Practice Management

Maximize Your Practice's Potential
Practice Management
Written by Daniel Dahan, D.C.   
Sunday, 14 November 2004 22:37

In an effort to help you maximize all your services, Dr. Daniel Dahan has identified 7 departmental areas in your practice, which need to be addressed.  Each of these areas is being dealt with sequentially in The American Chiropractor.  By following the suggestions given, your office will not only maximize its potential, but also delineate areas of weakness that need your attention.

3. Billing Department

As is well known, the billing department has the most critical job in any one office.  Indeed, insurance companies, as well any third party payers, use highly computerized systems to analyze and sort through doctors’ claims.  Hence, the billing department must pay close attention to make sure that every detail on an HCFA 1500 form is not only accurate but appropriate.  Accuracy has to do with the code which best describes the service rendered.  Appropriateness deals with the usual and customary fee as well as repetitive use of any particular code.

The billing department should conduct continuous reviews/audit:

  • Weekly: Auditing the accuracy of codes used.
  • Monthly: General review of reimbursement for each code per service.
  • Quarterly: Thorough in-depth look at how codes are being classified by payers and if there are any updates to implement.

The biller should be experienced and qualified.  It is highly recommended, as well, that he/she be certified.  One qualified biller is necessary for every $500k billed per year.

The doctor should meet with the biller weekly to get a complete analysis on any follow-ups made.  Changes should be posted daily and, typically, billed at the same time.  For the smaller offices (i.e.,< $8k per week) billing can be done 1-2 times per week to cut down on setup time.  The biller should have a current CPT codebook, a zip code driven fee analyzer, “code it right” manual and the ICD-9 book.

Even with the best treatments and remarkable office protocols, unless codes are billed properly, reimbursement will be very weak.

Dr. Daniel H. Dahan is the founder and CEO of Practice Perfect, one of the nation’s largest management and consulting firms for multidisciplinary centers.  For more information, call 866 67-DAHAN, (866) 673-2426 (Toll Free #), email This e-mail address is being protected from spambots. You need JavaScript enabled to view it or visit

Why and How to Conduct a HIPAA Walkthrough
Practice Management
Written by Dr. Eric Kaplan, D.C., F.I.A.M.A.   
Sunday, 14 November 2004 22:34

Much like the safety audits your office already performs, a walk-through can prevent violations before the Department of Health and Human Services’ Office for Civil Rights gets involved. Whether inspections are announced or executed without your staff’s knowledge, experts agree that they should be done at least annually for all departments and more often for high-risk areas. If you’ve found a problem area, then you want to do a walkthrough more often than once a year to get things really ironed out.

Though not mandated by the privacy rule, third party or anonymous reviewers are often an efficient, if costly, method of examining your facility’s HIPAA compliance program. The big thing is making sure that nobody knows what’s going to happen, because you want to see what people are doing on a day-to-day basis, not what they’re doing on their best behavior.

The types of violations often caught in walkthroughs range from simple mistakes—like leaving confidential faxes unattended or discussing Protected Health Information (PHI) in public areas—to trickier situations that may have been overlooked. Many times the problem is not a procedural violation, but an issue that hasn’t been thought through all the way.

Focus on Your Front Lines

Focus on areas with a significant amount of interaction with the public or patients. Waiting rooms, elevators and even fax machines are all areas where information can accidentally be heard or viewed by the public.

Example: In a recent walkthrough, I noticed that, though the office had obviously positioned computer monitors so that they could not be seen from the waiting room, staff members hadn’t considered the glass entryway to be an area of risk. As you walked in, you could look right over the employee’s shoulder.

Any time a privacy official is on the ground walking through, they should have their eyes and ears open.  However, experts agree that, while privacy officials should conduct informal walkthroughs frequently, there must be some method to document and track violations, and there must be follow-ups.

To solidify the process of monitoring HIPAA compliance, one consultant developed a walkthrough checklist. As a tangible record of violations, the checklist should be based on the privacy policies and procedures central to your organization. It can also include how many times the violation was observed. It gives you something to start tracking to see if you see any improvement or not.

The Next Step: Once the walkthrough has been performed and the violations logged, compliance officers and others can review the document to see what went wrong and where. The two main areas we look for are our training and the clarity of our policies.  If a violation is observed multiple times, you have to ascertain the causes behind it.

