Practice Management

Going “Paperless” or “Fully Automated Paperless”?
Practice Management
Written by Claude Cote   
Friday, 12 November 2010 15:10

by Claude Cote


There is no doubt that one of the most popular trends in chiropractic is going paperless.  Software companies have never been so active at programming all kinds of paperless office systems.  Most chiropractic offices are already using computers for front desk tasks such as billing, appointments, etc. For most chiropractors, going paperless is the elimination of the health record paper file or travel-card.  The chiropractor would use a keyboard instead of a pen to take notes.  This is all nice, but not that big of an improvement for the overall practice.  Although doctors will not have to search for a lost file, the benefits are very limited and the productivity and efficiency will remain basically the same.  Fortunately for the chiropractic profession, the growing trend of going paperless has made Health IT companies surpass themselves with automated systems that, 10 years ago, none would have thought possible.  The key word in these systems is "Automation."  Going paperless is great, but going fully automated paperless is impressive.  Lets say you are in a situation where your CA is wanting to go on vacation next week because of a family emergency.   You want to do everything you can for them and let them off, but you are expecting 250 patients next week.  Then you start to think, “I can’t do everything by myself.”
Instead, what if your answer to your CA would be:  "No problem, take next week, and then take an extra week to take care of your family."  Believe it or not, a new fully automated system will let you do this very easily, and with no stress at all.  Many doctors that I know are handling these kinds of situations regularly.  

The concept, a very logic one:
This fully automated concept was invented in 2001, and was available for all chiropractors in March 2003.  Basically, you need three computers in your office.  One installed for patients to signin electronically.  This Sign-in computer will be installed near the entrance door or near the waiting room area.  The patients sign in by themselves and then sit in the waiting area.  This eliminates the need for the patient to go and see the busy CA to tell her "I am here...." By signing in, the entire system is aware that the patient is in and is presently sitting in the waiting area.  Another computer is in the treatment room for the doctor.  At a glance, the doctor sees who is in already and who will come during the day.  When the doctor is ready, he presses one key to release the room for the  patient to come in.  This single key press will activate a calling system where speakers in the waiting area will call the next patient and invite them into the room number one,  as an example.  You could have two or multiple rooms with a computer in each and just do the same thing.  What is really impressive is that the system will use the CA’s (or doctor’s) voice to call the patient.  At the first visit, the CA will record the patient’s name and everything is done for all subsequent visits.  Having been witness to thousands of patients being called this way, I can tell you they are very impressed and excited.  Then, the patient shows up in the treatment room.  The Health Record file comes up on the screen instantly, including X-Rays, posture images, and everything the doctor needs to know about the patient.  You may also want the patients to answer a few questions on the Touch Screen to build the subjective note themselves before the treatment.  As the normal routine goes, the doctor will build the SOAP note on a Touch Screen or electronic Touch Pad (no keyboard needed) and the system will automatically generate all the billing required for this patient.  When the treatment is finished and the patient leaves the room, the doctor will close the Electronic Health Record by pressing one key again. This final action will close the file and, believe it or not, the system will call the next patient in line and direct him to this new available room without any human action needed.  In fact, if the patients have prepaid for a few treatments and have a few appointments already scheduled, they can leave the clinic without stopping at the front desk at all—unless they want to ask your CA how her last vacation was?  
The reactions of patients using these automated processes are incredible. You need to go and visit an automated clinic for yourself to realize how impressed the patients are. Also these systems give your CA a lot of free time so, instead of managing an arrival sheet and entering data for billing, they can walk around educating your patients, reminding people about marketing promotions or can actually be a Chiropractic Assistant instead of a Chiropractic Administrator.  
So, if your CA needs a week or two of vacation, tell her to “Have fun….”


M. Claude Cote  is an expert in EHR systems, insurance billing and chiropractic clinic management for 22 years.  He has installed EHR system in 17 countries over 5 continents and nationwide in USA.  He is the President and Founder of Platinum System C.R. Corp (  For comments or questions please email to This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

The Keys & Principles for Success
Practice Management
Written by Dr. Eric Kaplan, D.C., F.I.A.M.A.   
Friday, 24 September 2010 11:22

The Keys & Principles for Success

by Dr. Eric Kaplan, D.C.


Make Clear Cut Goals

"If you don’t know where you are going, how do you know how to get there?" Goals are like maps, they help us set direction in our personal as well as our business lives. There are many similarities between business and war. In both cases, the victor is the one who uses superior strategy against his or her competition.

