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Cell phones can be a nuisance. They can interrupt the harmony and pleasant atmosphere of your office. If you don’t have a sign up for your patients to remind them not to use their mobile phones, you can download this document, print it, and use it. Ensure that your patient’s experience in your office is not hampered by someone shouting to their aunt on their cell phone about their bunion operation.
[ Download/View File ]
Every insurance company has a time window in which you can submit claims. If you file them later than the allowed time, you will be denied.
For most major insurance companies, including Medicare and Medicaid, the filing limit is one year from the date of service. If you are a contracted or in-network provider, such as for BC/BS or for ACN or HSM, the timely filing limit can be much shorter as specified in your provider agreement. It may be six months or even 90 days.
There should seldom be a time when claims are filed outside the filing limit. The only exceptions might be when you are dealing with a Medicare secondary and were appealing a denial prior to submitting to the secondary, or when an account was sent to work comp, then after much review was denied as not liable and now must be billed to health insurance. In these cases, you can appeal the claims, but you must call the insurance company and see what their appeal rights are. Medicare and Medicaid have specific appeal guidelines in their provider manuals, but other insurance companies vary.
If you actually were outside the timely filing limit, many insurance companies and most provider agreements prohibit you from pursuing the patient for the denied balance. It is also poor consumer relations to make the patient pay for your office’s failure to submit the claim.
Rebills on Claims Filed Timely
A frustrating problem when doing account follow-up is that most insurance companies only hold or “pend” claims in their system for 60 to 90 days. After that, if they are not paid or denied, they are deleted from their computers. A large insurance company may receive over 100,000 claims a day and their systems cannot hold that volume of pending claims. When you call to follow up, they will state, “we have no record in our system of having received that claim.”
Now your only recourse is to rebill the claim. If it is outside their “timely filing”, you will get a denial back. You should and must now appeal the denial. The first thing that you will need is proof that you actually did file the claim within the time window allowed.
Proof of Timely Filing
For paper claims, you can reprint and attach the original claim, however some billing software will put today’s date on the reprinted claim. Ask your software provider to walk you through reprinting a claim with the original date. There is no reason to photocopy all claims just in case you need to prove timely filing. For electronic claims, you should have the claims submittal report from your clearinghouse. These should always be kept (in electronic format) on your computer by date in a folder that is regularly backed-up.
[Sample Appeal Letter for Timely Filing]
Name of Insurance Company
Address (get address for appeals if it exists)
Re: Appeal of Denial for Timely Filing
Patient Name:
Group Number: DOS:
Subscriber No: Reference No.:
(etc – get this information from the denial)
We are appealing the denial of claims for (patient name) and request that these claims be reviewed and paid.
On (original submission date) we submitted claims for services rendered to the above patient. This was well within your timely filing deadline.
The promptly and properly submitted claims were neither paid nor denied by your company. On (date of resubmission) we resubmitted the claims for consideration. On (date of denial) we received a denial of the claims for “timely filing”. Please see the attached EOB from your company.
I have attached copies of the original claims showing the date they were printed. Our office policy is to send all claims on the date they are produced. The printed date is the date of submission and is well within your deadline. (or) I have attached a copy of our Claims Submittal Report provided by our electronic claims clearinghouse showing that the original submission date was well within your deadline.
We respectfully request that these claims be promptly processed and that are office is paid for the services rendered to your subscriber as allowed by the State prompt payment regulations. If this claim is further denied, we intend to then file a complaint with the Office of the Insurance Commissionaire.
If you have any questions, you are welcome to contact me directly at (123) 456-7890.
Sincerely,
Your Name
Cc: Patient Name
Home Address
Special Circumstances
Occasionally, because of coordination of benefits or denials from the primary insurance or questions of liability, you will end up filing outside your agreed limit and get denied. In these cases, you have to call the insurance company and find out what their appeal guidelines are for late filing. I have not run across a company that does not have an appeal process for these rare circumstances, but it does vary from company to company.
Prevention
There are always some times when you will fall outside a company’s timely filing deadline. By reviewing your accounts receivable aging report every single month, by ensuring that your review all electronic submission reports (both from your clearinghouse and from the insurance company), and by setting up accounts correctly from the start, you minimize these problems.
David Michel
Petty, Michel & Associates
© 2009, All Rights Reserved
This article is not intended as legal advice or as replacement for legal representation. You should always consult a local attorney or tax advisor, as well as your State Board, when setting up any contracts, ads or policies. The reader is responsible for ensuring that he or she is operating within the scope of his or her practice and abiding by local regulations.
Busy-busy-busy. Promotions, staff training, hiring, new procedures, patient finances, and patients, patients, patients.
There may be a recession, but with the doctors with whom we work, there sure hasn’t been a recess!
They are working harder than ever (and so are we!) And, their practice “scorecards” show it. Some offices report a slight decline but many in fact have been going up.
