Tag Archives: chiropractic

Make each day an Ode to Joy!

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“Music is … a higher revelation than all Wisdom & Philosophy”
― Ludwig van Beethoven

Takes 5 minutes. This is an inspirational musical event. The link is below.

It is worthy of the best humans have to offer – and akin to what you provide innately to your patients – as doctors, providers, and support professionals.

Match this with all you do in April and you’ll have a great month!

-Ed

 

For more information on how to create a more profitable business that is more fun than what you are doing now, please purchase and then use the book, The Goal Driven Business.

The Missing Role in Your Practice

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The cause of almost all relationship difficulties is rooted in conflicting or ambiguous expectations around roles and goals. Stephen Covey

The reason many offices have a difficult time growing has to do with missing roles.

A role is the identity assumed to perform a series of tasks that produce a specified outcome.

In the hundreds of offices that we have visited over the years, the doctors take on essentially two roles: doctor and owner. This works in the beginning for a few years as the practice grows. In time, however, the practice begins to roller coaster. Numbers go up, then they go down, cycling up and down until everyone fatigues and just settles.

There are several causes for the Practice Roller Coaster. There are hidden barriers that hold an office back and sabotage its growth. These are covered in my book, The Goal Driven Business.

One of the barriers has to do with a missing role that most business owners overlook. Can you guess which one that is?

Let’s look at goals: What is the goal of a doctor? “A healthier person,” right?

What is the goal of a business owner? A secure and solvent business. Dividends from ownership.

What is missing? The doctor can achieve their goal by seeing 10 people a week. As a business owner, they can keep their overhead very low – perhaps working out of their home. But is that what you really want – to see 10 people a week out of your house? Overhead is low and you are getting good results. So, what is missing?

The CEO – the chief executive is the missing role. The goal of a CEO is a very profitable business that operates at full capacity providing world class service and delivering extraordinary results.

The CEO is the chief manager, leader, and marketer, which are the three functions that drive the business to its goals.

Sometimes we hear the doctor being referred to as the “boss,” but boss is not a well-defined role. “Boss” is generally recognized as the person who gives orders and makes decisions. However, it is an overlay of an existing role, as in a “bossy” doctor or “bossy” owner. The role of a CEO is much more than this.

Most providers are too busy providing services to do much managing – and besides, they are paid for their services, not their managing or leadership. Doctors are trained to manage patients, not businesses.

Still, this is a role that must be fulfilled as distinct and separate from the owner or provider roles if the business’s full capacity is to be achieved.

Three Functions of the CEO

The role of CEO includes these functions:

  • Leadership: Leadership is all about goals. It defines where you are going and why and helps everyone you work with embrace this knowledge with commitment. Leadership includes your mission, long-range plans, values, and … the insistence upon achieving them.
  • Management: Management deals with how to get to the goals. Management works to ensure that people and procedures are effectively working and improving.
  • Marketing. Marketing includes procedures and projects that help generate new patients/clients and retain them. Marketing is business, and business is marketing.

Once your practice is at least at 50% capacity, a couple of hours spent each week on effective leadership, management, or marketing activities as a CEO is worth 8 hours or more doing anything else. For example, time spent going to a seminar – perhaps 20 hours including the transportation, may increase your numbers for months afterward. A little can go a long way.

Because the role of practice CEO must be very part-time, we have developed the Fast Flow CEO System for the Goal Driven Business. This can take as little as 2 -3 hours per week, depending on the scale of your business. Here are five components of the Fast Flow CEO System:

  1. Get Out to Work On. Regularly take time to get out of the business so that you can work on your business.
  2. The CEO Works for the Business. The business does not work for the CEO. Sure, the business works for the doctors so that they can provide better service to the patients. But that is for the doctor. Sometimes called “servant leadership,” the CEO is the Chief Coach, helping others understand the goals and how to achieve them.
  3. Team Members. The CEO works to create team members who take on a portion of departmental management, marketing, and leadership.
  4. Manager. The CEO creates the role of manager and delegates a team member to assume this as a part-time role. The manager can take on much of the CEO’s daily and weekly duties.
  5. Study. The CEO studies leadership, management, and marketing to improve their skill as a CEO. Leaders are … readers!

Certainly, all this requires some skill and training – and coaching! But just clarifying the role of CEO and its expectations as distinct from the roles of owner and doctor (or “boss”) will significantly improve your chances of breaking out of the Practice Roller Coaster and achieving your goals.

