In Your Chiropractic Office, Do You Have a Golden Goose in Your Hands?

(an article by Phyllis Frase)

Do you remember the movie Willy Wonka and the Chocolate Factory? One of the characters named Veruca in the story wanted the goose that laid the Chocolate Golden Eggs. She demanded that her dad get her the goose that laid those eggs. She was a spoiled brat. Keep in mind she didn’t want to care, nurture and train that goose to lay those golden eggs. She just wanted the end product which was the chocolate golden eggs. She disobeyed Willy Wonka. Veruca and her dad are rejected as “bad eggs” and sent plummeting down a garbage chute in the golden egg sorting room. If Veruca had just stayed the course, in the end, she would have had all the golden eggs she could have wanted or needed.

What does this have to do with your practice?
Every day you have geese (patients) that want to lay golden eggs in your practice .  We just don’t look at their signals to help those eggs to be laid.  If you haven’t figured out what the “golden” eggs are, it is your internal referrals from your existing patients. We believe that if we have patients that they should automatically refer their friends and family to us. We are a little like Veruca that just wants the end product which in our case would be lots of new patients. Some patients do refer and most do not. It’s not that they don’t want too; it’s just that they are not cared, nurtured or trained to refer their friends and family to you.

Let’s look at your average new patient. Typically, the average chiropractor is blessed to receive 8-10 new patients a month, without really doing anything out of the ordinary such as  yellow pages, internal referrals and other marketing efforts. If we really care, nurture and train those 8 to 10 geese to lay their golden eggs in your practice (which would be their friends and family), you typically could double your new patients or golden eggs without a lot of effort.  These eggs are warm and ready to produce beautiful geese that will produce over and over given the right environment.

So how do you get production or referrals from your existing patients? You have to feed them every day. Set the referral seeds within your practice. Within the first 30 days of a patient starting care is when they are most enthusiastic about their chiropractic care. Set procedures to create the referral to happen.
In the first visit.  Invite the spouse to the report of findings. Make sure the staff follows through with this as well by giving a spouse pass to the report of findings. Will all of them come no, will a lot of them come, yes if you ask and it happens every time. If the patient doesn’t bring a significant other to the report of findings make sure it is noted in the report of findings and tell them they have another opportunity to learn about your care at our foundations, WOW or new patient orientation workshop.  Yes, patients do come to those workshops and that is another article all by itself.

These procedures seem old and worn out and most of the time we forget to ask the patients for these things because we have gotten beaten up or is not worth the effort anymore.  They do become worn out if the practices are not doing the procedures each and every time with each patient and having the staff follow through when the doctors have forgotten to review this on the first and second visit. Calling the new patients after the first adjustment is a referral stimulator. Those few things we all know and we tend to let them slide by as the opportunities for our golden eggs slip through our hands.

Here are a few referral opportunities that you can start right away in your practice and get good results from practicing them every day. Will you get the golden egg every time as the goose lays an egg, not all the time but if we care, nurture and train that goose, we will get more golden eggs than bad eggs.

Non promotional and promotional referral opportunities
Have the referral talk with specific people.
Can I talk to you a moment?
Sit next to the patient.
Have you been getting good results with your chiropractic care? Great
Do you enjoy coming here? Great
Can I ask you a question?
Why haven’t you given me the opportunity to check/scan your family?

PAUSE LET THEM TALK FIRST

It is my mission to check as many spines as possible so that people can be a healthy as possible.
I want to give you this coupon.  Bring in cans of food and I will waive the $25.00. (Let the patient see you mark through the price or whatever monetary cost you have associated to the coupon) Let me check their spines.  There is no obligation for them to start care.
Sports- Are your kids playing sports?  Really?  Did you know that chiropractic increases reaction time and reduces injuries?  The athletes that are under care usually perform better.