And that is, in the final analysis, our best solution: In a recess-ion – don’t take a recess. At least not a mental one. Now and then, it is good to get out, but that is just so you can come back with more energy than ever.
Quit Whining
Arnold Schwarzenegger recently told a group of Europe’s top trade officials:
“It doesn’t make any sense for people to sit back and whine and to complain about the economy slowing down because we have to look forward rather than back.” He went on to say: “We have to be part of the solution, not part of the problem.”
So, what is the solution?
When the Going Gets Tough
Over the years, we have seen so many chiropractic offices get by with poor procedures, hit and miss marketing, bad management, and sloppy clinical. The thing is, chiropractic works SO WELL that a poorly run office could limp along and survive. But not any more.
When the going gets tough, the tough get to work improving their business, or to paraphrase Stephen Covey, they get to work “Sharpening their Saw.”
You have to improve all aspects of your business. If you don’t, people will go to a doctor’s office that is.
First thing you should do?
But when numbers start to slip, what is the first thing you should do to improve your business? OK, let’s start out this way: what is the first thing you should NOT do?
Read the results of these 2 studies and see if you can guess the answer:
In a study of U.S. recessions, McGraw-Hill Research analyzed 600 companies from 1980-1985. The results showed that business-to-business firms which maintained or increased their advertising expenditures during the 1981-1982 recession averaged significantly higher sales growth, both during the recession and for the following three years, than those that eliminated or decreased advertising. By 1985, sales of companies that were aggressive recession advertisers had risen 256% over those that didn’t keep up their advertising.
Or how about this study by Roland Vaile:
“Advertising executive Roland S. Vaile tracked 200 companies through the recession of 1923. In the April 1927 issue of Harvard Business Review, he reported that the biggest sales increases throughout the period were rung up by companies that advertised the most.”
You guessed it: don’t stop marketing. Marketing costs money and takes time, and this is one of the first things business owners want to “cut back on” when frightened by a recession.
Hmm, is that defensive or offensive? And the best defense is a what? That’s right, a continuous outreach program. Talks, screenings, special promotions, networking, do it all and more. Now is not the time to cut back or economize. The time to do that is when you are making the money. If you try to save now, you will have less and less to save with. Most people spend money when they make it and try to save it when they don’t. In fact, the exact opposite should be done as a business strategy. More on that for a later post.
But marketing isn’t all external. The truth is, it is mostly internal to your office. This means you should work each week on improving your internal marketing procedures. These include patient education and extra-ordinary service procedures, and literally everything you do and that goes on in your office that each patient experiences.
What the patient experiences is a critical part of marketing. If the patient has a satisfying and rewarding experience, he or she will come back and maybe bring a family or friend. If she doesn’t, she will go somewhere else.
So, don’t go blaming the economy if your patients aren’t coming back or referring, or if your practice is not growing. Improve your patient’s experience in your clinic and get to work on improving your marketing outreach and all aspects of your business.
Even with the challenges that the economy sends your way, this still could be your finest year.
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Come to our Boot Camps and get trained. We are going to train train train, and have fun doing so.
Minneapolis, MN – Thursday, April 2. 8:30 to 5
Milwaukee, WI – Thursday, June 4. 8:30 to 5
Learn about them here.
Listen to Dr. Peter Kevorkian on our next Teleclass on March 23 at 12:30 Central Time. Special talk on “Creating Lifetime Patients”
To learn more or register, go here.
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link to above mentioned studies: Studies
We all know or have heard that the number one reason that a patient drops out of care, based on surveys, is that they experienced an “attitude of indifference” on the part of the doctor or the staff.
Most offices nod knowingly and are assured that their office cares about the patients, that their staff show concern, that their doctors have the patient’s interest at heart.
But what is an “attitude of indifference?” How does it manifest in a clinic? What does it feel like to a patient?
A patient experiences an attitude of indifference when they feel they are the 38th visit on a 60 visit day. They experience an attitude of indifference when they feel like they are on visit 15 of a 36 visit treatment plan and that everything is the same as the last 13 visits.
They feel an attitude of indifference when the doctor says, during the ROF, that he will give them some home exercises, and then doesn’t. Or when the doctor instructs them to attend the spinal care class as an important part of the treatment plan and no one schedules them for it, or when the front desk says they will order a supplement for them and a month goes by without the order, or the doctor says she will do a re-exam and then keeps putting it off, or when the doctor is running 5-10 minutes behind each visit or worse, comes in late.
Normally, you may still get that patient to follow through. But put yourself in the patient’s shoes. They are feeling better, even feeling “healthy” now, they have a $30 copay twice a week, and they have just heard that the company their husband works for may be laying off some people.
90% of the population right now, according to USA Today, is worried about the economy. Many have been affected, and many more are concerned – they are uncertain. When will things get better? Are we heading down farther? Am I going to have any money left?
