Practice Management

The Professional PI Practice - Know the rules, and do it right
Practice Management
Written by Dr. Eric Kaplan, D.C., F.I.A.M.A.   
Sunday, 30 November 2003 00:00

As a consultant, I find more and more doctors turning to Personal Injury.  Why?  The great bank robber Willie Smiths was once asked, “Why do you rob banks?” 
His response was, “That’s where the money is.” 
As regular insurance is becoming more difficult to collect, more and more DC’s are turning to PI.  Why?  Again, that is where the money is.  This is a bad place to put your practice solely in.  The key is to diversify.  PI should be part of your practice, but not 100%.  Otherwise, you will be put into a position of failure, if regulators make changes.  New York already has PI limits; more and more states are looking into changing the current model.  It should be your job to work with national and sate representatives to bring back equality in our profession.  However, many of you will continue to do PI.  If you do, know the rules and do it right.
First and foremost, don’t just beg attorneys for patients.  Attorneys refer to doctors that are thorough and whom, they believe, will add value to their case.  Remember, their income comes from the settlement.  The larger the settlement you can help the attorney procure, the more valuable you are to his team.  He/she is out to make a living.  Provide him/her with great reports, know how to do impairment ratings, know how to document your file.  Be professional.
If you’re going to travel the auto insurance route, you had better know how to navigate around potholes. Follow these tips for circumventing billing roadblocks when filing auto insurance claims for motor vehicle accidents (MVA’s):

Your Manual for Billing Auto Insurance

  • Keep good records.  Save all relevant information from patients, insurers and other professionals involved in MVA’s.  Get pictures from the accident, and do a thorough consultation.  Get copies of and other doctor or hospital records.  Save your e-mails especially, because you can make copies of conversations and keep them in the patient’s chart.  Keep track of key phone numbers, contact names, and dates of conversations, and mark your information in the computer with special codes so you can run reports on them.
  • Establish a hospital contact.  Many patients go to the hospital first.  When working with my MD/DC clinics, we know who is on staff at the hospitals.  We let them know we specialize in SOFT TISSUE INJURIES.  We provide these emergency room doctors with information that is viable to them.  The key is establishing yourself as the expert.  In addition to establishing good communication with agents, attorneys, the insurer’s claims department and the patient, you should look for a hospital contact to find out useful information regarding auto or health insurance, especially from inpatients whom the contact can visit.  Remember these contacts take time; be patient.
  • Fill out your insurance claims completely and send them immediately.  Send a copy of your initial exam to the attorney as well as the insurance company.  I NEVER CHARGE FOR THIS INITIAL REPORT.  Get the insurance form filled out as completely as possible.  Contact auto insurance as quickly as possible, since there’s usually a medical maximum on the policy.  The first claim in gets the money, so out-kick competitive submissions with speedy filing.  Know if there are limitations and know your state laws in regard to billing.
  • If health insurance is involved, prepare for denials.  Don’t be surprised if you have trouble billing health insurance after the patient’s auto insurance tops out.  If you’re lucky enough, health insurance will pay the claims.   When you bill health insurance for the remaining amount, you need to obtain a letter from the auto insurance stating that auto insurance has maxed out, and be prepared for health insurance denials.  One medical office reports that it can rarely get an HMO or PPO to extend the filing deadline when a patient’s auto insurance is exhausted.  So, the office bills the health insurance from the start, using the ICD-9 code for MVA’s.
    One way around this problem is to notify the HMO or PPO before you do any billing,  When you encounter an MVA that involves an HMO or PPO, make sure you get the referral from the HMO or PPO, because the MVA will most likely top out quickly.