  • Remember to review your new patients at each staff meeting.  Determine who has family members that have not been checked and make an effort to put a coupon on their travel card, promotional flier or a stop manager/reminder on electronic notes so it will remind you to talk to them. Create a friends and family coupon to give to the patient.  Change the color or the wording every 2 to 3 months so it looks different each time. Print coupon on card stock. You can create these in word or publisher or go to our member’s site and find several customizeable samples. Always list the retail value of any services you are offering that are complimentary or at your expense.
  • Target specific people every day to have “the Talk” with and make a goal to hand out the friends and family coupon to a specific number of patients each week. This should be decided on as a team. Have a contest to see how many people get signed up. Dinner, lunch, time off, make your goal to get people checked regardless if they start care or not.
  • If the patients come to the counter with the coupon, that should signal the staff to ask the patient about the coupon.  “Great, Joe the doctor gave you the special coupon. Let me give you some new patient times, that way it will be easier for them to schedule an appointment. Who are you thinking of referring?”
  • Even if the patient doesn’t come up with the coupon and you know they are suppose to have one based on your communication with your doctor, the staff should go through the exercise of the referral talk.
  • Have a referral follow up sheet at the front desk and list the name of the patient, when the coupon was given, expiration date and whom they are going to refer and next date to follow up .
  • If they have not called yet in a week, when the regular patient comes in ask if they gave out the coupon. If yes, “okay we were just checking because he/she has not called yet. That coupon expired in so many days.  We won’t be having another promotion like this for another two months or the doctor only gives out the friends and family coupons four times a year.” Create a sense of urgency around that special. “Would you like to take some additional material with you that will explain chiropractic more?”  Have special brochures that can be handed to the patient. Make sure your name, address and phone number is on any literature that goes out your door.
  • Always have a bulletin board promoting your offers and as the time gets to the end create a banner that is put across the bulletin board- 5 days remaining or 3 new patients’ slots remaining. Or mark through any remaining fliers or material that you have.
  • Decorate your office during promotions. If you think you have decorated enough, it’s not enough.  Create a new experience when your patients come in. You need to stimulate them visually so they will ask questions.  Why all the hearts or the shamrocks? “Well, Joe I am so glad you asked, we are having a new patient opportunity.  Let me tell you how it works.”
  • Print enough fliers to be in your office everywhere.  In the adjusting areas, in your new patient orientation folders, in your bathroom, behind doors.  Anywhere people will see it and can’t miss it.  Enough is never enough.  Print your materials in color don’t be cheap by only using black and white copies. Always review your promotions after they are complete to see what needs to be changed or tweaked.

Chiropractic and Earth Day

A healthy earth has a lot to do with a healthy body. But over the years, we keep pouring chemicals into the atmosphere and earth as well into our bodies.

Chemicals in Our Environment

  • 1972: DDT, an organochlorine pesticide, was banned
  • 1976: The Environmental Protection Agency (EPA) establishes the Toxic Substance Control Act (TSCA)
  • 62,000 chemicals were grandfathered in as being safe Two chemicals have been banned.
  1. 1978 Polychlorinated Biphenyls (PCB)
  2. 1989 Asbestos

“There has been no attempt to ban a toxic chemical since 1989.
“The amount of chemicals produced or imported by the United States in one day would fill up 623,000 tanker trucks with a capacity of 8,000 gallons each.” (taken from Dr. Dan Murphy who quotes: The Body Toxic How the Hazardous Chemistry of Everyday Things Threatens Our Health and Well-being. By Nena Baker 2008) Not counting the chemicals Americans take in from hormones, pesticides, herbicides, and other poisons in our Fast Food, Super Sized nation, we pound prescription drugs in to our bodies.

American Prescription Drug Use

  • “The average number of prescriptions [drugs] per person, annually, in 1993 was seven.
  • The average number of prescriptions [drugs] per person, annually, in 2000 was eleven.
  • [The average number of prescriptions drugs per person], annually, in 2004 was twelve.