When people are uncertain, the decisions they make are either “no” or “maybe” (which isn’t a decision but a postponement). They don’t decide that now is a great time to spend more money. Not on cars, not on restaurants, not on healthcare.
Expressing an attitude of interest is an “every visit” manifestation. That patient’s visit is not the 38th of the day or the 15th in their treatment plan – it is a singular, unique moment in time that will never occur again. It is a one and only opportunity to make an impact and a difference in that patient’s life. When you talk to them about the weather (“gee, cold out today, isn’t it?”) or tell them a joke in the treatment room or bs about the Packers – and if that is ALL you do that visit, you are just more white noise in their life, just another piece of spam in their mental inbox.
You have to manage a patient’s care EVERY visit, you have to work to make a difference in that patient’s life EVERY visit. If you don’t, that is an attitude of indifference. There is no other way to put it.
There are four critical factors that go into growing during a recession. These are:
1) Great customer service. During a recession, other businesses cut back on the front end. People want and need good customer service. They deserve it from your office.
2) Excellent patient financial plans, well communicated. The first response in some clinics when times get tight is to tighten up your financial plans. “All patients have to pay their copay before they see the doctor. No copay, no visit.” Do this and watch your practice drop by 50% (actual case).
3) Step up your marketing. Great customer service and flexible financial plans don’t mean anything if no one comes in. Marketing is a variable expense and one of the first areas businesses cut. There were over 650 auto makers in the US before the great depression. After, there were six. Clinics are closing, going out of business right now. You can pick up market share.
4) Increase your patient education. Patients aren’t going to blindly come in “because you said so”. Educating patients on wellness, having a wellness report of findings, and a “can’t resist” wellness financial plan are keys to building your practice.
Following the 3-Goals principles, review the above four points. Implement them personally. Review them with your staff and see how they can implement them further. Review them again and refine them.
There has never been a better time to grow your practice.
We enter the New Year in unprecedented times. There is no denying this. We do not live in our offices as islands, separated from the rest of the country or world. Some websites will tell you that the end is near. I have been reading doomsayers since the 70’s and they still sound the same. I think it bolsters their ego and gives them a cause, but that is just my opinion.
But it would be wrong to pretend everything is as it always was and we live in prosperous times. Not just our economy, but the world’s economy is going through massive, even revolutionary changes. But there are, and have been, other changes taking place as well. In the last 15 years, electronics have gone through many unthinkable transitions for us coming from the mid 20th Century. Social changes world wide have taken us beyond the Third Wave, as Alvin Toffler described in his book. And, there is the ongoing “Wellness Revolution” and “Green Revolution”, which those of us in the chiropractic profession can take pride in the fact that we have been in the forefront. Needless to say, the “Times Are a Changing.”
But with this change comes opportunity. The country is going through a severe “cleanse”: parasite cleanse, colon cleanse, you name it. It is a time that offers many new avenues for growth and prosperity.
Jeffrey M. Stibel, an entrepreneur and brain scientist writes in recent article in the Harvard Business Review:
Let’s look at some general strategies that will help you prosper in this New Year. We offer a few below and will mail out more practical action steps soon.
Over the Christmas, most stores did poorly, except for Wal-Mart and McDonalds. I am not advocating
reducing your fees. You probably do not charge enough as it is. But, you have to be prepared to offer different plans
based upon the time of payment (payment on assignment, at time of service, or in advance.), as well as other
programs.
Now is a great opportunity for growth and entrepreneurship. You are the captain of your ship as it crosses the seas
through storms and gales. Stand at the helm (steering wheel) as the misty wind blows and know that you can beat
any storm and take your crew and passengers to sunny skies and calm waters.
It is a challenge, an adventure, and a worthwhile goal you and your team can achieve.
We will be there too.
See you on deck!
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Sometimes you got to get away.
It could be for an hour, fifteen minutes, a week, or more. To be fully engaged in your chiropractic practice, studies have confirmed, you also have to fully disengage every now and then.
One of my favorite books on this is by Dr. Jim Loehr and Dr. Jack Groppel, The Power of Full Engagement. Disengaging from work, and engaging in other activities, adds more power and insight when you return to it.
More than 80 years ago, this subject was discussed by B.J. Palmer, known as the Developer of Chiropractic, with insight and character. His advice is completely supported by modern research and is worth reading and applying today.
Rule No. 9 ( PDF version to download.)
(720 words; about a 4 minute read)
[to download a PDF version: download]
The average businessman has long since forgotten Rule No. 9, “Don’t take yourself too damn seriously.”
Thousands of businessmen have one fault in common. They are so close to their own thoughts, their own minds, their own selves, desk, office friends, employees, clerks, detail, correspondence that they suffer from the illusion of the near.
They are with what they think, see and do so much at a time that they take it all too seriously and thus suffer from the nearness of themselves to themselves.
