Category Archives: Ask Lisa

Cracking the Code

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icd 10 code revisionsICD-10 Code Revisions Start Today October 1

Diagnostic coding is the translation of written descriptions of diseases, illnesses and injuries into codes from a particular classification. In medical classification, diagnosis codes are used as part of the clinical coding process alongside intervention codes for proper reimbursement. The translation is called the International Classification of Disease codes, or ICD-10-CM*. There are annual updates which may include deleting codes, adding codes, and minor edits to existing codes. Keep reading for information regarding ICD-10 changes for 2027.

Although there are only a couple of changes for 2027 directly relevant to chiropractic coding, the diagnostic updates contain 190 new, 30 deleted, and 4 revised codes. The 2027 ICD-10 codes will be used for patient encounters from Oct. 1, 2026, through Sept. 30, 2027.

The updated codes listed below may be relevant to your patient encounter and can be included on your claim form depending on payer group:

1. Plantar Fasciitis Current: M67.A

New subcategories distinguishing right from left foot: M67.A01 (right foot), M67.A02 (left foot); M67.A09 (unspecified/do not use if you get the information from the patient)

2. Plantar fascial fibromatosis Current: M72.2

New M72.20 (right), M72.21 (left), M72.22 (unspecified/do not use if you get the information from the patient)

3. The following Sprain codes could impact your Auto Claims:

Sprain of sternoclavicular joint or ligament
Deleted S23.420, S23.420A, S23.420D, and S23.420S
New: S43.61XA: Sprain of right sternoclavicular joint, initial encounter
S43.62XA: Sprain of left sternoclavicular joint, initial encounter
S43.60XA: Sprain of unspecified sternoclavicular joint (do not use if you learn from the patient which side)

4. M99.01 through M99.05 (segmental and somatic dysfunction) – No Changes

5. M54.2, M54.50, M54.51, M54.59 (cervicalgia and low back pain) – No Changes

Coding and Billing Tips:

  • Make sure if you use a code listed above, you relate it in your SOAP note to the patient’s condition as to why they are seeking care.
  • If you bill a 98941: 3-4 region adjustment, make sure you have at least three ICD-10 subluxation codes for Medicare and Medicaid (The M99.0X series) on the claim.
  • If you bill a 98942: All 5 regions adjustment, make sure you have at least five ICD-10 subluxation codes (again the M99.0X series) on the claim for Medicare and Medicaid.
  • Make sure your procedure codes and diagnosis codes align, so you can prove:
    • What was done (the treatment procedure)
    • What was wrong (the specific diagnoses)
    • Why the care was medically necessary

If you are interested in obtaining the entire file of new/updated/deleted ICD-10 Codes, click this link from the Centers for Medicare and Medicaid Services:
https://www.cms.gov/medicare/coding-billing/icd-10-codes#CodeFiles

If you have questions on how these new codes can be implemented in your practice, reach out!

And, BTW… we still make house calls! Not collecting what you are owed? Something just doesn’t seem right with collections and your deposits? Give us a call to discuss whether an onsite visit or video conference works best for your office.

*CM refers to the ICD-10 coding system used in the United States.

Happy National Chiropractic Month! Celebrate the entire month of October!

Lisa

Credits:

  • ChiroCode
  • Center for Medicare and Medicaid Services (CMS)
  • chiropractorbillers.com

 

Ask Lisa: Want to Sell or Grow? How to Elevate Your Practice’s Value Now

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how to elevate your practice's value now

In today’s healthcare landscape, practice value is a complex blend of operational effectiveness, modern technology, financial health, and clinical reputation. Whether a practice owner is looking to sell, partner with, or simply build a sustainable business, several areas can significantly enhance its market value.

Keep reading as I delve into a few of these areas with you.

  1. First, maximizing financial and collections management and diversifying revenue streams remains critical. Practices that depend on a single payer, service, or a narrow patient demographic are viewed as high-risk and are rare nowadays. Enhancing value requires rigorous billing and collections processes to minimize days in accounts receivable.
  2. Integrating ancillary services and hiring non-DC providers can boost revenue per patient while providing comprehensive, whole patient care one-stop. Group chiropractic practices are getting more on board with implementing a hybrid model by hiring PTs, LMTs, Acupuncturists, MDs, PAs, as well as continuing to perform ancillary services such as custom orthotics, ultrasound, EMS-Interferential, Laser, EMMS, Nutrition Counseling, Exercise and Rehab Education, ergonomic and backpack checks, and Shockwave therapies. Yes, all of these are billable and some are insurance payable.
  3. Clean, auditable financial records and practice statistical reporting are the foundations of a high-value practice. I’ve been there and have helped clinicians and managers with this while working at offices to help improve collections and revenue.
  4. Adopting robust, user-friendly digital systems and procedures. A modern (EHR) system that integrates seamlessly with billing and patient portals is a significant asset. Offices and clinic owners need and want systems that reduce administrative burdens. I’ve seen this – the better and more open staff are to learning the plethora of features in your practice management and EHR programs, the better collections are. Newer technologies in advance scheduling, automated appointment reminders, and digital intake forms minimize costly no-show rates and maximize physician utilization. The EHR-rating website Capterra just updated its list of top-rated, and compliant, chiropractic software programs. Click [Here] for details. Insert hyperlink with here as link name.
  5. A tech-forward practice signals to prospective buyers that the business is built for the future. For example, technology to administer and record a precise adjustment can help prevent wear and tear on your body, and includes devices such as the Activator, Impulse Adjuster, Sacro-Occipital Technique (SOT) Blocks, Impulse Adjusting Instrument, ArthroStim Adjusting Tool, PulStar FRAS Adjusting Instrument, and the Atlas Orthogonal Percussion Instrument.
  6. Patient retention and brand loyalty serve as powerful indicators of value. A practice with a high volume of recurring, satisfied patients represents predictable future cash flow. On the other hand, a steady flow of new patients under the pain relief only model can also prove a powerful indicator of value-based services. Implementing structured patient feedback systems and maintaining a strong online reputation can drastically lower patient acquisition costs.
  7. Additionally, standardizing clinical and operational workflows ensures that the practice can function smoothly without relying entirely on the founding physician. When operational knowledge is documented and transferable, the practice becomes far more attractive to external buyers.
  8. Cultivating a positive workplace culture reduces staff turnover, which is notoriously expensive in the healthcare sector. A practice staffed with skilled people demonstrates operational leverage and shows revenue generation is diversified across the clinical team.
  9. Ultimately, improving a healthcare practice’s value is about reducing risk and proving scalability. By implementing and maintaining solid financial workflows, embracing modern technology, and fostering patient and staff loyalty, practice owners can maximize their business worth and ensure long-term clinical success.