Some questions you should ask are:

1. Is our training missing the mark?
2. What could we do differently?
3. How can we better respond to complaints?
4. Are our policies unclear?

By pinning down answers to these questions, you can streamline your facility’s procedures and, thereby, avoid glaring HIPAA violations.


Tip: Remember to take HIPAA violations seriously, if and when they do occur. That means you’ll have to outline and impose sanctions according to the gravity of the violation. Not only does failure to apply penalties jeopardize your compliance program–it’s also against the law not to have a sanctions policy in place.

Following your sanctions policy will benefit you in the long run, as it proves to your employees the importance of maintaining privacy standards, while at the same time preventing them from using past inconsistencies to excuse or eliminate their responsibility to protect health information.

Word To The Wise: To correct the problems encountered during the walkthrough, experts concur that it is best left to the discretion of the privacy officer to determine how and when a sanction will be imposed. Usually, that officer complies with the overall HR sanctions policy; however, as the issues move in the direction of malicious and willful breaches of privacy, higher levels of sanctions—including termination—must be applied.

SAMPLE: The Walkthrough Checklist

Conduct a walkthrough to quickly and easily monitor your staff’s HIPAA compliance. This checklist, created by Patricia Johnston, a consultant with Texas Health Resources in Arlington, can help you catch violations and track problem areas.

 The Walkthrough Checklist  by Patricia Johnston, consultant with Texas Health Resourceds, Arlington


Activity Observed

# of




Confidential information is discussed by staff in public areas. ___ ___ __________ __________________
Conversations with patient/family regarding confidential information are held in public areas. ___ ___ __________ __________________
Overhead and intercom announcements include confidential information. ___ ___ __________ __________________
Phone conversations and dictation are in areas where confidential information can be overhead. ___ ___ __________ __________________
Computer monitors are positioned to be observed by visitors in public areas. ___ ___ __________ __________________
Unattended computers are not logged out or protected with password-enabled screen savers. ___ ___ __________ __________________
Computer passwords are shared or posted for unauthorized access. ___ ___ __________ __________________
Documents, films and other media with confidential patient information are not concealed from public view. ___ ___ __________ __________________
Whiteboards in public areas have more than the allowable information. ___ ___ __________ __________________
Medical records are not stored or filed in such a way as to avoid observation by passersby. ___ ___ __________ __________________
Confidential patient information is called out in the waiting room. ___ ___ __________ __________________
Confidential information is left on an unattended fax machine in unsecured areas. ___ ___ __________ __________________
Confidential information in left on an unattended printer in unsecured areas. ___ ___ __________ __________________
Confidential information is left on an unattended copier in unsecured areas. ___ ___ __________ __________________
Confidential information is found in trash, recycle bins or unsecured pre-shredding receptacles. ___ ___ __________ __________________
Patient lists, such as scheduled procedures, are readily visible by patients or visitors. ___ ___ __________ __________________
Contractors, vendors and other non-patient visitor third parties are not appropriately identified. ___ ___ __________ __________________
Staff are not wearing name badges. ___ ___ __________ __________________
Patient records not filed in locking storage cabinets or rooms that are locked when unattended. ___ ___ __________ __________________
Security access mechanisms for buildings or departments are bypassed. ___ ___ __________ __________________
When questioned, staff demonstrate lack of privacy awareness. ___ ___ __________ __________________


Dr. Eric S. Kaplan is CEO of Multidisciplinary Business Applications, Inc. (MBA), a comprehensive coaching firm with a successful, documented history of creating profitable multidisciplinary practices nationwide.  For more information, call (561) 626-3004.

The Positive Office Visit Experience: Consistency vs. Confusion
Practice Management
Written by Maurice A. Pisciottano, D.C.   
Sunday, 14 November 2004 22:32

Have you ever stopped to consider the importance of consistency?  Could consistency have an effect on profitability? Could having more consistency in day-to-day procedures save time?  Consistency is a key tool for success in any business.  Likewise, lack of consistency means confusion, and confusion is a challenge. Surveys show that people choose the places they do business based upon consistency. Customers or, in our case, patients like to be prepared for what they are going to do or to buy.  What would happen if you stopped in at your local fast food restaurant chain, and at that location, an arbitrary decision was made to only serve fish sandwiches, because the manager didn’t like red meat and French fries?  Would this cause confusion?  Would the staff member have to attempt to explain something she, herself, was confused about? Would you go back?  What would happen if you went into a grocery store and, each week, the food items were moved to different locations? Once again, confusion.