I now live in a town where I am sold to everybody. They call me “B.J.” everywhere. I live in an immediate family of some 5,000 whom I bring to that city, who love me and I love them. These people appreciate what I do for them. They tell me and I listen to the plaudits of deeds well done. People come from far and near to thank me for what I have done, via some salesman. All of which makes me take my detail seriously. I suffer from it.
YOU need the vision of the far. I need it. I keep my grip (suitcase) packed and when I begin to take my reform work seriously, right then is when I book a few Rotary, Kiwanis and other club talks and hide myself away from my thoughts, ideas, work, students, school, friends, that I might get myself away from myself, that I may walk the streets of strange towns, see strange faces, listen to strange tongues, that I may get the proper perspective of myself.
Many people suffer with a constipation of thought and a diarrhea of words. Many a man has the eyesight of a hawk and the vision of a clam.
Going away from home makes a man shut up and think. It also teaches him to overlook the hawky detail and gain a distant vision of himself, his service and his Big Job.
Every man owes it to himself, his people and his service to go away about every so often. The more detail he has, the oftener he should go. The more worries, the more he needs to go. The bigger his work, the longer his vacation should be.
He should go to conventions, attend luncheons, go fishing or hunting, anywhere that he may get away from himself; that he may sit on the banks of the river and there see himself at his desk, with his people, on the job. It is surprising how foolish all of us look when we gaze at ourselves after we get away from ourselves and see ourselves as others see us.
Many a man realizes without analyzing. A certain clothing merchant of our city is noted for his ancestral business qualities. Business and money are his gods. Yet this same man told me but recently that he is now playing golf two afternoons a week. I inquired as to how he could get his mind into that state where he could make it pay. He tells me that the next morning he works three times as hard and accomplishes more than three times as much work. He comes home tired, sleeps sound, wakes up refreshed and piles in solid. Playing golf, he realizes the vision of the far without the mental analysis that accomplishes the end. He stumbled upon the conclusion and even yet doesn’t know. You and I can go into this with comprehension and intention.
I am told that John D. Rockefeller rarely went near oil fields; that Mr. Carnegie knew little about steel itself; that John Patterson spends months in Europe away from his huge plant to know better how to run it when at it; that James Gordon Bennett managed the New York Herald from Paris; that Mr. Pulitzer manages the New York World from afar; that Mr. Wanamaker spends and Marshall Field did spend four months out of twelve in Europe for the express purpose of gaining vision; that a Boston department store manager is responsible for this statement:” I must study other business at least THREE MONTHS every year in order to manage my own business properly the OTHER NINE.’
We should get away from ourselves, our office, our business to get the proper perspective on its services.
[to download a PDF version: download]
3 Goals Management System
How to Achieve Financial Abundance and Practice Freedom
A unique practice development strategy and process created by Petty, Michel & Associates
An Introduction
Goal Driven
We all have goals. When we were younger, they might have been brighter than they are now, they might have been clearer, or seemed closer. Maybe yours still are. Or, maybe, they have become dulled with wear and tear, with disappointments and frustrations.
But we are goal driven creatures and our goals stay with us. The better we can define these goals in concrete terms, the more likely we are to achieve them.
What All Doctors Want — The 3 Goals
Ultimately, all doctors would like to create a practice that allows them to provide the highest quality care to the most people for the most profit.
Most doctors want to do this with professional and personal integrity. Maybe most importantly, they want to be able to do this in such a way that they are not chained to their practice, slaving at their work at the expense of their personal and family lives.
This is a fundamental goal for all doctors, so fundamental that we call it Goal 2.
Even more fundamental, however, is basic survival and solvency. We call this Goal 1.
But nobody works just for money. Whether it’s saving the planet, helping your grand kids, assisting the poor, or funding your church, we all have higher goals.
Goal 3 are your higher purposes.
All three goals can and should be achieved, and with over 20 years of experience, we have put together a practice development system that allows doctors, and their teams, to achieve all three goals.
The 3 Goals Practice Development System is a step by step approach to help your practice grow naturally to its full potential and stay there.
Goal 1
Goal 1 is survival. In business, this means solvency. Are you making enough profit to pay your bills? To achieve Goal 1, solvency and survival, you have to move fast. It requires passion, energy, and an aggressively friendly approach to getting your services known and delivered. For the patient, you can think of Acute Care. For a staff position, you can think of 20 – 30% proficient.
Goal 2 and the Practice Development Process
Goal 2 is a fully functional, franchise-able, sale-able, and sustainable business that is very profitable. For a patient, it is a maximum spinal correction. For a staff position, it is 100% proficient and competent, rain or shine.
After you have achieved Goal 1, you can now start identifying those procedures that worked best. You can write these down on checklists. These checklists will become your Practice Playbook.
With more staff training, you can delegate more procedures to staff. As you continue to grow, you refine your procedures and continue to train your staff so that they become more competent.