Now through October 31st I’m offering a complimentary 30-minute consultation on how you can boost your particular practice’s value and answer any questions you may have

Complete the easy form below for details on this complimentary offer.

Complimentary Offer

And just ask…
Lisa

*Offer does not apply to current active PM&A clients. You’re already getting the best bang for your buck in Abbondanza with us anyway!!  😉

UPDATES: Fulcrum Closure August 31, 2026

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Note:  This article pertains mainly to offices in the Midwest, but you may find the information interesting if you live outside of the Midwest

Following up on my June article, I wanted to update you on insurance plans and who will be managing them at the time of this writing.   Plans and which company is managing them are quickly changing, but it’s only fair to keep you in the know as these changes impact your bottom line and admin burden.    Here is an updated listing of the payer groups and what is scheduled to happen now and going forward with contracts and claims:

Plan Managing company and other information
Health Partners Optum UHC is managing effective 7/1.  As of this writing, 1) no pre-auths/clinical submissions are required, and 2) Use Health Partner’s payer ID, 94267 for claims
Cigna Unknown at this time.  Possibly direct-contract (groups only) or going to American Specialty Health.  Continue sending claims per patient insurance card.
Aspirus Medicare Advantage Whole Health/Tivity
The Alliance Whole Health/Tivity
Aetna Whole Health/Tivity
Aspirus Commercial HMO Unknown at this time
Quartz Direct contract only via invitation from Quartz
Zelis Direct contract for now
WPS Chiropractic Management Services, Brookfield, WI

Remember!

  • Tip: Use the actual payers’ IDs for claims submission.
  • Tip: Continue doing your financial consultations after verifying new patient benefits. Patients who are already in the middle of a care plan shouldn’t need a separate exam due to the above changes.

Are patient pre-pay packages looking like a better option for you and your practice?  Let us guide you within the can-do’s and can’t-do’s to set up these plans!

Additional Questions?  We can help!  And we will find an answer for you.

Lisa
920-334-4561

Ask Lisa: Practice Roadmaps to Help Your Bottom Line.

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chiropractic roadmap business plan

Ever get the innate sense something is missing in bridging gaps you may be experiencing in your practice? As a result, you may tend to keep guessing and overthinking processes. Understandable from both a clinical perspective, and in today’s reimbursement landscape. Documenting and mapping out a business plan/practice roadmap can help calm the chatter.

According to Investopedia, “A business plan is a document that defines in detail a company’s objectives and how it plans to achieve its goals. A business plan lays out a written road map for the business from marketing, financial, and operational standpoints.”

A business plan can help You navigate and evaluate the revenue cycle categories, which by the way are our specialties:

1.) Credentialing: The better HMO/PPO payer networks you participate in based on your geographic location and patient insurance type, the better the value of your practice.

2.) Practice Appraisals are a great foundation to your overall plan to see what your practice is worth at the time the appraisal is done.

3.) Network participation assessments: Have you recently ran reports on each payer group in your practice management software to see if you are getting reimbursed per contract? Where are any shortfalls you may want to voluntarily opt out of participating in? You’ll want to make sure you opt out of a network voluntarily, and intelligently – getting kicked out of a network involuntarily can bite you in the ass later on if you or your successor want to be in the network and continue filing insurance for patients. A common question on credentialing and re-credentialing requests is if you have ever been terminated involuntarily from a payer group or government program.

4.) Accounts Receivables: Where are your payer and patient receivables month to month? Is it increasing? Decreasing? According to Healthcare Financial Management Association (1), your ideal A/R percentages should fall here:

0–30 Days: ≥ 80% of your total A/R should fall into this category.

Over 90 Days: Less than 10% to 15% of your total outstanding A/R should be in this bucket.

Over 120 Days: Should ideally be kept under 15%. Accounts older than 180 days are often written off as bad debt.

If your financial policies are strong, you should have very little outstanding cash accounts over 90 days. Auto claims with attorneys and commercial secondaries should be about the only claims out in these categories.

5.)Meeting state and federal compliance requirements. Have you had a compliance assessment completed?

We can, have, and do help offices in each of these areas. Just Ask…

Lisa

Happy 250th Birthday, America!

Reference:  hfma.org- 7 KIPS Providers Should be Tracking

What’s Happening with Fulcrum/Chiropractic Care?

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Note: This article pertains mainly to offices in the Midwest, but you may find the information interesting if you live outside of the Midwest.

As you may have heard, Fulcrum/Chiropractic Care (a Minnesota-based, nonprofit physical medicine benefit management organization) will be ceasing contract operations effective August 31, 2026.

For those of you participating with Fulcrum, please watch your emails from Fulcrum and/or each payer group for further details and timelines. Whole Health Inc. will be taking over most of the below payer groups, and have advised some offices, via email, that they will be in contact.

We strongly recommend you ask Whole Health for a contract to review, along with a Fee Schedule.

Below is a sampling of what we know to date. Please refer to the FAQ included here Fulcrum Health Inc.  for a full list of the payer groups impacted.

  • Aetna/Allina
    • Termination date with Fulcrum: 07/31/2026
    • Contract through MultiPlan to stay in network (non-Minnesota), and SecureCare (Minnesota offices)
  • Aspirus:
    • Termination date with Fulcrum: 07/31/2026
    • Aspirus is working on a transition plan; no further details at this time
  • BPA
    • Termination date with Fulcrum: 5/31/2026
    • Claims for dates of service on or before 5/31/26 must be submitted to Fulcrum no later than end-of-day 7/17/26.
    • No further details available at this time.
  • Cigna
    • Cigna will contract their chiropractic network through First Health.
  • Quartz
    • Termination date with Fulcrum: 6/30/2026
    • Quartz will handle services in-house and will contract with provider groups only. They are focusing their outreach based on member utilization, geographic coverage & network needs. Provider groups that haven’t submitted claims within 12 months may not be contacted. If chosen, Quartz will send a group contract via Docu-sign and should have been received by 6/1/26.
  • The Alliance
    • Termination date with Fulcrum: 8/31/2026
    • The Alliance is actively finalizing the contract and coordinating transition details with the new provider network partner. Once completed, their new provider network will reach out with next steps.
  •  Zelis
    • Termination date with Fulcrum: 6/30/2026
    • No further details available at this time; however, if you are credentialed and contracted directly with Zelis, you should not be impacted by this change.
  • WPS
    • Termination date with Fulcrum: 7/31/2026
    • Fulcrum is sharing provider credentialing files with WPS. WPS may contact providers or providers may reach out to WPS at Provider Contracting.
    • WPS informed me that the administration of their chiropractic network will transition to Chiropractic Management Services. To remain participating, providers will need to reach out to  CMS Services LLC.
    • WPS indicated their termination date with Fulcrum is 7/1/2026 (different than Fulcrum’s termination notice indicating termination on 7/31/26).

