Tent Poster – Two Wolves

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Two Wolves

An elder Cherokee Native American was teaching his grandchildren about life. He said to them…

“A fight is going on inside me… it is a terrible fight and it is between two wolves. One wolf represents fear, anger, envy, sorrow, regret, greed, arrogance, self-pity, guilt, resentment, inferiority, lies, false pride, superiority and ego.

The other stands for joy, peace, love, hope, sharing, serenity, humility, kindness, benevolence, friendship, empathy, generosity, truth, compassion and faith.

This same fight is going on inside you and every other person, too.”

They thought about this for a minute, and then one child asked his grandfather… “Which wolf will win?”

The old Cherokee simply replied… “The one you feed.”

 

For a printable copy of this tent poster click: 2017-02-Two Wolves-3

Chiropractic Spring Marketing

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chiropractic marketing with petty michel
(Free sample marketing planner below.)

Practice marketing may not be entirely what you think it is.

 

If you are having challenges with your “marketing,” or you just want to generate more new patients, you need to consider something.

There are many good and great marketing activities you can do. (You can go to our website under “Free Resources” and find buckets of marketing. And, for those of you who are active members, there are mountains of even more marketing programs for you on our Member’s site.)

There are many paid programs you can purchase that explain different methods of generating more new patients. You have seen them, perhaps purchased them: DVD’s on dinner talks, workshops on how to present to businesses, Facebook and print advertising programs, and automated newsletters and Facebook posts.

These all can be useful in generating new patients, but the results often fall short from what the few successful doctors who promote the programs claim. This is usually because there were two major components missing in the marketing.

When doctors return from marketing programs, I like to ask them what they thought of the material.

“Yes, I liked it. It was good info. Learned a lot.”

“Great.” I say. “So, who is going do it?”

“Well, Susan can do it.”

“Oh really, when? She has a backlog in insurance and is working overtime trying to work with your sketchy notes as it is.”

“Hmm, well, we’ll hire someone.”

“Great. Who is going to train them? You?”

Not trying to be a jerk, but part of any good consultant’s job is to provoke analysis!

Besides the marketing event or procedure, there are two other critical elements to practice marketing that have to be included for the promotion to work. These are not always taken into account.

This was the basis of the Marketing Manager System I wrote and published some 17 years ago.

Most companies, as Simon Sinek talks about in his TED talk*, boast about what they do, or how they do it. It is all about them. Look at us!

But the better companies talk about WHY they do what they do, and they do it for YOU. They do it for your kids, grand kids, community, and the betterment of the world.

This is practice marketing. It is personal. You tell people why the heck you do what you do — and you say all this with genuine care and confidence – in your own VOICE. You do this in your newsletter, in your talks and in your ads. The best marketers do this – often naturally.

  1. So, the first missing component that must be included with your marketing is motivation. Marketing must have a mission and it has to be embraced by everyone on your team.
  2. The second missing component is organization. The events and procedures must be assigned to different people with enough time for implementation.

Complete practice marketing then, has three major components:

  1. Motivation. Why. Make sure you and your team WANT more new patients. Get that accomplished first. That may take a while. An office staff and doctor who are backlogged with their paper work, already working full time and more, who also may have a few inter-office unexpressed grievances, confusions, or doubts about your service or you… no matter how many programs you sign up for, nothing will work.
  2. Organize. Then, work out who will be doing what. Spread the marketing around to everyone and put someone in charge just to coordinate.
  3. Marketing Procedures and Events. With the above 2 components in place, you are now more likely to “rock” your marketing efforts more successfully.

Increase the WHY, increase the CAPACITY, then yes, please — lots of marketing activities.

Let the party begin!!

Ed Petty

Spring Marketing Planner- (DOC) Sample Marketing Planner for Spring

*TED Talk link: www.pmaworks.com/observations/2011/02/10/leadership-in-chiropractic-the-golden-circle/

Oklahaven “Have A Heart” – 2017

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Oklahaven, a non-profit children’s chiropractic center has been dedicated to making sick children well using natural, drug-free chiropractic care for over 55 years.    To help fund their efforts the Annual Have A Heart Campaign is held in conjunction with Valentine’s Day each year.