Buckle Up for Patients
Involved in Auto Insurance Lawsuits


Strap in tight.  Your automobile accident patient’s legal proceedings can mean a long, bumpy ride for your office, even if you’re not directly involved.  Avoid financial dents by practicing these safety tips:

  • Immediately talk to the lawyer or paralegal on the case.  They will be very honest with you about whether they think there is a good lawsuit.  This information will give you a good idea about your patient’s future financial situation.  Often it is the paralegal that runs the case.  It is the paralegal that often refers the case.  The paralegal is a good person to educate.  Are you able to educate the paralegal on the value of the case?  If you answer NO to this, you need to attend more seminars.  Kaplan (no relation) and Croft are two excellent ones in regard to PI.
  • Provide medical records when requested in a timely fashion in order to protect yourself.  In many states, like Florida, if your claim is not filed in a timely manner, the insurance company does not have to pay you.  Reporting is part of health care today.  Keep good notes and records; this is the key to referrals. 
  • Obtain a lien against the settlement by contacting the patient’s attorney.  The lien basically states that the attorney and patient must pay your bills out of the settlement before the patient receives his/her portion.
    Beware of two dangers with liens.  First, a hospital lien takes precedence over a physician lien, so you may not get paid.  Also, an “unscrupulous” attorney may not honor your lien.  If that happens, you should contact the BAR.  You have worked hard for your money.  Everyone must play by the rules.
    Some attorneys will not sign a lien.  Be careful of these attorneys.  Have the patient sign a lien.  If no one will sign a lien, consider not taking on this case.  You are setting yourself up for more problems.
  • Follow up on the settlement’s progression.  Write a reminder to check up on the account, and keep in touch with the lawyer’s office and the patient.  Set up a meeting with the attorney.  DO NOT CHARGE FOR THIS MEETING.  Be a doctor, not a salesman.  Talk about the case only.  Review your notes; help him or her establish value to the case.  Do not ask for referrals at this meeting.
  • If all else fails, turn to outside collection agencies.  If your patient loses the court case but doesn’t end up paying you, what do you do?  Do not forget about the money.  YOU EARNED IT.  Consider sending the claims to an outside collection agency, which has “better sources” for collecting.  Your patient may receive a settlement large enough to cover the medical expenses, but may try to skip out on paying.  This is why a lien is so important.  Try to have the attorney pay your bill upon receiving the settlement money.  A good relationship with the attorney can help you here.  Put in the time that is necessary.
  • Integrate your practice.  Many of my clinics add an MD, this way they improve their chance for a greater settlement.  By providing both medical and chiropractic records, you build up twice the case.  Often this results in a larger settlement.  Remember, this is what attorneys want.  This is what they do for a living.  The PI market is also getting competitive on their end.  They want to make more with fewer cases.  An MD/DC clinic offers a “one stop shop” for PI, by providing chiropractic care and medical care.  It almost removes the paper IME component.  This also helps our profession, as now MD’s validate chiropractic care.  For the purist at heart, remember B. J. Palmer had MD’s working in his rehabilitation clinic and documenting the validity of chiropractic.
  • Be Professional.  The key to a PI practice is being professional.  Prepare your file with care.  Put the time into your records and reporting.  If you are good, attorneys will find and court you.  The PI world is a competitive world.  Scout the competition and develop a better game plan.  A more complete and professional plan.  Also, be proud of what you do and do it with excellence.  If you do that, you will do well.


Dr. Eric Kaplan is the CEO of MBA, Inc., one of the nation's largest multi-specialty consulting companies.  Dr. Kaplan ran and operated five  of his own clinics, seeing over 1000 patient visits per week.  He is the best-selling author of Dr. Kaplan’s Lifestyles of the Fit and Famous, endorsed by Donald Trump, Norman Vincent Peale and Mark Victor Hansen.  He was a recent commencement speaker at New York Chiropractic College and regularly speaks throughout the country.  For more information about Dr. Kaplan or MBA, call 561-626-3004.

Feeling vs. Functioning: A Simple Solution to a Common Practice Problem
Practice Management
Written by Maurice A. Pisciottano, D.C.   
Sunday, 30 November 2003 00:00

Despite our extensive background in the philosophy of our profession, we, as chiropractors, often fall into the “MEDICAL MODEL OF THINKING.” We may find ourselves making care decisions based upon the symptoms the patients report on the day we see them, rather than relying upon objective data collected that day or at a previous appointment.

People in today’s society have been led to believe that, if they feel fine, then they are healthy.

They also have been indoctrinated to believe that, if they have a symptom, then they need to see a doctor. Symptoms, therefore, are believed to mean that a person is not “healthy.” When the symptoms are no longer present or are less bothersome, people feel they no longer have the need to see a doctor.

