Strategy Review
In most cases insurance companies have 45 days to process the claim once they receive it. Key words, process, and receive. Remember, they make up to 50% of their profit from interest earned on your money. Not just premiums they have collected from patients. The insurance company strategy comes in four basic flavors.
- Delay claim submission
- Prevent claim submission
- Prolong the “processing” time.
- Take the money they paid back from the doctor.
Now we know their motivation. If you look at the chart below it is pretty obvious. What tactics to they use to make it happen?
Tactic # 8 – Documentation –
I have spoken to dozens of doctors who are so scared of not writing SOAP notes correctly they don’t do them at all. Seems counter-intuitive but it is the extreme example of the documentation issue. Remember that your state board has requirements for daily notes that must be followed. That is not what scares doctors. What scares them is not knowing what the insurance company will accept as medical necessity. What is medical necessity anyway? I’m a chiropractor. The fear of getting it wrong is huge. Usually when I explain there should be a bigger fear of not doing it at all then getting it wrong, it is motivation enough. More on that in the next section. The rules for what is and what is not “medical necessity” are intentionally ambiguous just like coding, insurance verification and reading EOB. Know the game being played and do not fear it. If you at least look like you know what you are doing you will drastically reduce the chances of poor documentation biting you in the butt. You can get software to help with this. That’s another subject.
I have spoken to dozens of doctors who are so scared of not writing SOAP notes correctly they don’t do them at all. Seems counter-intuitive but it is the extreme example of the documentation issue. Remember that your state board has requirements for daily notes that must be followed. That is not what scares doctors. What scares them is not knowing what the insurance company will accept as medical necessity. What is medical necessity anyway? I’m a chiropractor. The fear of getting it wrong is huge. Usually when I explain there should be a bigger fear of not doing it at all then getting it wrong, it is motivation enough. More on that in the next section. The rules for what is and what is not “medical necessity” are intentionally ambiguous just like coding, insurance verification and reading EOB. Know the game being played and do not fear it. If you at least look like you know what you are doing you will drastically reduce the chances of poor documentation biting you in the butt. You can get software to help with this. That’s another subject.
3 Responses
I know the tactics all too well. It is getting harder and harder to get paid by the insurance companies all the time. I miss the good old days!
Hi Dr. Devine
What are you doing to fight back? Have you joined a billing network? Do you use a true “workflow management system” or a typical “practice management system”?
Brian
Doctors of Chiropractic – often referred to as chiropractors or chiropractic physicians – practice a drug-free, hands-on approach to health care that includes patient examination, diagnosis and treatment.