It’s not too early to start planing your own “Have A Heart” Campaign for your office bringing a global awareness of the power of chiropractic for the children in your own community while helping out a greater cause!

If you’d like to participate, a complete marketing kit is available directly through Oklahaven simplifying the event preparation for your marketing coordinator.

Click here for a pamphlet with more details or visit the Oklahaven “Have A Heart” web-page.

Chiropractic Patient Reactivation Program and Sample Postcard

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We recommend offering a special promotion to patients who have not been active for 6 months or more.

The links below will take you to a couple of articles describing procedures that can be used to encourage less active patients to come in to see you.

The Reactivation Program has a number of sample letters and a sample postcard and the Reactivation Card is a sample post card that can also be customized for your email newsletter.

Sample Reactivation Postcard – Sample postcard layout and instructions on how to customize your postcard.  Information can also be used for email notification.

Reactivation Program An article on the importance of regular reactivation program.

Best Wishes for your New Year!

Phyllis To Speak at Parker Seminars – Las Vegas

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Phyllis has been on the Parker Seminar speaker circuit since before starting with PMA.  She presents a powerful presentation to motivate and inspire doctors and staff alike.

Coming to you from Las Vegas Nevada, February 23-25, 2017, Phyllis will be joining other colleagues in the chiropractic profession to bring a well rounded presentation of new patient procedures, billing and coding, obtaining referrals, handling objections, creating great patient experiences, and much more specifically designed for your Chiropractic Assistants.

Don’t miss out on this amazing lineup of CA Speakers:

  • Kathy Mills Change, MCS-P
  • Phyllis Frase Charrette
  • Becky Walter
  • Heidi Farrell
  • Holly Jensen
  • Brandi MacDonald

For more information or to register visit parkerseminars.com

or download the flier here: Parker Seminar Flier

Are You One of the 8500 Who Received a Letter From Medicare? Keep Calm and Don’t Panic

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Have you received a fax or letter from Center for Medicare/Medicaid Services regarding Comparative Billing Reports?  Don’t panic – call me and I will provide an onsite assessment at your practice to ensure your documentation, billing, and coding stay compliant.

Call Lisa:  nine two zero 334-4561

Email Lisa:  lisa@pmaworks dot com

MACRA- New Info on Medicare!

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rs-medicare-info-icon

New Info on Medicare!

Happy Holidays Chiropractic Friends!

First snowfall always seems to bring renewed energies and hope – my wish is you experience this, too.

Are you ready for January 2017? Ready or not, here it comes. Today I want to introduce and give you some of the latest and greatest on what’s happening with the new Medicare reimbursement model also beginning our new year.

To start with, six new acronyms to introduce to you: MACRA, MIPS, CHIP, APM, SGR, CPIA

  • MACRA: Medicare Access CHIP Re-authorization Act of 2015
  • MIPS: Merit-Based Incentive Payment System
  • CHIP: Children’s Health Insurance Program
  • APM: Advanced Payment Model
  • SGR: Sustainable Growth Rate
  • CPIA: Clinical Practice Improvement Activities

Here’s a bit of background for you regarding the initiative. In April 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act 2015 (MACRA). This is an act to transition Title XVIII of the Social Security Act to the Medicare sustainable growth rate and strengthen Medicare access. How? By improving physician payments and making other improvements, like the Children’s Health Insurance Program. We could say MACRA is the umbrella to the program.

What is the purpose of the change in reimbursement model? The purposes include simplifying reporting for the convenience and ease of the providers participating; decreasing the current costs of healthcare, allowing patients the best quality of care; and to make patient information sharing safe and easy. The blueprint for pay for performance is the Merit-Based Incentive Payment System, and the goal is to create an acceptable payment system for physicians and the program.

Who are the stakeholders in the broader MACRA program? They include beneficiaries (your patients), businesses, payers, providers, and state partners.

Are you eligible to participate?

Both participating and non-participating providers are eligible to participate if you meet both of the following criteria: 1) Have seen 100 or more unique patients in a year, and 2) Have billed for covered services at $30,000 or more a year. You are exempt from participating in 2017 if 2017 is your first year as a Medicare provider. You are also exempt if you do not meet one of the two criteria above.