Additional Questions? We can help! And we will find an answer for you.

A big Thank you to Wisconsin’s Robyn Tozer for her work in helping to get initial updates – Thanks, Robyn!

Lisa

Ask Lisa: What the Heck is HETS? And Other Helpful Resources

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SPECIAL ANNOUNCEMENT RELATING TO THIS MONTH’S ARTICLE

KMC University is hosting a live “Answer Call” to help you take action now on the CMS HETS update.

Keep More Cash: Don’t Let the CMS HETS Update Disrupt Your Revenue
Presented by: Rebecca Scott, CPC, CPCO, CPB, CPPM
Date: TODAY! May 7, 2026
Time: 1:00 PM – 2:00 PM (MT)
For more information read their newsletter

Download the Free Template NOW
Insurance Benefits Verification Form(docx)

If you have received communications from Medicare regarding HIPAA Eligibility Transaction System (HETS) requirements, keep reading for information that will be helpful as you navigate if this applies to you.

First don’t panic if you received communication instructing you to register … HETS is only a beneficiary eligibility tool that will sync within your Clearinghouse or EHR Program, and may apply to you only if both of these scenarios exist in your office:

  1. Insurance Verifications are part of your practice operations. (Verifying is a key component to your revenue cycle and keeping you in the know for your patient financial consultations.)
  2. You normally use your clearinghouse or EHR Program as your insurance and Medicare benefits verification tool.

If you do not pay extra for and do not have the benefits eligibility verification service with your clearinghouse or EHR Program, HETS is not applicable to your office.

You may be now asking… What are the best third-party payer verification tools? Here’s a current breakdown for you:

Medicare Verification: Connex is CMS Medicare’s Portal to use to verify eligibility and benefits, and claims. If you do not have a Connex account you have two options:

  1. Apply for an account Here
  2. Add this service to your Clearinghouse contract for an extra fee. If you go this route, you will need to follow the HETS policy and procedure. Learn more here: HETS

Medicaid Verifications: Each state has its own Medicaid Portal/website for checking eligibility in advance of treating your patient. Use your favorite search engine to search for your state’s Medicaid online Portal website. Keep in mind each website may have a different default browser that works better; for example, Google Chrome may sync better with the site vs. MS Edge.

Major Commercial Payers:

  • UHC/Optum/AARP: Verify here UHC Optum or call the Provider Line on the patient insurance card. Make sure to get the representative’s name and a call reference number if you need to follow up on a claim once the remittance comes back.
  • UMR: Verify here UMR or call Provider Line on the patient insurance card. Make sure to get the representative’s name and a call reference number if you need to follow up on a claim.

Use Availity Portal for patient benefits and eligibility: Availity

Currently for these payers:

  • Aetna
  • BCBS Plans, most states
  • Humana
  • CIGNA
  • Well Care for Medicare/Medicaid

Implementing and maintaining patient benefits verification will help you plan ahead for your financial consultations which is an important part of managing your revenue cycle and generating income.

Follow-Up Questions? Just Ask…

Lisa
920-334-4561

Please share this newsletter with your colleagues so they may
benefit from this information too!

Ask Lisa: The Hybrid Bus is Here! Are you Ready to Board?

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ask lisa sitting on a physio ball reading chiro economics magazine billing and collectionsWhile at my desk on my physio ball, I was reading Chiropractic Economics annual Salary and Expense Surveys and took a deep dive into the Billing & Collections (B&C) category. I was jarred by a pattern over the past five years which makes me continue to fear that we are falling behind. The surveys in B&C category are a wake-up call that proves we can no longer ignore the impact of decreasing third-party reimbursements.

Below are the survey results countrywide in the chiropractic office B&C category and Average Reimbursement Percentages over five years. It is noteworthy that billings/charges increased each year with the exception of one year’s slight decrease. Here’s what the survey reveals from billed charges/reimbursement ratios:

2021 – 65% Reimbursement
2022 – 69% Reimbursement
2023 – 74% Reimbursement
2024 – 71% Reimbursement
2025 – 62% Reimbursement

So, what can you do to increase/improve income in your practice? Here are some tips:

  • Improve your practice’s patient care plans to ensure patients stick with their plan. Have you offered a visual picture of the patient’s report of findings, for example, and is your confidence in your adjustment where you want it to be when discussing your clinical findings? Are you making the best use of your therapies in your care plans?
  • Offer care plan packages to create a hybrid reimbursement practice or close the gap between your insurance model and patient self-pay model. It’s okay that you want to continue billing patient’s insurance as a courtesy to your customer base. Know your obligations when doing so regarding treatment plan standards, documentation/medical records standards, billing standards, obligations to respond to payer requests, and credentialing & compliance standards.
  • Offer valued products for retail such as ergonomic/rehab equipment like foam rollers, cervical rollers/pumps, resistance bands, and pillows. Other items include massagers, nutritional supplements, fitness trackers, orthotics, and your own branded merchandise such as water bottles or ice packs. Keep in mind the anti kickback laws. You’ll want to ensure these products are for sale and not giveaways to induce referrals. Please consult a healthcare attorney if in doubt.
  • And finally, you’ll obviously want to keep your collections by having a solid compliance program in place to avoid potential payback penalties for not having a solid program in place.

Need guidance on developing your hybrid practice and navigating the reimbursement landscape? We can help! Just ask…Lisa

Source: Chiropractic Economics Online Magazine, www.chiroeco.com

Lisa
lisa@pmaworks.com

Ask Lisa: Benefits Verification: Because Guessing Is Expensive

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chiropractic assistant verifying insurance benefits for patient

In today’s healthcare landscape, verifying a patient’s insurance benefits is more than an administrative step – it is a critical safeguard for both the patient and you. Benefits verification ensures that coverage details such as eligibility, co-payments, deductibles, and authorization requirements are clearly understood. When done accurately and promptly, this process lays the foundation for transparent care, financial clarity, and trust.

