Key Updates and Workarounds For the New ICD-10 Codes That Impact Your Office.

icd-10, key updates for 2022Dear Chiropractors and Staff:

Are you having issues with not getting reimbursed due to the new ICD-10 codes and the deleted low back code? Having difficulty getting reimbursed from Humana and BCBS due to precertification requirements and other crazy denial codes?

Please read below where I provide you three key updates to the ICD-10 Codes and some workarounds that are of interest to your revenue cycle.

UPDATES: ICD-10 code Changes relevant to chiropractic

1. Deleted code: M54.5 low back pain.

2. NEW codes to replace the above deleted code include:
• M54.50 Low back pain, unspecified
• M54.51 Vertebrogenic low back pain
• M54.59 Other low back pain

3. Other Chiropractic-Relevant New codes added:
• M45.A0: Non-radiographic axial spondyloarthritis of unspecified sites in spine
• M45.A1 : Non-radiographic axial spondyloarthritis of occipito-atlanto-axial region
• M45.A2 : Non-radiographic axial spondyloarthritis of cervical region
• M45.A3 : Non-radiographic axial spondyloarthritis of cervicothoracic region
• M45.A4 : Non-radiographic axial spondyloarthritis of thoracic region
• M45.A5 : Non-radiographic axial spondyloarthritis of thoracolumbar region
• M45.A6 : Non-radiographic axial spondyloarthritis of lumbar region
• M45.A7 : Non-radiographic axial spondyloarthritis of lumbosacral region
• M45.A8 : Non-radiographic axial spondyloarthritis of sacral and sacrococcygeal region
• M45.AB : Non-radiographic axial spondyloarthritis of multiple sites in spine

NEW Cough codes:
• R05.1:Acute cough
• R05.2: Subacute cough
• R05.3: Chronic cough
• R05.4: Cough syncope
• R05.8: Other specified cough
• R05.9: Cough, unspecified

WORKAROUNDS
If you have claims to send (hopefully only a few) with DOS prior to October 1, with low back pain diagnoses, what should you do to ensure they do not reject by the clearinghouse and payer for adjudication? Your clearinghouse should, by now, be updated to include accepting claims with the old M54.5 code IF the DOS is prior to 10/1/2021. The commercial payer claims adjudication systems should also be updated now to accept claims prior to 10/1/2021 DOS if you billed with the old M54.5 code. Please make sure to get any outstanding claims with DOS prior to 10/1 submitted as soon as possible, if you have not already. If you only have a few claims going to commercial, you also have the option of sending these on paper instead of through your clearinghouse. Do not do both.

State Medicaid programs and Medicare will still require the use of the M99 codes for billing, so continue using those codes for these claims.

HUMANA is requiring pre-authorizations on all chiropractic therapy codes. The latest news is that starting in January, there will now be three entities that will be doing the pre-authorizations. a. Optum, b. Humana itself, or c. A new vendor, Cohere Health. Humana has advised us that the entity will be selected based on the patient’s policy.

When you verify a patient’s benefits you will need to make sure to ask:
if preauthorization on your therapy/rehab codes is required on the member’s policy,
which entity will be preauthorizing/reviewing,
and the process to follow when requesting services requiring preauthorization.

Not getting paid by BCBS, with crazy denial codes? No one at BCBS to help? You’re not alone. Offices across the country are experiencing this. So what can you do at this point? First, do a claims audit on your BCBS claims. Do you have the GP modifier attached? Is preauthorization on therapies required on the patient’s plan using AIM Specialty Health?

Your other option is to ask the patient to call into BCBS and advise that claims are being denied even though they have been billed out correctly. We do have scripting available to help your patients with the communication. Click here and request more information.

Questions? We’re here to help!

Lisa Barnett
PH: 920-459-8500
Email: lisa@pmaworks.com

“Increasing your collections through better billing and documentation”

SPECIAL PROMOTION – The Kindle version of the Goal Driven Business is FREE Oct 21st – 25th.

