Tag Archives: lisa

Ask Lisa: Setting Up Finances With Your Patients

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BJ Palmer had a quote: “Chiropractic is health insurance. Premiums small. Dividends large!”

Following this super quote, we have worked with offices for many years schooling them into implementing these mottos:

  • We will accept all patients, regardless of their ability to pay, but we also must operate the clinic as a proprietary business, i.e., for profit, and the patient must want the care–not just “want a discount.”
  • Each case will be individually handled and patients will receive a copy of their financial arrangements.
  • Each patient file will have a copy of the patient’s individual financial arrangements.

How does the successful office achieve these goals?

First, to comply with Centers for Medicare and Medicaid’s No Surprises Act as a covered entity, each patient will have an idea what our range of charges are and that the charges will vary depending on what is done. Explain that the adjustment charges will vary from $XX to $XX, therapies will add $XX to $XX, and exams, diagnostic tests, etc. will add to that. Typically the average office visit will be from $30.00 to $140.00 per visit. This can be shared when the new patient calls in for their first appointment, or placed on your website.

Second, determine if you will be filing claims to insurance, and if patient has a copay or deductible. If there is a financial barrier with co-pays or deductibles, work with the patient during your meeting with them so that the patient does not drop out of care for financial reasons. To stay in compliance, note any waived fees or co-payments on your financial form, indicating why they were waived (no job, too many bills). Alert payment arrangements in your practice software so that the front desk and anyone doing follow-up knows exactly what the patient has agreed to pay each visit.

The patient should already have a good idea after Day 1 from the Report of Findings and the schedule you just worked out with them how many times they will be coming in. Ask the patient if they will have any problem with this and watch the patient to make sure that they will be comfortable with the fees you are presenting (previously calculated prior to meeting with patient).

(These next sections are specific to Wisconsin offices and offer examples. However, if you find this information interesting and you want more information and are outside WI, contact us for further information.)

If you are not filing to insurance, patients are considered self-pay. Let the patient know that they must pay at the time of service for any discount given. To be successful, you cannot reduce your fee while running up patient balances.

Any discount or special fee must be noted on the financial agreements and in the computer. The financial agreement must indicate why there are special discounts given. This can be simply noted in the space provided, such as “patient discount to $30 per visit-financial hardship” or “patient has just started new job-discount given to $30 per visit”. The CA or doctor, and patient, must sign the form.

For self-pay patients who can afford care, are on a routine schedule and show up, in order to give a discount they should be required to prepay, for a package of XX visits, typically with up to a 35% discount.

With the above policies in place, you can help many more people increase their health dividends, removing any financial barriers. Implementing these steps are key to expanding and growing your practice!

If you have any questions regarding financial arrangements and/or insurance please feel free to reach out to me.

Lisa Barnett
920-334-4561
lisa@pmaworks.com

ASK LISA: The Vital Importance of the Post Report & Patient Financial Consultation

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Greetings,

In our last two webinars, we discussed the importance of patient financial consultations.

Let’s delve into why they are so important to your bottom line and how you can set them up for success.

First, changes to insurance coverage and managed care have created an environment where third-party reviewers sometimes have more say in your patient’s length of care than you do.

Second, it is important to note that the financial consultation is a part of the overall Post Report. To be successful, all steps below should be reviewed and completed with each patient, whether they are new or re-activating their care. Why a post report?

The purpose of the post report is for the staff to fully address with the patient any obstacles to the patient getting the care they need and to set the patient up for their schedule of care. This includes setting up multiple appointment schedules, emphasizing the importance of staying on the schedule of care, discussing missed appointments, discussing any needed financial arrangements, going over how to check in at future visits, establishing where the patient should turn with questions or problems, and reassuring the patient in their decision to follow through with care.

Before you meet with the patient for the financial consultation, you also have to have a clear understanding of what you want to accomplish with your financial plans for patients. Your plans need to line up with the goals you have in your office and you need to individualize the plans. Do you want a high percentage of cash, wellness patients? An insurance-based family practice? PI or Work Comp acute care rehab practice? Is the patient undergoing a financial hardship? Each has a different set of criteria for tailoring patient financial agreements.

As these become more common, you can increase your patient retention and compliance by offering more OPTIONS for patient payments. Yes, this requires more work and more follow up, but adjusting to changing business practices in the world often require changing your internal procedures and policies. Adapt and offer ways to make care affordable, then promote these options so that patients see there is a way for them to get the care they need at a price they can afford.

Our Motto: Financial Plans are Liberal; Collections Policies Are Not.

This doesn’t mean reducing your fees or giving away services. On the contrary. For example, a new car costs many thousands more than your treatment plan, but auto dealers are adept at showing the customer ways they can drive that car home today.

Standardizing these procedures will ensure that your patients feel well taken care of at the office at all times.

Questions? We can help.

Click HERE for a sample care plan and financial plan template. [LINK]

Ask Lisa: Payer Notes Request: Now What Do I Do?

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stack of medicare insurance paperwork

picture of a womanWith the increase in notes requested from third party payers, more recently Medicare secondary plans, it is good time to review the process once you receive a request.

First, do not ignore the notes request. You can call the payer acknowledging receipt of their request, or simply print or export the SOAP notes from your practice management program and send them to the payer. It is also highly recommended to include the initial patient intake form, or New Episode patient form, exam form(s), and care plan schedule including treatment goals which can simply be specific ADL functions pre-injury.

I also recommend looking to see what the most current Onset date is in your patient profile. Many recurring notes requests are due to the onset date going back two years and more. If this is the case, the patient is due for a re-exam and more than likely a new set of diagnosis codes, and you can include this information in your response to the payer.

If you need a review on what exactly to include in a SOAP note, click on this link HERE to access the checklist that complies with Medicare documentation requirements.

I use this checklist when I conduct onsite documentation reviews.

Questions? Need help with a documentation audit? Ask Lisa – I can help!

920-334-4561

lisa@pmaworks.com

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”