There are three principles of military strategy you can apply to your work every single day. The first idea from the military is called the Principle of Maneuver. The principle of maneuver says that you should be clear about the goal, but be flexible about the process of achieving it. According to the Menninger Institute, this quality of flexibility is the most important single quality that you will require for success in times of rapid change.

The world of health care is changing. Technology is changing the face of our profession. You should set aside a goal to update your office. When you update your office, update your marketing. Get patients excited again about what you do. Nothing stays the same. The automotive industry, one of the most powerful in our country and the world, understands change. Soon they will get you excited about their 2009 editions. Get patients excited about your office for the year ahead. Add something new to your office and let the patients know about your growth and what is new in health today.


Be Open to Patients’ Feedback

William Esteb originally made Back Talk Systems effective by listening to the patients’ thoughts while creating his marketing. Their feedback is germane to your success. A key peak performance quality for you is to "accept feedback and self-correct." Peak performers are those who can take information from their environment and, even if the information is contrary to all of their planning, they can accept the information, modify their plans, and continue moving forward. They are always open to new ideas and insights. Are you a Peak Performer? Do you want to be? Ask your patients what they want, show them some technologies and ask them their opinion. Respect them and their answers.


Learn What You Need to Know

The second military principle you can use is the Principle of Intelligence. This principle of intelligence means, simply, "Get the facts!" Prior to buying anything, know everything. As President of DiscForce, I wanted to know everything about Spinal Decompression. It is an exciting technology. Decompression works for two reasons: one, it gets results; and, two, marketing, when done accurately and appropriately, works. A new technology without New Patients will not be successful. Do your homework first, make your acquisition, second. Remember, part of your homework is getting community and patient feedback.

The most important thing in business decision making is for you to get accurate information. Facts don’t lie. It is important that you get the real facts, not the assumed facts or the apparent facts or the obvious facts, or the hoped for facts, but the real, provable facts. Ask the company for testimonials from other doctors; ask to see the marketing; take your time making any decision.


Make Better Decisions

Perhaps the key job of the doctor is decision making. The quality of the decisions that you make will be in direct proportion to the amount of time that you take to gather timely and accurate information. The very best thing that you can do, if you have insufficient information, is to delay making a decision at all. Often, we must spend the time to diagnose our own practice. Symptoms of a sick practice are:

1. No new patients

2. No referrals

3. Insurance dependant

4. Poor collections

5. A sloppy office

6. Constant staff turnovers

7. Prolonged patient waiting.

A sick practice will have any or all of these. Each symptom must be attacked; but the key, doctors, is to find the cause and correct it.


Invest Wisely

The third military principle applied to strategic planning is the Principle of Economy of Force. Economy of force means that you expend only the resources necessary to achieve the objective and not more. It also means that you commit sufficient resources to achieve the objective once you have decided upon it. In life, in business, the principle applies. Plan strategically; this is a part of goal setting. Aren’t goals a means of planning? Your first goal is to start writing down your goals. If you succeed at doing something as simple as this, you are on your way.

Time is my most valuable commodity. In life, you can always get more money, but time spent is gone forever. Since your own personal energy is all you really have to invest over the course of your lifetime, the military principle of economy says that you should be very selfish when deciding how you are going to use your self. Keep asking yourself, "How important is this?" and, more importantly, "How important is this to me?" Then ask yourself, "How important is this to my patient, to my practice?"

The #1 key to any success is to always remain flexible when you are working toward your goal. In times of rapid change, all of your best ideas can be contradicted by new information. Be willing to try different things. Be open to new inputs and ideas. My father used to say, "Even a clock that doesn’t work, is right twice a day." Be open minded; be flexible.

The #2 key: Get the facts! The more and better information you can acquire before you make a decision, the better your decision will be. The very best managers spend a good amount of time getting the real, provable facts before they take action.

The #3 key, in my experience, any virtue translated into action leads almost invariably to positive results. This applies to integrity, persistence, courtesy, love and courage. I’ve always liked the advice of an old man to his grandson, "Act boldly and unseen forces will come to your aid." Success is not always for the timid. It took a risk to go to chiropractic school; a larger risk to open your practice. Without taking those two risks, you would not be where you are today. Life is about taking risks and, of course, faith.

Key # 4: Perhaps the most obviously important part of courage is the courage to step out in the face of uncertainty. Every great venture in the history of man has begun with faith and a giant leap into the unknown.

General Douglas MacArthur said, "There is no security in life, only opportunity."

The creed of Frederick the Great, one of history’s most successful leaders was, "Audacity, audacity—always audacity."

