Can you afford to fail an insurance audit?
It seemed like things might get worse for Ben’s chiropractic clinic before they got better. Sure enough, he received another letter from Blue Insurance. This time they wanted him to pay back the money he had already received for the claims that failed the audit last month in addition to paying a hefty penalty of $30,000. “Why don’t you contact a chiropractic compliance expert,” Carmen suggested. “He might be able to help you figure out this audit fiasco without losing your clinic.” Ben was trying to appear calm as he responded: “I guess it’s worth a shot.” He did not want his wife, Carmen, to know how worried he really was. The truth was, he doubted that anyone could help him make it through this audit-nightmare in one piece. But at the same time he did not want to give up on his dream of having a chiropractic clinic so he could save as many people’s lives as possible. When he met the compliance expert, David, later that week, he did his best to stay composed as David prepared him for the worst case scenario. “You should be aware that Blue Insurance might blacklist you,” David warned. “And once they do that, all the other insurance companies will come after you like a pack of wolves. Then you will have to deal with even more audits and disruptions of your chiropractic billing cycle.” “Something tells me that’s not even the worst outcome,” said Ben. “Unfortunately, it’s not,” David admitted. “You could also lose your license, not to mention the legal fees you would incur if Blue Insurance takes you to court. In case you are convicted for fraud, you could also serve time.” Ben swallowed hard. He started thinking about his patients. Would his patients stay loyal throughout these fraud accusations? It’s not like they would understand how difficult the insurance companies made it for chiropractors to stay compliant with ever-changing regulations for chiropractic billing and documentation. His professional reputation was clearly taking a big hit. Would anyone still think of him as a stand-up guy who was not interested in cutting corners? “Is there any way to minimize the damage from this failed audit so that I don’t lose my entire patient base?” Ben asked. “I can’t blame people for not giving me any referrals until this is over. But I can’t afford to lose my current patients, too.” David sighed. He felt Ben’s pain and wanted to reassure him. But he had to avoid giving him false hope. Ben had to be ready for an uphill battle, no matter how ugly it might get, if he wanted to prevail. Have you ever been audited or do you know anybody who was audited? What was the worst part about it?
Chiropractic Billing Compliance | Can you avoid getting audited?
The audit of his chiropractic documentation a few weeks ago did not go well for Ben. Now he had to pay $30,000 as penalty, according to the letter he just received from Blue Insurance. Ben felt angry as he crumpled the letter in his hand and said: “Where am I going get this kind of money?” His wife, Carmen, stopped feeding their 8-month old baby boy, Jonathan, for a moment to look at Ben. The dark circles under his eyes were a testament to his many sleepless nights this month. She was concerned, but did not want to add fuel to the fire. He was already stressed out enough. This fine came at the worst time possible since she was still staying home with the baby and wasn’t able to alleviate her family’s financial burden with an additional income. In spite of her MBA she had no helpful business advice to offer either. She felt helpless and powerless as she watched her husband struggle with this new burden. It all started three weeks ago when Ben received a notice from Blue Insurance to review the notes for chiropractic claims that he was paid in 2012. Apparently some of his patients had received inaccurate information due to sloppy accounting and complained, which raised red flags with the insurance company. Next thing he knew, the auditor was knocking on his clinic’s door to inspect the notes for those claims in question. Carmen suddenly had an idea:”Why don’t we meet your friend, Tom, who had to go through an audit last year? Maybe he can give you some pointers on how to deal with this situation.” Tom owned a chiropractic clinic in the same neighborhood and was happy to meet them for lunch. “I’m sorry you have to go through this, too, Ben,” he said. “Being audited and fined is no walk in the park, but don’t beat yourself up over it. I have learned that the insurance companies come after all chiros because they simply do not want to pay us. In fact, the fewer providers they have to deal with, the better. So they just try to blacklist as many of us as possible.” Ben was taken by surprise:”Seriously? Are you saying that anyone can get audited?” “That’s exactly what I’m saying,” Tom responded. “Audit penalties are pure revenue for the insurance companies. And just like every other business, they want to increase their profits. I read in this recent article by Palmetto GBA that chiropractors have a high error rate of 84.41 percent. That makes it easy for the insurance companies to come after us.” “So audits are pretty much a fact of life,” Carmen said flatly. “I just wonder if there is any way Ben can reduce his audit risk so that we still have money for diapers and the electric bill after the next audit,” she added half-jokingly. What do you think? Can audits be avoided, or is there at least a way to reduce your error rate as chiropractor?
