Practice Management


What Do Insurance Companies Really Want From Me?
Practice Management
Written by Kathy Mills Chang, MCS-P   
Wednesday, 26 October 2011 20:40
insurancepolicy4
D
o you ever sit at your desk, look around at the stacks of requests, letters, and charts and ask yourself, “What do insurance companies really want from me, anyway?”  The volume of new regulations and rules are raining down at a fast and furious pace, and may feel like an out of control, runaway train.  We just master one new policy and they change the rules.  Keeping up with the modifications can make our heads spin, but it is vitally important to stay on top of everything. Usually, staying connected to your State and National Association, a trusted advisor, or consultant can keep you in the loop and up-to-date on regulatory changes. But what about the day-to-day inner workings of your practice?  With all that you manage, what are the handful of most important things to keep track of to steer your practice out of the danger zone, and operating on all cylinders?  Make sure that among all the stacks, rules, regulations, and forms to fill out, you master these five basics to keep your show on the road to success.
 
Understand Their Definition of Medical Necessity
There is a clear difference between most chiropractors’ definitions of what is clinically appropriate and what a carrier may define as medically necessary. When you are a third party to the relationship between your patient and their contracted insurance carrier, it’s important that you follow their rules. If you happen to be a contracted provider in their network, then you have your own rules to follow as well.  It’s my opinion that if you try to find out medical necessity definitions from the carriers you deal with, you will be well on your way to better documentation and an unmistakable showing of an effort toward compliance. 
 
Remember that medically necessary care is that which the carrier can justify as payable through the insurance. It is usually tied to certain diagnosis codes and based on medical review policy. They will not dictate what you recommend to a patient as needed treatment, but will dictate that portion which they will pay for. You can treat as you wish, but be sure you only submit for reimbursement that segment that your documentation shows will align with the medical review policy for that diagnosis. The remainder is the part the carrier expects the patient to pay. And the doctor is the link between the two. It’s based on your interpretation of the review policy, and your documentation of medical necessity is the lynchpin. 
 
Medical review policy is usually found on a carrier’s website, in the physician area, sometimes requiring a password. You can search using their search tools, or navigate to the appropriate section and use key words such as “chiropractic” or a specific CPT code like 98940. For example, many carriers will pay for orthotics. They will tell you upon verification that they are a covered service. But if you failed to read the medical review policy for orthotics, you may have missed the fact that orthotics are only covered if the diagnosis is “Diabetes”.  If you didn’t know that, you may be frustrated when your bill is denied for your diagnosis of “Plantar Fasciitis”.  
 
Be Proactive with Compliance
In 2000, the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) encouraged the voluntary implementation of compliance programs in healthcare offices, particularly those that served the Medicare or Medicaid beneficiaries. In March 2010, as part of the Patient Protection and Affordable Care Act (PPACA), also known as “ObamaCare”, these compliance programs were made mandatory. While there has been no specific deadline by when they must be implemented, it’s likely going to be very soon. The majority of chiropractic offices do not have a compliance program in place. Those that do likely have a program that they bought years ago, thinking it made them compliant, and it has an inch of dust on it from sitting on the shelf. 

But if you failed to read the medical review policy for orthotics, you may have missed the fact that orthotics are only covered if the diagnosis is “Diabetes”.

 
Think of a compliance program as a self-policing program, where you proactively state that “this is how we do it here” and then keep to it. A Code of Conduct for your office sets the tone of compliance for your team as well. It involves voluntarily auditing yourself for coding, documentation and billing errors, and reporting them and paying back overpayments if necessary.  When these standards are stated, implemented, and managed, a third party looking in from the outside can see that you are not part of the problem, but part of the solution. A well organized office with a compliance program is less prone to simple mistakes.  And if they make errors, they catch them early, and deal with the fall out quickly. An office writing in to a carrier with an overpayment caught by the self-auditing process will be set apart as a stunning example of the way it should be. And you can imagine that if an error was found on a carrier’s audit, the fact that you routinely self-police is a strong, mitigating factor in your favor, trumpeting that you are not doing something fraudulent, which implies intent. 
 
