Are you losing the “battle” with insurance reimbursement? I say “battle” because that is what it has become. The insurance industry’s fiduciary responsibility is to their stockholders and profits, not providers. They have internally mandated that they will create systems that will increase profits and limit payment to all health care providers, especially chiropractors.
Why chiropractors? According to James J. Mathis, a former executive of Allstate and State Farm insurance companies, “There exists a discrimination of the chiropractic profession, which results in chiropractic treatment billing being denied, in part and in whole.” In his recent article “How to Get Paid” in The American Chiropractor, Mr. Mathis reveals the true motivations in the insurance industry. “Insurance industry claim departments were viewed as profit opportunity entities. Goals were developed to produce billions of dollars from a reduction in claims payments.”
What has become commonplace in your office has become an extension of the insurance companies’ request departments. They want claims to be uniquely submitted, and they employ tactics, such as reduced fee reimbursements, requests for complex documentation, and routinely postponed payments, that add to your struggles.
If you, the doctor, are allocating more time and energy to the documentation of the services performed and less time to building a quality practice, you are the typical chiropractor. If your office insurance billing staff is putting out a Herculean effort to collect claims, and reimbursement has continued to stagnate, once again, you are the typical chiropractor. The insurance industry’s strategy is working! It’s not all dollars and cents though; the emotional wear and tear on you and your office staff will continue to grow. We are in a “David and Goliath” relationship with the insurance industry—how do we endure when the odds are weighted against us?
We must alter the view of our practices. We must not only be in the practice of chiropractic, we must be in the business of chiropractic. We can no longer run our practices as a “mom and pop” candy store, when the biggest of businesses, the insurance companies, dictate our livelihood.
The most effective business model to combat insurance pressure is to separate the patient interaction from the insurance billing and collections. Recognizing that front desk and insurance personalities are completely different is the most important element. Your front office staff must be patient, friendly, loving and caring. By design, the patient will receive the maximum attention, instruction and education to achieve the best results. In contrast, your insurance personnel must be aggressive, highly motivated, detail-oriented, and educated about the newest procedures and nuances of each company. This area requires strong personalities that will follow up on each claim submitted until it is paid. The personality of each office task is in direct opposition to the other.
Equally as important is the outsourcing of the billing and collection of the service performed. The probability that a chiropractic office with a staff that wears many hats can be as effective as an organization whose sole purpose is to process and follow-up on claims is low, at best. How can a single office keep up with the constant changes in coding, claim submission protocol and constant follow-up?
A good billing and collection company processing a large volume of chiropractic-only claims is able to distill data and efficiently manage changes in insurance procedure. In this business, information is powerful. As they obtain knowledge about a new code, documentation process, or insurance law, the new information is applied and quickly distributed to their clients early in the learning curve.
Allowing a professional billing and collection organization to execute this arduous task will maximize both areas within your practice. Imagine concentrating on patient education and care knowing that billing and collection duties are being accomplished with a higher level of efficiency and lower costs.
The advantages of outsourcing billing and collection can easily be measured quantitatively, but the value added is in the intangibles. Removing the headaches of dealing with insurance companies brings a positive and upbeat energy to your office. You can then reprioritize to practice building and focus on marketing, patient education and employee encouragement.
What will it take to outsource billing and collections in your practice? Will it take further deterioration of your collection percentage, or your insurance staff resigning and taking with them every bit of vital information about your practice? The future of the business of chiropractic is outsourcing the specific tasks to specialists that can do a better job.
For the typical chiropractor, it’s a “leap of faith”—a leap that will allow you to concentrate on the practice of chiropractic, while having the confidence that motivated professionals are working for you on the business of chiropractic.
David G. Foster, DC, co-owns and operates six Family Chiropractic Centers in New Jersey and has been practicing for 14 years. He also writes and consults about multi-practice expansion, the buy/sell process, practice evaluation, associate contracts, and shareholder agreements. He can be reached at 800-908-3040, by email at
, or visit www.familychiropracticcenters.info.
Joseph Labriola, DC, has been in practice for 6 years. He is the co-owner of New City Chiropractic Center in New City, NY, and is the co-founder of Axis Billing & Collections, a chiropractic billing company based in New Jersey. He can be reached at 201-997-6905, or by e-mail at