Handling Insurance Company Refund Requests of Chiropractic Patients

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More and more, insurance companies are doing post payment audits or hiring outside firms to conduct payment reviews and requesting money back from your chiropractic office.

Refunds should never be automatically sent out based on a request from an insurance company.  Each request needs to be individually reviewed and processed and the patient’s account should be audited to determine if a refund is actually due and to whom.

Sometimes, a refund is due. Examples may be when an insurance company has double paid dates of service, or when two insurance companies both pay on the same date of service. These are legitimate refunds – ie: you have been paid more than you billed or were due for services rendered. These should be refunded.

Often however, a refund is NOT due and should be disputed. Examples might be when an insurance company or third party does a “post payment review” and determines that the care was not medically necessary, or when insurance pays but later determines that work comp or PI were primary, or when an insurance company decides that the patient did not have a particular benefit or coverage for what they already paid.

Essentially, when you have delivered quality services to a patient that were medically necessary and in the best interest of the patient, and the insurance company pays for those services, you have NOT been overpaid and no refund is due. Even if the insurance company later decides they overpaid or paid in error. These refund requests should always be disputed.

Legally, you are not obligated to repay the insurance company when you have been paid in good faith for services rendered and they paid in error. These should always be disputed.

This will not stop some insurance companies from ‘recouping’ the payment, but you should still attempt to dispute the refund request first. Our experience is that by disputing the refund you will avoid 85% of all refund requests. It is well worth the time and effort to do so.

The exception to the above involves government programs such as Medicare and Medicaid. We generally advise refunding these right away and THEN disputing the request. Remember that you must use the approved Medicare refund form and mailing address (check on line with yur local Medicare carrier for the latest form and address).

Points that can and should be used whenever disputing a refund include these (use any and all reasons that are applicable to each case):

– All services were medically necessary for the health of the patient. Our review indicated that the care was medically necessary; therefore no refund will be issued.

– This request is for a patient no longer active with our office. We have no alternative methods of collecting on these accounts. Because of a supposed error on your part, you are asking us to refund monies to you for services rendered to your insured without a foreseeable ability to collect for said services.

– We called/verified benefits on line with (Insurance Company) on each of these patients prior to the delivery of care and verified coverage for services rendered by our office. Had we been informed, we or the patient could have made a more informed decision regarding the delivery and payment for care.

– It is our understanding that (Insurance Company) has maintained a policy of not reimbursing for services if they are submitted for payment one year or longer after delivery. You are requested a refund for services over two years after their delivery and payment. It would seem that the policy should apply both ways.

– Your letter mentions that 98940 and 97140 are mutually exclusive. This is not the case when they are performed in different regions of the body as defined by the AMA. You also state that manual traction and mechanical traction are mutually exclusive. Again, this is not stated in the AMA CPT codebook and the services were performed by different providers, as our chart records show.

– The time and effort to have our office pull charts and research services from 2009 and 2010 is considerable and cannot be done without prior reimbursement, nor can these records be forwarded to (Insurance Company) without prior consent from the patient.

– We would also like to know if you have informed this patient, in writing, that due to the error on your part, that they are now liable for their medical bill from 2009?

– Our feeling is that the following court cases concluded that the insurance company is responsible for knowing their policy limits prior to paying and therefore must bear the responsibility for their own mistakes.

  1. City of Hope National Center vs. Western Life Insurance Company, 92 Daily Journal D.A.R. 10728, Decided July 31, 1992. (In this case the hospital obtained standard assignment of benefits from the patient and submitted claims, which were paid by the carrier. The insurance company later decided the treatment was experimental and requested the money back. The California Court of Appeals stated that if it’s your mistake you have to pay for it.
  2. In Federated Mutual Insurance Company vs. Good Samaritan Hospital (Neb. 1974) 214 N.W.2d 493. (The carrier contended that it mistakenly paid claims beyond the policy limits. The court held that the insurance company could not recover the money as it places an undue burden on the providers of service to subject them to retroliability.)
  3. Lincoln Nat Life Ins vs. Brown Schools (Ct.App. Tex 1988) 757 S.W. 2d 41 1. (In this case the carrier mistakenly paid claims after its policy had expired. The court denied recovery stating “Here the insurer knew it’s own policy payment provisions, but failed to notify the health care providers as to these provisions and the insurer alone made the mistake of paying beyond its responsibility . . . in the normal course of such business, the hospital has no responsibility to determine if an insurance carrier is properly tending to its business.”)
  4. National Ben. Administrators Vs. MMHRC (S.D. Miss. 1990). (Similar case as #3 with same conclusion.)

– Our office made no misrepresentations in filing claims for your insured. We extended valuable services based on preverification of benefits and assignment of payment by the insured. We were not unjustly enriched, and simply had no reason to suspect that any of the payments for services rendered were in error. Refunding the monies at this time would place an undue burden on our office.

As always, send a copy of your letter to the patients involved. The insurance company will send a letter to the patient (if we don’t send them a check) saying that “we are not cooperating and therefore the patient may be responsible”. So, strike first by presenting our side and preparing the patient.

Situation: The insurance company paid twice on one date of service and missed payments on another. They are now requesting repayment on the double payment.

Solution: Send them a letter explaining that the payments were posted to the unpaid dates and no refund will be made.

 

Situation: The insurance company claims that the work comp carrier is responsible for payment and is asking for all their money back.

Solution: Send them a letter explaining that you will bill the work comp carrier and if and when payment is received, you will refund any duplicate payment.

 

Situation: The insurance company paid for the first eight visits, then denied the next five and now wants a refund on what they paid.

Solution: Dispute the refund as per the above points and request immediate payment on the five denied visits.

 

Situation: The insurance company paid for care, but then came back and stated the patient didn’t have an active policy or coverage.

Solution: Dispute the refund as per the above points. It is the insurance company’s job to pay within the limits of their plan; you have been paid for services rendered.

If you have questions, feel free to contact me.

David Michel

Chiropractic Patient Service

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Remember Me?

I’m the fellow, who goes into a restaurant,
sits down patiently and waits while the
waitresses do everything but take my order.

I’m the fellow who goes into a department
Store and stands quietly while the sales
Clerks finish their little chit-chat.

I’m the man who drives into a petrol
Station and never blows his horn, but waits
Patiently while the attendant finishes
Reading his comic book.

Yes, you might say I’m a good guy.