For your patients, unverified benefits can lead to unexpected bills, delayed treatment, or denied claims long after services are rendered. These surprises not only often create stress at moments when patients are already vulnerable, but become a compliance issue with regards to the No Surprises Act. Verifying benefits in advance also empowers patients with accurate information about their financial responsibility, preventing fears about surprise charges.

From your perspective, benefit verification reduces claim denials, improves your revenue cycle management, and supports effective, functional operations. It bridges the gap between clinical care and financial responsibility, ensuring that your services provided align with billing requirements. Ultimately, verifying benefits is not just about reimbursement, it is about protecting patients, strengthening provider-patient relationships, and promoting a more transparent and sustainable practice.

The best time to verify benefits in the chiropractic office is either 1) before the new patient’s Day 1 if you obtained their insurance information when they called or came in to schedule, or 2) After the patient’s Day 1 visit and prior to their Day 2 visit. This fosters continued trust and adequate time for your one-on-one financial consultation. You’ll also want to verify benefits if the patient has a change in insurance during the year.

Best Verification Methods: How to Verify Benefits

  • EHR/Clearinghouse: For a minimal extra monthly fee, verification of benefits feature is available for immediate output through your EHR or clearinghouse.
  • Insurance Payor Portals: Using specific payer websites provides the most up-to-date, detailed, and accurate benefit information, often surpassing phone checks.
  • Phone: The most reliable method for complex or high-cost services, enabling confirmation of specific benefits, authorization requirements, and obtaining a first name and reference number for the call.

Be ready to provide the following information:

  • Patient Name
  • Date of Birth
  • Member ID
  • Group Number (if applicable)

Some Coverage Questions/Criteria:

  • In-network or out-of-network status of provider
  • Annual or visit limits (if any)
  • Deductible amount and remaining balance
  • Co-payment or coinsurance
  • Is prior authorization required
  • CPT codes
  • Effective date of coverage and if calendar year or policy year coverage

If an appeal is needed:

When you need to appeal a benefits verification that mismatches the reimbursement on your EOB, the best method is to call the payer regarding the specific issue and provide the call reference number and representative’s name if you originally called to verify. If you used your EHR/clearinghouse or the payer’s portal, provide the information stated on the printout to the appeals representative. Focus on what you need for resolution, such as, “It appears your claims system miscalculated what we are to be reimbursed. We are expecting $XX remaining, and are requesting you resend the claim(s) to process per the member’s policy coverage.” If they paid correctly on another DOS, let the rep know this.

You may want to inform the patient of your appeal as well. Sometimes the patient will need to ultimately call to sort out a coverage dispute. If they signed your financial agreement, they’ll be more than willing to call their insurance company if they were expecting their insurer to pay a portion for their care.

Need an insurance verification form for use or to compare what you currently use in your office? Click HERE for an insurance verification form. On the house.
Questions? Just Ask… Lisa

Ask Lisa: Front Desk and Insurance Departments Hook Up for Start of New Year!

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balance scale between aesthetics and your bottom line in the chiropractic profession

Balance Between Aesthetics and Your Bottom Line

Greetings!

I’m condominium and cat sitting from December into January and am looking out of a window of natural beauty. If you are familiar with the Kettle Moraine areas of Wisconsin, affectionately referred to as “The Kettles”, you’ll deeply appreciate the beauty balanced with serene livability. The Condo complexes are built on a solid but interesting foundation of intertwining drumlins and kames of deposit sediment from glacial melts, making it challenging to keep your footing if you hike these.

Which brings me to you, and the balance between the sometimes hilly, lose-your-footing areas of your office and the beauty of it when you help a patient return to their own footing. And such is the time for your Front Desk and Insurance Department roles to intertwine at the start of the New Year!

Here is a simple New Year Checklist for your front office and your insurance departments to maintain balance of beauty and your bottom line:

1)  Obtain all patient’s insurance cards and make a copy for scanning into your practice management software. This is also the time to verify patient’s current address, cell phone number, and email address. Both areas of your office – front desk and insurance, need this information, and need it to be current. Maintain a pleasant, aesthetic reception area that is welcoming for patients and creates an amicable environment for patients, who will now be more likely to be kinder in providing you their personal insurance information. I know the difficulty this request can pose.

2)  Team up to discuss and decide who will be holding patient financial consultations post-insurance verifications on new patients or change of insurances. Remember these need to be done at the very minimum, in a semi-private, to fully-private area. Will it be the front desk? Will it be an insurance staff? CT? Will it be you, the doctor, conducting these in the treatment area? We’ve seen it done all four ways and sometimes combined. Whatever works best, with the framework of respecting and staying compliant with the patient’s privacy and finances.  What have you done regarding communicating benefits to patients up until now? Has it worked? If so, keep doing it. If not, how can you tweak this process to make it better for you and the patient? See last month’s article* on process improvement while not necessarily focusing on efficiency improvement.

3)  Working and following up on Patient Receivables. As with financial consultations, it needs to be done. Your prep work is to decide who will do the patient receivables follow-up: front desk, insurance, a combination? Consider updating your office policies to almost always collect at time of service to prevent the need for future follow-up on aged receivables.  Insurance follow-ups are best done by your insurance department. Consider sourcing out your insurance billing to someone who will do the insurance follow ups for you if you do not have internal insurance staff.  And…

4)  Make it a great, serene start to 2026!

And I have more great news for you! Our newly updated Welcome to Wellness* program is ready for purchase. As a special bonus this version includes:

  • 15 minute telephone consultation with the author, Dave Michel, on how to implement this class in your office. This includes sample versions of the most recent classes.
  • 90 Day Subscription to thePMA Members Library of over 500, helpful, customizable documents and articles.  You can read more about it here. [LINK]
  • Additional add on services for the Welcome to Wellness are also available.

We are currently in the process of updating our Patient Financial Consultation Kit for early Spring delivery.

Just Ask…

Lisa
920-334-4561
lisa@pmaworks.com

Ask Lisa: Actions you can implement now to reach your Goals in 2026 and Beyond!

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It All Goes Back to the Goal!

Greetings!