How will it work?

CMS has indicated through various webinars that they will notify via written communication if you are or are not eligible to participate. Once you learn of your eligibility, the program will require participating providers to report on three categories for the Merit-Based Incentive Payment System:

  • Quality (i.e., Physician Quality Reporting System, also known to you as PQRS but with some tweaks).
  • Practice Improvement, focusing on clinical quality measures. For examples, patient outcomes; patient engagement and compliance; adherence to your practice systems and guidelines.
  • Advancing Care Information (this is the technical component; i.e., Meaningful Use and minimum five measures recorded in your practice’s healthcare technology).

Additionally, if you are eligible to participate and choose not to, there will be a negative adjustment of 4% to your Medicare reimbursement. If you are eligible and do choose to participate, you may receive a positive adjustment of 4 to 9% depending on your level of reporting involvement, as well as a minimum 0.5% bonus for exceptional performance if your final reporting score meets or exceeds a certain point value.

You will have two reporting options: You may report for the entire 2017 calendar year, or you may report for the partial year, one quarter, and may begin no later than October 2, 2017.

PM&A will continue to monitor any changes to the above information.

In addition, I will be conducting onsite MACRA readiness assessments at chiropractic offices and am available to visit yours. Please contact me if you are interested in learning more!

Best,

Lisa Barnett, Consultant
Petty, Michel & Associates

Call: nine two zero.334.4561

Email: Lisa@pmaworks dot com

How To Make Your Chiropractic and Natural Health Lending Library Work

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lending-library

A natural health lending library is a very practical marketing tool – if used.

A lending library is a collection of books, DVD’s, and other information that you can loan your patients. It is part of an ongoing patient education program. The better your patients understand what you do and why you do it, the more likely they will be to stick to a long-term care program and to refer their family and friends for services.  Patient education, compared to other marketing activities, is not that expensive.  It has a good ROI!

Download a list of suggestions here for your chiropractic or natural health care library.  [Ideas for your Lending Library]  Please give us your suggestions as well.

This all is logical, right?  We all know this.

So…why is it rarely done? Most of the offices that I have seen with lending libraries have them on the bottom shelf in some corner of their office filled with books from a garage sale and old VHS video cassettes.

Everyone knows patient education is important. Like the Spinal Care Class, or new patient education class, everyone knows this is good for the patient and helps the office grow. Right?

Funny story… I attended a small get-together of chiropractors one evening here in Southeast Wisconsin. The presentation was given by the lead doctor of a multiple doctor office. Great doctor, nice practice. He had been in practice for years and looked weathered and ready for retirement. The talk was how to give an effective Spinal Care Class for new patients. The presentation was full of practical content. The only thing… the doctor wasn’t that cheerful about his presentation.

After he finished, and as he left the front of the room looking down at the floor, he muttered, as if passing on a confidential apology to another spy… “But we don’t do the classes anymore.”

So, no need to fool ourselves here. It might be just easier to buy some nice posters and be done with it.

Ah, but there is a trick to making your lending library work… and patient education in general work!

The lending library is primarily for YOU — and each member of your professional team.

We have been looking at it all wrong.  The lending library is a reflection of YOU!

If YOU study, and if your support team studies and learns, you all will be so enthusiastic about the information that you will insist that your patients learn this information as well.

Be curious and ask yourself some questions. For example:

  • Chiropractic adjustments have been shown to significantly lower blood pressure. Do your patients know this? How does it work?
  • Why do some intervertebral discs degenerate and others (in the same spine) do not?
  • Do your patients understand the myth of cholesterol, heart disease, and how statin drugs may be causing some of the symptoms they are coming in to see you for?
  • How is the adaptive immune response affected [during “cold and flu season”] by the adjustment?
  • Is the average time for a whiplash patient to achieve maximum improvement 7 months 1 week? If so, why? If not, what is it?
  • Nonsteroidal anti-inflammatory drugs for rheumatoid and/or osteoarthritis conservatively cause 16,500 Americans to bleed to death each year. Do your patients know this? Do their families?
  • Glutamate and aspartame can cause chronic pain sensitization, and removing them from the diet for 4 consecutive months can eliminate all chronic pain symptoms. Do your patients know this? Do their spouses? *

Read a book, watch a video, question authority, ask questions — seek the truth. Get excited about learning new things about your profession.