the goal driven businessSPECIAL PROMOTION
National Chiropractic Month
The Kindle version of the Goal Driven Business is FREE
from Thursday, October 21 to Monday, October 25
= = =
What’s in the book? To give you an idea of some of the subjects covered in the Goal Driven Business, I put together a list which you can find below. You can also access this on the website, GoalDriven.com
In addition to the Free Kindle version, when you also sign up for our
Goal Driver’s newsletter with tips you won’t find anywhere else, you will receive 10 Powerful Goal Driven Tools FREE to build and develop your practice.
or go directly to Amazon and get the Goal Driven Business book only, in hard copy or Kindle download
I truly recommend you get the free Kindle version of the Goal Driven Business book. I also encourage you to pick up a hard copy. It is valuable information which we have used over the years to improve offices, just like yours. A hard copy book is nice to read, and re-read, like Dr. Peter Heffernan mentions:
“Ed has nailed it, with all his years of experience, in this book!
Read it and reread it, it is that valuable.”
J. Peter Heffernan D.C. DPhCS.
= = =
The Goal Driven Business –
A New Business-Building Methodology
List of subjects and key concepts
Part 1. Your Road, A Hero’s Journey.5
We Can’t Get There from Here.7
The Practice Roller Coaster and What Causes It10
Symptoms Of a Personality Practice12
16 Attributes of A Successful Business and Practice13
The 3 Goals Of “To Live Better.”19
First 2 Goals and The Eisenhower Matrix20
Goal 3: Your Greater Purposes23
Applying the 3 Goals to Improve Business Performance 24
The Synergy of the 3 Goals 33
The Hidden Barriers to Practice Success35
The E-Myth and Michael Gerber39
Your First Big Shift to Your Goals: The Goals Lab Where You Work on Your Business.43
Pareto Principle and How to Add More Time to Work ON Your Business. 47
Parkinson’s Law of Time 52
Edwards Deming and Kaizen54
Goals Achievement Process (Kaizen for Practice and Business Improvement.)54
The Coaching Review for Team Member Improvement 56
Your Practice Development Map: The Stages in Developing Your Business61
The 5 Engines That Drive Your Business to Its Goals66
The 20 Big Shifts You Will Need to Make to Achieve Your Goals67
Self-Study and Review of Part 170
Part 2: The Map and Manual to Your Goals72
Stage 1. Launching or Relaunching Your business. The Marketing Stage75
Peter Drucker and the Purpose of Business79
What Is Marketing79
Becoming a Marketing Evangelist 80
Simon Sinek and Your Why82
8 Successful Marketing Attitudes83
Overcoming Fear of Marketing Using The 8 Marketing Attitudes and WOC
86
Direct Marketing Versus Indirect Marketing 89
Unique Selling Proposition and Your SOB92
Marketing Boosters and Fast Action Marketing Tactics 93
Stage 1 Study Review99
 Stage 2 Blueprinting Your New Business. New Roles, Goals, & Flows 101
Moving Past the Personality Driven Practice103
Servant Leadership: Your New Role – Coach And CEO.105
Goal Driven Team Members – Characteristics and Key Training Elements109
The Goal Driven Manager – A New Role Than Leverages The CEO Role112
Your Marketing Coordinator and Other Key Roles in Your Business114
New Goals: Determining Your Higher Goals and Calculating Your Financial Goals116
Tony Hsieh and Your Core Values123
New Service Flows: More Efficiency for Better Service 126
How To Find Bottlenecks, Eliyahu Goldratt and The Theory of Constraint
127
Creating Your Systematized Marketing Machine129
Marketing Mix Chart for Each Stage of Your Growth 132
Time And Money Charts to Showing How Much to Spend on Your Marketing at Each Stage. 134
Study Guide Review on Stage 2  136
Stage 3 – People and Procedures: Implementing the Blueprint141
Why Employees Are Disengaged: The Assembly-Line Mindset144
Hierarchy Of the Boss and Employees as “The Girls”146
Summary Of the Old Practice Management Model149
Big Shift #12: The Employee as A Goal Driven Expert and Team Member
150
Self-Determination Theory and Edward Deci: Secrets to Employee Motivation152
Daniel Pink: And Greater Purposes and What Motivates Us154
9 Steps to Making Goal Driven Expert Employees155
Hiring The Right People – Jim Collins157
Let My People Go Surfing – Yvonne Chouinard 159
Goal Driven Procedures: Faster and More Effective159
The Humble Checklist162
The Checklist Manifesto – Atul Gawande 163
Simplicity And 80/20 Principle – Richard Koch163
A Sample Checklist165
Big Shift #14: Goal Driven Continuous Improvement – the Engine Within Your Business. 166
The Learning Organization – Peter Senge168
Study Guide Review on Stage 3 172
Stage 4 – Using Lean Management to Improve Customer Service and Personal Power175
How To Deal With 5 Common Challenges When You Are Winning178
Lean Management: How to Get More for Less180
Why Your Service Needs to Be World Class 183
Your Replacement Is Being Shipped: The Dismantling of The Professions — Susskind & Susskind185
7 Barriers to Extraordinary Service187
9 Components to Delivering Goal Driven Outstanding Customer Service190
Ken Blanchard and Raving Fans190
Become The Best Like Pablo Casals, Jiro Ono, Clarence Gonstead191
19 Steps to Create Extraordinary Customer Experience194
Freeing Your Personal Power201
Ben Franklin and His Practical List of Virtues202
Martin Seligman And Virtues in Action203
The 3 Goals and Your Personal Power205
Study Guide Review on Stage 4 207
Stage 5 – Total Team Leadership – Your Goal Driven Business211
Managing The Groundhog Day Syndrome to Avoid Burnout214
Creating Team Leadership Is Now Possible. Here Is How:215
Integrating Your Greater Goals for a More Powerful Business220
The Golden Gate Bridge Again – and Your NEXT New Game.224
Study Review on Stage 5  226
Part 3: The Reason for Everything: The Heart of the Goal Driven Business228
Getting Out of The Box. How Quantum Physics Can Help You to Your Goals. Sheldrake, Frankl 231
Conclusion – Liberty 237
Part 4. The 23 Principles of the Goal Driven Business238
1.      Power of Choice 241
2.      Constant Improvement 244
3.      Goals 245
4.      Self-Determinism and Drive 247
5.      Reality – Confronting the Brutal Facts 248
6.      Communication 247
7.      Collaboration and Self-Organization Works Better 251
8.      The Bridge to Your Goals: Procedures and Policies 253
9.      The Vital Few and 80/20 254
10.  Keep It Simple, Make It Simpler 255
11.  Log Jams 256
12.  Leverage Points 257
13.  Newton’s Laws 259
14.  Be A Farmer – Grow Your Business and Your Customers 260
15.  Be A Hunter – Direct Your Unique Selling Proposition to You Target Market 261
16.  Goals, Games, Groundhog Day 262
17.  Deliver the Goods – Abbondanza! 264
18.  Roles 265
19.  Getting Away 266
20.  Training and Coaching Make an Expert Team 268
21.  Network Effects 269
22.  Our Thoughts Affect Our Business and Life 270
23.  The Golden Rule 272

The Mental Immune System

mental health, immune system, goaldriven.com

A healthy body has a well-functioning system to protect it or make it physically immune from disease. I am sure you have seen this occur with your patients as you adjust and treat them.

But there is no doubt that the mind also affects the body. In your practice, could you improve your patient’s mental immune system? Of course, and already do. I am sure you bolster your patient’s mental immune system even though you or your team may not have looked at it this way. Providing your patients with genuine positive feedback and showing them gratitude for their regular visits can go a long way in enhancing their mental well-being.

A mental immunity system would help individuals be protected, or immune, from negative influences or circumstances in the environment. This would be the ability to “roll with the punches” and keep one’s stress level low despite potentially stressful situations. You can’t be expected to help your patients achieve this in all areas of life, but you can help them with this regarding their health.

Your patients and clients are under a constant deluge of frightening and drug-related messages that can be demoralizing and lead them to less than optimum health choices. There is not much incentive for large corporations to promote exercise, eat organic food, take vitamins, and encourage people to be nice to their neighbors. Instead, there is more money in promoting drugs and fast food, and beer. It took a long time and great expense to stop cigarette advertising, but pharmaceutical advertising has now taken its place.

So, it is for this reason I recommend positive health advertising to your patients regularly. The more they know and understand how to maintain their physical health, the better prepared they will be to critically interpret the corporate advertising of products masquerading as “healthy.”

Here are some methods to improve your patient’s mental immune system regarding health:

  • Extraordinary customer service. Through empathic communication, get to know your patients so that they know you care about them and can trust you. You are in their corner and have their “back.”
  • Positive reinforcement. Genuinely recognize their good efforts to improve their health and any positive responses to your program of care.
  • Table Talk. Listen to their stories and provide quick positive educational tips about health related to their story.
  • Educational themes. Pick an educational them each week and have literature for patients.
  • Patient successes. You can include notable case successes with your education themes each week or each month. Spread the good news!
  • Lending Library. Stock your book shelves with books on subjects you would like your patients to read. Encourage your patients and staff to study. (See a sample list of books we selected a few years ago over at pmaworks.com.)
  • Workshops. These can be done virtually or in person.
  • Newsletters. These can be electronic as well as hard copies by snail mail. They help “keep the conversation going.”

You are the positive lighthouse of health in a storm of gloom and unhealthy corporate products. You can improve the physical immune system of your patients by also improving their mental immune system regarding health.

Ed

the goal driven business by edward petty

buy the goal driven business by edward petty

Image from: Kellogg, Yevgenia Nayberg

KINDNESS and the Strength of Your Practice

 

"a practice is a network of relationships that is created and sustained through communication and service. goaldriven.com

A practice is a network of relationships
that is created and sustained through communication and service.

I have used this definition for ages.

Customers, potential patients, and clients, seek you first and foremost for your services and results. This could be relief from a troubling condition, or perhaps general wellness care. Therefore, in marketing, you want to promote that you can deliver the outcomes people are looking for, and prove that you can produce them. There are many ways to do this, but this is the basis of direct marketing.