But do you know who else I am?

I’m the fellow who never comes back, and
It amuses me to see you spending
Thousands of dollars every year to get me
Back when I was there in the first place…
And all you had to do was show me a little courtesy.

~Author unknown

Printable Version

Your Chiropractic Root System and Patient Retention, Referrals, and ROI

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Updated: April 2016

When people go to the grocery store for produce they are mostly just interested in their plump cucumbers, zucchinis, or other vegetables.  They don’t much care about the garden that actually produced these nutritious wonders of nature.

But a lot of work goes into a well managed garden. If you don’t take good care of your garden, you won’t have its fruits and vegetables.  It’s that simple. And a good part of a garden takes place underground in a network of roots.  Roots provide water and minerals to the plant, and keep it in place when the wind blows.  The top part of the plant, its stem, can get mowed under by a lawn mower (I have done this) and the plant comes back to life – because of its strong root structure.

Your office is kind of like a garden.

It produces healthier people. You take care of your team, polish up your systems, do some training, and you will continue to have a productive “health garden” that produces healthier people.

And the roots? 

In this analogy, the root system is the loyalty and good will of your patients. Here’s how:

Many offices struggle to get new patients.  Even offices that have been in business for years and years.

Why?  No roots.

If some doctors spent the same time and attention – and money, on giving extra care and service to their existing patients as they did on trying to hustle up new patients, they would have more patient visits than they would know what to do with.

Why?  First, because the service and care was SO extraordinary, patients would refer their family and acquaintances because they would want them to receive similar treatment as they had.

But more obviously, existing patients would never drop out of care. (Some would, of course.) They would continue to come back for wellness visits. How busy would your office be now if all the new patients you ever started still came in for services? You couldn’t handle…there would just be too many patients!

Over the years, there have been many studies to support the fact that it is more expensive to chase after new patients than it is to keep the ones you have.

 “A common rule of thumb is that the marketing costs of landing a new customer runs three to five times the costs of retaining an old one.” (Total Customer Service, Davidow)

Some articles talk about it costing 10 times the amount to get a new customer as to keep the ones you have.

I am all for getting new patients, but do you also keep your existing patients? And do they refer family and friends and work associates? And why do your patients leave? An interesting survey pointed out that most companies believed it was because of price, or that the needs of the customer changed. However, from the point of view of the customer, they left because of poor service. (The Loyalty Connection: Secrets To Customer Retention And Increased Profits By Bob Thompson, CEO, CustomerThink Corporation Founder, CRMGuru.com, March 2005)

 

There are a number of procedures to improve your services to patients – to help generate stronger and more productive “roots”, or healthy patient relationships. Let’s focus on the most fundamental: Communication.  To put it more accurately, let’s call it “conversation.”

BEGINNING THE CONVERSATION

A conversation is a dialogue, a giving and receiving of communication back and forth. It is an interactive exchange of thoughts. It shows that you respect the other person and that you are interested in them and what they have to say.

Many patient conversations are one-way, from the staff and doctor to the patient. They are also rote, robotic, and too scripted to be genuine.  Do an audio recording of how the front desk answers the phone or how you do a consultation and you might be able to see room for improvement.

The conversation usually starts with the first phone call. Does the prospective patient feel that the front desk is listening – really? Is she interested, or just reading her script and trying to get to her next task and hang up the phone?  Does she introduce herself and show interest and even gratitude for the call?

It is these little things that make such a big difference.  Think about how you like to be treated when you contact a business…

In the consultation, do you really listen and seek to understand the patient, even though it is like the 5 millionth time you heard about someone’s low back pain?

In your report, do you have a conversation with the patient, or do you just rehearse your script to the patient while they are nodding in appeasement?

You see so many patients… and have so many tasks… that real conversations are too often sidelined.  You don’t have much time, usually. But in the time that you do have, you have to be present. You have to be THERE, with all of your attention on the patient, and not on your next task.  That moment with that one patient will never happen again. It is its own time that just you and that person share.  The Japanese have a saying for this: “Ichego Iche.”  One time, one moment. This is a plaque that is often found in tea rooms in Japan.

You have started to create a relationship.  Now, you have to continue to nurture it. This is done by continuing the conversation – and of course, great clinical and administrative service and care.

With each patient encounter, you have to be interested, attempting to understand and then get understood. Improve this and you are well on your way to better patient retention and referrals.

CONTINUING THE CONVERSATION

But when your patients are not with you, you have to find ways to continue the conversation.

How?

Your Newsletter.
You can easily set up an email newsletter with an a provider such as Constant Contact or Mailchimp. Send these out monthly or even twice per month. The most important aspect of these letters is to keep them real, personal, as if you were writing to a friend.  It could simply be a few paragraphs from the doctor relating a recent case success, or a home health tip. You can also include patient testimonials and a review of a recipe.

But we are inundated each day with hundreds of emails so keep in mind that old fashion snail mail still works, and in fact, works better.  It does cost, of course, but the return on investment makes it worth it.  A hard copy newsletter will have “shelf life,” and can be read and reread.  Most emails are overlooked -there are just too many of them.  Send out a hard copy newsletter every 4-6 months.  It can even just be a one page foldover, self-mailer.

Other Mail.
Cards are very considerate. Just think about the few you receive. You may still have them! A system can be set up to send out birthday cards, welcome cards, humorous reactivation cards, bereavement cards, and congratulation on starting your “wellness program” cards, as well as other cards each month.  These all help keep the conversation going.

Social Media.
Facebook is your primary social media with your patients. This can be similar to your newsletter.  Like email, it has become glutted with ads and “content” information.   Ask your patients to “LIKE” your page so that they can stay in touch with the office and receive new information about health and upcoming office events.  Some offices even hold special contests only for their Facebook “friends.”  Then, post regularly fun and education information. For example:

 “Our patient, Burt, just got accepted back into his hockey league thanks to chiropractic. Here is a photo of Burt and Dr. Smith and his new puppy eating apple pie made by Rose, a long time patient who can’t stop bringing us apple pies!” (Of course always get patient approval to post their picture.)

 

Upload patient testimonials, in writing or even videos. If they are interesting, other patients can comment, or even share.  And if anyone does comment, make sure that you comment back.

Delegate these types of communication to your team, but you have to be the one to ensure that the conversation continues.