Many times, chiropractic patients also fall into this medical model of thinking. They base their progress and the need for future care on how they “feel” rather than the objective actuality of their current physical condition.

When a chiropractor asks the patient how they are feeling, the medical model of thinking is intensified. When a patient enters your facility for the first time, the chances are good that he or she IS experiencing symptoms. If you ask them on each and every visit how they are feeling, then they will begin to adopt symptom-based criteria for their continued chiropractic care. As a result of this method of thinking on their part, they will likely decrease their care or drop out of care as soon as they are feeling better. We have all seen them, The Relief Care Patients.



The Primary Objective of Your Office Visit!

The primary objective of a chiropractor is to effectively communicate to patients, thereby changing this medical model of thinking. An educated patient with a good understanding of how their body should function is more likely to follow through with their prescribed treatment plan and also pay for the care needed to improve their health and well-being. The well-educated patient knows their health is their responsibility.

Knowing how entrenched we are in this symptom-based medical model of thinking, we should quickly realize that a change is in order. The first step of this process is to change the way a patient is greeted every single time they enter your practice. Keep in mind, if the receptionist asks a patient how they are feeling, they will typically answer the question with a symptom. Then, the doctor asks them how they are feeling. Once again, they will answer with a symptom. Very quickly, your patients will develop the idea that it is important to be aware of how they feel each time they visit the chiropractor. Do you see the problem?!!!

You have the power to change this sequence simply by changing the question. Greet your patient in a new way. You and your staff should always ask, “How are you FUNCTIONING?”

Initially, out of habit, people will answer the question with a symptom. It will be your responsibility to immediately change their thinking. You will want to shift their focus toward how their body is functioning and away from their current symptoms. When you ask a patient to consider how their body is working as opposed to how they are feeling, they will begin to realize symptoms are not the only factor involved in determining whether they are “healthy” or whether they need continued care. The answers you are seeking from your patients include statements regarding improvement in their ability to carry the laundry basket up the stairs or an increase in energy levels when playing with their children. As chiropractors, we can ascertain whether we are improving the overall health of a patient as it relates to their ability to function in their activities of daily living.

Instead of the patient thinking we, as chiropractors, are trying to improve their symptoms, they will quickly get the viewpoint that we, as chiropractors, are really improving their life, and all aspects of it. What a difference this can and will make in your practice when you shift the patient’s focus away from symptoms during the course of their care plan.

When a chiropractor improves a patient’s functional capabilities, lifetime patients are created. When the symptoms are the only things that are improved, the relationship with the patient is going to be short lived, and so is your referral cycle. When you change the way people function, and they truly understand that the mechanism for their improvement is due to your educational process, you will broaden the scope of referrals this patient will contribute to your practice. When a person realizes they no longer suffer severe pain, but ALSO have more energy, a better appetite, are less irritable, perform better at work, sleep better, create better relationships among their family members and friends, etc., they WILL refer others!

This type of patient is more inclined to be a long-term chiropractic patient, because they have experienced the increase of function and the benefits of optimum health and well being. They will want the optimum condition to continue, and will, therefore, be willing to pay for maintenance or wellness care.

Chiropractors and their staffs need to make this change and be consistent with the change in order to make a difference in this widely accepted medical model of thinking. The change of only one word in your dialogue with patients over a few weeks time will make a difference. Your patients will begin reporting they have, indeed, experienced a change in the way their body functions. The amount of words used and the amount of time spent on handling patients regarding their symptoms can be saved and used as dialogue for all of your new patients. This one word is worth a million words! TAC


Dr. Maurice A. Pisciottano, CEO and founder of Pro-Solutions for Chiropractic, is a practicing chiropractor, noted lecturer, author, producer and research and development technologist. He is well known for his practice management expertise, as well as new patient development programs. He has devoted the past twelve years to the development of the instrumentation and the computerization of chiropractic treatment and documentation. Dr. Pisciottano regularly lectures at Palmer College of Chiropractic in Davenport, IA, and at Logan College of Chiropractic in St. Louis, MO. He can be reached at Pro-Solutions for Chiropractic in Pittsburgh, PA, at 1-877-942-4284.