A doctor I work with called recently with what they thought was the end of practice as they knew it….a team member had been falsifying billing for quite some time, and then stealing the extra money that came in. The numbers were staggering once we started digging and auditing. The amount that would need to be repaid was more than they could fathom. Some of it was from Medicare, which layered on another series of deadlines and regulations. But trust me when I say that this doctor coming forward to the several carriers involved, showing that “we found this as we audited” was a huge mitigating factor in their favor when the carrier began extending payment plans and other considerations. Just think of what would have happened if a carrier began an audit for another reason and found it before the doctor did. Setting up a compliance program is a simple process with an uncomplicated structure. Don’t be caught without one. 
 
Code and Bill Correctly
If you have a compliance program in place, then you probably will do your coding and billing appropriately.  The CPT and ICD numbers reported on your patient’s billing is the language used to communicate your services to the third party payer. Simple auditing techniques will make sure that errors are minimized. But, if you use codes that are not a clear and obvious description of the work you’re doing, you could run into trouble. Make sure that you clearly understand the parameters for the use of every code you bill. Some codes require particular modifiers, and others require certain pieces of documentation to be present in your notes for use of the code. When you report a code, and it’s paid, don’t assume that because they paid it all is well. Usually, errors are found on post payment audit, and “I didn’t know” is not an excuse that will hold water. Repayments of erroneously billed codes still have to be refunded. The great news is that coding and billing correctly in chiropractic is pretty easy.  Diagnosis codes are straightforward, and there are a small handful of CPT codes that apply to our services. Even with the implementation of ICD-10 in 2013, it’s an area of your practice that must be exactly correct. You can’t afford to take the risk of erroneous coding and billing. It will cost you time and money when you may have precious little of both.
 
Be Aware of Documentation Requirements
Federal and state reports on the audit of chiropractic documentation indicate that chiropractors don’t have a good handle on proper case management and documentation requirements. Some jump to purchase EMR software thinking it will solve all documentation problems, but end up with an unhappy experience. You must learn the requirements on your own and master the documentation of your care.  The best way to do this if you find your documentation lacking is to use a good paperwork system that will prompt you along the way with appropriate requirements so you don’t miss a thing. It’s a great bridge from the travel card you may be using now to EMR software that may be required in the future. Using appropriate forms will guide you and teach you the nuances of documentation that you must learn. The Medicare documentation requirements are easily found in your Medicare carrier’s Local Coverage Document (LCD). Read it! And implement those requirements. 
 
Don’t Charge the Carrier Significantly More Than You Charge Your Patient
Offices that routinely offer cash discounts to patients under the guise of “time of service” pricing are usually in violation of a myriad of inducement and compliance rules. It usually goes like this:  An insured patient’s carrier gets a bill for a manipulation, traction, and exercise at the doctor’s actual fee schedule, which comes to $120.  Meanwhile, a patient who has no insurance comes in and is quoted the “time of service” fee of $40.  Can you see why a carrier may have a beef with being “overcharged”? It’s a violation pure and simple, unless you’re following the OIG’s guidance of no more than a 5-15% prompt payment discount. Would an average of $12 savings (10% of the $120 actual fee) really help that cash patient? This is why most doctors are discounting far more than the allowed 5-15%. The easiest fix is to join a reputable Discount Medical Plan Organization (DMPO) like ChiroHealthUSA. This allows you to set a network fee schedule for your cash paying patients too, and this keeps insurers from feeling like you’re gouging just because someone has third party coverage. 
 
Focus on these five areas should strengthen your relationships with the third party payers you deal with. It’s important to keep them healthy and strong, so you can continue helping your patients be the best they can be, without worries of third party payer interference.  It’s possible! And it starts with you!

Kathy Mills Chang is a Certified Medical Compliance Specialist (MCS-P) and, since 1983, has been providing chiropractors with hands-on training, advice and tools to improve the financial performance of their practices. A well-known and sought-after speaker, Kathy 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 2007, KMC University was created to streamline, develop and offer a broader range of chiropractic solutions in the areas of coding, insurance, patient financial procedures, Medicare and compliance. She can be reached at 888-659-8777 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it
 
The Economy, The Boll Weevil, and Your Unexpected Prosperity
Practice Management
Written by Tom Owen III   
Sunday, 25 September 2011 21:40

 

moneystack

T
alk to just about anyone, in any profession these days, and a similar theme weaves itself throughout the conversation; our nation’s poor economy has left few untouched. Many chiropractors have certainly felt the sting of this unfortunate downturn. We’ve had numerous conversations with several practicing chiropractors in recent months and no doubt, times are tough out there.  However, we’ve noticed that while many stories started out with the same details– lower collections, few patient visits, a few of these doctors have ended the conversation by saying their practices are healthier than they have been in a long time and their outlook is optimistic for the future. The circumstances started out the same, why were the outcomes different?  It may surprise you to know it had nothing to do with the market, their staff, or a magical newspaper ad. The difference was in the doctor’s response to the adversity he or she faced.