If you have good roots, there is nothing to fear.  Insurance reimbursement can decrease even more, the economy can decline, staff changes can occur, but if you have taken good care of your patients, they will take good care of you.  Conversations with your patients will help nurture a strong “root system” that will keep your office productive, no matter the storms that may come.

SUMMARY – TAKE AWAY:

 When the patient is on the phone or in the office:

  • Be present and attentive.  (Present Time Consciousness “PTC” as Jimmy Parker would say.) Be genuinely interested.
  • Seek to understand the patient.
  • Get your point understood and have a conversation.

When the patient is out of the office – continue the conversation:

  • Snail mail real newsletters and cards mailed.
  • Emailed newsletters.
  • Get Facebook “fans” and post local/personal news.

Zucchini’s and Chiropractic Businesses

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Home grown zucchini's

It has been a good summer.  The crops are coming in.

Growing a practice and developing a business is much like farming. It takes nurturing, care, and just the right about of help at the right time.  A plant can seem to be dormant while underground its roots are growing and getting strong.  Sometimes practice improvement seems to occur slowly even though we may be working hard.  It could be that that you are just developing the “root” system before your practice is more productive.

Your practice follows natural laws – it has its own innate life force.

Just like a zucchini does.

You have to trust in your own goodness as you do in the power that made you and gave life to your patients. That Power — it also runs through your office and eavesdrops on your thoughts and intentions.

You have to smile about the truly awesome benefits your patients and you receive with chiropractic, which we all too often overlook.

It’s not about insurance or money or policies and procedures or schedules or management or marketing or meetings – which we all can use at the right time to the right degree. In the end it’s about the help we provide and that help should not be separated from the love in which it is given or the joy that it produces.

There is truly a lot to celebrate.

It’s a good procedure to look for and have many celebrations with your patients and those you are close to. Don’t be shy about it.

Keep nurturing your practice and it will continue to produce happy patients.

Billy DeMoss Shakes Up Appleton Wisconsin at Petty Michel Seminar

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Billy DeMoss, ChiropracTOR

Dr. Billy DeMoss gave a heated and edgy presentation for 3 hours to chiropractors and their staff in Appleton, Wisconsin, Friday night, Aug. 19th. Full of anecdotes from his own practice, along with statistics, slides and videos, “Billy D” reminded everyone what chiropractic and natural health care is all about.

He talked about how providing chiropractic care is actually fun and how you should have fun in your office. He stated that patients want to come to a place that is enjoyable, where staff and doctors are having a good time in a positive atmosphere.

But he also explained that it takes a great deal of work to have a successful office. He recounted the days that he had to do manual odd jobs just to make it through school. He works hard at his office but keeps it fun.  “If you want a more successful and profitable practice you are going to have to work for it.”

“The days of the $200 dollar office visit are fading,” he said.  Workers Compensation reimbursement in California has been cut back and some money motivated chiropractors have abused the system. But money is not the goal, and never has been, he said.  Serving people will always be rewarded financially, but that is not our primary objective.

He emphasized that our main goal should be to teach and adjust. Some doctors complain about doing screenings or lectures, but Billy asks the audience: who do we do it for?  Are we worried about inconviencing ourselves or do we want to help people get healthier?

He discussed issues such as vaccinations, diet, United States health statistics relative to other countries, and said that the chiropractors were the ones best poised to take a leadership role in the health care of the U.S.

After 3 hours of Billy’s high energy, the mesmerized and energized crowd gave him two standing ovations.

One member of the audience who owns a small farm and who was not a doctor or staff member, said he wished there were more people speaking out like Dr. Billy DeMoss. He said it was one of the best presentations he had ever seen.

The next morning,  Phyllis Frase spoke to staff and doctors about how to be a “Rock Star” C.A.  Phyllis also gave a dynamic talk and will be speaking at the Cal Jam in California, February 24-26.

PM&A encourages all who can make it to Cal Jam to do so.  I attended 2 years ago and it was absolutely the most unique and refreshing chiropractic seminars I’ve attended in 20 plus years. Well worth the time and money.  More info about CAL JAM.

Dave Michel, Billy DeMoss, Dana Pittner, Phyllis Frase, Ed Petty

 

CATCH DR. BILLY DeMOSS SPEAKING MONDAY NIGHT, AUGUST 22 AT LAKE GENEVA, WI.  FOR MORE INFO, CALL: 262-275-5005

Video here

Photos here

School Supply Drive for Chiropractic Offices

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Jump on the bus…it’s back to school time!

 

To some this means the excitement of shopping for new school supplies. To others who are less fortunate, it means embarrassment of arriving on the first day of school without the necessary materials to get a good education.  Some teacher’s spend an average of $1000 per year of their own money providing necessary school supplies to those students in need.

Your chiropractic team could help change that by holding a special chiropractic promotion – the  School Supply Drive.  As the kids head back to school, why not head to the “top of your class” and “jump on the bus” by hosting a School Supply Drive.  It will give you visibility in the community, potential new patients and an overall good feeling of satisfaction for helping the kids in your neighborhood!

Click the link above for a sample poster.

(For active clients of Petty, Michel & Associates, go to your PMAmembers site for a customizable poster, patient handout, press release, and summary outline of how to hold a school supply drive.)  [Link]

========

Chiropractic School Supply Drive: Implementation Summary

A school supply drive is designed to help local kids, and their parents and teachers, round up supplies to help them with their school work.

Many teachers end up purchasing school supplies for those less fortunate with their own money.  So, the need is there.  This can be a rewarding promotion that can help your community and help you generate some publicity, good will, and a few new patients.

Here are some sample action steps you can use to help you organize and put together an effective school supply drive.

1) PLANNING

a) Decide the dates you will be running the drive. Summer works, August, Sept. Hold it for 1 week. You can actually run a number of them during the year if the perceived need is there.

b) Decide what you will offer. For example:

i) New Patients:  a consultation, exam, (if indicated) initial x-ray, and report of findings for $25 and at least 5 school supplies

ii) Existing Patients: May a receive raffle ticket for a valuable gift, such as 5 car washes, $20 gas card, or a Subway Gift Card for at least 5 school supplies

c) Decide what the patient’s responsibility will be.

i) New Patients:

(1) Donation of 5 school supply items plus $24

ii) Existing Patients:

(1) Donation of 5 school supply items
(2) Referral of family and friends

d) Choose a local school (or more) that patients would be motivated to help.

i) Contact the school, preferably the Principal, to obtain:

(1) Information for a press release in regards to the needs of the school and students.
(2) Supply lists

e) Set up area for collection

2) MARKETING (examples)

a) Write a press release and submit to local papers
b) Post your event on your Facebook page
c) Post your event on your Google page
d) Make a flier to post in your office
e) Make a statement stuffer with details of the event
f) Tell all of your patients personally, and regularly remind them to bring in their donation and
g) Encourage existing patients to refer their family and friends.
h) Include in your newsletters
i) Submit a press release with photos after the event and also place news story in fan page and in newsletters.