I recently took a book off my bookshelf to re-read …

The Goal by Eliyahu M. Goldratt is one of my favorite business books. I love that Eli drives home being human, while at the same time having great capacity to improve systems and procedures in the workplace. As a business owner this relates directly to you.

Keep reading to learn how.

A few key takeaways from the book and how this ongoing process can help YOU improve your collections and income include:

Keeping in mind that the true goal of any for-profit company is to make money now and in the future.  Two features of this are:

  1. All operational decisions are evaluated based on whether they help achieve this goal.
  2. Performance measurement is framed around three metrics:

1)  Throughput, or productivity (Service productivity is reflected in your NP, PV, charges, and collections stats)

2)  Inventory (making purchases intended to sell, such as supplements, pillows, exercise rehab supplies; and

3)  Operational Expense, which is money you spend to turn your inventory into productivity.  This can include your practice management program and billing program’s monthly payments, maintaining and enhancing the office space, and maintaining functional chiropractic equipment such as your adjusting tables.

So, what specific actions can help you achieve the true goal for your business?

  1. Identify constraints or bottlenecks in the office.

a.  Look at time studies of the doctor(s) and staff.  Can scheduling be done differently to open up blocks of time for more patients and/or paperwork.

b.  Look for a breakdown in policies and procedures. How can it be done more effectively with better results?

2.  Second, maximize and support the constraint,

a.  decrease interruptions;
b.  delegate tasks that are not directly clinical;
c.  work on office flow for greater capacity.

3.  Take note of variables. When a variable is presented such as doctor or staff vacation and holidays , make adjustments to accommodate and still maintain your goals.

4.  Repeat steps 1 through 3, and you’ll find another constraint/

bottleneck to work through.

It may not feel good at first, but each time you cycle through the steps, according to the theory of constraints, you actually are improving the quality of your practice and its value!

Want to learn more about specific action steps for identifying bottlenecks and improving your collections and income? Give us a call. We’ve got your back.  Just Ask . . .

Lisa

lisa@pmaworks.com

PS: Another great book that directly relates to this topic is “The Goal Driven Business” by Ed Petty.

Ask Lisa – Compliance 201: Your Shield Against Bad Risk

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compliance in the health care field for chiropractorsAs a follow-up to our previous compliance articles, I thought what I’d do this month is put together a FAQ list for my dear readers and call it Compliance 201. Keep reading to learn about upcoming new requirements in the compliance/cybersecurity world to keep you at least safe-guarded when you are hit with a cybersecurity incident. Special thanks and credit goes out to ChiroArmour and Dr. Scott Muensterman for his research and presenting at the Chiropractic Society of Wisconsin Fall Experience last month on some of the content in my FAQ.

Q: What is HIPAA and HITECH?
A: HIPAA is the acronym for Health Insurance Portability and Accountability Act of 1996, in which uniform standards and requirements for the electronic transmission of certain health information were put into place and made into law. HITECH is the acronym for Health Information Technology for Economic and Clinical Health Act of 2009, a countrywide adoption and standardization of information technology to securely support the sharing of clinical data.

Q: What is Cybersecurity?
A: Cybersecurity is the practice of protecting digital systems, networks, and data from malicious attacks, damage, and unauthorized access.

Q: Is there a checklist available to ensure we are in compliance?
A: Yes. Current and Active PM&A clients have access to our HIPAA/HITECH compliance checklist, on the PMA Members Site, and compliance services are included upon request from the client.  If you are currently inactive or not a client, we can provide you with the checklist for a nominal fee. Please keep in mind your staff are already very busy, so ask yourself who is going to take on ensuring compliance at your office and going through the checklist? We can help.

Q: Isn’t it a matter of IF a cyberattack at my office occurs, not WHEN as you stated above?
A: On average there are 11 to 12 cyberattacks happening per minute in the US. So in today’s world yes, it is a matter of when, not if. And after research, it has been found that small businesses are more of a target for an attack than large organizations mainly because large organizations can put more dollars into security measures.

Q: What does Windows 10 and Windows 11 have to do with compliance?
A: Windows 10 no longer supports the security patches it used to support, effective 10/25/2025, so all of your computers must be operating on Windows 11 at minimum by this time. You CAN extend your Windows 10 protection for 1, 2, or 3 years at a significant price, but your software vendor may not honor the upgrade.

Q: I heard that there is something called an OIG Exclusions report – what is this and does it affect me and my practice?
A: The OIG Exclusions database is a reporting site listing every individual who is prohibited from seeing Medicare/Medicaid patients due to prosecution of a criminal activity, which can include being found guilty of fraud against Medicare/Medicaid, non-compliance of court-ordered child support payments, and illegal drug convictions. It is and will be a requirement to run a report MONTHLY on every person in your office including owners, subcontractors, and upon a new hire.

Here’s the link to check names: https://exclusions.oig.hhs.gov/
If you don’t see your name, that’s a good thing. Some of you are already running and checking this report due to insurance contract requirements. Save or print and file the results page.

Q: How can I confirm if my practice management program is fully compliant?
A: The website for verifying compliant healthcare software programs is down as of this writing, so for peace of mind if you are not 100% certain, call your software company or IT person.

Q: When do changes/new requirements occur?
A: As of now, no date has been set by HHS, but if you are doing the above steps and have written policies in place, you should not worry, but watch for future communications. You can subscribe to HHS email notifications here: https://cloud.connect.hhs.gov/subscriptioncenter

Q: What does Medicare documentation have to do with cybersecurity?
A: To avoid a documentation audit and subsequent potential visit from the OIG to further audits on compliance with HIPAA and your cybersecurity policies, keep your documentation and billing practices solid per Medicare chiropractic documentation standards, and make sure to securely send your notes to Medicare upon audit (and any other payer group who requests) to ensure you are staying HIPAA compliant.

Q: Can my staff be our Security officer?
A: By law, yes, but you as the doctor owner are always ultimately responsible for any attack or breaches, and payments to the government, so it is strongly recommended that the doctor owner be the compliance security officer for the business.

That concludes our FAQ for now. I know you’ll have additional questions. Feel free to reach out with those we’ll respond within three calendar days!

Stay Secure,

Lisa

References: ChiroArmour

 


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Ask Lisa: Cracking the Code – ICD-10 Code Revisions Start on October 1

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lock and key cracking the code of ICD-10 insurance codes

Diagnostic coding is the translation of written descriptions of diseases, illnesses and injuries into codes from a particular classification. In medical classification, diagnosis codes are used as part of the clinical coding process alongside intervention codes for proper reimbursement. The translation is called the International Classification of Disease codes, or ICD-10-CM*. There are annual updates which may include deleting codes, adding codes, and minor edits to existing codes.  Keep reading for information regarding ICD-10 changes for 2026.

