Other Articles


A Square Peg, Round Hole and Insurance
Other Articles
Written by John Davila, D.C.   
Monday, 15 November 2010 11:22

by John Davila, D.C.

 

Over time, we have all tried to force a large square peg into a small round hole and found that there are always leftover pieces that were sloughed off.  And, in order to make this job easier, we’ll need a big hammer to create enough force to ram that peg into the hole and shave off those edges that didn’t fit.
In practice this happens all the time when it comes to dealing with insurance.  If we look at all the parts involved, we could easily label them and make it applicable to what we do. The round hole is what the insurance company allows, the square peg is what we think the patient needs to get to ideal functional wellness, the excess shavings are what the patient owes the doctor for non-covered services and the hammer is the doctor’s intention.
Of all the pieces, the hammer is the most important.  This is because it is the doctor’s intention to not allow the patient to influence their decision on who needs to pay for the services billed.  But, unfortunately this happens all the time when the patient is right in front of the doctor and the patient is able to sway the doctor’s decision to bill insurance when the visit should be paid for in cash.  So, we must start with the doctor's certainty on what it is that the patient purchased.  
This certainty must come from the policy itself and from nowhere else. It is not about anything but the policy. If the policy states that it doesn’t pay for wellness care, then it is easy to understand that the pieces sloughed off the side of the square peg are wellness care visits and should be paid for by the patient.  The same goes for exams, x-rays and therapies if the policy excludes these services.  All of these services would be considered “excluded” or “non-covered” and must be paid for by the patient due to policy restrictions.  It would now make sense that when these issues are totally understood by the doctor, it is much easier to stand firm and not be swayed to “just add one more visit on to the insurance company’s bill”.  So what, who cares! The insurance company will never know!
Billing these extra visits that are non-covered can create an insurance profile that causes the carrier to pick you out of a line up and trip the wires to launch an audit.  This would be equal to taking the extra pieces that fell off the square peg, gathering them up and pushing them down the hole, knowing full well is that not where they were supposed to go.  You can avoid this all too familiar scenario by taking the time to do two things.
First, you need to READ your insurance contracts and the policy that the patient has purchased.  Once that is done, it becomes easy to apply the policy to the situation. But, you may be concerned or even confused by all the carriers that you deal with on a daily basis.  In fact, it’s easier than you might imagine to understand the rules, because all insurance carriers have adopted “Medicare” type rules for medical necessity. Finding those rules are simple because each state’s Medicare carrier posts the definition of medical necessity on their websites.   Second, you need to improve your ability to ask the patient to pay cash for certain services when their policy is not going to cover a service, and then be willing to let patients leave the practice if they don’t want to pay.
If you are certain about what your contract requires you to do, and about what the patient has purchased, you can start to look forward to a better profile with the carriers you work with. All it takes is a little time and the understanding that all those little pieces not paid for by the carrier can trigger and audit when pushed down the hole.

 

Dr. John Davila is a 1994 graduate of Palmer College of Chiropractic in Davenport, IA, and practiced in the Myrtle Beach, SC, area for 13 years.  Since 2000, he has been consulting with insurance companies and doctors in private practice in the areas of coding and documentation.  His company, Compliant Services & Solutions, Inc., helps doctors of chiropractic to ethically maximize their practices, while avoiding audits and repayments to insurance carriers.  You can reach Dr. Davila, toll free, at 1-877-322-6203 or by email at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or at www.ComplaintUSA.com.

 
News BYTE
Other Articles
Written by Pharmanex   
Saturday, 02 October 2010 14:17

Dietary supplement to the next level

 

Lifepak® nano is a nutritional anti-aging program formulated to nourish and protect cells, tissues, and organs in the body with the specific purpose of guarding against the ravages of aging. Lifepak® nano offers the highest bioavailability with a first-ever nanotechnology process and advanced levels of key anti-aging nutrients in a comprehensive formula available exclusively through Pharmanex.* Taking this product will increase your anti-oxidant score or they will refund your money.