Making a Chiropractic Patient Community

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Is it just YOUR office?

Or does it also belong to your patients?

One office we have the privilege of working with has been smashing its past records – month after month. We plot their growth on charts and nearly every month have to adjust them to keep the lines on the chart. And it has been in business for over 20 years.

Why? Well, there are a number of reasons, really.

But a key factor is that it has created a patient community. That is, it has created a systematized business where all the patients still feel that they are part of the clinic’s “family.”

They have created an environment where patients feel they belong, that the clinic is also THEIR clinic.

The principle behind this, and why it works to generate more patient volume, is that everyone wants to have friends and belong to like-minded groups. Facebook, for example, and the rise of social networking is simply a new twist to a basic impulse we all have for belonging and fellowship.

So from a practical marketing point of view, the more you include your patients as part of your chiropractic “family”, the more apt they will be to stay, pay, and refer.

For example, we have done our share of patient focus groups. Focus groups are informal discussions with 7 or so patients where we ask them about their likes, dislikes and general opinions of clinic activities. We’ve been able to learn things from the patients that we might not otherwise have known.

But what we also learned and hadn’t anticipated was that those attending suddenly started to be more active in the office. They kept their appointments and they started to refer more of their family and friends.

OK, so back to our client’s office: Each year, they give away t-shirts with the clinic name. The only requirement is that the patient has to wear the shirt at the local county fair.

This year, they sponsored a “T-Shirt Contest.” The contest was to help the office come up with a slogan for the back of the T-shirt.  The winning slogan would receive a 6 day pass to the fair.

The suggestions are…hilarious.  Some are good, some are fun, and some are just plain silly.  But.. the point is, many patients are eager to contribute.  (Some of the suggestions are below.)

 

It is no wonder, by the way, that this office which has been in business for over 20 years in small town, has been breaking its all time records for production month after month. (SHOUT OUT: Congratulations to Team Bartz Chiropractic!)

The lesson to be learned here is that it pays to empower your patients and make them feel like it is their office too.  Here are some ideas:

FRIENDLY CHATTING. Yea, I know doctors and staff aren’t supposed to spend much time socializing with the patients. I have heard that some consultants tell doctors to forbid staff to talk to patients other than talking “TIC” (chiropractic), doing a two handed hand-shake,  and mentioning the patient’s name 14 times at each visit.  Well, that is just silly.

A practice is a relationship and like any relationship, it simply has to be genuine. Be genuinely interested in your patients, like any friend.  All else can then follow.

NEWSLETTERS. A real newsletter just continues this chatting – between friends.  It can be both email and hard copy, and should include a column from the doctor. This continues your conversation with the patients.

Include survey results and patient successes and news about staff, doctor, etc. Keep it a “non professional” bulletin about your chiropractic patient community. Nothing glossy from some big company New York City. Keep it just short of being gossipy – but with pictures.

SUGGESTIONS FROM YOUR PATIENTS ABOUT UPCOMING EVENTS. The t-shirt slogans are a perfect example, but you can also survey patients about what color to paint the wall or color for the new carpet.

TESTIMONIALS FROM PATIENTS. These are another way patients can contribute to your purpose of helping more people to find better health, naturally.  It can be their purpose too.

FOCUS GROUPS. Get 7 or so of your patients, old and new, together for a luncheon and ask them survey questions about the office, promotions, advertisements, your services, etc. Best done by someone other than the doctor.  Mention the results in your newsletter.

# # #

Some examples:

T-SHIRT CONTEST ENTRIES FOR A CHIROPRACTIC OFFICE SLOGAN FOR THE  COUNTY FAIR

To be healthy and feeling fine, keep your spine in line at Bartz Chiropractic

Get your back in tact Jack….John…..Sue…. Larry at Bartz Chiropractic

You don’t even want to KNOW how bent outta shape I USED to be!

Back your Future with Chiropractic Care  (flaming tire tracks picture)

Make Your Day!  Help is on the way at Bartz Chiropractic

Get ACTIVATED at Bartz Chiropractic so you can spend the week at the Fair

Get a BOATLOAD of relief at Bartz Chiropractic (life jacket picture)

Got Pain? Be FAIR to yourself, see Dr Bartz!

I only have one spine, so I keep it in line at Bartz Chiropractic

IT NO LONGER SMARTS, WHEN YOU SEE DR. BARTZ!!

(Front)  Are you living with a pain in the neck??  (back) Dr Bartz CAN HELP!  Bartz Chiropractic Elkhorn, WI

It’s FAIR to say Dr Bartz Keeps me Healthy EVERY Day!

NO PAIN…………MUCH GAIN!!!!

Changing lives….One Adjustment at a Time!

Happy Bones = Healthy Life!

Don’t Slack…..Fix your BACK

Bartz Chiropractic, your adjustment Junction!

Less yacking, more Cracking!!

A HEALTHY SPINE WILL MAKE YOU SHINE!

BE WELL-ADJUSTED, BE HAPPY, BARTZ CHIROPRACTIC

MOOO’VON OVER TO BETTER HEALTH AT BARTZ CHIROPRACTIC (COW PICTURE OVER THE moooo)

A lifelong journey of health starts with CHIROPRACTIC

Put your life BACK IN LINE with Bartz Chiropractic Care

Walk STRAIGHT to the FAIR

Dr Bartz will CRACK you up!!

Dr Bartz is a “god” Chiropractor

Back aligned, feeling fine!!

Electronic Health Records and Chiropractic

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There is more and more attention being placed on the topic of Electronic Health Records. For those of you who are not familiar with this subject, you can find basic information on the web sites of CMS (Centers for Medicare and Medicaid Services) and of course, Wikipedia.  There are other sources, but reader beware: many have ties to software companies (and their advertising and promotional distributors) that are trying to make a case for buying expensive software now.