Ed Petty

March 14, 2022

Motivation

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No matter how many goals you say you have or how you write them out, unless you have the motivation to achieve them – you won’t.

“Motivation is the driving force behind the energy required to complete a task… a person’s willingness to exert physical or mental effort in order to complete a goal or set aim. (Psychology Dictionary.org)

This is a key element in a Goal Driven Business.

You first need to define your goals – and they must be practical as well as meaningful. But you also need the drive to achieve them. Without the drive, the motivation to get to where you want to go, you are just a poser in the business world.

(Case #345) The doctor and I had discussed a plan to motivate his team and increase production. This was many years ago. Over lunch, we had a team meeting to announce the plan to his other two doctors and about 10 support staff. He announced that if certain goals were met over the next 7 months, everyone could get a trip to Hawaii.

Everyone was shocked. Including me! The doctor and I had discussed a two-month plan for rewards based upon a modest performance improvement – but not Hawaii and not the increase in production he wanted. He came up with this on the spot during our meeting.

But that afternoon, amazingly, the phones lit up. People were calling in for appointments. (Never mind that this was an example of Innate or Quantum Entanglement!) As I recall, they had their best month ever. But unfortunately, they soon realized that the goals were unrealistic, they had little support to achieve them, and the doctor saw that he couldn’t afford it even if they did reach their goals. The practice subsequently went into a long-term slump.

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

What is the lesson? Well, there are a few of them, but I want to focus on motivation.

While it may seem like people become motivated because of the “carrot,” or the reward, there are deeper reasons – or principles.

Edward Deci, along with others, put forth a new framework for motivation called Self-Determination Theory. Essentially, it states that we are all driven by intrinsic goals as part of our fundamental nature. Our reward comes from the satisfaction we feel from the achievement more than from any external prize.

These are the three intrinsic goals we all share:

AUTONOMY. We all want to play in our own sandbox! We need to feel in control of our own corner of the world. Just like we don’t like insurance companies intruding into our clinical decisions, staff does not like being micromanaged.

COMPETENCE. We all want to be superheroes! Deep down, the prospect of becoming more skilled, more masterful, and better able to be in control of our environment is a drive we all have.

CONNECTION. We all want to be part of something bigger than ourselves. This manifests in two ways: a) being part of and working with a supportive group or team, and b) working to help bring about something more significant than our paycheck or the accomplishment of our everyday tasks.

The office staff was excited to go to Hawaii, but this was not necessarily because they could lie in the sun. It was because it was a huge goal that gave them a very large sandbox to play in – together – to work for a very large result.

Self-Determination Theory is why games work. In Kevin Werbach book, For the Win, he discusses the subject of Gamification.

“For thousands of years, we’ve created things called games that tap the tremendous psychic power of fun. A well-designed game is a guided missile to the motivational heart of the human psyche. …monetary rewards aren’t even necessary because the game itself is the reward.”

Whether it is a sporting event, video game, or Sheepshead (a popular game of old-time Wisconsinites, so I’ve heard), we love our games. And I think we need them.

But it all goes back to the principles of Self-Determination Theory.

Remember when you started your business? The challenge that lay ahead? The new business card that identified you as the hero to conquer new plateaus?

Those drives are still there and can be rekindled, regardless of prior disappointments.

As Soon as You Make a Goal—You Have Created the Potential for a Game.

Win or lose, IF the principles of Self-Determination Theory are in place, you will be motivated and so will those with whom you work.

Apply these principles to yourself and your team – for the game, for the fun, and for the win!

Seize the Future,

Ed

For more information on how to apply self-Determination Theory, games, and motivating yourself and your team, please purchase the book,
The Goal Driven Business. [Link to sell page]

 

How to Create a Full Appointment Book with Goal Driven Marketing

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busy desk, planning calendar

Happy Valentines Month!

This article is about sharing the love… the love of your services and how they can help people.

And what is the best way to do this? Create a Goal Driven Business.

A Goal Driven Business runs at FULL CAPACITY, or close to it.

That means no more room in the appointment book. It can mean that there is a waiting list to get in to be seen. But how is this achieved?

In a practice, it is a combination of excellent service and clinical results, inspired leadership, sound management, personal integrity, and … marketing.

Let’s take a took at marketing first. What is marketing?

It is a method of helping people get what they innately want through communication. Marketing communication, either through one-to-one contact or through media, communicates and educates in such a way as to point to what an individual wants. It also can inspire them to get it.