Chaos vs. Control Are You Organized for Success?
Practice Management
Written by Maurice A. Pisciottano, D.C.   
Tuesday, 30 September 2003 00:00

Organization is a large word that can have a great impact on the success of your practice.  Without a systematic way of organizing your practice, chaos and havoc will rule with no guidelines to help sort out the confusion.  In a chiropractic practice there are three components to building a successful organization:  Policies, procedures and systems.
Policies, procedures and systems add the structure that is necessary to run a successful practice.  It is helpful to understand the difference between these components and why each is important for your success.


Policies are the rules and regulations of running your practice relative to your staff and your patients.  Policies are written in order to help your practice run smoothly.  Each and every chiropractic office should have a General Policy Manual that is followed by all staff members (regardless of position or seniority.)

Chaos vs Control - Are You Organized for Success?

A General Policy Manual will minimize and eventually eliminate staffing problems.  When all staff members are following the written policies, there are fewer issues for staff members to discuss or dispute.  Once the rules and regulations are in place, correcting a staff member also becomes easier.  Most staff or practice problems are in equal proportion to the doctor’s willingness to confront the staff member.  Having a well-written and proven set of policies supports the discussion and resolution of the problem.
When a new staff member is hired, it is imperative that you introduce them to the General Policy Manual and make sure they understand and agree with your policies.  Have them complete a “Check-Off Form” to ensure they do not miss any important policies.  Also, have them write several essays during their probation period on their understanding of your policies.  This will eliminate any misunderstandings and potential staffing problems down the road.
You can change the way your practice operates by following these few simple suggestions.  Policies allow you exponential growth in your practice, regardless if you have one, five, fifteen or thirty staff members.  Policies are critical.


A procedure is a specific course of action that can be repeated in order to achieve a certain response.  Procedures are the step-by-step processes that you utilize in your practice.  Your procedures take place from the moment a patient walks through your front door, until the time they are released onto maintenance care.
Procedures are critical for a chiropractic practice to continue to expand.  Once you have developed your procedures, you should write them down or put them on audio or videotapes.  By doing so, you are making them available to everyone to learn from and incorporate into your daily operation.  The more specifically your procedures are defined, the smoother your practice will operate.
The anxiety level over hiring new staff members will significantly diminish when you have proper procedures in place.  It will be easier for a staff to duplicate a position when the procedures are already defined for that position.  You will find that you will have more compliant staff members and a greater willingness to replace non-compliant staff members with the appropriate procedures in place.  Procedures are vital.


A system is a functionally related group of elements that interact harmoniously.  Systems need to be put into place in order to have your practice function overall.  A system incorporates your policies and procedures into a workable and consistent structure that will succeed regardless of the personalities involved.
For example, you would have a “new patient” system that would handle all aspects of serving a new patient, from the time they walk in the door until they are put on a maintenance program.  The system would specify the exact way to handle setting up the first appointment, how to greet the patient upon arrival, paperwork procedures to follow, etc.   With a system, nothing is left to chance.
Systems are incorporated into a practice for a number of different reasons.  Regardless of the specific end result of the system, it is only considered effective if it will work for anyone, in any town, in any practice, at any time of year.  A system is bulletproof, and put into place in order to help your practice function more effectively.  Increase your systems, increase your productivity and increase your opportunity for growth. Systems are essential.
Organize your practice for success.  Eliminate chaos and embrace control.  Write your policies and procedures and put your systems in place.  You will be setting the stage for success in an organized and expanding practice! TAC

Dr. Maurice A. Pisciottano, CEO and founder of Pro-Solutions for Chiropractic, is a practicing chiropractor, noted lecturer, author, producer and research and development technologist.  He is well known for his practice management expertise, as well as new patient development programs.  He has devoted the past twelve years to the development of the instrumentation and the computerization of chiropractic treatment and documentation.  Dr. Pisciottano regularly lectures at Palmer College of Chiropractic in Davenport, IA, and at Logan College of Chiropractic in St. Louis, MO.  He can be reached at Pro-Solutions for Chiropractic in Pittsburgh, PA, at 1-877-942-4284.