Here is a Q&A with Dave Michel and one of our clients regarding this subject which may be helpful in understanding what is going on:

===============

Dear Dave,

Dr. H wanted me to e-mail you with some of our questions and concerns. We are hearing a lot of different things the more people we talk to about it. We are hoping that you can shed some light on the situation. Here are some of our questions:

Is the deadline for reimbursement this October 2011? Or do we have until October 2012?
There is no deadline at this point. It is not a requirement and, even if it is, there will be an exemption for small offices (usually less than 10 FTEs).

Is there a checklist of things that need to be completed in order to be compliant? Do we need to have digital x-ray in order to be compliant?
Yes, there is a checklist. If you google CMS EHR Incentive you will find a couple on the CMS website (skip software vendor websites …). Digital x-ray is NOT a requirement.

Is it a tax credit or would we receive a reimbursement check? Will it just cover the EHR software or will it cover equipment upgrades/replacement as well?
Beginning May 2012, you would be possibly eligible for up to $18,000 per year in incentives paid as a check to each provider. The limit would be based on 75% of your prior year’s Medicare reimbursment. IF you are “an eligable provder” and you have demonstrated “meaningful use”.

How much should we expect to spend on this process? And how much will we get reimbursed? Is it a percentage or the exact amount? And is it a guarantee?
Great questions. EHR software for chiros ranges between $2.5 – $27k. Add to that the cost of conversion in your office (thousands) and the reduced efficiency (eg if the new program adds 2-3 minutes to each patient encounter). This is going to be a big process.

Dr. H  wants to know “what happens if we don’t become compliant?”.
Nothing. Yet …

Thank you so much for taking the time to answer our questions.
No problem! Bottom line (if you haven’t picked up on this so far …): I am not a fan of any of the EHR programs currently out there. They either add too much time to each patient visit or they produce a SOAP note that would not pass an audit / records review. There is NO guarentee that Big Government is going to be mailing out $44k checks to each provider for doing something that will really not improve the heath care delivery system

Most of what you have seen are from companies marketing their products (seminars, EHR software, etc). There is NO mandatory deadline (yet) to convert to EHR and so far, I have not received confirmation from CMS that chiropractors will receive any money or incentives to convert to EHR. I do have a letter in to CMS to get an official word and will let you know. It does not make sense to me that CMS will give each chiropractor $44,000 to convert to EHRs when the CMS program is going broke. But I will let you know.

For questions about EHR, feel free to contact Dave at Dave@PMAworks.com

Dr. Brian Kelly Scheduled for a Live Teleseminar Interview

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Dr. Brian Kelly

Dr. Brian Kelly will be our guest in this months teleseminar interview on Tuesday, June 28, at 12:30 Central Time.

Dr. Kelly is the new president of Life Chiropractic College West. He is from New Zealand, where he completed his professional education and training in chiropractic at the Phillip Institute of Technology (PIT) now the Royal Melbourne Institute of Technology (RMIT), Melbourne, Australia.

After successfully owning and operating multiple clinics, Dr. Kelly became the President of the New Zealand Chiropractic college where he has served for the last eight years.

He is the second president of Life West, succeeding Dr. Gerry Clum, who retired earlier this year after 30 years as College president.

Dr. Kelly will be discussing how he sees chiropractic applied in the U.S. compared to New Zealand and Australia. From this perspective, he will also offer insight on how doctors here can improve both the quantity and the quality of their services.

Don’t miss this special seminar.

–>To Register<–

And, we should also tell you about a power packed line-up of speakers for a 2 day seminar in the San Fransisco Bay Area at Life West, August 5th and 6th.

This two-day event is all about information, motivation, and inspiration! Hear from over 35 chiropractic super stars! ‘The WAVE’ offers three tracks including a full-day chiropractic assistant program on Friday, and a day-long series of short, bold presentations on Saturday.

Purposely constructed to make you think and stir your soul, attend this event and you’ll never be the same!

Click the image below to see the full size poster for more info.  Or visit their web-site at: Life West Wave

The Wave Email Flyer 3

Procedures Follow From Principles

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Many times we work with chiropractic clinics that have offices procedures that just don’t work that well for them.

Sometimes, the procedures aren’t being applied all that professionally and we can help the doctor and staff improve the execution of these procedures.  But often the doctor is trying to implement an office procedure that, like a shoe on the wrong foot, doesn’t fit.

You should learn about different approaches to patient and practice management and marketing. Give these different procedures a go. But in the end, you have to find out what works best for you and your team.

What you want to look for are the principles behind the procedure. Work with the principle and then you can discover the procedure that best works for you. Then, you have to be come expert in it through determined practice.

Take a boxer: you’re trained to keep your arms and fists close to your head as a guard against your opponent’s strikes hitting you. Good procedure. Makes sense.  However, every boxer has their own unique physical make-up and has to work out, in the end, their own style of fighting.

For example, one fighter, Chuck Lidell, has won many fights and is a former light heavy weight champion. If you watch how he fights, he rarely covers his face and fights with his arms out and his head wide open.   This goes against common boxing procedures.

However, he does apply the basic principle: protect the head from blows. His procedure is to stay out of range from the opponent’s blows, requiring the opponent to move forward with his whole body to land a strike.

Some years ago, one seminar company was promoting the 4-5 day report of findings. It had its merits; however, few doctors that we saw could actually stick with it and make it work. The principle, however, was educating the patient continuously at each visit to help them understand the need for continued adjusting and care.  From this principle, many different and effective procedures can be worked out.

When procedures are not working in your office, you may be trying to pound a square peg into a round hole. Work with your coach to help you tailor the procedure effectively. Your coach can help you customize your procedures so that they work and work for you.

No two boxers fight the same and no two jazz pianists play exactly alike. But each follow key principles and apply them expertly in their own style to become the best.

Customize the procedures in your office to fit your style, just make sure the key principles are not bypassed. Work to learn the fundamentals behind each procedure. This will help you develop procedures that work for you.  Then, practice your procedures and maintain continuous attention to detail.  Continually work on improvement. This is how you become an expert and create a prosperous business.

“Highway to Health Summer” Tour 2011 with Dr. Billy DeMoss, Founder of the Dead Chiropractor Society

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It’s summer. Time to get away… and spend the weekend getting high on chiropractic and just relaxing.