Every 2 months, or as needed, you assess your list of successful procedures and add to them, or revise them. Every week you work on improving them, and train your team on them. Much like any athletic team, you practice and review your plays and procedures.
We call this process the Practice Development Process. It helps you to continually improve the practice and gradually take the office to Goal 2.
Getting Organized: The Baseball Diamond
To get to Goal 1, organization is not vital. Production, speed, and promotional activity is. However, getting to Goal 2 requires good organization.
Imagine a baseball team that stands around the pitcher’s mound with the pitcher. A batter hits a fly ball to the right field. The whole team goes to chase it. Once they reach it, they realize that no one is on the first or second base to throw the ball to in order to stop the runner. They are all out in right field.
Many offices operate this way. For example, in some offices the front desk does insurance, the insurance department does therapy, the therapist schedules appointments, and the doctor takes time off to buy office supplies.
Moving the office upward to its peak capacity includes all areas of the office improving: first base, third base, centerfield, etc. If you only have a few of the departments doing well, the other departments will hold down the entire growth.
Goal Three
Our greater goals give us meaning. These are the accomplishments we want to have said we achieved at the end of our lives. They are based in love, hope, and faith. They are for our heritage, our parents and those upon whom we owe so much; they are for our legacy, our children and their children; they are for our community and the fellowship we share with rich and poor.
Goal three is your “Give Back” goals, to your family, to your community, and to yourself.
All Three
This is your road map up and out of the roller coaster. These three goals form a sequence, but you have to keep all of them in mind as you travel up your road to success.
This is directed to a business owner, but also applies to team members and how they can improve their competency. It applies to patients, and how they travel from acute care, structural care, to wellness. It actually applies to many activities.
You have to be willing to shift between goals, and if you find yourself suddenly in the poor house, you have to lose your self-important attitude and run like a rookie again until you build your business back up to Goal 1.
Where many doctors fail is that they are not willing to shift, either up, or down, as needed. Having achieved Goal 1, they are two insecure to delegate their duties to staff and procedures, or work on improving themselves. Many doctors, having achieved Goal 1 who should be working on Goal Two, feel the need to keep doing what they did to get to Goal One and so, quickly find them selves back down struggling just to survive.
It is easy to get lost, but now, with the 3 Goals Management System, you have a road map.
We have seen too few doctors achieve financial abundance and practice freedom. Hopefully, with the tools provided in the 3 Goals Management System, more doctors will be able to reach their dreams and help others do the same.
For information on our coaching and management consulting programs. LINK
(3 goals image copyright 2009)
Chiropractic Case Manager Job Description Summary
In many chiropractic offices the majority of the attention on patient care is on the first 5 to 12 visits. In some offices, it is only on the first 5 visits, or less. It can get so bad that the primary concern is only on getting more and more new patient first visits.
An old maxim in dental consulting is that the biggest cost to the dentist is the incomplete dental program. A patient who discontinues care after the first $1,000 of a total program of $10,000 just cost the dental office $9,000. This also applies to the chiropractic office.
Actually, many chiropractors are producing incomplete cases. This is not in the best interest of the patient’s health or in the viability of the office. Imagine a hygienist that only cleaned the upper teeth, or a baker that only baked his bread half way through. Yet, many offices are only getting their patients partially through their treatment programs.
The job of your clinic is to get your patients to complete their entire treatment program and on to a Wellness Program. During the course of a patient’s care, the doctor and staff may concentrate only on their specific duties with the patient, such as scheduling, treating (adjusting), collection, etc. Usually no one has the job of overseeing the patient’s progress along the entire treatment pathway, through all the adjustments, scheduling, therapy, education, payments, until they finally “graduate” and go on to a Wellness Program.
Yet a full Wellness Program takes some of the pressure off of the need for a constant stream of new patients and makes for a smooth running office.
To help ensure that patients get complete and comprehensive care, the position of Case Manager should be held by someone in the office.
Who should be the case manager: It can be fulfilled by the doctor, or the therapy or back office assistant, or the front desk or even the billing and collections staff member.
Time spent as a case manager: It should take no more than one hour per week.
Mission: The mission of the Case Manager is to ensure that all patients move through the various departments of a health care clinic smoothly and quickly, ensuring that they get excellent service such that they complete their treatment program as quickly as possible.
Duties and Responsibilities
1. Coordination. Once a week, or daily before treating hours, the case manager should get the doctor and essential staff together for a Case Management Meeting. A great time to do this is 20 minutes before the first patient for the day, or weekly for one hour. During this time, the appointment book or a list of active patients should be reviewed.
This is the most important tool the case manager (or case coordinator) has. During these meetings, the following points, among others, can be reviewed on each active patient:
2. Outcome and Statistics. Keep a statistic of “Completed Treatment Programs”. Once a patient reaches a maximum level of improvement they are ready to go on to Wellness Care. One way to keep this statistic is to track the number of patients beginning a wellness care program.