The total number of annual prescriptions [drugs] in the United States now stands at about 3 billion. The cost per year is about $180 billion, headed to and estimated $414 billion by 2011.” (taken from Dr. Dan Murphy who quotes:How Prescription Drugs Are Altering American Lives, Minds, and Bodies Greg Critser 2005)

This is actually old data and the average number by 2010 is probably much higher. I have seen patients walk in with pages of 20 “’scripts”, and heard of even as many as 50.

In Our Drinking Water
A vast array of pharmaceutical including antibiotics, anti-convulsants, mood stabilizers and sex hormones have been found in the drinking water supplies of at least 41 million Americans, an Associated Press investigation shows. in the course of a five-month inquiry, the AP discovered that drugs have been detected in the drinking water supplies of 24 major metropolitan areas from Southern California to Northern New Jersey, from Detroit to Louisville, Ky. http://www.usatoday.com/news/nation/2008-03-10-drugs-tap-water_N.htm

Our Babies Swim Now In A Soup Of Chemicals.
287 human-made chemicals – most of them hazardous – in the blood of infants .

According to a study released by the Environmental Working Group, a policy research and activist organization, tests measuring the so-called “body burden” of industrial chemicals, conducted on ten random samples of umbilical cord blood, detected 287 chemicals.

The samples, supplied by the American Red Cross, registered 180 chemicals known to cause cancer in adults, 217 that are linked to brain and nervous system damage, and 208 that have been shown to affect fetal or child development in animal tests. For 209 of the contaminants, this was the first time researchers had identified the chemicals in newborn blood. http://www.usatoday.com/news/nation/2008-03-10-drugs-tap-water_N.htm

Earth Day is Health Day
Learn more. Read books. Talk to your chiropractor. Eat natural and organic food. Get regular spinal adjusts to support your spine and nervous system. Educate others. You can help your family and friends find relief and better health without the use of toxins by encouraging them to come in for an initial consultation with the doctor to see if chiropractic can help. Chiropractic is 100% organic and always has been. No drugs or toxins. The chiropractic lifestyle supports a healthy spine, nervous system and body.

Chiropractors: Never Work Another Day in Your Life!

Did you know that 73% of chiropractors can make all the money they want without ever working?

This is proven by 83% of studies.

Yes, that’s write. You two can make all the money you want, and even more, without even working.

Honest.  No more talks, letters, or yellow pages or even internets.  You don’t even have to sea patients.

moneyman

With this SECRET system I was able to make lots ‘o bucks.  (Doctre Phulo Vit)

Am I talking to you?  Yes, we are.

I have just discovered 6.3 steps on how to make all the money you want with out hardly working ever and getting all the love you need.   Honest.

Yea. Baby.

So, call us now at 800 APR-FOOL

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Don’t be fooled.   Get the real stuff.   Come to our seminar in Minneapolis and Milwaukee this spring.

See you there.

Happy Easter to you all.

Love,

The PM&A Team

Chiropractor to Chiropractor: Reclaim the Joy of Practice

Being a chiropractor can be a lonely job.

Who knows what it is like to adjust patients late in the afternoon while one patient is going on and on and the next one is dirty from work and smells?  And yet another just called in who has been under care for two weeks and is in pain and wants to be seen right away – who knows what that is like?

Someone who has been there and done that – another doctor.

You aren’t looking for advice, that can wait. You don’t need a lecture.  It would just be good to talk with someone who has been there before and survived, or better, thrived.

Let me introduce Dr. Tom Potisk.  He is not the overbearing charming salesman type of a doctor that you often see in consulting programs.   Actually, not too many doctors are really like that.  In fact, most doctors are very similar to Dr. Tom.

Dr. Tom and Dave, Phyllis and myself have been discussing an additional ingredient to practice success that that we feel doctors need. Simply, another doctor to talk to.  They have us, of course. But we are managers and marketers and practice builders.  That is our specialty.  And we too have been there and done that, since the 1980’s.  But as managers – not as doctors.

We feel doctors need both for practice success: a professional manager to help build a profitable and self sustaining business AND the support and perspective of a professional, experienced chiropractor.