 

Join us Friday evening, August 19th, in Appleton WI as we celebrate chiropractic with Dr. Billy DeMoss, founder of the Dead Chiropractic Society and CALJAM, the yearly music festival and seminar program that is lighting up the chiropractic profession.

Billy D will rock your world with a rip roaring presentation Friday evening, August 19 at the Paper Valley Hotel in Appleton, WI.

Saturday morning there will be a special presentation for staff (and doctors) with Phyllis Frase, Internationally renown staff trainer and practice development coach.

Later, you can go for a walk to the local farmers market, catch a free concert, or just walk by the Fox River and enjoy a beautiful summer day in Wisconsin – all while inspired again about chiropractic.

The Apple Valley Hotel is a deluxe resort on the north side of Lake Winnebago in Central WI, located next to the beautiful Fox River. With many amenities, it is a great family destination as well as nice for those who just want to get away from it all.

Date, Time, Location
Friday, August 19, 7-10pm
Dr. Billy DeMoss: “Highway to Health Tour”

Saturday, August 20, 8-10am
Phyllis Frase: “How to Be A Rock Star C.A.”

Paper Valley Hotel — LINK
333 W. College Avenue, Appleton WI 54911
Hotel Reservations: 1-800-394-7046 US/Canada Toll-free
Telephone (920) 733-8000

—Hotel Information…. Special room rate of $99.00. Will be extended for the weekend if you wish.

Price of Admission – and Registration

Fees double at the door. Space limited so register now.

Dr. Billy DeMoss:
PM&A Client: $25  Per person, doctors and staff
Not an active PM&A client, just $35 – Per Person, doctors and staff

Ms. Phyllis Frase:
PM&A client – no charge  –  Just let us know who is coming by sending us an email at services@pmaworks.com or faxing us at 1-877-868-0909
 Not a PM&A client:  $25 per person

To register, click the registration form, open the file, print it, complete it and fax it back to us at: 1-877-868-0909  Registration form.

A Poem about Responsibility

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by Charles Osgood

There was a most important job that needed to be done,
And no reason not to do it, there was absolutely none.
But in vital matters such as this, the thing you have to ask
Is who exactly will it be who’ll carry out the task?

Anybody could have told you that everybody knew
That this was something somebody would surely have to do.
Nobody was unwilling; anybody had the ability.
But nobody believed that it was their responsibility.

It seemed to be a job that anybody could have done,
If anybody thought he was supposed to be the one.
But since everybody recognized that anybody could,
Everybody took for granted that somebody would.

But nobody told anybody that we are aware of,
That he would be in charge of seeing it was taken care of.
And nobody took it on himself to follow through,
And do what everybody thought that somebody would do.

When what everybody needed so did not get done at all,
Everybody was complaining that somebody dropped the ball.
Anybody then could see it was an awful crying shame,
And everybody looked around for somebody to blame.

Somebody should have done the job
And Everybody should have,
But in the end Nobody did
What Anybody could have.
===================

Abridged Version.
Author Unknown.

The Parable of Responsibility
Everybody, Somebody, Anybody, and Nobody were members of a group.
There was an important job to do and Everybody was asked to do it.
Everybody was sure that Somebody would do it.
Anybody would have done it, but Nobody did it.
Somebody got angry because it was Everybody’s job.
Everybody thought Anybody would do it, but Nobody realized that Anybody wouldn’t do it.
It ended up that Everybody, blamed Somebody, when Nobody did, what Anybody could have done.

How to get a steady stream of new patients from the internet!

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Webinar:  Tuesday, May 24th

Internet marketing works.  We are seeing great results from some offices… and not so much from others.

In this webinar, you will find out what is working and what isn’t – and you will learn how your office can get more new patients from the Internet.

You can no longer say that the Internet is not for you. It is.

You can’t dismiss it all and state that it is too technical and that “you aren’t into computers or tech things.”   You have an insurance department, don’t you? Well, the Internet is a LOT simpler than billing for Medicare, if you understand its basics.  And, you can delegate a lot of the detail work to maintaining it, like you do with your insurance work. But neglecting your Internet marketing is perilous.  You have to get on top of it now or be left behind.

When prospective patients search for a chiropractor, they may get directed to a physical therapist when they should be finding you and your web site first.  It all depends on how well you set up and maintain your Internet presence.

Rather than our usual teleclass, this program will be a training webinar. It is free for all of our active clients. (If you are not a PM&A client,  there is a small fee.)  You will need a computer with speakers. Or, you can just call in and hear the audio portion of the program only.

Dr. Jamie Phillips of Bloczone Marketing, a company that focuses on helping chiropractors to acquire new patients via internet marketing, will be discussing what is working in Internet marketing for chiropractors today.

Then, she will zero in on and teach you one of the eight main ways to get new patients from the Internet that is working now.

Dr. Phillips will be explaining the secrets of how to optimize your Google listing (which also applies to Yahoo and Bing) so your website can start showing up on the first page of Google.

This webinar is good for the doctor, marketing coordinator, and especially for your internet marketing assistant.

Our webinar is on Tuesday, May 24th, at 12:30 Central Time. If you are an active client, there is no charge.  Please register here and we will send you the special invitation and link by email.  Register us for the  webinar!

If you are not an active client, you can register here. There is a small fee for this ($40) which will be donated to Oklahaven foundation Doctors with a Heart Program.

A Few May Promotions for Your Chiropractic Practice

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Mother’s Day is coming up soon (Sunday, May 8th).

This brings up the whole topic of women’s health care.

There are many types of health related events concerning women that you can participate in during this month (or any month, really) that are not only good causes, but can act to spotlight your services.

These include:

  • talks outside of the office
  • workshops in house
  • movie screenings
  • special awareness, or “Appreciation Weeks” for free health screenings
  • sponsor radio programs, interviews
  • letters to the editor
  • gifts (flowers the Friday before Mother’s Day)
  • and tape video “health tips” and post to YouTube.
  • donation drives

The list can go on and on. Some offices have had talks about pregnancy and pre and post natal care, sometimes with a midwife or nurse. One office does very well simply sending out a mailer each year to all local homeowners sponsoring a Women’s Health Care Week, offering free exam, x-ray, and massages.

Special promotions can work but they work much better if they are connected to a legitimate cause. There even is a name for this, and you guessed it, it is called “Cause Marketing.” For it to be effective, however, it has to be sincerely supported by the entire practice team. Doing a special event to support women just to get new patients will appear phony to others and can have negative effects.