Next to results, your patient wants to be understood. They know that no matter how competent you are, unless you really understand their condition, you may be applying the wrong remedy. Plus, you may come across like you really don’t care. You show how much you care by seeking to fully understand how they feel about their condition. This is called deep empathetic communication – feeling how the other person feels.

I think just being genuinely interested in the other person brings about this kind of communication and feeling on the part of the patient that you do care.

This type of communication determines the quality of the relationship. But I believe that it can go deeper. Let’s look…

KINDNESS

Kindness is more than empathy.

It acknowledges not just how the other person feels, but in fact, that the other person is privately fighting their own personal battle.

Every one of your patients is suffering — to a greater or lesser degree — though they may not fully confess it. Yes, people are tough. They must be. But when they see you, they hope that you will understand their struggles, their fears and their challenges.

There are many ways you can let them know that you grasp their situation. Most of all, seeking to understand their feelings and letting them know you, now, have a better sense of what they are talking about is sufficient. You can repeat some of what they said to emphasize that you heard and understood them. You can let them know you have experienced something similar, if you have, and sometimes, as appropriate, touching them on the shoulder compassionately can go a long way.

But there is no gimmick that expresses kindness – it is just deep human empathy.

Kindness doesn’t cost you anything, except a few moments of present time consciousness and mindfulness. Yet it strengthens trust, alleviates fear, and can help your patient improve faster.

You want to be a positive coach. But in the beginning, all your advice, adjustments and treatments, education, scheduling, and payments, must be based upon the trust you earn from your patient simply through your empathy and kindness.

Patients will seek you for your services, but they will stay with you because of their relationship with you.

Deliver excellent outcomes and promote them, initiate and maintain empathetic communication, and be kind. Include these as your goals in your mission, core values, and complete outcomes and see your practice and business grow.

Edward Petty

“…in the world, what counts more than talent, what counts more than energy or concentration or commitment, or anything else – is kindness. And the more in the world that you encounter kindness and cheerfulness … the better the world always is. And all the big words: virtue, justice, truth – are dwarfed by the greatness of kindness.”

Stephen Fry (azquotes.com)

Download PDF copy

How To Develop Your Niche for Greater Profit and Better Care

Develop Your Niche for Greater Profit and Better Care with goaldriven.com

You can try to sell ice water to Eskimos or sandbags to desert dwellers, but you would go broke.

You need to offer your services to those specific people who would want them. The more you do this, and the better you do this, the larger your customer volume will be and the more profitable your business will become.

So, what is your market? Who are those people who want to see you or are looking for what you have to offer?

It is people who want to relieve a health issue more naturally.

And this market is growing and certainly becoming more motivated.

You wouldn’t think it, though. The media would have you believe that everyone is spending their time in drug stores, behind masks, maintaining social distancing.
The governmental “agencies,” looking out for us, are warning us about new “variants” that are “surging.” But, what is apparent is what is NOT talked about!

What is that you ask? Oh, that would be Health!

Do you hear them talk about better food, more exercise, more sunshine, better nutritional support, or natural health care services? How about proven medicines already in the public domain? I don’t think so.

Why not? Well, I don’t know, it might have something to do with …money.

This may not seem marketing-related, but I think that it is essential to examine the environment that your market is dealing with. The people who want natural solutions to their health issues, those that you want to reach out to, find themselves in a sea of conflicting, even frightening, messages.

We can look at the ongoing debacle in Afghanistan. Scared civilians falling out of airplanes after we spent over two trillion dollars and the lives of 47,000 civilians over in Afghanistan. Why? Well, money. (1)

Was the “war” a failure? Not for the stock market, especially for Lockheed Martin, whose stocks increased 1,236 percent since 2001. Other weapons companies like Raytheon, Boeing, Northrop Grumman, and others all saw their stock climb. (2) So, the Afghan war was a success – for these companies and their CEO’s and stockholders. Selling the idea of stopping terrorists was a profitable campaign – for some.

Could there be a parallel scenario with drug companies? Could the government be working at the behest of another industry besides the Military-Industrial Complex? Well, for its COVID vaccine alone, Pfizer expects to generate 33 billion this year. (3)

In both cases, it was the marketing use of FEAR that justified enormous changes in our lives. Fear of terrorists, fear of a virus.

But here’s the thing: You can scare all the people some of the time, and some of the people all the time, but you cannot scare all the people all of the time.

There is a large percentage of the population that want better health naturally and do not necessarily buy into fear-based propaganda. In fact, the constant omission of health solutions amidst the drumming for drug solutions may just motivate health-oriented people to more staunchly pursue better health!

Look at the sales of organic food. As you can see from the graph below, organic food sales have been on a steep uptrend. Sales of organic food were 16 billion in 1999, and has been rising continuously, reaching 106 billion in 2019. (4)

And here is a more recent chart of health supplements and their expected rate of growth (5):

These consumers want better health. They don’t want poison. Big Tobacco was clever with its marketing strategy and fought hard, but it eventually lost. Monsanto (Bayer) has worked every angle, but it too is slowly losing its fight to keep Roundup, which contains a cancer-causing chemical called glyphosate, in the marketplace.

Though not broadly promoted, Big Pharma companies have been fined billions for their illegal activities, including killing people (Merck, Vioxx).

Your market is right there, with you. They may not all be speaking out, but they know, or at least sense, that something is not right. And, they want better health.

Almost every office we work with has been seeing their numbers rise over the last year or two. Why? I want to think our coaching and new systems have something to do with it, but the fact is, your market is hungry for trustworthy health solutions and providers.

You don’t have to froth at the mouth against Big Pharma, but you certainly can stand up for natural health. This is your province. You own it, and always have. So let your community know that you are on their side for health, natural and wholesome, without additives. Peer reviewed for thousands of years!

They are looking for you. Just let them know where you are, who you are, and what you can do for them. (You can also add, WHY you do what you do!)

Here are few steps to better engage your niche – and help more people:

  1. Position yourself as a natural healthcare office, clinic, or facility. “See us to feel better and be healthier — naturally!”
  2. Celebrate your patient and client successes. Be happy with your patients. They may underappreciate their health successes. Most do, in fact. Be their cheerleader and give them positive, but genuine, support for their health improvements.
  3. Get their OK, in fact encourage them, to Share the Care.
    1. Patient testimonials published on all media – website, social platforms, even YouTube.
    2. A homemade monthly newsletter from you.
    3. Case histories you talk about
    4. Staff successes! Patients look at how cool the office is. If the team says it’s great, well, it probably is!
  4. Take time to study your market and the environment it is dealing with. Yes, this will take time. But you are a professional and a leader. To educate others, you need to be educated yourself. Study the science, get the verifiable stats, the first-hand reports of others, and draw your conclusions. No one is sitting out this game. You need to be prepared.

There are many different methods you can use to tell people where you are, who you are, and what you can do for them. But know that they are out there, people who want healthier solutions to their health issues. This is your niche.

And they are looking for you right now.

Seize the week and help more people.

Ed

 

And buy my book – The Goal Driven Business. Read and use it. It will help take you to your next several levels!

Download the PDF [HERE]

The Five Engines Driving Your Business Towards Your Goals

A service business needs 5 different engines to become a Goal Driven Business

Having goals is not enough.