So we are very happy to partner with Dr. Tom Potisk in providing services to our wonderful wonderful clients.

We are pleased to announce that Dr. Tom will be giving a number of presentations at our upcoming seminars this year.  One of the classes will be on Doctor to Doctor: Reclaiming the Joy of Practice.  This is his basic theme: how, as a doctor, you can truly enjoy each day doing what you do as a doctor.  His approach is simply – doctor to doctor. Not as a coach, but as a fellow doctor who has been through what you are going through and made it to the other side – very successfully.

Listen to this his first teleclass you – you will find it very motivating and reassuring.

Hope to “see” you there,

Ed

Here is what others have said who have listed to his full presentation:

“Dr. Tom’s program was fantastic! I laughed, I cried, and I went back to my practice with a new, deeper sense of dedication and confidence. All DCs need to hear his message!” – Dr. Donna Stackpool, Lake Geneva WI

“Reclaim the Joy of Practice was an amazing presentation!  Dr. Potisk made the evening fun and enlightening with great tips on how to stay happy and truly enjoy Chiropractic.  I loved the history references with BJ.  It was a great reminder of how generations past fought for Chiropractic and how we need to honor them and the profession AND continue the passion.  Thanks Dr. Potisk for lighting the fire again!” – Tara Gill DC, Delevan WI

“After nearly 40 years of practice, I thought I heard the last of the great, authentic, and sincere chiropractic programs years ago; then along comes Dr. Tom Potisk with his Reclaim the Joy of Practice presentation. He brought me right back to what I remembered as the good-ole-days with an adjustment between my ears. High pi Dr. Tom !”  – Jerry Zelm DC, Oconomowoc WI

And you can read more about Dr. Tom Potisk here.

New Health Care Legislation and Chiropractic

Late last night the House of Representatives passed a major bill affecting health insurance.

According to a press release by the American Chiropractic Association, “This means that the provisions contained in HR 3590 now only await President Obama’s signature to be enacted into law. These provisions include an important provider non-discrimination provision long championed by the American Chiropractic Association (ACA).

Incorporation of this provider non-discrimination provision, also known as the “Harkin Amendment,” was achieved primarily due to the efforts of Sen. Tom Harkin (D-Iowa), with help from other key players such as Sen. Chris Dodd (D-Connecticut). Although he did not support the final bill overall, Sen. Orrin Hatch (R-Utah) also lent his support for the advancement of the non-discrimination provision.”

A key feature of the bill which will benefit chiropractic patients is the subject of ERISA.  According to the ACA press release:

We now have a federal law applicable to ERISA plans that makes it against the law for insurance companies to discriminate against doctors of chiropractic and other providers relative to their participation and coverage in health plans.

Read more here.

More Videos and Photos from PM&A’s Adventure to the Chiropractic California Jam 2010

Dr. Tom Potisk gives a succinct and complete accounting and review of our travels to, and as it turned out, through Southern California. (see earlier post)

Here are some various videos and photos if you want more, though rough and candid, reporting. (Some videos may need the volume turned up.)

Walking to Cal Jam

Opening – Don’t Back Down – Chiropractor

Some photos

Cal Jam 2010 Chiropractic, Petty Michel - Associates

Clips from various talk. May have to turn up volume.

Dr. Brian Porteous – a clip from his talk on the hyperstension study. LINK

Dr. Dan Murphy – talks about recent research on toxic chemicals and how they affect nervous system and adjusting – (9 min) LINK

Dr. Dan Murphy – talks about cervical spine, referencing the hypertension study. LINK (5 min)

Dr. Dan Murphy – refers to book by M.D. references Innate. LINK

Dr. Fabrizio Mancini – applying chiropractic is not complicated. (2 min)   LINK

Motorcycles, Natural Hot Springs, Sushi, and Chiropractic Philosophy – Wowee! What a Weekend!!

In the natural hot springs.

In the natural hot springs.