DON’T GET BORED. If you are bored, quit and go home!

Otherwise, be grateful for the opportunities we all have to learn and expand our knowledge and understanding of the services we provide and the world in which we provide them.

Be curious.

Ultimately, you sell yourself before you sell your services. How can you sell a care class or an extended treatment plan if you are not truly excited about them?

Learning new aspects of chiropractic, health care, wellness, sickness, the sickness industry, how your patients are being manipulated and exploited… all this should agitate you one way or another.

For example, I watch Vaxxed – the movie — and then listened to Dr. Andrew Wakefield and Brandy Vaughn (former Merck employee) talk on YouTube about the movie and how they are now being covertly and overtly intimidated to shut up.  If this pharmaceutical company is trying to help members of your community get healthier, why are they now attempting to squash dissent and in such a sinister and yet powerful way? I can’t help but wonder: just how powerful are they at manipulating public opinion? How are they influencing my community and my family?

If you look further into the effects of pharmaceuticals, from Vioxx to statins to MMR and vaccines, and explore some of these questions, you can’t help but feel compelled to educate your patients on how to keep their children healthy and free from a toxic environment.vioxx

Some of the most successful offices I have seen have spent untold sums on going to seminars (and on coaches!). The verysuccessful can be reckless with book buying and webinar watching and seminar attending.

Continuing education isn’t just for re-licensing seminars. How dull!

If you are not impatiently curious about different aspects of your profession – its science, its philosophy, what it is up against in the market place, you are becoming part of the problem.

Stay curious. Question authority. Study.

Do this:

Assignment #1. You. Order a book – or video- from Barnes and Noble, your local books store, or Amazon. Read most of it on a weekend or weeknight evening rather than watching TV.  Present what you learned at the next staff meeting and put the book in your Library.

Assignment #2. Your Team. Have your staff read a few chapters from a book, or watch a video from your lending library and then give a presentation about it at a staff meeting. Everyone learns and the staff member learns twice! Give bonuses for outside study.

Just like we work on our patients, just like we work on our business, we must work ON our roles as professionals and we do this by studying.

Then, no doubt, you and your team will be dragging your patients over to the lending library to check out the latest editions to your collection.

And your patients will know that they came to the right place. They may think you are all a little nerdy, maybe even fanatical about better health, but they will know that you sincerely care about them and their wellbeing, not just in collecting some money for some fast or rushed service.

Assignment #3. Stay curious and learn – and provoke others to do the same.

Sincerely,

Ed

See our attached list of sample books and videos for your Lending Library Ideas for Your Lending Library

Please give us your suggestions for informative books or videos!

*Questions taken from Dan Murphy’s web site.www.danmurphydc.com

 

More Fun Pics from the CSW Fall Summit

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Petty, Michel and Associates recently attended the Chiropractic Society of Wisconsin’s Annual Fall Summit.  The Fall Summit is a great time to get together with others in the profession and share stories of the lives we change on a daily basis.

We always manage to have some team camaraderie also.  Saturday as the sessions began to wind down we held our annual Petty, Michel and Associates photo session.  Shown below are a few of our favorite shots.

Unlike many of the offices we work with our team is scattered across the country which makes it challenging to physically come together as a team. This year we were able to accomplish having everyone present, and a few extras, for cocktails at the Kalahari’s Diamond Cut and our team dinner at Wally’s House of Embers in the Dells.  Lots of chatter, laughter and love shared with all!

Those Blues Bros…. sure know how to treat their team!

Thanks Dave and Ed!

Linda

 

 

Chiropractic Society of Wisconsin Fall Summit in Review

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Team PM&A (Petty, Michel and Associates) recently attended the Chiropractic Society of Wisconsin Fall Summit at the Kalahari in Wisconsin Dells.