Your business needs power, and lots of it, to propel it to its goals. There are five primary engines that you need to drive your business to its goals.

  1. Customer Service and Outcomes
  2. Marketing
  3. Leadership
  4. Management
  5. Personal Power

Most businesses have a few of these engines already firing. However, in most cases, full power has not been realized. This means that you may not have enough propulsion to make it to your goals.

Let’s take a brief look at each one, and as we do so, consider how each one rates in your office: half on, fully on and functioning, or barely functioning?

Customer Service and Outcomes. As a doctor and provider, your primary focus is on providing the best service and outcomes possible. This is both in terms of the subjective satisfaction of your patients as well as the objective criteria expected in your results. But to achieve this, you need support, and this support is provided by the organization you put together as the CEO.

Marketing. As the CEO of your business, your organization must first generate customers. As a businessperson, marketing will always be your number one and primary focus. A business is dependent upon the customer. In fact, it could be said that a business is the customer. If you are not providing a service to people that pay you for your care, you do not have a business.

Leadership. An essential quality of the CEO is leadership. Leadership helps define the goals of the business and keeps the team inspired to reach them. It also insists that they are achieved.

Management. In most offices, I have seen attention placed on service, marketing, and leadership. Management, however, is often not given enough attention. Management works out how we achieve our goals. This can be a laborious and difficult process that most business owners just don’t have the time for. Plus, you are paid for your services, not for “managing.”

Personal Life Management. Lastly, often brushed aside, is how well your personal life is managed. Are you happy, and is your relationship with your family and friends healthy? Is your personal life in good order? Too often, because of the stresses of work, our personal lives can drift off in directions we later regret.

THE MANAGEMENT ENGINE

Using the Goal Driven System as explained in my book, The Goal Driven Business, you can learn how to get each engine fully firing so that you have abundant power to make it to your goals.

It has been my experience working with offices across the country that the weakest engine is always management. This isn’t true when the office is just beginning or stays at 40-50% capacity. But once the volume picks up, there are more details that need to be addressed. In addition to providing outstanding service, there is… everything else.

Management deals with “everything else.” And when it doesn’t or can’t, all these untended-to “Everything Else’s” start gumming up the works. Paperwork gets backlogged, phone calls and emails stack up, staff becomes disengaged, patient communications get cut short, and marketing gets put on the back burner. Soon, there is just too much work to do. This clogs up and limits your capacity to provide more and better service and adds more stress to you and the team.

The default solution, which occurs naturally, is a reduction of the volume of services to a more comfortable level. This is the Practice Roller Coaster, the syndrome that causes continuous stress and unfulfilled potential. Service volume goes up, it can’t be sustained comfortably, so the volume comes down.

But good management solves this. It takes you off the Practice Roller Coaster and allows your service volume to continue to increase, unimpeded. And with more services, with good management, there will be more profit.

Of course, if this was a simple solution, more offices would be seeing many more patients and doing much better. The fact is, it is not a simple fix as there are unseen barriers, booby traps, and dead ends that thwart your best efforts to streamline your management and procedures.

I cover this in my book, The Goal Driven Business. I shine the light on the hidden barriers and show you a path that, regardless of your personal skills and personality, you can follow and make it to your goals. The book covers a system of business development I call the Goal Driven System.

Of course, essential to effective management is having a manager! Oddly enough, there are no in-depth training programs for this role, and as far as I can recall, there never has been one. I cover the reasons for this in my book. Yet the ROI on an effective manager is 3 to 4 times, or more, than what you pay them

According to Gallup:
“Based on our largest global study of the future of work, Gallup finds that the quality of managers and team leaders is the single biggest factor in your organization’s long-term success.” (It’s the Manager, Clifton and Harter)

In October, we will be launching our first training program on the Goal Driven System that will include in-depth training for practice managers – and their CEO’s.

If you are interested, contact me  for more information about the Goal Driven System Program and how you can turn your team into Goal Drivers!

Meanwhile,

Seize the Day!

Ed

Why What You Stand For is Important

Ed Petty, at Goal Driven, talks about masks for kids.Why What You Stand for Is so Important

I want to tell you about my experience on TV talking about masks for kids, but first, here is a related short story…

A few years back, an office asked me to meet with them for lunch. They wanted to discuss how their office was doing and if I could help them.

I liked the doctors and had known them for some time.  They had a group practice and had been in business for several years.  We met over sandwiches, and they said they had been working with a consultant who emphasized “evidenced-based” chiropractic.

My response could have been better as I look back on it now.

Barely concealing my disdain, I asked them whose approval they were seeking. Wasn’t there enough “evidence” from the results that they had with their patients over the years? Sure, double-blind studies are good for validation – but didn’t they already have enough evidence from their happy patients and their remarkable outcomes?

Had I been trying to “sell” them on our services, I would not have acted so irreverently to their seemingly serious question. But, instead, I tried to re-convince them that they did have enough proof, and the problem with their office (one of many problems) was that they were not promoting the successes they routinely achieved with their patients.

The doctors seemed equivocal about their services, so I asked them if they were committed to their profession and helping their patients reach their health goals. Unfortunately, I didn’t get a straight answer.

It seemed that they were seeking approval from some authority –  rather than from their neighbors who struggle daily with pain and poor health.

Now, years later, I recently had a friend see one of the chiropractors I met for lunch years ago. The doctor currently works as an employee for a local hospital and the office that he once co-owned no longer exists.

All this is a true story, and the lesson is that you have to have faith, confidence, and belief in your services, and mostly, in yourself.

You must stand up for what you know and use your voice to help others – find theirs.

You shouldn’t be too outrageous as this can completely alienate you from others, not unless you want to! But find your level of certainty, independence, and rebelliousness and help others to do the same.

Masks for Kids: I am on local television

I was reminded of all this recently when a local TV station asked what I thought about masks for school children. I was on our main street, and a local reporter started asking me questions. You can watch my response and that of others here. Ed’s on T.V.!

Standing up for natural health care,

Ed

Buy my book, the Goal Driven Business. It is a distillation of my 35 years of in-the-field lessons about building a profitable practice and business. It will help you help more people. Go here to learn about the Goal Driven Business –A New Business Building Methodology for Professional Practices

Tempus Fugit (time flies)

As the ancient Greek reminds us, Time Flies — and July comes at us fast.

We are halfway through the year – 2021!

While enjoying the summer, I suggest you take a Half-Time Break and reassess, readjust, and recommit where needed. That is, reassess your progress so far this year.  Make any adjustments to your yearly plans. Recommit to your higher goals.

This is a team exercise. You can discuss with each team member first, but I would focus on the four categories below:

                What are the goals for the rest of the year?

  1. Yourself as a professional?
  2. The office as a whole?
  3. The quality of service/outcomes of your patients?
  4. Yourself personally.