Goal Driven marketing is helping people get to their goals!

People want to be free of pain and discomfort, but they do not know about your services or how your services can achieve this. And if they do, they may not trust that you can do it for them.

Every marketing approach you have must help those people who have a particular need or want to find you, and discover how your services can help them, and why they should trust you. This can be accomplished through patient referral programs or events, setting up external alliances, direct response ads in social media, radio, through one-to-one external relationship building, speaking events – all these and more point to how you can help people and that you can be trusted.

Testimonials and reviews top the list, but so do articles, newsletters, and support from opinion leaders. These are all outward types of marketing communications.

What would someone who knows what you know about your services do if they had pains, or lacked mobility, wanted to improve their immune system, and just be healthier? They’d drop by and see you for an adjustment or for some kind of a treatment from your office.

Not everyone wants what you have to offer, and even fewer want it bad enough to do something about it. But there are more than enough people who are looking, right now, to act who could keep your office full – if they just knew about what you could do for them.

Many times, I have heard chiropractors amazed at comments from patients who say, “Headaches? I didn’t know you could help with … headaches!” And the doctor just assumed everyone knew that they fixed headaches!

Don’t assume anything. It is a noisy world, and you and what you do is drowned in the snow storm of competitive messages and personal activities.

You must be industrious in getting your message out. You have to be continuous. And this is where most doctors fail in their marketing.

Marketing fails because it is not systematized,
organized, continuous, and managed.

A Goal Driven Business focuses its marketing three echelons of activity.

  1. Marketing Procedures. Obviously, the different types of marketing communication and marketing procedures need to occur. This is the most evident (and fun) level of marketing – marketing procedures.
  2. Marketing Motivation. But even if you have bookshelves of marketing binders and libraries of marketing books, they will do nothing unless you and your team are motivated to use them. So, this is the second level of marketing.
  3. Marketing Management. The third, and I believe the most essential level of marketing activities, is marketing management.

Your front desk is organized and routine. Your billing is systematized and well managed — or should be. So is your therapy area and your new patient procedures. But in most offices, marketing is not organized! It is hit and miss, now and then. When numbers are down, “Hey, let’s do some marketing.” When numbers are up, we all get “too busy,” and it is neglected.

Most practice marketing is reactive and symptomatic. This causes the PRACTICE ROLLER COASTER.

There are simple methods to effectively manage your marketing systems to help create a full appointment book which we can cover in another newsletter.
But keep in mind two important points in marketing:

  1. Help People Get to Their Goals and Obtain What They Want. You are helping people who already have a perceived need and want to purchase what they are looking for. You simply must help them find it in what you offer and convince them that you are worthy of their trust.
  2. Manage Your Marketing Procedures and Keep them Running. Stay motivated, find the procedures that work best for you, but organize your marketing procedures so that they continue. This will help you avoid the Practice Roller Coaster.

To find out more about how to create a Goal Driven Business and create a full appointment book, buy and read the book the Goal Driven Business. Read about it here.

Happy Valentines Month! Spread the Love!

Ed

 

Are Your “Engines” Driving Your Practice?

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

Five engines drive your business to its goals.

If these are installed and firing at 100%, practicing will be enjoyable and profitable. When these engines are not fully performing, the daily demands of running a business shift to, and fall upon, the owner.

These engines are functions and characteristics of a dynamic team that drive the practice toward its goals.

Many offices that seem to be doing well are driven by heroic owners fighting each day to grow their practices, and not by their engines. But this isn’t easy to sustain. At some point, it becomes too much, and they settle into a comfort zone below their abilities. As a result, their long-term goals remain unfulfilled.

This is the plight and path of the entrepreneur – brave, independent, but too often without a map on how to build a strong business that drives itself.

The five engines that drive a business to its goals are:

  1. Marketing
  2. Leadership
  3. Management
  4. Service
  5. Personal Integrity

I want to begin passing on tips on the marketing engine– what is working now and my best estimation of what will be working in the future. Marketing is vital, for without paying customers, the other engines won’t work and aren’t needed.

But before I do, I want to invite you to look at your business and gauge the health of each of your engines.

You can do this by reviewing how successful you are at achieving each engine’s outcomes (goals) and giving them a grade from one to five (1-5). 5 would be the point where the engine is achieving its goals.