One movie that has been shown is the Business of Being Born, a movie about harmful health practices connected to births in America. From its web site:

Should most births be viewed as a natural life process, or should every delivery be treated as a potentially catastrophic medical emergency?

Another example of a movie suitable for screening will be: One More Girl. This is a movie documentary how the pharmaceutical company, Merck, knowling continuted to advertise their drug Gardasil (a drug promoted to help HPV infections) to girls after Merck knew it was dangerous.

From the movie’s web site:

Merck’s marketing techniques earned Gardasil a “pharmaceutical brand of the year” award from Pharmaceutical Executive for its ‘savvy disease education,’ and creating ‘a market out of thin air.”

Even though most HPV infections clear on their own, invasive cervical cancer deaths affect 2.7 women per 100,000, and the American Cancer Society lists cervical cancer as the 12th ranking cancer in the United States, parents lined up to get their daughters protected and doctors were ready with needles in hand.

Consumers are not aware of the trail of deception behind over 21,133 adverse reactions and 94 deaths in previously healthy, athletic, competitive and scholastic adolescent girls.

(Thanks to Dr. Ebner for referring us to this movie!)

The movie producers are seeking donations to produce this film. Perhaps your office could help raise funds!

Another idea would be to have a special week just for mothers and daughters: free health screenings, tea, a spa day with manicure and massage for mothers and daughters, etc.

Our member’s site has a few posters and other ideas available to you as active clients.

Here is a poem by Tina Fey for her daughter. (mild profanity)

Best Wishes for a Merry Month of May!

Ed

“The Mother’s Prayer for its Daughter” – Tina Fey

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A Mother’s Day Poem.

First, Lord: No tattoos. May neither Chinese symbol for truth nor Winnie-the-Pooh holding the FSU logo stain her tender haunches.

May she be Beautiful but not Damaged, for it’s the Damage that draws the creepy soccer coach’s eye, not the the Beauty.

When the Crystal Meth is offered,

May she remember the parents who cut her grapes in half

And stick with Beer.

Guide her, protect her

When crossing the street, stepping onto boats, swimming in the ocean, swimming in pools, walking near pools, standing on the nearby subway platform, crossing 86th Street, stepping off of boats, using mall restrooms, getting on and off escalators, driving on country roads while arguing, leaning on large windows, walking in parking lots, riding Ferris wheels, roller-coasters, log flumes, or anything called “Hell Drop,” “Tower of Torture,” or “The Death Spiral Rock N’ Zero G Roll featuring Aerosmith,” and standing on any kind of balcony ever, anywhere, at any age.

Lead her away from Acting but not all the way to Finance.

Something where she can make her own hours but still feel intellectually fulfilled and get outside sometimes

And not have to wear high heels.

What would that be, Lord? Architecture? Midwifery? Golf course design? I’m asking You because if I knew, I’d be doing it, Youdammit.

May she play the Drums to the fiery rhythm of her Own Heart with the sinewy strength of her Own Arms, so she need Not Lie With Drummers.

Grant her a Rough Patch from twelve to seventeen.

Let her draw horses and be interested in Barbies for much too long,

For Childhood is short — a Tiger Flower blooming

Magenta for one day —

And Adulthood is long and Dry-Humping in Cars will wait.

O Lord, break the Internet forever,

That she may be spared the misspelled invective of her peers

And the online marketing campaign for Rape Hostel V: Girls Just Wanna Get Stabbed.

And when she one day turns on me and calls me a Bitch in front of Hollister,

Give me the strength, Lord, to yank her directly into a cab in front of her friends,

For I will not have that Shit. I will not have it.

And should she choose to be a Mother one day, be my eyes, Lord,

That I may see her, lying on a blanket on the floor at 4:50 a.m., all-at-once exhausted, bored, and in love with the little creature whose poop is leaking up its back.

“My mother did this for me once,” she will realize as she cleans feces off her baby’s neck.

“My mother did this for me.” And the delayed gratitude will wash over her as it does each generation and she will make a Mental note to call me. And she will forget.

But I’ll know, because I peeped it with Your God eyes.

Amen.

Tina Fey (from She Knows Parenting )

Billy DeMoss, the Dead Chiropractic Society (DC-S), and a free Chiropractic

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Dr. Billy DeMoss has changed chiropractic.

He has done this by offering an alternative model to the standard chiropractic seminar.  In so doing, he has helped to bring chiropractic back to chiropractic.

We all know that there are various versions in how this great profession is presented and applied.  But there is a common denominator in the profession that makes it special and in which everyone can agree.

What is it?

The subluxation…? Well, sure, but even this is disputed.  Let’s go for something even more basic.

The fact that chiropractic truly helps people get healthier and avoid getting run down in the medical-pharmaceutical-sickness complex?  Yes. True enough.

What else makes it special that we can all agree to?

NO ONE OWNS IT. Chiropractic wasn’t bought out by a Chinese company, a multinational firm, or bailed out by the Federal Reserve or the World Bank.  Your skills are not trademarked by Eli Lilly (Pharmacy Company). You can use Activator or the knee-chest. For the most part, you are free to do whatever you want.

But there is also something else that makes chiropractic special and that we all can agree to. What is it?

Well, chiropractic, if you are doing it right, is fun. In fact, it is a blast.  Adjusting patients and seeing them get better and loving you and your team for it! What could be better?

So, let’s add it all up: chiropractic helps people get healthier, it helps them avoid costly medical procedures, it allows them to live a better life, it allows you and your staff to have a better life, it is free from outside financial interests, and, it is fun.

NOW this is cause for a party!! THIS, if anything, should be celebrated.

This is what Billy preaches, practices, and sets an example for us all.

There are many professions out there that are soulless, goalless, and hopeless. Many are also too burdened with their own seriousness. We also can fall into this “chiropractic-as-drudgery” daily work mindset.

But, this is NOT chiropractic. And, as B.J. Palmer said:

The average businessman has long since forgotten Rule No. 9, “Don’t take yourself too damn seriously.”

Dr. DeMoss practices Rule No. 9. and helps us all celebrate the work we do.

The next Cal Jam, which he calls “ kiro-Woodstock”  is scheduled for March 12th  & 13th, 2012.  You can visit his website at www.californiajam.org where you can sign up to receive his newsletter and be a part of his worldwide referral network.