You can reprint this and send it out to your team as a memo next week. Then, meet as a group in the following weeks to discuss.   Here are some tips you can pass on to the staff and doctors:

  1. Goals for yourself as a professional. How are you going to improve your level of competence as a support professional or doctor? What subjects do you want to study, or skills you want to improve, in anatomy, customer service, chiropractic, chiropractic history, marketing, health care in society, etc.
  2. Goals for the entire office. Review the mission, core values, and outcomes of our office, and from these, consider what improvement goals we could set for the next six months.
  3. Goals for the services we provide our patients? Consider such things as faster service, more complete outcomes, more fun for the patients, and more engagement with our mission.
  4. Goals for yourself personally. This is personal and can be private. It can be discussed, but that is optional. This might include such things as more time with nature, family, exercise, prayer, recreational reading, a new hobby, and travel.

Enjoy your summer but be PROactive and meet with your team to plan out the rest of the year. Keep it fun. You can meet at the lake, in the park, by the mountains or near the sea. Integrate health and an unquarantined life into your work meeting.

But remember… TIME WAITS FOR NO ONE.

Carpe Diem,

 Ed

ALSO, if you haven’t yet — buy my book now while it is still only $8. The Goal Driven Business.   It will help you achieve your goals.

The Goal Driven Business: A New Book by Edward Petty

July 2021

 I went and wrote a book!Edward Petty displaying his new book, The Goal Driven Business

Took me more than 5 years.

Here it is:

It is called:

The Goal Driven Business
A New Business-Building Methodology That Is Simpler, Faster, More Profitable,
and More Fun Than Whatever You Are Doing Now

What the Book is About
The Goal Driven Business is a distillation of my 35 years of in-the-field work with business owners, doctors, and their teams from across the country. It also includes what we learned when we owned, with other providers, 22 practices here in Wisconsin and had to overcome significant financial, organizational, and clinical challenges – in which we ultimately profited.
Carefully reviewing what worked and what didn’t and correlating my observations with the results of other researchers, I was able to uncover certain universal practice principles I had not seen before. I was also able to isolate the hidden barriers that kept most hardworking doctors from achieving their full potential.

With this information, I put together a step-by-step map that any business owner could follow that, with good effort, could help them achieve their full potential. This a totally unique system of business development which I call the Goal Driven System. It is all covered in my new book, the Goal Driven Business.

What Others Say About the Goal Driven Business
The book has been receiving great reviews. You can read them at GoalDriven.com. Here are a few:

  • “A must read for doctors in private practice — read it and reread it, it is that valuable.” J. Peter Heffernan D.C. DPhCS.
  • “I wish I had this book 30 years ago!” Ann Metzler, D.C.
  • “The goal driven business is a “must have” for every business owner – the book is fantastic!” Cindy Munson, D.C.
  • “Mr. Petty, I have just finished reading your recent book “the goal driven business”. It is a masterpiece.” Maxwell Synsvoll, D.C.
  • “This book is more than just thorough. It’s the truth!” Tom Potisk, DC

Why I wrote the Goal Driven Business

  • Based on principals and Goal Driven. Too many offices are Personality Driven. In a Personality Driven practice, everything is dependent upon the owner. As the business grows, the burden on the owner can become too much. Stress increases, and production quantity and quality can suffer. So does income. Using the principles I observed, I worked out the natural system of business development that unfolds regardless of the owner’s personality. Knowing and applying this system in a Goal Driven Business, success is no longer dependent solely on the owner and their personality – stress decreases, and service and revenue easily increase.
  • The complete picture. As a consultant, I did not have the time to pass on all the information I had about business development in consulting sessions. As a result, clients would not get the complete picture. I also noticed that many key components to business success were avoided by other practice management consultants, books, and seminars. There are real barriers to success – and many are hidden. I reveal everything in the book — no stone was left unturned! I have charted a complete path and show you how to bypass the barriers and make the shifts necessary to reach your goals.
  • Only the best will survive. Market forces are eliminating individual businesses as monopolies continue to expand. We see more providers working for hospitals or competing with lesser skilled technicians. Large companies can dominate their markets through price, convenience, advertising, as well as “lobbying.” To survive, you need to provide world-class service and outcomes. Only the strongest practices that give the best service will survive and thrive in this decade. The Goal Driven Business shows you how to provide extraordinary service that creates extremely happy customers!
  • Your success is vital for our communities. It has become evident to me that many solutions offered by corporate entities are not always the best for the consumer. This puts the health of our communities and children at risk. Now more than ever, your patients – your neighbors – are better served by independent professionals like you whose help is not dictated or biased by titanic industry interests.

You must not overlook the grassroots power of goodwill when your patients receive excellent and genuine care. Like a stone dropped into a pond, there is a positive ripple effect that goes far beyond your office. This is why I suggest that one of the most effective methods in dealing with our challenging environment is to simply — help more people. Why not help 5 times more people? Why not help them become healthier and teach them about health? And why not earn much more? You certainly deserve it!

My book will show you how to help more people, earn more, and yet have more free time to pursue personal and professional goals. And in the bargain, you will have more fun.

And you will also help safeguard the health of your community for generations to come.

I have my book on sale for a limited time.
Usually $18, from
July 4th – Independence Day — to July 11th,
you can buy it for just $8.
Go straight to Amazon or through our website at www.GoalDriven.com

Get the book NOW!

Carpe Diem,

– Ed

P.S. A portion of all income from this book, and future training on the Goal Driven System, will go as a donation to the Children’s Health Defense (ChildrensHealthDefense.org).

Get the book! If you like the book, please post a review on Amazon. Buy more and give them to your colleagues.

What is an Adjustment

B.J. Palmer

What is an Adjustment by B.J. Palmer

An adjustment (“setment”) is one if not THE most exact in operation in the world; greater by far than ripping out an appendix, etc. It requires that “intuitive” sense of direction, proportion, distance, and ability to deliver just that and all that, and nothing more; a sense of fitness to do this one thing, which few seem to possess, which can be acquired if one is willing to pay the price in thought, study, development of mind and body.

I have spent 40 years to do what I can do today. The “follow thru” of an adjustment IS IMPORTANT, but not nearly as important as “the approach.” If the “approach” is natural, easy, perfectly timed and distanced, then follow-thru is The sportsmanship of adjusting subluxations is no different than the perfection in tennis football, baseball, or any sport where ONE gets this top, MANY drag behind, and MANY are way down at the tail of human endeavor.

The MIND thinks all action. As the MIND understands, the muscles deliver. I will spend no less than ONE HOUR studying a DISlocation before I adjust it. WHY? The mind THINKS all action, and the MUSCLES deliver. The more the MIND knows, the better will be the delivery of MUSCLES. I had a child-like that recently — 6 months old — a DISlocation to correct. It was done in a split fraction of a second. When your muscles come through, THEN they haven’t time to think action. Action must be formed IN THE MIND ahead of time.

(Page 844, Up From Below the Bottom, B. J. Palmer, 1950)

PDF Version for downloading: What is an adjustment by B. J. Palmer

The Future Belongs to the Best

Time spent on business improvement projects in your "Goals Lab," or during down time. From GoalDriven.com (c)2021

A few years ago, a staff member at an I office visited confided in me and told me the following story:

Our office was really slowing down last year. So, the doctor decided to take everyone out of town to a weekend practice management seminar. The speakers discussed really cool methods for doing our work. It was fun and we learned a lot. Plus, we also went over some great marketing ideas. We were all pretty excited when we returned to work after the weekend.