  1. Marketing. Abundant new patients and goodwill with local allied businesses, organizations, and your community. A waiting list practice. (1—5: ___)
  2. Leadership. A business with clearly defined goals that are agreed upon and pursued happily. (1—5: ___)
  3. Management. Expert team members, acting as an expert team, implementing simple but effective procedures. (1—5: ___)
  4. Customer Service. Customers (patients, clients, customers) who are extraordinarily satisfied with the services they receive and their outcomes. (1—5: ___)
  5. Personal Integrity. Each team member is happy because of the positive and and responsible manner in which they manage their personal lives. (1—5: ___)

By grading each engine’s “output,” you can immediately see what needs the most work.

But these engines do not work independently. One affects the other so that there is a synergy created. As one improves, so do the others. The opposite is also true – the more one engine dies down, the more the other ones do as well.

It could be said that everything begins with leadership, and that may be true. But unless you are marketing your services, there will be no one to lead!

So next week, let’s look at a few effective marketing strategies and tactics that will help drive your business to its goals.

And by the way, how to achieve a 5 for all your business engines is described in The Goal Driven Business. If you haven’t read it yet, I encourage you to do so.

A great new February to you all,

Ed

Faith Demands to Make a Difference

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GoalDriven.com - Faster to a Better YearDecember 30, 2021

A year ago, who knew what the next 12 months would be like?

Yet, here we are today.

As the New Year is just before us, again, one can only wonder at what the future holds. Is this the “New Normal?”  How far will it shift in the next twelve months? For you, your patients, and your business?

Whathe goal driven businesstever new realities lie ahead, we are ready to help you and your business. We will be launching a new approach to practice and business building with the theme of Faster to Your Future in January. It is based upon the book the Goal Driven Business.

 

But just before we start the New Year, I wanted to pass along a message of encouragement.

It often amazes me that with all the wars, both “hot” and cold, the greed, the fear, and tyranny, with all of mankind’s utter insanity over the centuries, we are doing as well as we are. Somehow, as Abraham Lincoln predicted in his first inaugural address in 1861, “…the better angels of our nature…” came through and prevailed. Whatever challenges we may have, his were enormous. He was facing a nation divided, secession of the southern states, the policy of human slavery, civil war, and a world of other conflicts.

But in the end, there is something about the Innate Goodness of Life that seems to propel mankind forward towards a better future, however slightly. I think that the more we trust in the Better Angels of our Nature, and in the Goodness of Life itself, the more sure our road will be toward a better year for us all and a happier future.

“I have one life and one chance to make it count for something . . . I’m free to choose what that something is, and the something I’ve chosen is my faith. Now, my faith goes beyond theology and religion and requires considerable work and effort.

My faith demands — this is not optional — my faith demands that I do whatever I can, wherever I am, whenever I can, for as long as I can with whatever I have to try to make a difference.”

― Jimmy Carterjimmy carter supervising

So with this, we look forward to working with you to help make 2022 both prosperous and rewarding.

With admiration from all of us at Petty Michel and Associates,

Ed

Medicare Reimbursement Cuts Delayed in 2022!

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On December 10th 2021,  President Biden signed into law a bill to delay reimbursement reductions for physicians. Further, the proposed 2% sequestration reimbursement reduction to physician services as well as to farmers, has been delayed.

Please see the 2022 Wisconsin Chiropractic physician fee schedule below.

For your reference, here are the 2020 and 2021 Wisconsin Chiropractic physician fee schedules:

For over 35 years, Petty, Michel & Associates has been at the forefront of keeping up to date with CMS Medicare & Medicaid Service’s billing and coding standards. Questions? Contact us at 414-332-4511 or email Lisa-lisa@pmaworks.com

Source: https://www.jdsupra.com/legalnews/bill-averting-medicare-sequester-cuts-4029291/

For more details on fees and relative values in your practicing state, refer to your Medicare Administrator Contractor’s (MAC’s) website.

David Michel

The Problem With Seminars

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the problem with seminars

I am all for seminars. Been to many myself. I know I have gotten useful information and, no doubt, have benefited from them.

But, their usefulness is often wasted.

I just talked to a business owner that came back from a seminar he and his doctors and staff attended. He told me that they have started hitting their best-ever weekly numbers. His office manager told me that everyone is excited.

For now.

I have seen it time and time again… go to a seminar, get stoked, come back, numbers go up for a month or so, and then everything returns to how it always was. In essence, the seminar was only a short-term, “acute care” fix that addressed symptoms. Nothing was really improved or corrected.