While some doctors lament their falling collections and hopelessly describe their uncertain future, others, in the same circumstances, tell us a different story. They say when their practice started hitting bottom; they knew they had to do something different. Let’s take a time-out right here. That sounds simple, doesn’t it? Something isn’t going the way we need it to go, so we decide to do something different. Simple logic. However, we never cease to be amazed at the powerful results of acting on this simple thought, and we also never cease to be amazed at the number of doctors who don’t think this way.

We tell clients who find themselves in troubling situations that if they don’t do anything about their current situation, they’re insane. That may sound cruel until you understand our definition of insanity, which is, “continuing to do the same thing while expecting different results.”

If something isn’t going right, it may be time to do something different. This is the blessing of adversity. Adversity forces us to acknowledge that our current way of doing things isn’t working. It forces us to consider change and do things we may have otherwise never done. This was the common thread in the different outcomes of stories we’ve heard from doctors all over the country. Some of them do nothing, and watch their practices shrivel up and die, while the adversity our economy has brought has stirred others out of their comfort zones and forced them to make changes within their practices. Those changes, albeit uncomfortable or risky, brought about the success they needed to survive the perils of the economic downturn. For many of them, the change they made was calling us and asking for our help. Most admit, they would have never sought out our help had it not been for the desperation they felt as a result of this horrid economy.  The adversity they encountered was a blessing in disguise because of their proactive response.

The current situations of many chiropractors remind us of a true store that happened over a century ago in Enterprise, Alabama. This small town’s commerce was all but wiped out, but the same culprit that almost destroyed it, is now the town’s hero. What is on the monument that now stands at the center of Enterprise, Alabama’s town square? A boll weevil.

The monument honoring the boll weevil is a robed, Statue of Liberty look-alike, holding the enormous black bug over its head. The statue’s head is bowed in somber respect.

The boll weevil ravaged 60 percent of the region’s cotton crop in 1915, and even more the next year, decimating livelihoods and towns. Yet, the inscription on the monument’s base says, “In Profound Appreciation of the Boll Weevil and What It Has Done as the Herald of Prosperity.” The herald of prosperity? The boll weevil?

In 1917, with their economy and society almost destroyed, the down-and-out farmers of South Alabama faced tremendous adversity, much like many in our profession are facing today. However, the adversity the boll weevil caused, forced these farmers to do something different. They had no choice; they couldn’t grow cotton any longer. They were either going to die into extinction or they were going to have to adjust and innovate. Over the next few years, they began diversifying into peanuts and other crops and no longer depended so heavily on cotton. This forced change helped the farmers of Enterprise thrive, even when other areas of the South, primarily dependent on cotton, continued to suffer. Take note, the other areas of the South didn’t suffer under the destruction of the boll weevil, their adversity wasn’t as severe, therefore, they were not forced to make the needed changes and diversify their crops. For the farmers of Enterprise, the enormity and severity of their adversity, and their response to it, saved their economy and birthed their prosperity.

What changes is your adversity forcing you to make? Consider the cotton farmers of Enterprise, Alabama and consider making those changes to save your future. What you are suffering through right now may be just what you need to propel you into the changes that will bring the prosperity you’ve been waiting for.

 

by Tom Owen III, and Todd Osborne, D.C.

Dr. Todd Osborne, a 1989 graduate of Palmer College, ran a successful high volume multiple doctor practice, and is currently Vice President of AMC, Inc., as well as an author and lecturer. Visit www.amcfamily.com or call (877) AMC-7117 for more information.

 
Finding a Great Associateship
Practice Management
Written by Peter G. Fernandez, D.C.   
Sunday, 25 September 2011 18:44

 

associateshipthatworks

I
n my previous articles, I described the types of associateships that are, and are not, successful.  Now that you know the type of associateship you should look for—here’s how to find that “needle-in-a-haystack associateship from Heaven.”

