Since 1983, Kathy Mills Chang has been providing chiropractors with hands-on training, advice and a broad range of solutions aimed to effectively assess and improve the financial performance of their practices. A well-known and sought-after speaker, Kathy Mills Chang has served in National and State level chiropractic organizations, sits on diverse boards and advisory councils related to the profession, and is frequently invited to address chiropractors in important conferences and seminars around the country.
In an interview with The American Chiropractor, Kathy Mills Chang shares some of her tips on coding the right way.
TAC: So how did you get involved in chiropractic?
KMC: In 1983, my brother, who owned an X-ray company, told me about a client of his looking for an insurance Chiropractic Assistant (CA). It was a high-volume, very straight practice in Phoenix. The doctor, his wife, and I managed to see well over 200 patient visits (PV’s) per day. I learned by hook or crook how to bill insurance. I also became a patient the same day I became an insurance CA. It wasn’t long before I learned firsthand how chiropractic care impacts patients. My lifelong asthma was virtually cured. My own health was transformed and my career began. I’ve always felt that I owe back the profession for the way my health was restored. That’s why, when I harp on doctors to do the right thing in coding and documentation, it’s because I really do have a higher purpose to help doctors achieve the respect and the financial rewards so richly deserved.
TAC: How did working in such a high volume practice starting out shape your development as a consultant?
KMC: I’ve been a worker bee for most of my career. Working in the offices I have gives me a great perspective on what does and doesn’t work. Only since 1999 have I been out of the day-to-day inner workings of a practice. That original high-volume practice and, later, managing one of the largest chiropractic group practices in the state of New York, taught me to rely on systems. As a consultant, I’ve watched practices adopt new procedures that work, only to see them fall out again. Without these systems, there’s no predictability; and, when a team member or doctor leaves a practice, we start over at zero. My KMC University Standard Operating Procedure is one of the most popular pieces of our curriculum and serves this purpose. Many of the systems I teach are those I developed just to make my life easier and, in my day, I was a master collector!
TAC: What is the #1 most frequent coding mistake that you encounter?
KMC: The biggest mistake I encounter is doctors’ simply coding based on what they think is right or their buddy down the road told them to do, rather than learning for themselves. There is a high percentage of doctors who don’t think they need to know what code is what, and why to use it. I recently testified on behalf of a client in a deposition with Allstate Insurance, and it was confirmed for me just how much doctors are expected to know. I was grilled extensively about this doctor’s knowledge of Evaluation and Management codes that were used, and why they might have selected the ones they did. Similarly, some doctors will choose to down code the Chiropractic Manipulative Treatment codes, from 98941, the 3-4 region code, to 98940, the 1-2 region code, just to "fly under the radar." This is not good practice. Your payer profile will reflect the aberrant pattern, whether too low or too high. The simple answer is, always code for exactly what you do.
TAC: How can someone go about fixing this type of a problem?
KMC: Be willing to be educated, or employ and rely on someone who is. Gone are the days of simplicity in coding and documentation. Attention to detail has never been more important. When doctors have an opportunity to attend a seminar on this topic, they should embrace the opportunity. Use team members to monitor and guide you in this area. Hospitals often employ coders to decipher notes and apply correct coding. Be in partnership with your team to ensure that your various services are described appropriately. For example, in the previous question, I mentioned that doctors often down code the 98941 to 98940. Medicare recently posted a clarification that, when a doctor is treating a full spine, but only 1-2 areas meet the definition of medical necessity, the correct coding is 98940-AT and then 98940-GA, indicating that they have notified the patient the additional spinal region is not covered, and have an advance beneficiary notice or ABN form signed to this effect. This clears up a lot of confusion that has existed for full spine adjusters who want to be more compliant.
TAC: By growing as a non-D.C., how do you think your appreciation for coding and compliance is different from that of D.C.’s?