3. Patient Progress Card. Make up a general treatment plan for every patient in the form of a simple checklist. This would include all service procedures, therapy, diagnostic, as well as educational actions. The last steps would include transitional consultations onto a wellness care program. This could be called a Patient Progress Card, and placed in the patient’s folder.
4. Day 1 & 2 Procedures. Ensure that day one and day two procedures are well documented and kept up to date with current procedures, and a simple flow chart outlined.
5. Regular Visit Procedures. Ensure that regular patient procedures are documented, and a simple flow chart outlined.
6. Staff Training. Staff walk-throughs for day one and day two procedures, and other flow procedures rehearsed at least on a quarterly basis. The best offices practice monthly.
7. Financial Consultations. Financial consultations done on all patients as often as is needed.
8. New Patient Orientation. New Patient Orientation done on each patient.
9. Patient Satisfaction. Ensured patients are very happy with service.
10. Pathways. Pathways for different types of cases documented and reviewed by all.
11. Flow Charts. Flow charts for first three day procedures outlined and rehearsed.
12. Conversion. All patients completing services are converted to wellness or other programs.
Outcomes. The major outcome of the position of Case Manager is “Completed Treatment Programs.” That is, patients who have completed any acute or chronic treatment programs prescribed by the doctor and have reached maximum improvement. This definition could be extended to include: a patient who has completed their active care program and is educated so that they will continue onto a wellness program.”
Performance Monitors
It is easy to drop out important but not urgent actions with patients during their care. Ultimately, this leads to poor quality and a deterioration of results. With a Patient Progress Card, and the Case Manager System in place, quality and patient results will improve, and your volume will increase. Often it is not what we see that hurts us, but what we don’t see. It is the gradual omissions that eventually add up to an empty office. Ensure each patient completes all of the steps of their treatment programs.
For better patient retention, increased referrals, improved treatment compliance, and more revenue, implement the Case Management System!
Newsletters to Your Patients
Pity the poor practice newsletter!
So misunderstood. Forgotten, neglected, and ridiculed.
Scorned as too expensive, dismissed for eating up too much staff time, and disregarded because they just don’t “work.”
But is any of this true…?
Not necessarily.
Too expensive? They can be. Fancy paper, color photos, six pages, and sent first class can cost thousands.
Take too much time? Oh boy, how true this can be! Who is going to get the information and write it, format the newsletter, get the mailing list, organize the mailing, do the printing, add the postage, and take it to the post office? That is a LOT of work, and costly staff hours.
Do they work? After spending so much time and money on any other promotion, you would expect the new patients to come in for a good return on your investment. Often, this does not occur.
BUT WAIT… it doesn’t have to be like this. IN FACT:
Patient newsletters can cost as little .50 cents per newsletter. That includes, postage, paper, printing, and taking them to the post office. The offices where we see them used regularly have shown an increase in patient referrals and in reactivated patients.
Before we outline how to do it, here is why you should.
Why You Should Do A Newsletter
When a patient starts care with you, you and that one person, old, young, male, female, it doesn’t matter, that ONE person and you – have started a conversation. They confided in you about some things about which, outside of close family friends, no one knows. It is personal. Professional, yes, but the fact is, you and your patient have started a dialogue.
It is your job to continue it. It is not their job to do so – it is yours.
You are the doctor and they came to you. They reached out for help. All you have to do is to keep the conversation going. It may be one sided for a while, but they are listening.
We are all spammed to death. It has been estimated that each one of us receives up to 3,000 to 5,000 separate advertising impressions each day in the U. S. People are numb to advertising. It is no wonder that your ads in the local paper just don’t have the pull they used to.
Patients who have once been to you already know who you are. When they receive a letter from you, it is from someone who knows them. You are communicating to someone who already knows you and knows that you know them.
Statistics tell us that it is much more profitable to invest in keeping the patients you have, and marketing to them, than trying to procure new patients that do not know you.
Patients stop seeing you because sometimes, Life gets in the way. Finances, personal problems, work, and after a while, they kind of just loose touch. But you are mistaken if you think that your relationship with them is over. Once someone tells you intimate details about their personal condition, a relationship has started. Think about who you have confided in personally. You feel a special connection to them, right?
So, a conversation has started and by simply maintaining it, you will find that the patients stay with you longer, come back to care more frequently, and refer more of their family and acquaintances.
How To Do A Newsletter
For those of you who have the Marketing Manager System (sm) computer program, there are a number of sample templates and examples that can be easily reformatted for your office.
Newsletters are thrown away, of course, but they are reminders and brief advertisements about your services. They should not look like another pamphlet – homemade newsletters work very well. Too fancy is too expensive and look like the regurgitated pulp that gets thrown in most health articles and brochures.