A potential associate should search for an established doctor who is earning $500,000 or more per year.  Do not associate with a doctor practicing below this level, as one of your associateship goals should be to learn how to run a large, successful practice.  You can only learn this by either hiring an experienced consultant, or by associating with a doctor who is already doing it.  The established doctor must also be able to comfortably give the associate doctor 20 to 25 new patients a month, without a financial worry if any are lost. Only a very successful doctor with a large volume of new patients can match these criteria.  Don't settle for less when you're looking for a great associate position.

Looking for a Successful Associate Doctor Practice

Your first step is to talk to the president of the county chiropractic society of the area in which you're interested.  Ask him who the area's most successful and ethical practitioners are that hire associates. Your association president will know. Then, speak with those doctors and ask if they need an associate. If they do, apply for the position. If not, ask them who the most successful practitioners are in the state who operate good associate practices. They'll know. When you ask three or four doctors the same question, you'll find the same names cropping up.

Go to these doctors and ask them for a job. If they don't have a position available, ask them to refer you to other super-successful, ethical doctors who are good trainers of associates. If you appear to be good associate material, they'll be happy to do so.

By following these steps, you will find the super-successful associate practices. The doctors who run these practices are networked by mutual interests and concerns, and are openly supportive of each other.

Your next step is to contact the practice consultants that have clients in the area you are interested in practicing.  Ask them about large successful associate practices.  They’ll know and will be happy to guide you to a successful practitioner.  If the successful practitioner has a full complement of associates and is not hiring at the time, ask him for a referral to other successful associate practices.  He’ll be happy to help you.

Another method of finding a successful practitioner is to ask vitamin and chiropractic equipment vendors in your state.  These people know everyone.  They will be happy to steer you in the right direction because the more successful they make the established doctor by referring a good associate (YOU) to them, the more vitamins, orthopedic supplies, or equipment they will sell the established doctor and, thereby, the more successful the vendor will become.  Everybody wins.

Look for “Associate Wanted” ads in the classified ad section of the local chiropractic society newsletter, your state association journal, and our national journals.  Call these doctors and follow the previously described recommendations.

Another fruitful source of associate positions is through the profession’s employment agencies, vacation doctor companies, etc.

Finally, if the previous methods of finding an associate position are not successful, write a letter to all the practicing DC’s in the area of the state in which you’d like to practice.  In this letter, state you are looking for an associate position, your qualifications and your willingness to work hard.  You’ll be pleasantly surprised by the response.

Best of luck in finding a great associateship.  I did and it was one of the most rewarding experiences of my life. I had the best teacher and, because of the training he generously provided me with, I became a success. Forty years later, I still follow the principles and guidelines he taught me. I've had a dozen associates, who I trained the same way and I'm extremely proud of their subsequent successes.

Doctors, I hope you follow the guidelines of this article. Identify and avoid the types of associateships that will only trap and hurt you. Find a good associate position…become a great associate!  When you become a great associate, you'll become a great doctor. And, when you learn what the successful practitioner knows, you'll be able to duplicate the established doctor’s success after you have successfully opened your own practice.

More information on becoming an associate and the specific responsibilities of the established and associate doctors in an associate and independent contractor practice is available online at www.practicestarters.com.

When you're through being an associate and are ready to start your own practice, hire a consultant who specializes in starting practices to guide you.  Don’t think that you now have the experience necessary to start and build a new practice…you don’t!  Yes, you’ve gained the experience of caring for patients and learned some good office procedures, but that’s not enough knowledge to start a successful new practice.  You still have to learn how to find a great office location, effective bank negotiating strategies, cost-cutting remodeling negotiations, how to market a new practice, etc.  It’s the lack of this specialized knowledge that dooms new practices, not the lack of knowledge regarding patient care.

 

Dr. Peter G. Fernandez is the world’s authority on starting a practice.  He has 30 years’ experience in starting new practices, has written four books and numerous articles on the subject, and has consulted in the opening of over 3,000 new practices.  Please contact Dr. Fernandez at 10733 57th Avenue North, Seminole, Florida, 33772; 1-800-882-4476; This e-mail address is being protected from spambots. You need JavaScript enabled to view it or visit www.drfernandez.com

 
Chiropractors as Entrepreneurs
Practice Management
Written by Tom Owen III   
Tuesday, 23 August 2011 21:44

entrepreneurchiroWhen confronted with the full weight of running a practice, a chiropractor’s reaction is often:

  • Why didn’t they teach this to me in chiropractic school?
  • Can I hire someone else to run my practice for me?
  • Isn’t it possible to just practice chiropractic and not worry about the business?