Although there are very few changes in 2026 relevant to chiropractic coding, the updates contain 487 new, 28 deleted, and 38 revised codes. The 2026 ICD-10 codes will be used for patient encounters from Oct. 1, 2025, through Sept. 30, 2026.

The new codes listed below may be relevant to your patient encounter:

  • Pelvic Pain
  • R10.20 Pelvic and perineal pain unspecified side
  • R10.21 Pelvic and perineal pain right side
  • R10.22 Pelvic and perineal pain left side
  • R10.23 Pelvic and perineal pain bilateral
  • R10.24 Suprapubic pain

And new codes related to socioeconomic circumstance:

  • Z56.6 Other physical and mental strain related to work
    • Workplace stress
  • Z56.89 Other problems related to employment
    • Furloughed
    • Underemployed
  • Z59.02 Unsheltered homelessness
    • Lives in a homeless encampment
  • Z59.19 Other inadequate housing
    • Poor housing weatherization
  • Z59.86 Financial insecurity
    • Z59.861 Financial insecurity, difficulty paying for utilities
    • Difficulty paying for electricity
    • Difficulty paying for heat
    • Difficulty paying for oil
    • Difficulty paying water bill
    • Utility disconnect notice due to inability to pay
      • Excludes2: inadequate housing utilities (Z59.12)
    • Z59.868 Other specified financial insecurity
      • Bankruptcy
    • Z59.869 Financial insecurity, unspecified

Coding and Billing Tips:

  • Make sure if you use a new code listed above, you relate it in your SOAP note to the patient’s condition and why they are seeking care.
  • If you bill a 98941: 3-4 region adjustment, make sure you have at least three ICD-10 subluxation codes (The M99.0X series) on the claim.
  • If you bill a 98942: All 5 regions adjustment, make sure you have at least five ICD-10 subluxation codes (again the M99.0X series) on the claim.

If you are interested in obtaining the entire file of new/updated/deleted ICD-10 Codes, click this link from the Centers for Medicare and Medicaid Services:

https://www.cms.gov/medicare/coding-billing/icd-10-codes#CodeFiles

And, BTW… we still make house calls!  Not collecting what you are owed? Something just doesn’t seem right with collections and your deposits? Give us a call to discuss if an onsite visit or video conference is right for your office.

Happy Birthday Chiropractic! Celebrate the entire month of October!

Lisa

920-334-4561

*CM refers to the ICD-10 coding system used in the United States.Sources:

Sources:

ChiroCode
Center for Medicare and Medicaid Services (CMS)

Ask Lisa:What’s up with BCBS and Therapies Reimbursement?

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Within the last two years, Blue Cross Blue Shield started requiring precertification (precert or pre-auth) on select plans for therapy codes. This came about because by Insurance Equality law they can’t require precertification for chiropractic services 98940, 41, 42, and 43, so they got around that by requiring it for many therapy codes regardless of the provider type.

If you call to verify coverage for “chiropractic”, the customer service representative (CSR) may tell you that there is no precert required for chiropractic. They may or may not understand that they have separate precerts for physical therapy codes. You’ll need to give the CSR the specific codes you want verified for coverage and limits.  You can also verify benefits and usually are able to request authorization for therapies using Availity: https://www.availity.com/providers/

Specific Claim Tips for billing BCBS: 

1)  Qualifier 431: Make sure you are entering in Box 14 OR 15, the 431 qualifier to indicate onset date within a treatment plan.

2)  Taxonomy code for chiropractic, which is 111N00000X, in Box 33. Some states’ BCBS plans require the use of a ZZ prefix before the taxonomy. Please ask when verifying benefits with your patient’s state plan what their billing requirements are. For example, is the ZZ required in front of the taxonomy code? You can add the taxonomy code for specific payers by going into your Maintenance application in your practice management software, and once added to the payer information, it will automatically generate the claim form with this information defaulted.

3)  Modifiers: I understand some of you are using XS GP for therapies and are getting paid. Great! But use this with caution. The XS modifier indicates a separate and distinct service done by a different provider than the one billing under. Better to use GP and 59 for accurate billing if one licensed provider did the therapy and chiropractic adjustment. Your 59 modifier indicates a separate, distinct service but does not distinguish between providers.

What about 98940-98941-98942? For your Medicare Advantage plan patients, make sure to use AT modifier indicating the treatment was active care vs. maintenance/supportive. BCBS usually will not pay for the GA modifier use indicating maintenance/supportive care services were provided. You’ll want to advise the patient ahead of time they will be financially responsible for their maintenance/supportive care, while presenting your cash options or packages offered. Use AT when billing BCBS Medicaid plans, all states, while the patient is under a care plan.

Where are the preauthorization requirements headed?

Here’s a recent (June 2025) article from Blue Cross Blue Shield regarding precertification requirements going forward:  BCBS News

Here’s what it states: 

“Reducing prior authorizations:

BCBS companies routinely review their prior authorization requirements, and many have taken steps to reduce the volume of prior authorization requirements in recent years. We will build on these efforts and commit to reduce in-network prior authorization for medical services as appropriate for the local market each plan serves with demonstrated reductions by Jan. 1, 2026.”

Reach out to us lisa@pmaworks.com or dave@pmaworks.com, and we can give more “boots on the ground” info for your specific state.

Lisa

920-334-4561

Please share this newsletter with your colleagues so they may benefit from this information too!

Ask Lisa: When Your Patients Need Extra Help

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payment terms for chiropractic care plan

When Your Patients Need Extra Help

Tips and Sample Policies for Financial Consideration Cases

It does happen from time to time… patients will need care but are not in a position to be able to afford care. To maintain your goals of:

  1. getting sick people well and maintaining health through chiropractic, and
  2. remaining profitable, you do have a duty to provide care to those that cannot afford care.

The two goals do not conflict.  And you do not want a patient to discontinue care because they have financial problems. Your clinic should have policies in place to enable a patient to get care – regardless of their financial ability. For active clients sample policies can be downloaded from the PMA Members Site. For all others sample policies are included in our Patient Financial Consultation Tool Kit.