KMC: It gives me global perspective, and I can be impartial. My experience of doctors of chiropractic is that they are passionate about the treatment, the need for the patients to receive the treatment, and the need to be reimbursed for that treatment. Sometimes, that sullies their viewpoint, out of frustration, and doesn’t allow for impartial logic. As a staff member for the American Chiropractic Association, I had the opportunity to serve the profession from that level, and participate in the AMA coding process and work with Centers for Medicare & Medicaid Services (CMS) on Medicare issues. I’m several levels removed from the actual patient experience, which allows me to trust the systems and the policy or law. There is often more than one way to solve a problem and, with this knowledge, it allows me to look for the twists and turns in the rules that will best serve a client. Likewise, by understanding what you can’t do, it opens up a world of possibility for what you CAN do. That gives me a unique perspective to advise clients on ways to keep a robust reimbursement department, while staying safely on the right side of the law.
TAC: So what exactly is KMC University?
KMC: Well, our mission is clear: We inspire chiropractors and their teams to realize certainty about the financial aspects of practice, including Medicare, documentation, coding, billing, and patient financial matters, and to achieve their rightful abundance of practice profitability. It’s the education arm of Kathy Mills Chang, Inc., and the way we deliver our financial department coaching curriculum. What makes it unique is that we can accommodate a doctor who needs a single, quick fix, by selling them a product or an hour of consulting time, without a long term commitment. In fact, one of our most popular products is our Straight A’s in Thirty Days. It’s a one month coaching program particular to only one topic, like coding, documentation, patient finances or setting proper fees. It’s a guided, one-month program, consisting of analysis, training, and personalized attention that is laser focused on a specific area. We are uniquely able to offer this at an outstandingly low fee, so it attracts a lot of doctors not interested in longer term commitments. We also offer our full curriculum when it’s needed and appropriate, and guide and train doctors with over 50 unique curriculum items from coding and documentation, to Medicare and patient finances. We do this with online training, consulting, and our very popular Hands On Lab, which is the two day training seminar we hold monthly.
TAC: Do you have any thoughts on how Healthcare Reform will impact chiropractic?
KMC: While our slice of the national health care pie is not the largest, we have dedicated patients who know the value of chiropractic care. I honestly can’t imagine a system that doesn’t include some kind of chiropractic coverage, not unlike Medicare. I’d hate to see all of our cash patients suddenly turn into Medicare patients, as I think most of the doctors I know would want to jump off a bridge. But we have a very strong American Chiropractic Association which has great inroads to the decision makers. The research is showing great outcomes for chiropractic, and cost effectiveness studies have been very favorable. It’s never been more important for our patients to get involved, and I love the new Chiro Voice available for them to express their opinions. I’m an old-timer who believes that our patients will find a way to get what they want, no matter what. It will force doctors to become better educators, clearer communicators, and superior health advocates.
TAC: What’s been your experience with exclusively cash practices versus exclusively insurance practices?
KMC: The concept of an exclusively cash practice is an interesting one. Because of the laws and rules pertaining to Medicare, even a doctor who is a cash practitioner must bill Medicare on behalf of those patients. So, billing and collections rules still have to be followed. That means there is almost no such thing as an exclusively cash practice. I’m an advocate of having a wonderful balance of cash and insurance, within the comfort zone of the doctor. The truth is that surveys have shown that about 70% of patients have some kind of insurance that will cover their chiropractic care. They expect to be able to use it. I’m not in favor of a practice that would turn those patients away, or have them bill on their own. Those practices that are exclusively insurance, or heavily imbedded in managed care, tend to be the more difficult ones to manage. Not only is there a great deal of work to do for billing and collections, but the patients could be more pain oriented, discontinuing care when they feel better. The most successful practices I’ve worked with have an adequate balance of cash and insurance patients, and ample educational processes that help insurance patients understand the benefits of continuing their care, while paying out of their pocket for wellness care.
TAC: Any final words for our readers?
KMC: Don’t underestimate the importance of accurate coding and documentation in the reimbursement process. We are lucky in our profession that we have such a small number of codes that apply to our services. It’s easy to master them and apply them for maximum benefit of your patients and your practice. Take the time and make the effort to be the best you can be in this area…the dividends that are paid back to you are tremendous.
Kathy Mills Chang can be contacted at
or call 1-888-820-7778