After reading the book, The E-Myth, by Michael Gerber, we couldn’t help but marvel at its applicability to chiropractors. Many in our profession often feel overwhelmed with the business side of their practice because they run it with the “entrepreneurial myth” or “E-Myth” that says, “If you understand the technical work of a business, you understand a business that does that technical work.”

It’s okay to love the technical part of chiropractic, but the aforementioned thinking confines you to running your practice as a technician.  This leads to frustration, because you need more than a technician’s skills to run a practice successfully.  The answer to this conundrum is to discover the possibilities open to you, not only as a technician, but also as an entrepreneur.

The truth is that for any practice to be successful, the chiropractor/owner must be able to blend and balance not one, but two roles effectively.  It’s not just about being the good “technician” and giving quality adjustments.  It’s also about being an aspiring entrepreneur.

What is an entrepreneur? According to Michael Gerber, “It is the dreamer in us, who sees a vision different from the present and is the catalyst for change.”  Entrepreneurs would run a practice by implementing new systems, skills, technologies, and setting goals.  Entrepreneurs dream about where they want that practice to be in the future and meet those goals by thinking outside the box and being creative.

The technician is the doer and loves to do the work. His or her focus is not dreaming about things, but doing them.  As long as the technician is working, he or she is happy. Therefore, the technician lives in the present. The entrepreneur plans and directs the future of the practice by setting goals and creatively meeting those goals.

In order to grow a practice, chiropractors need to shift their focus from working in the business to working on the business.

Most likely, you are already a good technician.  You know how to adjust. You get good results with your patients. You learned all of that in chiropractic college.  But what about the entrepreneur in you? Have you allowed that part of you to come into focus?

The entrepreneur is the inventor, goal setter, visionary, and dreamer within us. Begin by dreaming and creating new and better ways of providing chiropractic services, caring for patients, and reaching new successes.  Allow yourself to be more than “just” a chiropractor, understand that you are an entrepreneur, and be mindful of these two factors:  momentum and stagnation.

Have you ever known, early in a particular month, that it was going to be a bad one, with frustration, inefficiency, low production, and high stress? It seems the practice in general is moving in the wrong direction, but the momentum seems so overwhelming that you simply cannot apply the brakes? In times like that, imagine how you would react if someone said, “Wait a minute. Take a step back. Think about new ways to schedule, so that the month doesn’t have to be bad.” It would be easy to respond, “Leave me alone. I’m too busy doing what I’m doing to think about how to do it better!” If this sounds familiar, you’ve been taken by the force of momentum, the unhappy state of speeding in the wrong direction, yet feeling unable to stop yourself. Momentum challenges us all, but, by recognizing it and redirecting the momentum, you can take on a new direction in which to steer your life and practice.

Someone who has been taught to view creativity as risky simply stops being creative. Don’t let this happen to you. Invest in new skills, goals, and visions for your practice. Invest in yourself. When stagnation gets in the way, it becomes more comfortable to cling to the status quo. Are you caught in the rut of being unhappy with your practice, doing the same thing while wanting different results?  How many times do we hear chiropractors complain about an insurance issue or a staff problem—only to learn that they have been plagued by the same problem for years and have never taken steps to resolve it and move on. Stagnation prevents you from taking risks; it stops you from finding new pathways.

If you have been in practice for many years and have accepted the routine, the safe, and the comfortable, there will come a time when you will feel unfulfilled and uninspired. You will wake up one morning to find that you have lost your passion. Focusing on the entrepreneurial spirit in you means creating and pursuing new possibilities that you really want to achieve. Allow yourself to dream about your future, whether you’ve been in practice two months or twenty years.  Once you are ready to enter the world of the entrepreneur, you can begin to build the kind of practice you would really like to have.

 

by Tom Owen III, and Todd Osborne, D.C.

 

Dr. Todd Osborne, a 1989 graduate of Palmer College, ran a successful high volume multiple doctor practice, and is currently Vice President of AMC, Inc., as well as an author and lecturer. Visit www.amcfamily.com or call (877) AMC-7117 for more information.


