractic treatment.

It is not that you should promote chiropractic as a direct remedy for swine flu. That would be bad public relations, even if there are accounts of this. (See 1918 Flu Epidemic below.)  Instead, you are an advocate for health, looking after the general health of your patients and community.  You are a teacher.

It has been stated that there is a “Wellness Revolution.” People want organic and natural health. What doctor of what profession is better suited to lead the way other than you, the chiropractic doctor?

Take this opportunity and run with it.

###

Promotional Posters: 2 Sample Plosters

———-

Some immunization references. (Please list more.)

Tedd Koren’s Brochures:
Do You Know What’s In A Flu Shot and Vaccination: 18 Reasons to Just Say No

Mercola.com

Chiropractic and the 1918 Flu empidemic (article)

http://www.vaclib.org/

Pro-Immunization: New York Times recent article

Dr. Oz. Immunization OK for him, but not for his wife and kids. (Youtube. 5 minutes in.)

Video clip of flu shot promotion from 1970’s. (Video)

Congressman Paul on the Recent Swine Flu Scare (Video- 4 minutes)

Dr. Blaylock (4 video interviews)

How to Raise a Healthy Child in Spite of Your Doctor (book)

A Shot in the Dark (book)

Hello Doc,

My name is Dr. Tom Potisk. I operate a chiropractic practice in South Milwaukee, Wisconsin.

For nearly 25 years I’ve enjoyed tremendous success in my practice. My practice, although not the largest, has been described as the type many doctors want to attain. Some features include excellent patient retention, loads of new patients, fabulous systems and procedures that allow me to take 8-10 weeks off each year, and a dedicated staff (my office manager has been with me since year 1).

One of the reasons for my success has been the management and consulting services of PMA (Petty, Michel, and Associates). In the 24 years that I’ve been their client, I’ve come to know their dedication, passion, and enthusiasm for the growth of the chiropractic profession and chiropractor’s practices. This group is the best value in their league.

Do you need more new patients? They have a marketing program to boost your new patients and keep the flow going.

Do you want better billings and collections? Their ethical, patient friendly systems are the best around.

Do you want more time off? The procedures they can put in place for you can keep your office running smoothly in your absence.

The best news in health care is that PM&A is expanding their services with upcoming seminars, new programs, and their trademark coaching and consulting services. I have attended their 3-Goals seminars and, like all of their services, their goals are designed to get you a practice like mine.

I volunteered to write this letter and want you to attend their seminars and use their services and learn from this extraordinary group. I’ll be at the next seminar and look forward to seeing you.

Sincerely and God Bless,

Dr. Tom Potisk

PS Feel welcome to call me if you have any questions – (262) 835-1767.

[NOTE: Our next seminar is in Chicago on Thursday, November 5th. For more info, go here, or give us a call at (414) 332-4511. Ed]