There is a solution on how to benefit the most from seminars. I discuss it in my book, The Goal Driven Business, from which most of this article is quoted from. The following is a story related to me from a chiropractic staff member a few years back:

“Our office was really slowing down last year. So, the owner decided to take everyone out of town to a weekend business seminar. The speakers discussed new and efficient methods for doing our work. It was entertaining and informative. Plus, we also gained some great marketing ideas. It was a fun seminar, so we were all 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 had to take care of urgent matters first, 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, but then customers begin arriving for their afternoon appointments. We had to call the meeting to an end without getting through very much of our agenda, but we agreed to continue the meeting the following week. Turns out, we never did meet again about the seminar.

“But we were still pretty motivated from the out of town trip to the seminar and, as I recall, we had one of our best months ever. It’s 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 never opened; so I stored them 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. 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 exactly the same way countless times. Starting, and not following through. No management and marketing system is set up, and no time scheduled to ensure the system is followed, and no lasting improvement is realized.

And I am sure, for most of us, this phenomenon applies to our personal lives as well. For instance, how is your exercise program coming along? Hmm? You’ve set goals to work out more often and eat better, right? To work ON your body, not just in it. Yet, my guess is it’s been pretty hit and miss.

We want to improve, we make improvement goals, but what happens? Why can’t we achieve them? Consistently. Is it that we’re all too busy? Too lazy? There seems to be no solution, so we accept our condition and do our best.

Yet, there IS a solution, and it’ll seem like science fiction—but, it’s actually a science fact.

The Goal Driven System of Business Development covers 20 Big Shifts, or actual office adjustments, that need to be made to reach your goals — and stay there. It takes you out of the Practice Roller Coaster that forces you to finally “settle” and accept a lower level of success because the stress of the ups and downs becomes too much.

Here’s how to get the most out of seminars from The Goal Driven Business.

goals lab goaldriven.com “BIG SHIFT #1: Introducing the Goals Lab
You can’t improve your car while you’re speeding down the freeway. You must take it to a mechanic at a garage. Athletes and musicians alike spend time away from their audience to practice their game skills or their music, always improving their performance. Businesses need to do this as well. But where? And when?

 

The answer is you need to create a Goals Lab where you go to work on your business.

Your Goals Lab is a special place, a laboratory, an oasis for change. Here, you can think, study, learn, practice, become inspired, and have conversations. Here is where you go to reset your thinking and improve your actions—and the actions of others in your office as well.

I call it the Goals Lab, but you can give it another title, if you wish. Whatever you call it, this is the first Big Shift you’ll take on your journey to achieving your new goals.

Goals Lab to engineer your best route to your goals, Goalddriven.com

Why do you need a Goals Lab? Because you simply cannot focus on the other Big Shifts when you are in your office, juggling customers, staff, bills, phone calls, emails, vendors, and everything else that consumes your energy and brainpower.

Management companies and consultants may have advised you to work on your business, not just in it. While the idea of working on your business, as opposed to in it, is a clever and useful concept, I have rarely seen it applied consistently or comprehensively. Why? Because real business improvement can be more demanding than meets the eye. It is a separate activity that requires its own distinct time and place, and it has its own rules which must be followed to be effective.

I use the term Goals Lab because it is a virtual location that you visit to improve business performance. As an example, you spend most of your time with your car driving it. But you also take time to take your car to a special place where you let a mechanic work on it.

Not knowing about this place, this Goals Lab, its rules, and how it operates, is a fundamental reason why all your management books, marketing manuals, and practice improvement notes from seminars rarely get implemented.

Your Goals Lab has been mostly hidden from you. It almost has a fourth-dimensional location, which is outside the time and space continuum.”

Why don’t we spend more time on improving the business, not just working in it?

This is the real question, and it is answered in the book, The Goal Driven Business. You can read about it now, or wait for my next article where I explain WHY business improvement is so difficult and what to do about it.

Meanwhile, keep improving.

Ed

Learn more about book and get it here: https://www.GoalDriven.com

the goal driven business by edward petty

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

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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”

The Mental Immune System

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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

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Image from: Kellogg, Yevgenia Nayberg

KINDNESS and the Strength of Your Practice

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"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)

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Why What You Stand For is Important

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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)

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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.

What is an Adjustment

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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

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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?

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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

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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.

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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

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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”