Increased Public Awareness + Education = New Patients
Practice Management
Written by Maurice A. Pisciottano, D.C.   
Wednesday, 30 July 2003 00:00

You love chiropractic.  You want to share the benefits of chiropractic with the whole world.  You would like to add a few new patients a week to your practice.  Accomplish all this and more through a performance workshop presentation. 
Increased Public Awareness + Education = New PatientsOffering a performance workshop to businesses is a cost-effective way to share the benefits of chiropractic, establish yourself as the chiropractic expert in your community and increase your new patients.  You want to present a comprehensive workshop designed to improve the health and well-being of the individuals in attendance.  Look for a performance presentation product, such as a lecture series which might include video and/or slides, that has an established track record and focuses on increasing energy and productivity levels and decreasing the level of stress in the lives of the participants. 
Once you have chosen your performance workshop product, you need to target your audience.  Within your community are hundreds of businesses with thousands of employees that can benefit from a performance workshop.  Where do you start marketing this program?  Pick up your local telephone book and flip to the business-to-business section of the yellow pages!  You have at your fingertips, an abundance of prospects.
Focus your initial efforts on the professions that involve activities causing strain on the individual.  For example, businesses that fall in this category include hair stylists, factory workers, retail workers, and public service employees.  Companies operating within an office environment also make good prospects because of the level of stress the employees face on a day-to-day basis.  Employees in almost any type of business can benefit from the information and education provided during a performance workshop.
Compile a list of fifteen to twenty-five companies to contact and introduce yourself and your program.  Your goal is to speak to the person responsible for scheduling employee activities and to schedule a day to conduct the performance workshop.  Typically, the person you will need to speak with is the human resource director, employee relations supervisor or company owner.
Once you have the appropriate person on the phone, introduce yourself, provide your credentials and outline the benefits of the performance workshop.  Explain how this powerful program will help their employees function more effectively and work more efficiently.  The workshop that you choose should contain information that will teach individuals how to:

  • Enhance their Energy Level
  • Improve their Body’s Ability to Function
  • Strengthen their Body’s Structure
  • Increase Coordination and Safety
  • Reduce Stress

Address any questions or concerns the decision-maker may have regarding the performance workshop.  Highlight a few successes of the program that you experienced when it was presented to other businesses in the same or similar industry.  Be sure to schedule a time that is convenient for the majority of the employees and suggest that the company make the presentation mandatory.  This will help ensure the success of the program for the business and for your practice.  Once the presentation is scheduled, send a confirmation letter to the decision-maker.
You should always maintain a prospecting list of fifteen to twenty-five companies to call and schedule a performance workshop.  Keep in mind that companies add employees, change ownership and relocate on a regular basis.  With the yellow pages, you will never be without a database of prospects for your practice.
The presentation is scheduled.  Now you must prepare to present the performance workshop to your audience with confidence and enthusiasm.  Review your slide presentation and rehearse your scripts.  You should be comfortable with the material and the manner in which you will deliver the information.  If necessary, rehearse until you achieve a level of comfort that satisfies you.
On the day of the presentation, check the slide show and all audio-visual equipment.  Be sure to take all presentation materials, handouts, business cards and office brochures for distribution.  Arrive at the meeting location at least thirty minutes early.  This will give you enough time to set up your equipment, get comfortable with the environment and personally greet the attendees.
Keep your energy level high at all times and command the group’s attention.  How you close your performance workshop is extremely important.  Describe the type of help you can offer the attendees through chiropractic, productivity enhancements, increased energy, injury prevention and pain relief.  Explain that someone will contact them to ensure they receive information on the area in which they have a health concern.
Before leaving the company, schedule another performance workshop in six months.  The second presentation serves as a refresher course for current employees and an introduction for any new employees that have joined the company.
Within forty-eight hours of the presentation, call all the attendees of the workshop to schedule an appointment with them.  Track the number of new patients you receive from each workshop.  Use these numbers to evaluate your success in doing the performance workshop and securing new patients.
Decide how many external lectures you would like to do every month.  Use your list of fifteen to twenty-five companies from the yellow pages as your guide.  You will be amazed at how many people are eager to learn more about chiropractic and feeling better, naturally!