Consistency in your practice

People rely on and appreciate consistency to simplify their lives.  This concept definitely applies to a chiropractic practice.  Patients, as well as staff members, appreciate consistency in your office.  They are happier and more compliant when they know exactly what to expect while they are interacting with your practice.

Consistency in Staff

First and foremost is having a consistent staff.  Patients, once they are established, appreciate being greeted by a familiar friendly face when they walk in the door.  Regardless of the front desk assistant’s mood, health, or financial condition each day, each patient should be treated and greeted in the same friendly way.  Also, although it is virtually impossible not to have staff turnover from time to time, care should be taken during the hiring process in order to ensure that staff turnover will not occur often. Evaluate your applicants prior to hiring with regard to their past work patterns.  Look at whether they are consistent, or if they tend to “job-hop.”

Consistency in Office Visits

The actual office visit should also be consistent from visit to visit.  In other words, each time following the first visit that a patient is being treated in the office, he or she should know, within a reasonable degree of certainty, what to expect.  They should sign in the same way.  They should know where to go first, second, then third. For example, they should take a seat in the waiting room until it is time for them to be seen. How do they know this?  They are told what to do.  People will follow directions for the most part. Next, the patient should always be adjusted first.  This is a valuable aspect of consistency that a chiropractor can utilize right away.  If the patient always sees the doctor first, they can rely on that stability.  This avoids confusion among both patients and staff members.  All too often, the doctor will reverse the flow of therapy and adjustments in order to accommodate his or her own time constraints.  However, this will lead to your staff not knowing what you want to be done and when.  This will result in too many unnecessary questions!  “Doctor, what would you like me to do with Mr. Smith?”  The doctor will spend more time explaining than he will treating.  Most chiropractors never notice these flow problems because it is not their area of expertise.

Consistency in Care

The patient’s care plan must also be consistent.  All doctors should give their patients a detailed report of findings, and care recommendations that they should follow.  The care plan should be adhered to, not only in order keep your patient compliant, but also to keep the doctor in compliance.  Establish a standard of care, and stick with it.  Do re-evaluations, examinations, and therapy plan changes when they are scheduled. Always explain any changes to the patient and the staff so that everyone will be on the same page. Consistency reduces confusion, and will create more time.

Dr. Maurice A. Pisciottano, Executive Director of Pro-Solutions for Chiropractic, is a practicing chiropractor, noted lecturer, author, researcher and teacher.  He is well known for his practice management expertise and new patient development programs.  He has devoted the past 14 years to the development of the instrumentation and the computerization of chiropractic treatment and documentation.  Worldwide, Dr. Pisciottano has trained over 10,000 chiropractors and treated over 650,000 patients with the Pro-Adjuster®.  He regularly lectures at Palmer College of Chiropractic in Davenport, IA, and at Logan College of Chiropractic in St. Louis, MO.  Dr. Pisciottano is an honors graduate from the Palmer College of Chiropractic.  He can be reached at Pro-Solutions for Chiropractic in Pittsburgh, PA, at 1-877-942-4284.

Practice Management Tips
Practice Management
Written by Mark Sanna, D.C.   
Sunday, 14 November 2004 22:30

Q: I am interested in the field of occupational healthcare, but my approaches to industry have been unsuccessful in the past.  How can I break down the barrier I seem to be confronting?

A:  The treatment of most workplace injuries involves a “wait and see” approach, coupled with time off, bed rest, medication or surgery, and typically terminates in some degree of permanent disability.  This approach is unsuccessful and the statistics prove it.  There is little doubt that, if our occupational healthcare system is going to improve, the current strategy must change.  Chiropractic has a valuable role to play in revolutionizing the way the healthcare game is played.  However, chiropractors must learn to take an “inside-out” approach when offering their services to industry.  Many chiropractors make the assumption that industry speaks their language.  They make the fatal mistake of talking subluxation instead of prevention and rehabilitation.