I just returned from a few days in Costa Mesa CA.  I attended CalJam, a chiropractic philosophy/music convention, with Ed Petty from PM&A.   It was refreshingly different because of the focus on chiropractic’s unique philosophy combined with music.

The man behind it all is Dr. Billy DeMoss and his fun-loving personality really shows in the event. Check out my video of BJ Palmer resurrected[Longer Version]

Of course, I had to give Ed a lesson about why I’m called the “down-to-earth” doctor (www.thedowntoearthdoctor.com), a big part of it is going on adventures, so I took him on a high desert search for a natural hot spring called Deep Creek Spring. Yes, those are my feet in the picture.  Ed reciprocated by guiding me on a motorcycle tour one of the days – I drove my first Harley and now I’m hooked!  Thanks Ed.

My Harley in Laguna Beach, CA

My Harley in Laguna Beach, CA

As I listened to many of the greats like Dr Dan Murphy, Dr. Fabrizio Mancini, etc. I became even more grateful for the 25 years of tremendous success I’ve had in chiropractic. “Best profession in the world!” is what I told a 2nd semester student I bumped into there.  He was wondering if he made the right decision, given all the negative news circulating about the business of practicing lately.

The speakers were talented and the content inspiring, but it also became apparent to me, that the seminars of PM&A are better in the sense that they lack sales. What I mean is that all or most of the speakers at CalJam, as inspiring and fun as they are to listen to, have a hidden agenda – they want to sell me something. That’s one of several reasons why I stayed with PM&A as my practice management guide, and why I’m excited to now be a part of their team.

I teach a class around the country called Reclaim the Joy of Practice, based on my book of the same name (www.reclaimthejoy.com) for content, I’m always on the lookout for exceptional DCs.  I bumped in to Dr. Gerald Clum, president of Life West Chiropractic College.

Listen to his brief message in response to my question “What can chiropractors do to be more successful?”  LINK.

Doctor, how can you apply that message today?

How to Make Your Chiropractic Marketing More Effective: Give a Reason

A fundamental component to marketing your chiropractic services is communicating a reason, rationale, or a purpose for why you are marketing.

For example, if a store has a SALE each month with a discount on some of their items, you might think: “So what? Just another sale.”

So the department store thinks up some reason for the sale. It could be “Back-to-School” sale, a “Food Drive” sale, or a St. Patty’s Day party.

All of your marketing should have a topical theme. In our marketing materials, we have many, from Organic Health Care Week (in conjunction with Earth Day), Mother’s Day coupon with flowers, Fibromyalgia Awareness Week, etc.

But behind all of these themes should be a more dominate reason for your marketing. And here is a powerful truth: The better your staff, your patients, and your community understand this reason, the more responsive they will be in to your marketing efforts.

For example, we recommend that you write a letter to your patients explaining to them your real reasons for marketing your services. It could called: “Why We Promote – A Letter to Our Patients.”  To help you get started, we have a questionnaire here and a sample letter.

(For our clients, we have written a sample letter that has become popular which you may access on your Member’s web site under “New Stuff.” (need password.))

Why Do You Market Your Chiropractic Services?

Answer these questions thoughtfully.

Then, compose a few paragraphs for a letter, or for your web site.  You can also use this as a close on your patient lectures.

  • What do you experience when you see the family and friends of your patients get results from your care?
  • Do you ever see patients that have had unnecessary or failed back surgeries?
  • Do you ever see patients that take, or have taken, toxic drugs to alleviate their symptoms that you were able to alleviate naturally?
  • How would have the lives of these people been changed had you been able to adjust and treat them years earlier?
  • Since you are not supported by pharmaceutical companies or hospitals for your community education, how can you get the word out to your community?
  • This is why you have to rely on your staff and patients, and on occasional promotions and special events.

A Reason Behind Your Chiropractic Marketing

A fundamental component to marketing your chiropractic services is communicating a reason, rationale, or a purpose for why you are marketing.