Dr. Maurice A. Pisciottano, CEO and founder of Pro-Solutions for Chiropractic, is a practicing chiropractor, noted lecturer, author, producer and research and development technologist. He is well known for his practice management expertise, as well as new patient development programs. He has devoted the past twelve years to the development of the instrumentation and the computerization of chiropractic treatment and documentation. Dr. Pisciottano regularly lectures at Palmer College of Chiropractic in Davenport, IA, and at Logan College of Chiropractic in St. Louis, MO. He can be reached at Pro-Solutions for Chiropractic in Pittsburgh, PA, at 1-877-942-4284.

Understanding is key to Retention
Practice Management
Written by Maurice A. Pisciottano, D.C.   
Friday, 30 May 2003 00:00

Patient Retention in a chiropractic practice is defined as the number of times a patient visits your office for chiropractic care.  In order to increase your Patient Retention, you need to increase your patient’s level of understanding.  Patients will follow your recommendations for care if they have a high level of understanding about how your care is helping them.  Retention is equal to understanding.

The entire chiropractic profession needs to work together to improve our patients’ levels of understanding of chiropractic.  The best place to begin this educational process is with a new patient.  When a new patient walks into your office, their level of understanding, on a scale of zero to ten, is at zero.  As a chiropractor, it is your job to change their “Medical Model of Thinking,” and move them up the “Chiropractic Ladder of Understanding.”  As you increase your new patient level of understanding, you will also increase your patient retention level.

Patient understanding is built through patient management.  The ideal time to conduct patient management is during the patient consultation.  Some very critical decisions are made during this interaction between the doctor and the patient.  The manner in which you ask the consultation questions, how the patient answers, and the correct way you respond to their answers, builds the foundation for advancing their level of understanding.  It is important to take advantage of every opportunity to educate and teach your patient about the benefits of chiropractic care.

You continue your patient management during the “Report of Findings.”  You and your staff must remain consistent and precise with all communication during the first several patient visits.  This increases the patient’s level of comfort and confidence in your care.  This is the time that you must “reset the decision criteria.”  When you reset the decision criteria, you move your patient up a level of consciousness, so they are more willing to continue with chiropractic care.

When a person fully understands how they are benefiting from and what the advantages are to chiropractic care, they have reached the "ten" on the understanding ladder and you have increased your retention percentage.  You no longer need to sell the concept on a visit-by-visit basis.  Instead, your efforts must focus on routing the patient through their treatment plan with continued emphasis on their understanding.
Taking each patient through the following process will increase your retention rate and help move your patients from their first visit to participating in a treatment plan.

First Visit
- Patient knows they have a problem
- Patient knows there is a solution to their problem
- Patient knows and is committed to returning to your practice for a Report of Findings

Second Visit
- Patient agrees to chiropractic treatment
- Patient agrees to attend your in-office workshop
- Patient commits to returning for “treatment plan review” visit

Third Visit
- Patient knows the solution is “Corrective Care” over “Relief Care”
- Patient commits to treatment plan
- Patient has taken financial responsibility

A practice’s percentage of retention is equal to the number of patients on a care plan out of the total number of new patients seen during the same timeframe. You hold the key to unlocking the mystery of Patient Retention. Educate on the benefits of chiropractic care, educate on the specific condition and educate on the success of your treatment.  Education equals understanding.  Understanding equals retention. TAC

Dr. Maurice A. Pisciottano, CEO and founder of Pro-Solutions for Chiropractic, is a practicing chiropractor, noted lecturer, author, producer and research and development technologist.  He is well known for his practice management expertise, as well as new patient development programs.  He has devoted the past twelve years to the development of the instrumentation and the computerization of chiropractic treatment and documentation.  Dr. Pisciottano regularly lectures at Palmer College of Chiropractic in Davenport, IA, and at Logan College of Chiropractic in St. Louis, MO.  He can be reached at Pro-Solutions for Chiropractic in Pittsburgh, PA, at 1-877-942-4284.


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