On Monday, we agreed to get together at lunch to discuss how to implement what we learned. Some staff members were still dealing with patients, so our lunch meeting started 30 minutes late. Once we finally got together in the break room and started eating, we began a good meeting. We were interrupted with a few phone calls, and some patients started arriving early for their afternoon appointments. We had to cut the meeting short and didn’t get to discuss much of topics of the seminar, but we agreed to continue the meeting the following week.

As it turned out, something always came up each week and… we never did meet again about the seminar.

But we were still pretty pumped from the seminar and we had one of our best months ever. It was my job to clean the break room and, after a few months, I noticed that the binders of information we received at the seminar were still on the break room table, never opened. I stored them away for future reference.

“Now it is almost a year later, and everything is pretty much back to the way it was before we went to the seminar. The numbers are back down, some of us are a little burned out, and I don’t think we ever did implement anything from that seminar.”

Sound familiar?

I bet it does. I have seen it play out almost the same way countless times.

We are in the improvement business. We help people improve their health. We should be able to do the same for our business and for each other. In fact, if you are not constantly improving, your patients will seek practices that are.

In this new decade, apart from the many new events and changing tides of culture, technology, and mega-corporate influence, your future success is up to you. And it will be primarily based on the quality of your service and your outcomes – the experience your customers receive.

A report from a survey by Microsoft underlines this:

“As customer expectations continue to climb, it becomes more challenging for brands to set themselves apart from the competition. Markets are increasingly crowded, and both price and product are being steadily overtaken by customer experience as the number one brand differentiator” (Microsoft 2018, State of Global Customer Service Report).

More than any other short-term marketing tactics you may be using, only the best offices will thrive in the long run. And those will be the offices that are working on consistent improvement. Mediocrity could get you by in the past. But now, the future belongs only to the best.

But I have noticed that most offices just do not spend enough time consistently on improving their performance. After studying this for some time, I have observed a number of obvious and even hidden barriers that prevent us from working on improvement. I will explain what these are in a later article, but the following steps can help you ensure that you work ON your business to improve it, not just work IN it.

Your Improvement Clinic – Your Goals Lab

  1. Time spent on improvement doesn’t cost. It pays! Some business owners are concerned that time spent on improving the business or staff is too costly. It can be if the training or planning is poorly done. But remember that:
    a. Better team efficiency generates better revenue.
    b. Better trained and focused team members generate better revenue.
    c. Better outcomes generate better revenue.
  2. Head Coach. As the owner and CEO, you are also the Head Coach. How your team does – the business – is in large part based upon your coaching.
  3. Give it a name. In my new book, The Goal Driven Business (to be launched on July 4th of this year), I use the term Goals Lab as it is a location where you can go to work on getting to your goals faster. It could be your breakroom, a restaurant, a park, the reception area – anywhere really. You can call it your Practice Field, Improvement Dojo, or Mystic Garden! Just consider it a place and time that is separate from your time with patients.
  4. What gets done.
    a. Team meetings for communication, review, coordination, and planning.
    b. Team training and practice.
    c. One-on-one training and practice.
    d. Personal training, study, meditation.
  5. Schedule these routinely – weekly, monthly, quarterly, and as needed.
  6. No interruptions, no calls, 100% attention present.
  7. Be challenging. You don’t get better unless you question what you have been doing to see how it could be better.
  8. Go over this with your team. Let them know that they, too, are coaches. And players as well. So, improvement is a team activity, one that requires responsibility and professional discipline.

Your car mechanic can’t work on your car when you are driving it down the freeway. You can’t see patients while they are driving their forklift at work or cooking dinner for their kids at home. You need a separate time and place dedicated to work on improvement.

Your goal is to create an expert office that generates expert results and gives your patients the best experience they can receive from any other comparable health care business.

Imagine your business being so good that patients not only drive in from across town, or even across the state, but fly in from all across the country to receive your services. Imagine that there is such a demand for your care that you even build a motel next to your facility to accommodate the out-of-towners.

Well, there was a Doctor of Chiropractic who was just that good. His name was Clarence Gonstead. His advice?

“Practice. Practice. Practice. Never stop.”

Ed

Ed Petty - author

What Do You Think of When The Phone Rings?

This New Year has reminded us of a powerful fundamental principle in practice management and marketing.

It started with an office out West. 2020 was a bad year for them. There was COVID, of course, but there had also been repeated staff turnover and other issues. A once busy office in an upscale mall, it had seen better days. The doctor, staff, and I just could not find a way to get the office going like it once was. New patients had decreased to a trickle. We tried one thing and then another – nothing worked. With little fanfare, sometime in late fall, the lead doctor finally resolved a long-term personal challenge that had been haunting him for years. Not much seem to change in the office, but when I got the numbers for January and plotted them, they were literally off the chart. Somehow, doing nothing really that different, the office saw its highest number of new patients since it began, over 20 years ago.

Just last week, we had another reminder. Over in another part of the country, an office had been struggling with some recent procedural changes, and December and January (last month) saw its lowest new patient numbers in years. Ordinarily a high volume two doctor office, the first week of February wasn’t looking any better. We got together on a conference call to sort things out. Then, the team got together for a comprehensive meeting with doctors and staff and worked out confusions and log jams, focused on the mission and its WHY. Just a few days ago, the second week of February, they reported their highest number of new patients in months.

What does this tell us?

A few years back I wrote an article that I think explains this phenomenon.

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

What Do You Think About
When the Phone Rings?

You are sitting there, trying to finish your notes. You hear your phone ring. You are a bit behind. Maybe slightly irritated by an arbitrary denial of an insurance company and you haven’t yet planned out tonight’s evening with the family, spouse, or friend.

The phone rings again.

What are your thoughts? What are your feelings?

Do you kinda wish it wouldn’t ring? Is it a bit of an interruption? Do-you-just-want-to-answer- the – dang-phone-to-stop-the-ringing-so-you-can-get-back-to-your-work?

Essentially, your thought is “Stop.” It is: “Don’t call me.” “Phone, don’t ring, don’t interrupt me!” I am sure this has happened to you – even if ever so slightly or subconsciously.

Now, imagine if your front desk has these thoughts when the phone rings?

To some degree, even the most devoted and hard-working staff can reactively feel put upon by phone calls. Or, in fact, by walk-ins. Or, in fact, by any patient encounter. I have seen this happen on the front desk when the doctor was busy with patients. But remember, this can happen with even the most ethical team member, including you! I have seen doctors do this often. (Extreme examples: “Oh, only two patients coming in on Saturday, go ahead reschedule them. It is MY office, and I can do what I want.”)

Our thoughts can and do determine our behavior and affect how we treat others. Our environment mirrors our thoughts.

Going back to your front desk, realize that the staff on the front desk have tremendous control over the office, nearly as much as the doctor does. The front desk can be a magnet for your patients and attract or repel them.