Primary Benefits

• Nourishes and protects cells, tissues, and organs in the body with the specific purpose of guarding against the ravages of aging each day of your lifespan*
• Superior bioavailability with CR-6 LipoNutrients™ enhances uptake from the gut into the bloodstream and body for maximum anti-aging benefits*
• Advanced anti-aging formula helps protect the body with key nutrients, such as NanoCoQ10™ and nano carotenoids*
• Helps maintain normal inflammatory responses in the body*
• Feeds and helps protect the brain with DHA and EPA (two CR-6 LipoNutrient™ softgels contain the same amount of EPA and DHA as two MarineOmega softgels)*
• Offers superior DNA protection against damaging free radical attacks by providing the body with important antioxidants and phytonutrients such as alpha-lipoic acid and catechins*
• Protects cell health with an antioxidant defense network*
• Helps protect cardiovascular health with a comprehensive blend of omega-3 fatty acids and other nutrients
• Provides comprehensive bone nutrition support*
• Promotes healthy immune function*
• Supports normal blood sugar metabolism*
• Corrects nutritional deficiencies*
• SCS certified
For more information go to www.aolscanner.com or call 1-800-337-7715.


*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

 
Ask the Advisor
User Rating: / 1
PoorBest 
Other Articles
Written by Lisa Goldberg   
Thursday, 30 September 2010 10:48

Ask the Advisor

Q&A with Lisa Goldberg

 

Q I have all of my marketing in place, but I’m getting calls from potential patients who are on care plans that I’m not currently a provider of.  I would like to get credentialed with care plans, but I’ve heard that it can be costly: from $6,000-$8,000.


A Like any product or service, you can expect to spend money, and there are some companies out there charging anywhere from $6,000 to $8,000 and above.  We have found a company that is inexpensive, by the name of Practice Services and Solutions, but they still provide you with a quality service.  For example, they can get a chiropractor credentialed on ALL care plans for $3,000.  If there are some care plans that you may not be eligible for, the company will then refund some of your money.

Always remember to shop around and ask for references!  Do not sign up with the first company that you meet with; that goes for any product and service out there.  There is always somebody cheaper that will provide you with quality products and services.



Q Are there any quick ways to increase my revenue with products that are reimbursable?


A There are so many products that are either inexpensive or do not require any money up front.  A great product to bring into your office is a lumbar back support.  Especially for those chiropractors that are medically integrated, you must find a lumbar back support that is FDA and Medicare approved.  There are new Medicare regulations on billing and there are new parameters for what Medicare is covering with regard to lumbar back supports.  For example, you might find a back support for $45 instead of $125, which would make the reimbursement seem higher; however, if Medicare does not cover this and asks for the money back, that $45 belt can turn out to be more than you bargained for.
Patient comfort level is also a factor.  Finding a support that is flexible as well as sturdy is important, as most patients do not want to feel as though they are in a body cast for the duration of their treatment.

 

 

Dr. Lisa Goldberg is the executive director of Physicians Choice Concierge (PCC), a company specializing in revenue enhancement. If you have a question about a mentioned product or service or if you would like Lisa to answer your question in an upcoming issue, email
This e-mail address is being protected from spambots. You need JavaScript enabled to view it or call 1-888-369-2224 for a personal consultation.

 
Maximize Your Practice Potential
Other Articles
Written by TAC Staff   
Friday, 24 September 2010 14:39

Many of the profession’s leading practice coaches answer questions about the most common problems chiropractors face in their practices.

 

 

Practice Smarts from the Pro’s:

As we wrap up the end of 2008 and prepare for 2009, we've asked eleven of the profession's leading practice coaches to answer what they feel are the most important questions to help you advance your practice. From focusing on who you are as a doctor to over-all advice to the entire profession, these experts have the answers to help guide you through the rest of this year and beyond.

 

 

 

 

 

 

 

 

 "The first step toward absolute victory in the success of your office is creating an infrastructure that works."— Dr. Mark Studin, CMCS Management

 

 

Q: Who do you work for?

A. The answer is, usually, our staff, as most doctors are not experienced in business policies and procedures. Therefore, it is much easier to abdicate the creation and implementation of those procedures to those we hire.

Many of you will also change procedures with each new staff member under the banner of, "It will work better because the new staff member says so."The truth is, most offices have such little or no infrastructure (business systems) and this is the single reason for the "Roller Coaster" weeks and months in business. One week is great and the next, unpredictably, is horrible, where you can’t meet payroll or rent. I know, the problem is the insurance industry, the staff, the patients, the accountant and the dog. Did I miss anyone?