For example, if a store has a SALE each month with a discount on some of their items, you might think: “So what? Just another sale.”  So the department store thinks up some reason for the sale. It could be “Back-to-School” sale, a “Food Drive” sale, or a St. Patty’s Day party.

This is why many businesses over the last 15 years have used donation drives, or special causes, to help promote their services. Buy a bottle of water at Starbucks and a percentage of it goes to poor African children.

This works as long as the customer thinks it is a legitimate reason, but as soon as they find out that it is questionable, they stay away.  The Starbucks Ethos Water program, for example, has been discredited for a number of reasons. First, the retail bottle goes for $1.80 but only five cents goes to African kids.   The water bottles are manufactured by Pepsi and do not contain recycled materials. Plus, plastic bottles are ecological problems as they are reported not do decompose for a thousand years.

Over the Holidays, many businesses have sales and claim it is in conjunction with “Food for Families”, “Toys for Tots”, etc.   These are now so numerous that one can wonder about the genuine nature of such campaigns.

But donation drives are great. They can be effective, as can any promotion. But for any promotion to be effective, it helps if there is a reason behind it that is appealing and believable to your market. You should be genuine.

We recommend that all of your marketing have a topical theme. In our marketing materials, we have many, from Organic Health Care Week (in conjunction with Earth Day), Mother’s Day coupon with flowers, Neuralgia Awareness Week, etc.

But behind all of these themes should be a more dominate reason for your marketing. The better your staff, your patients, and your community understand this reason, the more active they will be in responding to your marketing efforts.

What is the underlying reason for your marketing?

Money, of course.  More new patients? Of course. But, as a doctor, what is your reason?  We suggest you work this out and communicate it to your patients and staff, and even your community.

(For our clients, we have written a sample letter (Why We Promote – A Letter to Our Patients) which you may access on your Member’s web site under “New Stuff.” (need password.))

Asking Permission, Gaining Respect

By Dr. Tom Potisk

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

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

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

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

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

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

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

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

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

Medicare and Wellness Pricing

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

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

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

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

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

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

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

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

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

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

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

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

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

Here is what Medicare states:

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

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

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

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

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

Dave

Meeting Family Deductibles

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

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

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

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

Thanks Laura D from Family Chiropractic

Heat Up Winter With Chiropractic Health Promotions

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

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

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

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

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Twas the day before Christmas – Chiropractic Version

santa-claus-pics-0112

 

Not sure who wrote this,but would like to know.  Kind of cute!

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

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

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

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

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Snow Days and Chiropractic Care

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

I love snow days.

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

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

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

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

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

2010

What does that mean to you?

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

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

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

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

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

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

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

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

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

So, here it comes.                                                                        2010.

Go seize the year and make it your own.

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

Chiropractic Marketing Tips for The Holidays And The Start of the New Year

Due to popular demand,  I am posting notes from our October teleclass on marketing over the Holidays.

Teleclass Outline with Ed Petty  — Notes

All marketing is broken down to:

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

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

3.    Marketing management.  Review, Planning, Implementation.

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

The  Marketing Manager System:

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

 

Procedures: Special events/promotions

NOVEMBER

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

DECEMBER

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

JANUARY

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

FEB

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

MARCH

  • Leprechaun Appreciation Day (Kid’s Day) link

Procedures: Recurring

Community Education: Talks or Awareness Weeks

  • Nov: Flu
  • Jan  Feb Food, Supplements/ Fast food Series —  With  a Dietitian and a trainer. February: Heart Heath- blood pressure
  • March: Headache Awareness Week

Communication Channels

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

Internal Recurring:

  • Morning case management meetings – (include a joke.)
  • Staff meetings
  • Patient Success Stories, Upbeat Atmosphere:  Take a “vibe check”:  too seriousness or pleasant can welcoming atmosphere. Where’s the party?
  • Spinal Care Class
  • Whiteboard
  • Brochures
  • Staff education
  • WOC (Whip out card)
  • Mission