 
An Associateship That Works
Practice Management
Written by Peter G. Fernandez, D.C.   
Tuesday, 23 August 2011 19:52

associateshipthatworksThe tandem associateship: 2 doctors successfully treating the same patients.

In the previous article of this, "How to Start a Practice" series, I discussed the "Associateships from Hell."  Unfortunately, most starting doctors get trapped in bad associate arrangements like these. However, this article describes an associateship structure that's very successful, an associateship in which both the established doctor and the associate doctor benefit.  It’s called a "tandem associateship," an arrangement where two doctors treat the same patients.

In a “tandem associateship,” the established doctor's practice is so full that he finds himself skipping procedures, turning away new patients, prematurely stretching out the care of existing patients, etc., because he quite simply has more patients than any one doctor can handle. To alleviate this problem, he hires an extra set of hands (an associate) to take care of all the patients he can't get to. By doing so, the established doctor can grow his practice larger. This type of associateship works well for both doctors.

"Tandem associateship” criteria

In this type of relationship, the established doctor, being very successful, is willing to teach the associate doctor everything he knows. The associate doctor, in a “tandem” relationship, must be an extremely willing student and learn everything the established doctor has to teach. The associate doctor must swallow his ego in order to welcome and accept constructive criticism. How else is he going to learn? The associate doctor must totally agree with this concept, otherwise the tandem associateship will not work.

The “tandem associateship” is a teacher-student relationship. All good teachers want their students to learn everything they have to teach. All good students want to learn everything the teacher has to teach. When this symbiosis occurs, the associate relationship will become successful.

The associate doctor must understand that he’ll have to work hard, go the extra mile and work more hours than the established doctor; however, the associate will still be working fewer hours than if he owned his own practice.

Financial arrangements for a tandem associate practice

In a “Tandem” associateship, the associate usually receives a guaranteed weekly or monthly compensation amount, which is a draw against commission. The commission is usually a percentage of the services or collections the associate doctor renders.

The associate doctor should expect to make 25% of collections on his services. An associate who feels he should make 50% or more is totally unrealistic. The average chiropractic practice has a 50% to 60% overhead, which leaves an average net profit of 40%. The established doctor must earn compensation for the time he dedicates to training his associate and for the patients he turns over to his associate. The established doctor can only share the net of his practice, and it's fair that he make 15% for his efforts, while the associate makes 25%.

Non-competition agreements

There is always a genuine and legitimate concern on the part of the established doctor that, after he provides an associate with valuable training, experience and patients, the associate will leave him and open a practice next door. If this happens, it will rob the established doctor of patients and income, while at the same time his overhead will not decrease, thereby forcing the established doctor into an unfavorable financial situation. To keep this from happening, the established doctor will require a non-competition agreement from his associate.

Believe it or not...non-competition agreements are in the best interest of both the established and the associate doctor. This type of agreement will help eliminate any hesitation the established doctor may have in turning over a large volume of his patients to the associate doctor. After all, the entire purpose of the “tandem” associate arrangement is for the established doctor to increase and improve his practice by using his associate's skills while, at the same time, the associate wants to be filled with patients, learn correct and successful practice habits, including how to run a large practice, and earn a respectable living in the process. The only way all of this can happen is if the associate doctor signs a non-competition agreement.

More information on becoming an associate is available online at www.practicestarters.com.

When you're through being an associate and are ready to start your own practice, hire a consultant who specializes in starting practices to guide you.  Don’t think that you now have the experience necessary to start and build a new practice…. You don’t!  Yes, you’ve gained the experience of caring for patients and learned some good office procedures, but that’s not enough knowledge to start a successful new practice.  You still have to learn how to find a great office location, effective bank negotiating strategies, cost-cutting remodeling negotiations, how to market a new practice, etc.  It’s the lack of this specialized knowledge that dooms new practices, not the lack of knowledge regarding patient care.

 

Dr. Peter G. Fernandez is the world’s authority on starting a practice.  He has 30 years’ experience in starting new practices, has written four books and numerous articles on the subject, and has consulted in the opening of over 3,000 new practices.  Please contact Dr. Fernandez at 10733 57th Avenue North, Seminole, Florida, 33772; 1-800-882-4476; This e-mail address is being protected from spambots. You need JavaScript enabled to view it or visit www.drfernandez.com

 
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