Immediately following the Report of Findings, the CA should meet with the patient (the Post Report) to work out any financial arrangements, and to answer any questions that the patient may have concerning the policies of the clinic.

If the patient expresses concern over their ability to pay for the services that will be performed, go over the different fee policies that you have and see if one of these programs will handle their financial problem.

First discuss payment at time of service and prepayment options.

Here is a sample Introductory Script you can utilize:

[Patient Name], it sounds like you know how important our care is for your condition, and we want to be able to treat you. We understand that money can be a problem and know that you have to eat, pay rent, etc. I would like to set you up on our individual “Financial Consideration” program. It will provide you with the care that the doctor has outlined, at a price that you can afford.”

If the patient pushes back, inquire, empathetically, if the problem is truly a financial problem, or if they have a problem with the treatment program prescribed.

OTHER TIPS

  • Avoid writing: “(“Clinic Name) agrees to waive $100 of patient’s $200 deductible.”
  • We suggeest this be worded: “(Clinic Name) agrees to accept $100.00 from patient towards their deductible and waive any remaining deductible.”
  • When writing up the agreement, please remember to use a “per visit” amount only, rather than per week or month.
  • Please note that in talking to patients, they are not a “hardship” case, but a Financial Consideration case.

For active clients sample policies can be downloaded from the PMA Members Site. For all others sample policies are included in our Patient Financial Consultation Tool Kit.

Contact us if you need help accessing the scripts or if you have any questions!

Lisa

920-334-4561

lisa@pmaworks.com

Please share this newsletter with your colleagues so they may benefit from these services too!

Ask Lisa: Deadline nears for Blue Cross Blue Shield Antitrust Settlement filings.

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On April 29th I shared information regarding the Blue Cross Blue Shield Antitrust Settlement.  (See Link below.)

As the filing deadline of July 29, 2025 approaches we wanted to send a reminder and also some key information you need to know.

=====

It takes less than 5 minutes to sign up – each provider can sign up individually (it is much easier than signing up as a clinic).

This settlement includes a $224 million allocation for medical professionals nationwide  including DCs). This is 8% of the total $2.6 billion settlement, the rest is for hospitals and large groups.

Here’s what chiropractors need to know:

Key Details:

Eligibility: If you billed any BCBS plan (includes Wellmark) between July 2008 and October 2024

Filing Deadline: July 29, 2025
bcbsprovidersettlement.com+2bcbsprovidersettlement.com+2

How Payments Are Calculated: Payouts are based on your total “Allowed Amounts” (reimbursed, not billed) using a point system:

≤$250K = 1 point
$250K-$500K = 2 points
$500K-$750K = 3 points
$750K-$1M = 4 points
$1M = 5+ points

Important Legal Consideration: Filing a claim waives your right to future legal action against BCBS (including Wellmark) for any reason related to this antitrust matter.

Considerations: 
If you had higher BCBS billing over 15 years:  May equal a potentially meaningful payout that may be considered when determining participation.

When determining participation or opting out, each provider must evaluate their personal situation regarding billing history and comfort level with the legal release requirements.

Thanks!

Lisa Barnett

Link to previous article [LINK]

 

 

Ask Lisa: The Art of Navigating Insurance Network Participation

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participation in insurance networks building blocks

One of the most critical decisions you will need to make in your practice is, should you be “in-network” with a payer group, or out? It’s a tough choice, and one size does not fit all.

So, what do you do?

First, determine which companies you already are in network with, and assess.

  • Do you have a contract?
  • What are your obligations as a participating provider?
  • Are you getting reimbursed what the contract’s fee schedule says it will reimburse?
  • Are you currently enrolled in Medicare, and are you a participating or non-participating provider?
  • Are you also currently enrolled as a provider in your state’s Medicaid program?
  • Are you enrolled as a provider with the Veteran’s Administration in your area?

Additional items to consider prior to enrolling in a plan include:

  • What is the reimbursement rate?
  • What percentage of the approved charges are taken out for contract discounts?
  • Is there a fee to join?
  • Do they want you to participate in their worker’s compensation, PI programs? (In our experience, opting in to the WC and PI products means no steerage to you, and cut reimbursements).
  • Are there pre-authorizations required prior to care?
  • Is there a visit limit?
  • What is the initial credentialing and re-credentialing process?

Next, make sure you have a profile set up with the National Council for Affordable Quality Healthcare (CAQH) universal provider database and that the information is current, and re-attested quarterly. There is no charge to create and maintain your profile in this credentialing database.

Third, audit your patient demographic. Run a report in your practice management software, to determine

  • What percentage of your reimbursement comes from insurance?
  • What percentage comes directly from patients?
  • Which payers are you mainly seeing patients from and are you finding that patients are requesting you be in network with a certain company?
  • Who are the main employers in your area insured with?

Fourth, develop a spreadsheet called “Insurance Networks” to help you and your insurance department keep the information organized and up to date.

Once you have a grasp on the above, you’re ready to determine if you need to pursue network participation with additional companies. Treating this like a sales or business venture, you’ll want to have insurance companies coming to you and requesting you be in their network.

Remember, it is to their benefit and their obligation to keep their paying policyholders happy.

Patients should feel free to call their insurer requesting you be on their plan. Patients have done this, and outcomes have been successful. Why? Because the worst phone call an insurance company can receive is from an upset policyholder who can’t afford to see their favorite doctor who is helping them (that’s you!) because the doctor is not on the plan.

We’ve just touched the surface of network plans and credentialing. PM&A can provide specialized and unique advice on making the choice of which networks to join, which to be out of network, and which to run away from! We also will run those audit reports to assess if you’re getting the best bang for your buck.

Email me for assistance with how these processes work for your practice. You may reach me at Lisa@pmaworks.com.

Lisa

Ask Lisa: Day One and Day Two Best Practice Procedures

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Greetings…
You asked for this … we heard you and have got you covered.

Here at PM&A, we consistently recommend the use of checklists, and establishing and documenting your Day 1 and Day 2 procedures is no exception. Keep reading for a comprehensive checklist to make your Day 1 and Day 2 run seamless.

Day One Upon New Patient Arrival

___1. Introduce yourself, what you do, and welcome the Patient.
___2. Provide office tour
___3. Check for questions, problems, and clear up questions as needed.
___4. Doctor Sees patient, does a thorough consultation by the use of objective tools
and history of patient such that the patient feels they were completely
understood, and all relevant facts that might relate to the patient’s current
condition(s) is learned. Adjustment is performed if appropriate and is part of your
typical clinical Day 1 process.
___5. CA does insurance/third-party benefits verification using the insurance verification
form and prepares for the financial consultation on Day 2, using worksheet.