Add a column just from you. We have a sample doctor’s column which you can use. On our members site for our clients, we have others. Add some news, maybe one of Margie’s favorite non fattening brownie recipes, a snapshot, a testimonial, and a list of upcoming events. That’s about it.
Put it on one piece of paper that gets folded over twice and become self mailer. Bid it out to local mailers and you will find that the printing, paper, postage, and mailing all comes out to about fifty cents each. If you have 1000 patients to whom you are mailing, that comes out to $500. If you do the mailing every 4 months, it averages to be $125 per month.
Make sure that one person is delegated to oversee the newsletter. It should not take but a few hours to do.
Email newsletters are nearly free, of course, and can be effective. You can capture the email addresses from your patients and send out personal newsletters using services such as constantcontact.com, aweber.com, or a new one icontact.com. There are many others that have simple templates where you can simple type in the information and send out.
Homemade Newsletters versus Preprinted Newsletters
There are a number of companies that will print and mail newsletters out to your patients for you. There are also a number of chiropractic commercial websites that will send out prefabricated electronic email newsletters to the email addresses you supply them. The advantages are obvious – someone else does all the work and patients receive a professional good looking copy in their mail box, or their email in box.
We have seen these work, however we prefer the home made newsletter. The reason is that professionally done newsletters are a bit like pamphlets – they look nice, but they are generic and soulless. This can be particularly true of email newsletters. Some prefabricated newsletters make room for your customized inserts. In this case, these might work well.
The primary problem with the preprinted newsletter, whether “hard copy” or electronic, is that it can take you out of the loop. You cannot really delegate all of your patient communication. You can delegate some of your communication, but the point is, you want to maintain a personal relationship with your patients.
There is more to it than this, but don’t worry about getting it too prefect or too fancy. Funky, friendly, and funny is good. Just do it and keep the conversation going. You will see your old patients returning, referrals increasing, and established patients coming in to thank you for that the recipe you put in your last newsletter.
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Fun Easter Egg promotion for your chiropractic office.
[Customizable posters available for member’s on member’s site.]
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Printable cartoon about exercising for staff and chiropractic patient discussion.
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The moon is back to normal again.
Just a few hours ago, though, standing in the middle of a snow-covered playground near Lake Michigan, in the night sky at about 3 degrees above zero, it looked like a smudge. A grey brown spot that was almost black, like someone had tried to erase it with an old eraser, but part of its image still remained.
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For a few hours, the earth blocked out the sunlight to the moon, at least from our perspective. These unimaginably huge spheres of matter, nearly perfectly in balance, were gracefully moving like billiard balls in a ballet. Compared to this, all else really seems insignificant.
Before street lamps, car lights, TVs and late night computers, the night sky entertained us. Everyone could recognize the constellations, and an interplanetary event such as an eclipse was a very big deal. All our ancestors were stargazers – the night sky gave them the comfort of familiar signs, as well as wonder and awe. And mystery.
Besides the city lights to distract us, we have our daily duties and deadlines that rivet our attention to the near. Your patients, your notes, your computer, staff members, phones; most things are just a yard stick away. Like a ping-pong game, your focus has to be complete, quick, and close, or, you lose.
When your attention drifts, patients think you don’t care, staff thinks you take them for granted or are displeased, and insurance companies can’t read your notes. Success in practice requires keen attentiveness.
You can’t survive asleep at the wheel, dreaming or daydreaming. To be a winner you have to be alert and actively attentive to your job each minute you are at the office.
And if that is all you do, you soon will burn out.
Studies have shown that you have to, now and then, disengage. Take a break. Learn Japanese. Play with your kids. Help the poor. Pray. In their best selling book, The Power of Full Engagement, the authors offer studies and examples on why it is important to become involved in disrelated activities to balance our hectic if productive lives.
All this goes back to the moon and the sky. I don’t think we look up enough. The sky, the stars, and the whole natural God given world are about us, mysterious and awe inspiring.
In business, we have to focus on the short term and build for the middle term. But it is the far away that calls us, if we can stop to listen. What makes you curious, fills you with awe, love, and seems a mystery? What does your future whisper back to you, as if you could hear your eulogy years from now? What are your greater purposes?
Balancing these three is the key to a successful practice, business, and life. Your first goal is to play each day fast, full out, like a basket ball game you have to win. Your second goal is to gradually build a strong organization with the right teammates and the best plays that have proven to work for you. But your third goal, and there may be many, are why you work at all.
If your business has plateaued and stopped growing, it is because one or more of these goals is not being worked on correctly.
We have developed a general pathway and framework for doctors to move upward so that they can correctly work on and achieve all three goals. It doesn’t matter what technique you use, therapies, providers, or offices.
We are excited and pleased about the development of this new approach to practice management and marketing and how it impacts our consulting and the results our clients can see, as well as our own business and personal lives.