The truth is, every week can be very predictable.

The problem is you! A doctor is also a business person and, as the CEO of your business, you need to lead with an infrastructure that is reproducible (just like McDonald’s or IBM) and tested. Your staff has no leeway in changing your systems and they must answer to you, not the other way around.

The first step toward absolute victory in the success of your office is creating an infrastructure that works. Secondly, take absolute control by delegating and not abdicating every facet of your practice. Remember, it’s your name on the shingle out front!

For more information, call 1-631-786-4253 or visit www.CMCSmanagement.com.

 

 "When your actions in practice are supported by your values and guided by a clear vision, you will stay on purpose."—Dr. Jeffrey Slocum, Learning Curves

 

 

Q: Why is it that so many chiropractors have a hard time with burnout and frustration in practice?

A. Chiropractors are a very unique group of individuals that are, at the core, very compassionate and altruistic, which, in a service model, makes us very good care givers. On the other hand, we have, as a profession, a general lack of training or education in entrepeneurialship or business acumen, which, in a business model, makes us very uncertain and insecure. What this creates is a driven, ambitious, and optimistic care giver who lacks confidence, clarity, and certainty in business. The answer is to build a practice that is values-based and vision-driven which incorporates the success triad in both the service and business aspects of the practice. When your actions in practice are supported by your values and guided by a clear vision, you will stay on purpose and this helps you maintain confidence, certainty, and consistency, which are the keys to avoiding and/or curing burnout.

For more information call 1-800-613-2528 or visit www.LearningCurves.us.

 

 "Training your staff on how to market your practice will instill awareness, generate interest and pay big dividends."—Dr. Peter          Gambacorta, Access Health Consultants, LLC

 

 

Q. Who is in charge of promoting your practice?

A. The short answer is, "Everyone". Training your staff on how to market your practice will instill awareness, generate interest and pay big dividends. Knowledge and pride about what you do as a team and the positive effects that has upon the lives of your patients produces a desire to share their personal story with others outside of the office. Viral marketing is sharing that personal story with everyone they come in contact with, letting them know that they take pride in what they do helping others. Train your staff to "Catch it, give it, and send the word along."

For more information, call 1-866-912-4355 or visit www.AccessHealthConsultants.com.

 

 "A practice clearly requires a chiropractor to wear two hats—one as a doctor and one as a businessperson."—Dr. Pete Fernandez      Fernandez Consulting

 

 

Q. Why does my practice lack new patients?

A. A practice clearly requires a chiropractor to wear two hats—one as a doctor and one as a businessperson. Typically, if a practice lacks an influx of new patients, it’s because the doctor is not keeping up with business. Business is like an automobile. The only way it runs by itself—is downhill.

Learn how to wear both hats comfortably, and take pride in being the treating doctor and businessperson who professionally and proficiently serves his/her patients. When you do, your patients benefit, your profession benefits, and you benefit. Everybody wins.

For more information, call 1-800-882-4476 or visit www.DrFernandez.com.

 

 "Get your patients thinking in terms of a process, not a quick fix. Complete your report with the idea of the process of correcting dysfunction."—Dr. Bruce Parker, Inside Out Practice Development

 

 

Q. How I do I convince patients who are "feeling" better, and say they will come back when it is "out" again…to remain under corrective care?

A. The largest misunderstanding patients have is "symptoms vs. no symptoms." In your report of findings, as you walk in the door, say, "I am so glad we performed those tests yesterday. I found some very important information. The pain you have been having, well it is NOT your problem! This is why the other treatment you have been receiving has not worked. The other doctors were simply working to cover up your pain and, when the treatment wore off, your pain returned because they did not address the real issue.

"Let me explain. Your body is designed to work in a specific way; your skeletal alignment is important for smooth joint function. When your body is in a normal state, it has normal function. If the structure begins to fail or become misaligned, it causes joint dysfunction. Dysfunction leads to irritation, then inflammation and results in pain."

Now, ask this question: "If you were going to ‘fix’ your problem, what would be your approach…treat the pain or the dysfunction? Dysfunction, yes!"