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Phyllis, Barbara, Lisa, Ed, Dave, Linda and Dana

We are pleased to announce the winner of our succulent dish (door prize): Dr. Chelsea Poland.  She is following in her father’s footsteps and she practices in Wausau.  Congratulations Dr. Chelsea!

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Linda and Dr. Chelsea Poland

The weekend was filled with meeting and greeting chiropractors and their staff.  It was fun to see so many of our clients, some of whom I had not yet had a face to a name, meet new docs and their teams, and reconnect with old friends and colleagues to share hugs and spread the love of our profession.

A doctor once told me that no other practice(experience) will ever be the same as my first.  I’ve found this to be very true.  We hang on to those memories of that first practice.  This weekend I was able to reconnect with the first associate Dr. Culp(my first practice) brought into his office, circa 1987.  We reminisced of the “old days” and  brought each other up to date on our journeys over the past 3 decades.

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Dr. Jon Wall and Linda

All in all, it was wonderful to see everyone again and share the weekend with you!

Tent Poster- Ali Will and Skill

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“Champions aren’t made in gyms.
Champions are made from something they have deep inside them – a desire, a dream, a vision.
They have to have the skill, and the will.  But the will must be stronger than the skill.”

~Muhammad Ali – 1942-2016

 

For a printable copy of this tent poster email us.

Rock Your Coding World! How to Evaluate Your Coding for Maximum Reimbursement

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Lisa J. Barnett

Lisa J. Barnett

Download a PDF of this article

Hello Friends in Chiropractic!

Hope you had an awesome summer and took several opportunities to soak in some UV and Vitamin D.

This month I’d like to both expand on my July Medicare Documentation article and coach you on self-auditing evaluation and management (E/M) coding for reimbursement. Are you consistently under-coding your E/M services? It is not benefiting you to do this because more than likely you’re meeting required elements and not getting the best reimbursement available.

So, what exactly does an auditor, be it Medicare or a Commercial Payer look for in determining reimbursement for your evaluation and management services? It is pretty simple and based on both quality and as it turns out, more importantly, quantity of certain elements. Let’s look in depth how you can self-audit your E/M services*:

First, a coding history and review. In 1992, the current E/M codes were introduced as a result of a ten-year study by CMS(Centers for Medicare and Medicaid Services) and the AMA(American Medical Association). Then in 1995 and 1997, CMS and the AMA developed documentation guidelines (DG) for use of these E/M codes.

Without re-inventing the wheel, let’s lay out how you determine which code to use for your patient evaluations and management of care. To review,

  • New patient E/M codes include 99201, 99202, 99203, 99204, and 99205.
  • Established patient E/M, or re-exam, codes include 99211, 99212, 99213, 99214, and 99215.

Charting out information from CMS and ACA’s ChiroCode book, here is what we have as quantifiable elements to determine which code to bill for. Keep in mind that Necessity of Care drives our discussion below.

History, Exam, Complexity of decision-making are the three main elements in the evaluation and management note.

Let’s now diagram out for you each code and corresponding description of each element, using both New Patient and Established Patient criteria. What differences do you see? Which descriptions share commonality?

NEW PATIENT

 CODE  HISTORY  EXAM

 COMPLEXITY OF DECISION-MAKING
IN MANAGEMENT OF CARE
99201 Focused/Minor severity  Focused Straightforward
99202  Expanded/Low-to-moderate severity  Expanded  Straightforward
99203  Detailed/Moderate Severity   Detailed  Low
99204  Comprehensive/Moderate to high severity   Comprehensive  Moderate
99205  Comprehensive   Comprehensive  High

 

ESTABLISHED PATIENT

 CODE  HISTORY  EXAM

COMPLEXITY OF DECISION-MAKING IN MANAGEMENT OF CARE
99211 No key component(s) required No key component(s)  required No Key component
99212 Expanded/Low-to-moderate severity Expanded Straightforward
99213 Detailed/Moderate severity Detailed Low
99214 Comprehensive/Moderate to high severity Comprehensive Moderate
99215 Comprehensive Comprehensive High

 

Building on that, here are the quantified components indicating the minimum number of each component’s required presence in the note to code appropriately and at the maximum level:

NEW PATIENT 

HISTORY  EXAM

 COMPLEXITY OF DECISION-MAKING
IN MANAGEMENT OF CARE
 Code Chief Complaint HX  of Present Illness  Review of Systems Past Family/ Social HX  Exam (1997 DG)  Diagnoses  Data to be reviewed; # of Complaints  Risk Factors
99201 1  1  N/A  N/A  1 in affected body area  1  1  Minimum
99202 1  1-3  1 N/A  1-5  1  1  Minimum
99203 1  4+  2-9  1  6-11  2  2  Low
99204 1  4+  10+  2-3  12+  3  3  Moderate
99205 1 4+ 10+ 2-3 All components 4 4 High

All 3 elements are required in the new patient note to consider reimbursement: History, Exam, Complexity

ESTABLISHED PATIENT 

HISTORY  EXAM

 COMPLEXITY OF DECISION-MAKING
IN MANAGEMENT OF CARE
 Code Chief Complaint HX  of Present Illness  Review of Systems Past Family/ Social HX  Exam (1997 DG)  Diagnoses  Data to be reviewed; # of Complaints  Risk Factors
99201 1 N/A  N/A  N/A N/A N/A N/A  N/A
99202 1  1-3 N/A N/A  1-5  1  1  Minimum
99203 1 1-3  1  1  6-11  2  2  Low
99204 1  4+  2-9  2+  12+  3  3  Moderate
99205 1 4+ 10+ 2+ All components 4 4 High

Two (2) out of the 3 elements are required in the established patient note to consider reimbursement: History, Exam, Complexity

As you may deduce from the above established patient table, 99211’s are rarely used in chiropractic offices. Can you see why?

Additionally, give your current score an extra two points for management of care, i.e., reviewing old records and summarizing in the note stability/worsening of condition, or, two points for obtaining history from someone other than the patient. Add one point for diagnostics performed and reviewed, (i.e., x rays).

Finally, make sure to attached your -25 modifier on all E/M codes if you are giving a CMT on the same DOS.

Have a specific patient in mind and you’d like to find out if you coded and billed at the most appropriate and highest level? Contact me on how you can qualify for a complimentary audit!  Call 920.334.4561 or email lisa@pmaworks.com

Sincerely in Chiropractic,

Lisa Barnett,
PM&A Coach and Consultant
Where Managing by Numbers and Progress Says It All.
My purpose is to be the Best Chiropractic Advocate in the World

*EHR systems may already have built-in features to automate the components for you via their macros/templates.References:

  • American Chiropractic Association ChiroCode Deskbook, 2014-2017
  • Centers for Medicare and Medicaid Services, 1997 Documentation Guidelines for Evaluation/Management Services, Reference II, Medicare Physician Guide, A Resource for Resident Physicians, Practicing Physicians, and Other Healthcare Professionals
  • Centers for Medicare & Medicaid Services, Medicare Learning Network, ICN006764, August 2015, https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNEdWebGuide/Downloads/97Docguidelines.pdf
  • Gwilliam, Evan M., DC, MBA, BS, CPC, NCICS, CCPC, CCCPC, CPC-I, MCS-P, CPMA

List of Components:
History of Present Illness – Elements:
Location (example: left leg); Quality (example: aching, burning, radiating pain); Severity (example: 90 on a scale of 1 to 100); Duration (example: started 3 days ago); Timing (example: constant or comes and goes); Context (example: lifted large object at work); Modifying factors (example: better when ice/heat is applied); and Associated signs and symptoms (example: numbness in toes)

Review of Systems:
Constitutional Symptoms (for example, fever, weight loss); Eyes; Ears, Nose, Mouth, Throat; Cardiovascular; Respiratory; Gastrointestinal; Genitourinary; Musculoskeletal; Integumentary (skin and/or breast); Neurological; Psychiatric; Endocrine; Hematologic/Lymphatic; and Allergic/Immunologic

Past Family/Social History:
Past history includes experiences with illnesses, surgeries, injuries, and treatments/medications. Family history includes a review of medical events, diseases, and conditions that may place the patient at risk. Social history includes an age-appropriate review of past and current lifestyle activities.

To download the article in it’s entirety click the here [LINK]