We will be publishing and just talking more about these three goals, but we encourage you to come to our seminars. You can learn more about them by clicking here. 3-Goals Seminars
And, in the meantime, as my old pal, Jack Horkhiemer the stargazer always says: “Keep Looking Up.”
photos from Microsoft and NASA
Angie’s Angles
From a Chiropractic Billing Consultant
For your protection, you should be aware of the Top 10 Red Flags for a billing audit in a chiropractic office. Here they are.
Since this is the beginning of a new year, I will start with the Top 10 Red Flags for a billing audit (in no particular order):
1. “Phantom Billing”—Billing for services not rendered.
2. “Double Billing”—charging more than once for the same service, e.g., using an individual code again as part of an automated or bundled set of tests.
3. “Clustering”—Using only a few codes on the theory that it will average out.
4. “Upcoding”—Using a higher reimbursement code than the code reflecting the service rendered; e.g., billing for complex services when only simple services were performed, billing for brand named drugs when generic drugs were provided, listing treatment as having been for a more complicated diagnosis than was actually the case.
5. “Unbundling”—Using two or more billing codes instead of one inclusive code where
regulations require “bundling” of such claims. Submitting multiple bills in order to obtain a higher reimbursement for tests and services that were performed within a specified time period and which should have been submitted as a single bill.
6. “Code Jamming”—Inserting or “jamming” fake diagnosis codes to get insurance coverage.
7. Billing for non-covered services
8. Billing for services that are not reasonable and necessary.
9. Inappropriate balance billing—billing Medicare beneficiaries for the difference between the total provider charges and the Medicare Part B allowable amount.
10. Routine waiver of co-payments and billing third-party insurance only.
The complexity of managing a practice is not a walk in the park. As a Billing Consultant with PM&A, my job is to free doctors from the worries that can accompany running the financial end of a medical practice. I can review and streamline your billing department, train staff, and credential doctors with insurance companies, among other services.
Questions on how any of these might apply to your office? Contact me and I will let you know.
Next month – look for tips on nailing your Financial Consultations!!
A news account about how a blind man regained his vision after seeing his chiropractor. Print story for office use. For Video.
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Feel bullied by insurance companies and the stresses of running your business? Some thoughts from Ayn Rand can help.
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Chiropractic Newsletter-Doctors Column
A distillation of chiropractic by Dr. R. W. Stephenson into 33 principles.
“Gratitude is not only the greatest of virtues, but the parent of all others.”
Cicero (106-43 B.C.)
Those Greeks were pretty smart, and Cicero’s statement is just one example.
According to an article in Psychology Today, gratitude is a sentiment we’d all do well to cultivate. “Feeling thankful and expressing that thanks makes you happier and heartier–not hokier.”
But more than that, when gratitude is expressed to others, many benefits occur. A simple “thank you” goes a long way in improving the morale and ultimate performance of others. Of course, it has to be genuine. Counterfeit praise is easily seen through and can do more harm than good.
According to Tom Rath, co-author of How Full Is Your Bucket, “Gallup polling has revealed that 99 out of 100 people say they want a more positive environment at work, and 9 out of 10 say they’re more productive when they’re around positive people.”
He points to research that shows when a work team has more than three positive interactions with managers for every one negative interaction, it is significantly more likely to be productive. The point is not to keep managers from correcting or reprimanding, but just to express more praise.
To improve your gratitude attitude, consider the following actions:
1. In your personal life, you can list the kindnesses of someone you’ve never fully thanked. According to Lauren Aaronson in Psychology Today, if you read this letter aloud to the person you’re thanking, you’ll see measurable improvements in your mood. She refers to studies show that for a month after a “gratitude visit” (in which a person makes an appointment to read the letter to the recipient), happiness levels tend to go up. In fact, according to her references, the gratitude visit is more effective than any other exercise in positive psychology.
2. In your practice life, list the positive contributions of each team member. Once each day, take just a moment to recognize your team member’s action and express it to them. Your communication does not have to be lavish, just a short 3 second notice of something good followed by a “thanks for the report, Dr. Smith” is all it takes.
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One chiropractor I worked with years ago seemed to always be in a bad mood. He was quiet and basically ignored his staff. His opinion was that he paid them to work, they should work hard, and that was it. But, his office wasn’t doing well so he called me in. I made several visits to his office, each time simply improving the communications between he and his team. I coached him on listening to each staff member and to simply acknowledge them for their contributions.
A few month’s later, we saw his practice grow. I remember this because he was always complaining to me that I was not doing anything for his office! (Sheesh!) His constant complaining and lack of appreciation was the real problem yet he just didn’t see it.
This concept is not new, of course, but it is worth remembering now and then. More studies that validate the practical aspects of this as a management tool are covered in the above referenced book. But beyond management, like Cicero says, it is just an all round good virtue to cultivate.
For a motivational tent poster with the above quote, click here.
And … thank you for taking the time to read this!
Note: If you feel you need some instant appreciation yourself, try this. (Will need speakers or earphones.)