Ben was forced to put all of his plans on hold. After paying the $30,000-fine to Blue Insurance they would have to cancel their Euro trip for another couple of years. He hated disappointing his wife, Carmen, and their baby boy, Jonathan.It seemed like failing that audit last month would have a ripple effect on his financial situation for a long time. He was still trying to figure out how to return the money he had already received for his failed claims without bringing his practice cash flow to a screeching halt. Although he was concerned about the future of his chiropractic clinic, he held on to the hope that he could emerge from this audit risk nightmare with a better way to stay compliant. He just had to come up with a plan for making his chiropractic billing and documentation audit-proof.
“Have you been worried about compliance since you got audited last year?” Ben asked his friend,Tom, whose chiropractic clinic was thriving after last year’s brush with disaster. “I am trying to figure out how I can improve my compliance so that I can avoid another failed audit.”
Tom smiled and said:”Yes, of course, but I have learned that we really can’t avoid an audit and the audit risk. So I decided to cut down my error rate to reduce my audit risk. Chiropractors can absolutely not afford to have any unsigned notes, unbilled visits, missed re-exams, or denied claims as number one rule. So you have to find a way to track these meticulously.”
“Ok, but it seems impossible to even remember all the different insurance protocols for each patient,” countered Ben. “It is so confusing to keep track of all the requirements, and just when you think you get it, they change everything again.”
“That’s true,” Tom admitted. “And many of those so-called compliance experts give advice that is really difficult to implement, not to mention that they all tell you something different.”
“So how can we get it right then?” Ben asked. “I can’t gamble with the future of my clinic and need a bulletproof process to stay compliant.”
- Unsigned notes
- Unbilled visits
- Missed re-exams
- Claim errors