When the phone rings, you want your front desk, and all staff, including yourself, thinking “YES.” “Call me. Phone – ring now!” “I can hardly wait to talk to this person and see how they are. I am interested in them and how they are doing. I want to help get them to come in for care — and their family too.” “They must be really really cool and nice if they are calling us.” “I WANT to know more about them.” “I am grateful for their call and appreciate the effort they made in calling us.”

These are good thoughts. These are positive thoughts that can help bring in more patients.

You can practice this with your staff at a team meeting.

For example, someone acts as the prospective patient calling. The person acting as the front desk assistant should answer the phone with the attitude of really not wanting to talk to the person. Act it up. This can be funny. Try it a few times.

Then, do the same rehearsal with the front desk assistant positively anticipating the phone call, wanting the phone to ring, and then eagerly answering and talking to the prospective patient.

Keep the role-playing brief. You can and should do it again. It should be fun and act as a reminder to one and all that we should want to meet new people, talk to existing patients, and look forward to phone calls. We can always dismiss the occasional telemarketer or wrong number.
This can also be rehearsed in other types of patient encounters, from taking the new patient back to the exam room, sitting down to do a financial consultation, or checking a patient out and collecting their payments.

And speaking of how our environment does mirror us, here is a little trick you can use. Get a real mirror, about 4 inches by 4 inches, and put it at the front desk counter so that the team member can see it. You can write something on it like: “Are My Teeth Showing?” “Am I Smiling?” And staff, you can also put one of these in your doctor’s office on any day that he is feeling grumpy. It applies to us all.

So, the next time the phone rings, smile. Be interested and curious in who is taking the time to call. Make your thoughts happy so they help create an office that is brilliant, colorful, and full of happy patients.

Ed

The Morale Virus: What doctors say and how they are combating it

Over the last few months, I have been noticing a particular phenomenon in offices that I don’t think I have seen before… maybe ever. It is like noticing a slight hand tremor that you never knew you had or a buzzing sound from outside that has become increasingly loud and annoying.

2020 was a long year, a stressful one. And you all have been in the thick of it. Daily, seeing more people in one day than most providers see in a week – or more.

My old football coach, Johnny Pappa from Davis, made a big impression on me as a young freshman when he said: “When the going gets tough, the tough get going.” In my then youthful life, I had never heard such profound words. They still apply – especially to you. You are tough!

But stoicism has its limits. The cognitive dissonance can finally get to you.

One doctor expressed to me extreme frustration about two young and very healthy patients, who exercised, got adjusted, ate well, took their vitamins, but decided to discontinue taking their outdoor walks for fear of COVID.

Another doctor, venting his dismay, told me that he couldn’t bear to watch the medical bureaucrats talk about masking and vaccinations as the only remedies to COVID when he knew of so many methods that have been demonstrated to ameliorate the virus. “People are frightened and told to stay at home, don’t socialize, wear a mask if you go out, and wait for the vaccine. That’s it? That’s all you got for people? This really shuts people down.”

One doctor I talked to who, after dealing with depressed and suicidal patients, many of them vets, has become depressed himself. Another wonders what the hell is happening to our chiropractic colleges – have they all been taken over by medical bureaucrats? Is chiropractic finally squashed?

Your good nature can become frayed, your patience worn thin, and regardless of your professional composure and your disciplined countenance, the stresses can have an affect. I mention this because most of you are tough as nails – you have successfully dealt with many types of stressful situations in the past, as a doctor, professional, and for many of you, a business owner.

Morale Virus

So if you are feeling a bit off, recognize that you might be affected by a contagious “Morale Virus.” The Morale Virus is what I call the social sickness that occurs as an emotional response to continual fear-baiting. Frightened, your patients are told they can’t do this and shouldn’t do that.

The Morale Virus is not caused by hardship itself. It is caused when you are pushed into a corner and given no way to fight back. You tend to give up. (Or go stark raving mad!) (Reminds me of the movie, One Flew over the Cuckoo’s Nest when the star, McMurphy (Jack Nicholson), says: “You guys complain how much you hate it here, and then don’t even have the guts to leave! You’re all crazy!”)

There has been a constant assault of bad news emanating from officials and authorities. Yes, and I know the media plays a part — it is mostly owned and controlled by just a few rich people and corporations who have their own agenda — namely, more money. But still – no one buys boring newspapers. Sensation sells the news, and we, the consumers, buy it. We listen and read the “news” that riles us up and confirms our bias. Social media does the same, times ten.

Dirty Laundry (Song by Don Henley) 

I make my living off the evening news
Just give me something, something I can use

People love it when you lose. They love dirty laundry
We got the bubble-headed bleach-blonde who comes on at five

She can tell you about the plane crash with a gleam in her eye
It’s interesting when people die, give us dirty laundry

Morale Virus Disinfectant

Here are some ideas on how you can fight back, disinfect your office from this disease, and better help your patients regain their spirit of hope, kindness, and free enterprise. And yours as well.

Good Vibe Year

One doctor we work with likes to anchor her practice around a yearly theme. For 2021, she is calling 2021 the year of Good Vibes and has events planned to support this philosophy. And just to reinforce the idea, she has T-Shirts made that say Good Vibes. (And by the way, she has a bustling two-doctor office.)

Study. Acquire More Knowledge. Teach

Fear is often a byproduct of lack of knowledge – so arm yourself with the facts.

For example: Roommate 1: “Oh my god! (A panic shout is heard.) The television isn’t working and the game is on. What will we do?” (Drama ensues.) Roommate 2:(Calmly) “Check the remote for new batteries.”  Roommate 1: “Ah, that fixed it, thanks.”

Study, use critical thinking, avoid bias – your own and others. Go to the sources – research studies and from people who are actually working on what you are studying. Then, please educate your patients and clients on how to be happier and healthier. And educate your team, help them increase their knowledge. Arm them as well. Doctor comes from the Latin to docere – “to show, teach, cause to know.”

Leverage Point

What area in your office, if changed, will produce the most significant effect?

Obviously, first and foremost is the doctor. Each day should be a trip to the playground, the ski slope, the baseball field, the dance floor. Ideally, each day is a fresh opportunity to accept the privilege of helping as many people from suffering as possible, to teach them, and have fun doing so.

In most offices, I would also say it is your front desk. The front desk’s power is so poorly recognized in most offices that at least 20% or more production is lost. A vibrant, aggressively friendly, caring, mission and goal-oriented front desk can and will boost your volume – this week. Front Desk team members may need more support and less admin (billing) duties. They may need a better understanding of the mission and how your office is helping people.

Entrepreneur Harder

During cultural upheavals and shifts, entrepreneur businesses remain and often thrive. New opportunities open up. More established and larger companies are weighed down by dogmatic rituals, have high overhead and many vice presidents, and vast networks of suppliers. Change is difficult. But not for the entrepreneur. Most entrepreneurs are all too “change-happy.” You can adapt, innovate, and overcome quicker than companies who are afraid to or can’t. So what if in-person care classes are out for now? Get everyone on a Zoom class, give them a secret word. Test them when they come in again and if they answer correctly, give them a gift – a bottle of Vitamin D or a lunch at another patient’s business.