A twelve-year study of successful entrepreneurs conducted by Babson College concluded that the only thing they had in common was the willingness to launch, to step out in faith. Once they had started, they learned the lessons they needed to succeed—many of them ending up successful in completely different businesses from where they started. Faith, confidence and belief, these words are the backbone of our profession. Keep the faith; but faith without action will never work. Take the leap of faith in your life, in your practice.

Key # 5: Dare to succeed. Dare to go forward. Successful doctors, like successful companies, are invariably those that continue to research, develop, experiment and introduce new products and services—even during the deepest recessions. Successful people are those who are continually stretching themselves to move out of the comfort zone, to face the twin fears of failure and rejection, and to move forward in spite of them. We must constantly look to step out of our comfort zone and move into the success zone.

Key # 6, Just Do It. First, just do it! Step out in faith! If you think of some action you can take to improve your life, give it a try. You may be surprised.

When fears steps in, I expect you to step up. Remember, when in doubt, act with audacity. Audacity may get you into trouble but, even more, audacity will get you out. Go for it!

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. Co -developer and President of Discforce, the next Generation on Spinal decompression. For more information, call 1-561-626-3004.

Double Your Practice Without Leaving Your Front Door
Practice Management
Written by Dr. Mark Studin DC, FASBE, DAAPM, DAAMLP   
Thursday, 23 September 2010 16:32

Double Your Practice Without Leaving Your Front Door

by Dr. Mark Studin DC, FASBE, DAAPM, DAAMLP


Over the years as a practice consultant, I always get the same question: "How can I get more new patients?" This seems to the mantra of the masses! This seems to be the only or best way to build a practice for most.

There are numerous issues that must be addressed before an answer to this question can be rendered. What is your volume, your patient visit average (PVA), practice mix of personal injury patients, cash, managed care, workers’ compensation, and Medicare patients?

The Healthcare Stimulus Package: Navigating the Buzz
Practice Management
Written by Michael Failla, D.C.   
Thursday, 23 September 2010 15:50

The Healthcare Stimulus Package: Navigating the Buzz

by Michael Failla, D.C.


There has been a great deal of buzz lately about the government’s healthcare stimulus package. And, as Doctors of Chiropractic, the plan is of great interest…as well as great confusion. The promising news is that this package could potentially provide reimbursement payments to qualifying chiropractors of up to $44,000 over the next six years.


We do know that providers mustUse a system which fulfills these

Requirements before the year 2013

As there has been much talk of the stimulus plan, there has also been much misinformation and speculation. So let’s take this time to set the record straight. Why do we say that clinics could potentially qualify for this stimulus package? And just how sure can we be that this stimulus package will apply to chiropractors after the measure is signed and sealed? Well, there are still some undefined areas and loose terms to be tightened up.

We do know that providers must use a system which fulfills these requirements before the year 2013 to receive the full incentive payout, and penalties for not adopting a qualified EHR (electronic health record) system will start taking effect after 2015, including a 1-3% cut in Medicare payouts.

 The stimulus plan

also requires a "meaningful use" of a "certified EHR system." This verbiage is subject to a wide range of interpretation and, therefore, the implications are still pending

We also know that, in order to be eligible for participation, clinics must submit over $24,000 for the year 2011 in Medicare Part B claims under a certain set of chiropractic treatments. These treatments are narrowed to include only the treatment of spinal subluxations. These treatments must be submitted using the AT (Active Treatment) modifier to ensure that they fall under the umbrella of medical necessity.

The stimulus plan also requires a "meaningful use" of a "certified EHR system." This verbiage is subject to a wide range of interpretation and, therefore, the implications are still pending:

Meaningful use will require the record-keeping and distribution of prescription medications, interoperability with other certified EHR systems, electronic exchange of medical records, and the provider’s submission of clinical quality measures. The specifics of these requirements have not been decided upon in any clear form, and so we will have to rely on future clarification to understand the extent of this term.

A certified system will most definitely require the software system to be reviewed and accepted by a formal certification panel, surely either the Certification Commission for Healthcare Information Technology (CCHIT®) or the National Institute of Standards and Technology (NIST®).

The Secretary of Health and Human Services has a deadline of December 31st, 2009, to solidify a set of standards for meaningful use and EHR certification. It looks as though we may have to wait patiently until then to learn the full requirements for participation in the stimulus package.

So why buy an EHR system now?