You have now got them thinking in terms of a process not a quick fix. Complete your report with the idea of the process of correcting dysfunction.

For more information, call Dr. Bruce Parker at 1-951-471-0601 or visit www.BackInActionsdc.com.

 

 "You and your team must always be able to predict what will happen next in your practice."—Dr. C.J. Mertz- Team WLP

 

 

Q. How do you provide high quality service to your existing patients and still attract a steady flow of new patients?

A. To accomplish both of these critical practice-building elements with any regularity, you must never ad lib! You and your team must always be able to predict what will happen next in your practice. However, eliminating ad lib in your practice is not easy. Generating consistent results requires three critical steps:

1. Learning a system that has been proven to yield such results;

2. Fully implementing this system in your practice; and,

3. Training diligently as a team to constantly improve your execution of the system."

For more information, call 1-877-832-6957or visit www.teamwlp.com.

 

 

 

 "When you do something that no one else does, you own the marketplace."—Mark Sanna, DC, ACRB Level II, FICC, CEO, Breakthrough Coaching

 

 

Q. How do I make my practice more profitable?

A. For over 100 years, the chiropractic profession has adopted a business model based upon two components: the fee for an examination and the fee for an adjustment. A recent survey reported that only 50 percent of chiropractors offer their patients exercise instruction, nutritional advice, or any other ancillary services. As we move ahead into the era of healthcare reform, our business model must change. It’s been said that "diversification dominates," which means that, when you do something that no one else does, you own the marketplace. In order for you to thrive in the years ahead, you must diversify your business model. As the Baby Boomers exert their market forces on the healthcare delivery system and the chiropractic profession confronts the pressures of healthcare reform, one choice becomes obvious. That choice is to adopt a business model based upon delivering wellness services along with the traditional chiropractic services of examination and adjustment.

For more information, call 1-800-723-8423 or visit www.MyBreakthrough.com.

 

 "Your patient documentation must be done at the time the patient is in your office for the visit."—Dr. Timothy J. Gay     Director, Ultimate Practices

 

 

Q. Why do I dislike doing my reports and chart notes?

A. What I find with doctors is they are creatures of habit and have a tendency to look for the short cut or the path of least resistance. Unfortunately, if you are depending on a third party to pay for your services, there are rules and regulations that dictate when and how reports and chart notes must be done.

Your patient documentation must be done at the time the patient is in your office for the visit. Don’t put off taking notes or writing the report because it will come back to you in the form of sleepless nights and even more work for you and your staff later.

Furthermore, if you were a little kid that didn’t like eating broccoli at dinner and you were scolded by your mother, your reports and documentation methods that you are avoiding may be stemming from that same feeling, so maybe it is time for you to become responsible for your destiny and step up to plate, no pun intended.

For more information, call 1-866-797-8366 or visit www.UltimatePractice.com.

 

 "If you don’t ever speak to people about what you do and how you can help, then no one will know to come to you."—Dr. David Singer      David Singer Enterprises

 

 

Q. How do I obtain more patients and remove their financial barriers to care?

A. New patient marketing has to do with you telling people what you do and how you can help them. If you don’t ever speak to people about what you do and how you can help, then no one will know to come to you.

Referrals are nothing more than patients telling others about you and what you do. Marketing is you doing the same thing except for yourself. The more people you meet and tell how you can help them, the more new patients you get.

You can meet people by doing lectures, health screenings, in-office workshops or by offering free consultations to the families or friends of your patients. Talk to ten new people a week and describe how you can help them and watch your practice go
up.

Once you get new patients, you need to handle their ability to pay for your care. There are two ways to make your care affordable. You can either lower your fees or put people on payment plans they can afford. Most doctors are reluctant to let patients pay a fee they can afford on a payment plan for fear they will drop out of care and never pay their balance. However, by using outside financial institutions, you can give your patients the care they need and still get paid.

Care Credit, found at www.carecredit.com, provides money for the patients with a credit score above 650. They pay you directly, in advance, but charge you a 10 percent fee. Mention "chiropractic legal action fund" when you register and they will donate 50 percent of your fee to our legal action fund.