Stay Out of the Weeds

One doctor told me that her solution was to “stay out of the weeds.” To stay in her lane and just keep helping people and not get caught up in the storms of controversy. I suggest that this is the best course of action. You want news? Sensational news…? Just listen to your patients and staff and community. But stay on the fairway and don’t get sidetracked, mentally or in real life.

Goals

Stay with your goals. Goals are agreements that you made with yourself, and usually others. If you stay true to them, they will lead you out of the den of the morale sickness. Staying true to your goals is a point of integrity. Your goals are not in the weeds – they are straight ahead. Figure out new and better ways to get there or resurrect old ways that worked. Fall down 7 times, get up 8. Each day and each week — begin with the end in mind.

Your goals are in three categories:

  1. Financial. This includes marketing and production.
  2. Service. Developing individual and team expertise with constant improvement..
  3. Purpose. Your higher purposes, those goals outside of work that are greater than this week and that are most meaningful need to be integrated into your work-life.

The Future is Bright and Roaring!

We have seen harsher times. The past is easily forgotten, and we think we are in the worst of times. Well, the 1918 flu was much worse than COVID. Plus, we were sending our young boys to suffer in horror and die in the trenches in Europe in the Great War. But society prevailed and soon ushered in the Roaring 20’s, a time of economic growth and cultural freedom.

Prepare to roar!

Carpe Deum (Seize the Day)

Ed

Ed Petty - author

This is such an important subject, I encourage you to share it with your team and colleagues:  To print out a hard copy

New Year = Coding Changes.

As we leave the crazy year of 2020 and enter a fresh 2021, here is a summary of  Coding changes taking place that impacts your clinic operations and bottom line:

I. CPT Code 99201 is being deleted effective 1/1/2021

A. Documentation for CPT Codes 99202 through 99205 will be required using criteria of Medical Decision Making OR Time element to determine the level of coding.

o Medicare requirements remain the same for medical decision-making criteria using P.A.R.T. (Pain, Asymmetry/misalignment, ROM decrease, Tissue tone changes) OR diagnostic imaging with documented report of objective findings.

B. CPT 99211 (re-exam) is not being deleted but not used very frequently, and some payers do not pay chiros for this code. You may still bill 99211 when a CT licensed in history-taking and exams performs a re-exam.

C. The 2021 treatment plan model will be the same as 2020:

o Number 1 documentation priority Medicare is looking for: Goals (time or distance element, for example ADLs or specific exercise)
o Number 2 element = duration of care (for example 24 visits)
o Number 3 element = frequency of care (Example – 2X/week for 12 weeks)

II. Changes to ICD-10 codes relevant in chiropractic

1. The following codes have been Added:

A. Arthritis of temporomandibular joint

i.   M26.641 right
ii.  M26.642 left
iii. M26.643 bilateral
iv. M26.649 unspecified

B. Arthropathy of temporomandibular joint

i.   M26.651 right
ii.  M26.652 left
iii. M26.653 bilateral
iv. M26.659 unspecified

2. Deleted ICD-10 Codes:

A. M92.50, M92.51, and M92.52 deleted. (Juvenile osteochondrosis). Use M92.8 or M92.9 instead
B. R51 (this headache code deleted). Here are two specific codes added, to use instead:

i. R51.0 Headache with orthostatic component, not elsewhere classified
ii. R51.9 Headache, unspecified

III. Medicare 2021 Reimbursement on covered CMT
Please note a significant reduction in reimbursement across the board for select specialty physicians and surgeons. Here is the chiropractic fee schedule:

Referring back to the exam discussion above, you may want to consider raising your E/M code fees. However, be advised insurances will not reimburse at your full fee, and Medicare as well as most Part C plans as of this writing do not pay for exams performed by Doctors of Chiropractic. These charges are patient responsibility.

Questions? We’re here to help!

Call 920-334-4561 or email lisa@pmaworks.com

Cheers!

~Lisa Barnett
Increasing your collections through better billing and documentation.

References:

New Medicare ABN-effective 1/1/2021

Medicare has released a new ABN which will be implemented starting January 1, 2021.  There are two versions, an English and Spanish version.  Click the link to download now.

ABN English

ABN Spanish

Remember . . .
The ABN is required for your Medicare patients to sign when:

They transition from Active Treatment to Maintenance or Wellness Care.

The ABN is voluntary when:

It functions as your financial policy, and the patient is still on Active Treatment.

GUIDELINES:

  • Do not have the patient sign an ABN at every visit, per CMS.
  • When the patient presents with a new episode/injury, the current signed ABN on file is nullified.
  • When the patient transitions back to maintenance/wellness, have them sign a new ABN.
  • The signed ABN is good for one year.
  • The patient/guardian should be the one to choose between Option A, B, or C, with the staff. explaining what each option entails. This prevents potential doctor liability down the road, i.e., the patient or guardian states to Medicare that they were forced or pressured into choosing a certain option.
  • Use an AT modifier when billing Medicare for Active Treatment (ABN not required).
  • Use a GA modifier if the patient chose the option on the form to bill Medicare, and an ABN is on file. Then the Medicare remits can be forwarded or are crossed over to the Medicare supplement plan for possible payment.
  • Use a GZ modifier when billing Medicare for maintenance/wellness care but an ABN is not on file. (The most common reason is the clinic got busy and missed having the patient sign it).
  • The ABN is not used with Part C/Medicare Replacement plans. Only use for Medicare Part B plans.
  • You may begin using the new ABN in December. The new one will be required as of 1/1/2021.

Questions? I am here to help! Contact me at lisa@pmaworks.com, or call 920-334-4561

Lisa
“Increasing your collections through better billing and documentation”

Wisconsin License Renewal Requirements – 2020

REMINDER:  Wisconsin License Renewal Credentialing Requirements

*Please Note:  Due to the pandemic, usual and customary continuing education requirements are waived this biennium.   However, even if you did not complete your hours, you still need to renew your license.

A review of the usual requirements follow:

Doctors of Chiropractic (DCs):

  • Continuing Education: Forty (40) hours minimum of state board-approved courses; four (4) of the 40 in nutrition
  • Maintain Current CPR

Starting now and prior to December 14th, renew online: https://online.drl.wi.gov/UserLogin.aspx

Chiropractic Technicians (CTs):

  • Continuing Education: Six (6) hours minimum of state-board approved courses

Starting now and prior to December 14th, renew online:  https://dsps.wi.gov/Pages/Professions/ChiropracticTechnician/CE.aspx

Chiropractic Radiological Technicians (CRTs):

  • Continuing Education: Twelve (12) hours minimum of state-board approved courses

Starting now prior to December 14, renew online:  https://dsps.wi.gov/Pages/Professions/ChiropracticRadiologicalTechnician/CE.aspx

TIP:  Keep your transcripts and file them safely, in the event of a continuing education audit.

Approved course listings can be found here:
https://dsps.wi.gov/Pages/Professions/Chiropractor/CE.aspx

All licenses (DC, CT, CRT) expire on December 14, 2020, at midnight.

Questions?

Contact Lisa Barnett
PM&A Consultant
920-334-4561