AND, you can listen to him live this Tuesday, April 26, at 12:30 Central Time. (For non active clients, we are charging $25 which will be donated to Oaklahaven.)

Register Here

For the full article on Rule #9 by B.J.Palmer, and a downloadable PDF file: Rule #9


Working with HSA / HRA / Flex-Spend Accounts in Your Chiropractic Office

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First, please understand the difference. Many chiropractic patients do not know what they have, so it is important that you understand these key terms.

Traditional Health Savings Account (HSA)

An HSA is a savings account set up to be used for medical expenses and nothing else. Funds directed to the HSA are pretax dollars, thus reducing taxable income, and HSA’s offer interest on the balance. The medical expenses and HSA can be used for include optical, insurance deductions, dental, chiropractic and some over-the-counter medications. Individuals who are covered by high deductible health plan (HDHP) are eligible to open an HSA.

Archer Medical Savings Account (MSA)

An Archer MSA is a tax-favored savings account designed to help you pay for qualified medical expenses if you are an employee of a small employer or a self-employed individual participating in a high-deductible health plan. Archer MSA assets may be rolled over or transferred to an HSA.

Health Flexible Spending Account (FSA)

A health FSA is an arrangement that allows employees to be reimbursed for medical expenses. Health FSAs are usually funded through voluntary salary reduction agreements with the employer. No employment or federal income taxes are deducted from contributions made to a health FSA. In general, balances in a health FSA at the end of a plan year cannot be carried over to the next year. For more information on health FSAs see IRS Publication 969,

Health Reimbursement Arrangement (HRA)

An HRA is an arrangement similar to a health FSA; however, an HRA must be solely funded by an employer. The contribution cannot be paid through a voluntary salary reduction agreement on the part of an employee. Employees are reimbursed tax free for qualified medical expenses up to the maximum dollar amount for a coverage period. Balances in an HRA at the end of a plan year can generally be carried over to the next year. For more information on health HRAs see IRS Publication 969,

Key Differences

The funds contributed to an HRA account are not subject to federal income tax at the time of deposit. Unlike a flexible spending account (FSA), funds roll over and accumulate year to year if not spent. HSAs are owned by the individual, which differentiates them from company-owned Health Reimbursement Arrangements (HRA) that are an alternate tax-deductible source of funds.

Billing Considerations for the Chiropractic Office

All of the above plans qualify for chiropractic reimbursement. The method of obtaining reimbursement varies by the plan type. Some plans will state that they do not pay for prepaid services. This is not accurate, as they will prepay for three years of orthodontic care (braces) and similar “pay upfront” services.

A FSA, or flex-spend account, only reimburses the patient for health care costs they have already paid. The patient must “use or lose” the money that has been put into their FSA each year.

An HSA plan is directed by the patient. They will have a card, similar to a credit card (and processed exactly like a credit card, not a debit card) that pulls from their HSA. This can be used for deductibles, co-payments and prepayments on discount plans.

An HRA plan is maintained by the employer and you must bill directly to the employer (in most cases) for reimbursement.

To avoid confusion for the patient and their HRA or FSA plan, the clinic must provide the patient a receipt or invoice showing that the patient has paid for the service. When a patient begins a treatment plan in your office, and you provide a discount for payment up front for the plan of care, the invoice should show that the patient paid for XX visits in your office. It should not indicate that the patient “pre-paid” for  a care plan as this will often confuse the plan and result in your patient not being fairly reimbursed.

Questions can usually be directed to the company’s human resource department.

Chiropractic offices should promote the fact that they can provide a “Discount for Using Your HSA / Flex Spend Account”. If you have established payment at time of service discounts, or prepayment discounts, encourage patients to use these by promoting the savings they can get. People with these plans are well aware of how quickly they can burn through their heath care dollars and welcome an opportunity to save.

Using HRA Money for Supplements & Vitamins in a Chiropractic Clinic

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Recent changes due to the Affordable Care Act change how patients may use their HRA or flexspend accounts. These changes took effect on Jan 1st of this year. Here was our answer to Mary, a great Front Desk Coordinator who is on top of this.
– – – – – – – – – – – – – – – – – – – – – – – – – — – – – – –

Good Morning Dave,

I have a question. Many of our patients have flex accounts but because of the new laws about not being able to buy over the counter and being reimbursed by the flex accounts I am running into problems with our supplements.

Do you think we could get around this if the Chiropractor wrote on a script card that they (the chiropractor) have recommended the supplement to the patient?

Please let me know what your ideas are on this subject.

Thanks,

Mary

– – – – – – – – – – – – – – – – – – – – – – – – – — – – – – –

Hi Mary,

Great question, you are the first to ask that one, so you get the award! 😉

According to the IRS website (http://www.irs.gov/newsroom/article/0,,id=227308,00.html),

Q. How are the rules changing for reimbursing the cost of over-the-counter medicines and drugs from health flexible spending arrangements (health FSAs) and health reimbursement arrangements (HRAs)?

A. Section 9003 of the Affordable Care Act established a new uniform standard for medical expenses. Effective Jan. 1, 2011, distributions from health FSAs and HRAs will be allowed to reimburse the cost of over-the-counter medicines or drugs only if they are purchased with a prescription. This new rule does not apply to reimbursements for the cost of insulin, which will continue to be permitted, even if purchased without a prescription.

So the question would be, would vitamins and supplements be considered “medicine or drugs”. According to the FDA, they are not. There would be exceptions, and they are:

Supplements – The cost of supplements taken for general well-being are not reimbursable. However, the cost of supplements taken to alleviate a specific medical condition is reimbursable. Physician’s diagnosis letter required.

Vitamins – Daily multivitamins taken for general well-being are not reimbursable. Vitamins taken as treatment for a specific medical condition diagnosed by a physician are reimbursable when accompanied by a physician’s diagnosis letter and a prescription.
Massage – Fees paid for massages are not reimbursable unless to treat a physical defect or illness. Physician’s diagnosis letter required.

A chiropractor is defined under federal law as a physician. So a script would not be needed per se, but a letter of diagnosis with the prescripted supplement would. It will vary based on the patient, case and condition. Sorry this is a longer answer than your question, but I had to look up the info and put it together for you. I have also attached an article that explains the difference between plans, how to use them for chiropractic care, and how to use them for prepay plans.

I hope that clarifies the situation. Let me know if you have any questions.

thanks,

Dave