Human Resource Directors are impressed with your ability to provide services such as DOT physicals, Drug Testing, Post-Offer Physicals, and Functional Capacity Evaluations—chiropractic adjustments are way down on the list!  Occupational healthcare services constitute valuable revenue centers for your chiropractic practice and, most importantly, they are the proverbial red carpet to treating workplace injuries.  Once you are on the inside—and have proven that you are a team player with the ability to significantly impact Workers’ Compensation costs—you have earned the opportunity to talk and deliver chiropractic.

Q: What is the most effective tip you can give regarding increasing collections in a practice?

A:  The most effective method for increasing your collections is to ask your patients for payment!  As Gandhi said, “If you don’t ask, you don’t get.”  Perceived value is an important concept to master when it comes to asking patients for payment.  Patients must perceive a value at or greater than what you charge for your service, or they will feel that your fee is out of line with the value they assign it.  It’s equally important for practice team members dealing with patient finances to have a high perceived-value for your services themselves. As the saying goes, you can’t sell what you don’t own!

In closing, remember, that person who asks the question controls the conversation.  Not only is it our duty to ask for and collect payments from patients, it is part of the healing process.  Patients who pay, stay, refer, and get better quicker!  Asking for anything increases the odds of getting it by 200%.  Once you master this skill—by exercising your asking muscle—often you’ll be surprised at how easy increasing collections can be!

Dr. Mark Sanna is the CEO of Breakthrough Coaching, LLC, a leading resource for personal coaching to chiropractic and multidisciplinary practices throughout the country.  He can be reached at Breakthrough Coaching, LLC, by calling 1-800-7-ADVICE.

Maximize Your Practice's Potential
Practice Management
Written by Daniel Dahan, D.C.   
Tuesday, 14 September 2004 21:55

In an effort to help you maximize all your services, Dr. Daniel Dahan has identified 7 departmental areas in your practice, which need to be addressed.  Each of these areas is being dealt with sequentially in The American Chiropractor.  By following the suggestions given, your office will not only maximize its potential, but also delineate areas of weakness that need your attention.

2. Treatment Protocol

Indeed, one of the most important aspects of a successful office is its treatment protocol (TP). Following are the advantages of having written treatment protocols:

1. Give your patient the best care available: Comprehensive note keeping will give each doctor a better understanding and, hence, the ability to give better treatment.  Rather than relying on memory, the doctor has thorough detailed notes and a plan of the proposed and recommended treatment.

2. By Organizing, you will maximize your patient flow: Too often, staff has no proper understanding of the doctor’s treatment or its necessity.  Thus, in any typical office, the staff and patients get frustrated which, obviously, results in poor management and poor retention.

3. Limit your liability: When TP is well and carefully established, a doctor can easily explain or even defend his or her position.  Detailed notes will show a carefully laid out treatment plan supported by objective treatment and medical necessity.

4. Enhance your billing/coding: By properly establishing TP, a good office manager/biller can easily identify possible errors and rectify them before sending out any forms. Even without having a medical background, a biller can easily determine proper coding by going over a well-structured TP.

5. Increase reimbursement: It goes without saying that insurance companies pay claims based on documentation provided by the doctor.  Using the proper TP is of utmost necessity given today’s sophisticated and automated billing systems, which allow for payers to thoroughly analyze any claim.

6. Decrease letter of medical necessity: As long as the doctor continues to treat patients day in and day out without paying attention to the complete TP, payers and their administrators will, understandably, demand letters of medical necessity explaining why such-and-such patient did not have a proper protocol as the regular established standard of medical/chiropractic care.

What to do to establish proper treatment protocol:
1. Take a seminar.
2. Review all forms used by your office and their usage.
3. Train staff on the reasons for establishing TP’S.
4. Regularly review all established TP’S and their procedures.

Dr. Daniel H. Dahan is the founder and CEO of Practice Perfect, one of the nation’s largest management and consulting firms for multidisciplinary centers.  For more information, call 866 67-DAHAN, (866) 673-2426 (Toll Free #), email This e-mail address is being protected from spambots. You need JavaScript enabled to view it or visit


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