Chiropractic EHR Software | Symmetry Spine and Wellness Center Dream Practice of the Month
Dr. Cynthia Boyd knows how to build a chiropractic dream practice: it takes hard work, a concerted team effort, and the expertise of Genesis chiropractic software and billing staff. “I have my dream practice,” says Dr. Boyd. “There are not many areas that need improvement.” The key to success for Dr.Boyd is balancing all aspects of practice management using Genesis cloud-based chiropractic software: “The [Genesis] system is amazing. I was 3,000 miles away for a month and I knew exactly what was going on.” Dr. Boyd doesn’t have time to micromanage her staff. With Genesis, she can easily track everyone’s individual performance anytime from anywhere. Dr. Boyd can also keep an eye on vital Key Performance Indicators, such as chiropractic billing, with the Genesis Radar. Best of all, Dr. Boyd does not have to change the way she runs her practice to optimize her workflow, complete her patient SOAP notes, and control compliance. As Dr. Boyd keeps growing her practice, she uses Genesis workflow engine to help manage teamwork among her staff and Genesis support team. The staff at Symmetry Spine and Wellness Center keeps the AR past 120 days low at 8 percent by consistently clearing the claims workbench while the weekly phone communications with her Practice Success Coach Heather Miller ensure her practice gets paid in full and on time. Coach Heather Miller: “Dr. Boyd is passionate about what she does and her business. She has found a balance with her practice and all of the other projects that she works on. Dr. Boyd trusts her employees to do their jobs without having to micromanage them. She has a great staff that works well together to get the job done and continue to grow the practice. In the end it all comes down to teamwork.”
Chiropractic Compliance | Check exclusions list to avoid denied claims
Dr. John Davila explains the importance of checking the LEIE or list of exclusions of individuals or/and entities for all staff members at your clinic to avoid chiropractic billing issues such as compliance risks and denied claims. Dr. John Davila talks about the significance of the List of Exclusions of Individuals and Entities for your chiropractic clinic in the video below: Cystic Fibrosis Services: $308,000.00. Radius Hospital Massachusetts: $334,000. Susony Hospital Puerto Rico: $382,000. Saint Francis Hospital Connecticut: $80,000. In a 6-week period of August 2013 the Office of Inspector General, recouped $1.2 million from these hospitals for one simple reason: someone on their staff was excluded from serving Medicare patients. My name is Dr. John Davila of Custom ChiroSolutions and today I want to talk to you about something very, very important that you should be looking at as far as compliance goes in your office. It’s the LEIE or list of exclusions of individuals or/and entities. Now, the reason this story is important is for a very simple reason, a couple years ago I had a client and he had a problem getting his Dr. his associate Dr. Registered with all these different insurance companies, and he couldn’t get the insurance companies to pay even out-of-network benefits and then he tried to get Medicare to register this Dr. and that didn’t work either. Next thing you know, he’s calling me going “Hey listen, I have all this money outstanding. I have these different issues.” We went in and looked and guess what– the first thing you do when you get a compliance manual is, check your employees. He didn’t know that. He didn’t know how. And that’s what we did for him. We came in and checked all of his employees and low and behold, the Doc he was trying to get registered was excluded about two years earlier from the Medicare program. Now the Dr. was cleared of all charges, he got his license back to practice, but Medicare didn’t let him back in. Major, major problem. So, what I want to do today was just bring this up because I think it’s really important for you understand that you need to check your employees. Now this Dr. didn’t know how to do it, we did. What we had to do was get him set up with a compliance manual and get this process going for him and that way he checked his employees. So if you’d like to know more about how to get a compliance manual in your office, especially to go ahead and check your employees on a regular basis, especially if they’ve been excluded from Medicare and if they’re on this LEIE list, let us know. You can give us a call at (800)-974-3479. If you dial extension 2 and ask for Stacy, she’ll go ahead and set you up for a free 30 minute consultation and we’ll get on the phone together, me and you and we’ll talk about how to get a compliance manual in your office. Now remember, call us now 800-974-3479 ext two.