Then there is Healthcare Payment Solutions. They will pick up and provide financing for all patients denied by Care Credit and charge 6 percent to the patient. Contact them at www.healthcarepaymentsolutions.com and, again, mention the "chiro legal action fund" and they will donate $100 to our legal fund when you register.

For more information, call 1-800-326-1797 or visit www.dse-inc.com.

 

 "The quality of compliance is always the end result of the quality of communication.... Effective communication is a practiced art. Keep working on your skills and your patient compliance will improve!"—Dr. Danny Drubin     ProPractice Partners.

 

Q. How can I improve patient compliance?

A. It is important to remember that, when it comes to causing patients to follow your recommended program of care, responsibility falls as follows...about 80 percent of patient compliance is directly the responsibility of the doctor and the remaining 20 percent is the responsibility of the front desk assistants. What we know for certain is that the quality of compliance is always the end result of the quality of communication. The doctor and assistants that truly understand how we impact others will ultimately be the most effective in influencing the actions of their patients.

Consider the following: When it comes to how we impact others, only 7 percent has to do with the words we choose, 38 percent of our impact is how we present those words and the remaining 55 percent are all of the other important factors to effective communication. These factors include eye contact, hand gestures, physical appearance, attire, animation, energy and enthusiasm. Remember, more people are moved by the height of your emotion, than the depth of your logic. This is why the more passionate presenter has the greatest opportunity to motivate their patients to health.

Effective communication is a practiced art. Keep working on your skills and your patient compliance will improve!

For more information, call 1-520-575-0207 visit www.ProPracticePartners.com.

 

 "How you do anything, is how you do everything. Think about that. If you learn to discipline yourself in the small things, and work up to the big things, this will spill over into all aspects of your life, including your practice."—Dr. Andy Harris, Dynamic Practices

 

Q. How could I improve my practice?

A. Many chiropractors have presented their problems to me, and most of the time these problems are simply symptoms. One of the biggest underlying causes of these symptoms is simply DISCIPLINE.

There’s a great saying I heard from Zig Ziglar a number of years ago: "When you’re hard on yourself, life is easier on you." And there’s the old military saying, "If you sweat more in peace time, you’ll bleed less in war time."

It takes discipline to get up early and workout. It takes discipline not to go back for a second helping of food. It takes discipline to take your vitamins and minerals. It takes discipline to raise a healthy and well functioning child. Discipline can be painful…but look at what happens to those who lead lives without any or very little discipline. They typically don’t exercise regularly, thus they gain more weight than they should. They eat until their heart is content; they don’t learn new habits; they are lazy.

I don’t know about you, but I cannot stand the word lazy, and I want to be the exact opposite of that. It’s a challenge for me to see so many chiropractors who haven’t disciplined themselves in their eating, exercise, etc…and they wonder why their practice is so slow.

The truth is, how you do anything, is how you do everything. Think about that. If you learn to discipline yourself in the small things, and work up to the big things, this will spill over into all aspects of your life, including your practice.

For more information, call 1-800-471-9421 or visit www.DynamicPractices.com.

 
America’s #1 Peak Performance Coach
Other Articles
Written by Anthony Robbins   
Friday, 24 September 2010 14:25

America’s #1 Peak Performance Coach

by Anthony Robbins

 

Having directly impacted the lives of more than 50 million people from 100 nations with his work in the field of leadership psychology and peak performance, Anthony Robbins is the one who gets the call from the superstar athlete when the game is on the line—fierce competitors like Andre Agassi, Serena Williams, Greg Norman, Wayne Gretzky, and marathon runner Stu Mittleman, who set the world record by running 1,000 miles in eleven days. Having spent the last three decades mastering the principles of vibrant health by studying a diverse cross-section of experts to find the most efficient and effective tools for getting real results, Anthony Robbins knows the mechanics behind taking the invisible and making it visible.

 
«StartPrev11121314151617181920NextEnd»

Page 11 of 63
 
TAC Cover
TCA Cover

Click on image above
to view the
Digital Edition


Advertisement

Advertisement

Advertisement

requestmagazinebutton

 

TAC Publications

The American Chiropractor Magazine: Digital Issues | Past Issues | Buyer's Guide

 

More Information

TAC Editorial: About | Circulation | Contact

Sales: Advertising | Subscriptions | Media Kit