If you research and make an educated decision about your EHR system now, while you have the time, you can ensure a boundless return on your investment before a mandated switch causes you to scramble for a system that may not meet the specific needs of your office. Selecting the right software for your practice is an important decision, and not one to make hastily when penalties for non-compliance are creeping up behind you, and you’ve missed your chance at a sizable stimulus payout.

Choose your EHR system carefully, and go with a progressive company that has its finger on the pulse of American healthcare. Select a company that is informed, responsive, and dedicated to keeping on top of the latest information. If you take the time now to choose wisely, your investment will be in place and ready to carry you effortlessly through the inevitable changes that are hovering on the horizon.


Dr. Michael FailaDr. Michael Failla is the President and Co-owner of Integrated Practice Solutions, the makers of ChiroTouch. Dr. Failla graduated from Life University College of Chiropractic in Atlanta, Georgia and went on to run a highly successful chiropractic office in Seattle, Washington for 25 years. Dr. Failla sold his practice in 2007 and continues to promote health and wellness by helping chiropractors run streamlined and successful practices with more time for their patients and less time with their paperwork.

Medicare Audits Becoming More Common in Deteriorating Economy
Practice Management
Written by John Davila, D.C.   
Thursday, 23 September 2010 15:20

Medicare Audits Becoming More Common in Deteriorating Economy

by John Davila, D.C.


Recently, Iowa Senator Grass ley started looking into Medicare’s acknowledgment that the amount of money overpaid to Durable Medical Equipment (DME) providers, due to fraud and abuse, has increased by 44% in the past few years. You may ask, what does this have to do with chiropractic and my practice? The answer is, “A lot!” With the Federal Government feeling the pressure of reduced income and increased expenditures, they are looking at any and all ways to reduce spending, especially for things that shouldn’t have been paid for in the first place.



The answer is, “A lot!”


Even though the cost of drugs far outweighs the amount of money spent on DME, it is the percentage of overpayments, due to fraud and abuse that makes this issue a political football. In chiropractic, we have been saddled with the same issues as DME ever since the 2005 office of the inspector general review of chiropractic. Because of the percentage of claims that should have been denied (67% according to the OIG report), payment for chiropractic care has become a political football that has nothing to do with patient care. To make things worse, within the next year Medicare will have launched recovery audit contractors across the country to review and try to recover part of the $10,000,000,000 overpaid within the Medicare System every year. But, what causes an audit? There are many things that cause an insurance carrier to decide to pick a specific provider of alignment. In the past, the most common causes of an audit were related to billing and coding procedures that took place within the office. But, because of increased scrutiny from the Federal government, there are many new reasons why a provider would be chosen to be audited. Those reasons can range from not charging for services provided, to paying for referrals. So, why does the government care if you give free X-Rays and examinations to Medicare beneficiaries? The answer is simple. The Office of the Inspector General released a special advisory bulletin in August of 2002, titled Offering gifts andother inducements to beneficiaries. The bulletin states: Offering valuable gifts to beneficiaries to influence their choice of a Medicare or Medicaid provider raises quality and cost concerns.Providers may have an economic incentive to offset the additional costs attributable to the giveaway by providing unnecessary services or by substituting cheaper or lower quality services. The use of giveaways to attract business also favors large providers with greater financial resources for such activities, disadvantaging smaller providers and businesses. But, what is considered a valuable gift? The bulletin states: The OIG has interpreted the prohibition to permit Medicare or Medicaid providers to offer beneficiaries inexpensive gifts (other than cash or cash equivalents) or services without violating the statute. For enforcement purposes, inexpensive gifts or ervices are those that have a retail value of no more than $10 individually, and no more than $50 in the aggregate annually per patient. Violating these rules can create harsh penalties for the practice. The bulletin states: A person who offers or transfers to a Medicare or Medicaid beneficiary any remuneration that the person knows or should know is likely to influence the beneficiary’s selection

of a particular provider, practitioner, or supplier of Medicare or Medicaid payable items or services may be liable for civil money penalties (CMP’s) of up to $10,000 for each wrongful act. There are two simple steps that a practice can take to avoid giving an auditor additional ammunition to use against the practice:

  1. If you offer gifts to patients in your practice, make sure they are less than $10, no more than five times a year. In addition, the gifts must not be considered an inducement for a reward to create new business from a Federal Healthcare program.
  2. Include your staff in all training on compliance issues. This will reduce the chances of a staff member becoming a whistleblower, which is the number one reason why a practice would get audited for offering inducements and expensive gifts to beneficiaries.

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. In 2001, he re-wrote the Medicare LCD coverage policy for Palmetto GBA (SC Medicare). 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 on the web at


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