Day Two

___6. Doctor thoroughly reviews the patient’s x-ray/objective findings before the report
of findings
___7. Doctor goes over with the patient the written Report of Findings and the patient
also receives an initial treatment plan with the necessary amount of visits and
treatments (adjustments and therapy) as best suited for the patient’s condition.
___8. Doctor reiterates “Time, Repetition, and Effort” as necessary to patient’s
successful treatment program and provides folder/packet to the patient.

In a private area away from other patients… the CA works with the new patient to:
___9.   Go over schedule of care and completes multiple appointment card.
___10. Stress keeping appointments.
___11. Communicate missed appointment make-up procedure and any fee associated
with no call, no show.
___12. Confirm doctor has discussed health care class, and invite patient and spouse.
___13. Discuss financial arrangements. This is your financial consultation with the
patient. Written financials are completed beforehand and made available to the
patient as part of their packet.
___14. Verify all needed paperwork in the packet.
___15. Stress that the patient review the written ROF from doctor.
___16. Go over check-in / check-out procedures, i.e., does the patient sign in using a
kiosk? Is the kiosk located at the front desk, or in the treatment area? Check-out
would include making sure their next appointment is on the schedule and
collecting any patient payments due.
___17. Validate patient’s desire for care & treating doctor’s skill.
___18. Ask the patient if there is anyone else in their family they would like to schedule
a complimentary consultation and exam, and if so, write down their names, and
follow up
___19. Provide educational pamphlets to give to the patients.

___20. Ask the patient if they thought of any further questions, and wrap-up, reminding the patient of their next scheduled visit.

After the patient has completed their care plan, the doctor recommends wellness care to each patient that achieves maximum chiropractic improvement, and the patient accepts the wellness care program.

Email us at services@pmaworks.com to request scripting examples for financial consultations.

Looking for additional information on how to customize the above checklist to your office? Give us a call – we’re here to help!

Lisa
920-334-4561

Ask Lisa: Best End of Year Reports to Run to Prepare for Success in 2025

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Know where your practice stands statistically going into the new year.

Happy New Year! Now that you’re back in the swing from the Holidays, we’ve put together for you a list of the most important reports we feel will prepare you for success in 2025! Have fun with running the below queries, while at the same time resolving to acknowledge the report outputs are your objective, x-ray analyses of where your practice stood in 2024.

1) Standard Financials/both month-to-month and January – December 2024 Practice stats. This will give you your new patient counts, your patient visits, your charges and your collections. What do you see month to month in terms of your high/low months? Did you do something different in the months that were higher statistically? And repeat that action!

2) Run your end of year Accounts Receivable. This is a number your accountant or CPA should ask for. You’ll need this for your balance sheet.

3) Review your Profit & Loss statements from month to month, run by either your accountant or your internal accounting software. Things to look for include:
a. Your expenses – were your expenses in line with your projected budget?
b. Your net income – were you able to pay yourself along with your associate(s) and staff salaries corresponding to livable wages?

4) Want to compare your expenses to what most chiropractic offices are doing? First, remember you want to compare you to you. But we can provide a breakdown of averages that you can look at and see where you may be high or low.

5) Accounts Receivables: 30/60/90+ days
a. Can these be reconciled? Expect 60% recovery for accounts to 60 days old; 55% recovery for accounts 60-90 days; and 20% recovery for accounts 90 days and older. The exception here is Personal Injury and Workers Compensation A/R, which are normally fully recoverable.

6) Retail Purchases – supplement/vitamin sales, pillow/therapy equipment (Durable Medical Equipment) sales.

7) Get your Sales and Use Report off your management software to your accountant or CPA by the end of January for filing the Sales Tax Report. You’ll also want to look at any independent contractors (cleaning services, IC massage therapists or other providers, snow plowing service, roofers, etc, etc) Provide their information and pay amount to your accountant by the end of January for 1099 preparation.

Once you have completed these reports and have assessed where your practice stands statistically, you can now:

• Update goals for 2025,
• Review your marketing efforts, and
• Review your retail inventory.

Need help with any of the above? Contact Lisa – I can help!

Lisa
lisa@pmaworks.com
920-334-4561

ASK LISA: The Vital Importance of the Post Report & Patient Financial Consultation

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Greetings,

In our last two webinars, we discussed the importance of patient financial consultations.

Let’s delve into why they are so important to your bottom line and how you can set them up for success.

First, changes to insurance coverage and managed care have created an environment where third-party reviewers sometimes have more say in your patient’s length of care than you do.

Second, it is important to note that the financial consultation is a part of the overall Post Report. To be successful, all steps below should be reviewed and completed with each patient, whether they are new or re-activating their care. Why a post report?

The purpose of the post report is for the staff to fully address with the patient any obstacles to the patient getting the care they need and to set the patient up for their schedule of care. This includes setting up multiple appointment schedules, emphasizing the importance of staying on the schedule of care, discussing missed appointments, discussing any needed financial arrangements, going over how to check in at future visits, establishing where the patient should turn with questions or problems, and reassuring the patient in their decision to follow through with care.

Before you meet with the patient for the financial consultation, you also have to have a clear understanding of what you want to accomplish with your financial plans for patients. Your plans need to line up with the goals you have in your office and you need to individualize the plans. Do you want a high percentage of cash, wellness patients? An insurance-based family practice? PI or Work Comp acute care rehab practice? Is the patient undergoing a financial hardship? Each has a different set of criteria for tailoring patient financial agreements.

As these become more common, you can increase your patient retention and compliance by offering more OPTIONS for patient payments. Yes, this requires more work and more follow up, but adjusting to changing business practices in the world often require changing your internal procedures and policies. Adapt and offer ways to make care affordable, then promote these options so that patients see there is a way for them to get the care they need at a price they can afford.

Our Motto: Financial Plans are Liberal; Collections Policies Are Not.

This doesn’t mean reducing your fees or giving away services. On the contrary. For example, a new car costs many thousands more than your treatment plan, but auto dealers are adept at showing the customer ways they can drive that car home today.

Standardizing these procedures will ensure that your patients feel well taken care of at the office at all times.

Questions? We can help.

Click HERE for a sample care plan and financial plan template. [LINK]