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Curve Ahead

curveahead.jpgThe end of third-party reimbursement is around the corner. It was a great run. There is little evidence that the erosion you’ve seen in the last couple of years will slow, much less reverse. If you don’t adapt, you’ll jeopardize your practice and your livelihood.

Welcome to the future.

This is the first of several posts exploring patient financial education and the transition into a self-pay practice. Will you make the turn? Can your practice thrive in this brave new world? Ask yourself these vital questions:

1. Do you take assignment, submitting the patient’s claims on their behalf?

Yes. Originally offered as a personal service to patients, today you may be inadvertently reducing their coverage and inviting claims cutting!

No. Great. That means you’re distracted by fewer off-purpose tasks, enjoy a lower overhead and a more predictable income.

2. Do insurance companies routinely cut your claims?

Yes. It’s because they can. In actual fact, you’re the third party. You’re not to be trusted. You may be trying to “sell” their policyholder unnecessary care.

No. Apparently you don’t take assignment. Excellent!

3. Do most patients discontinue their care when their carrier cuts off benefits?

Yes. This is an example of the Golden Rule: he who has the gold, rules. Attempting to serve two masters is pure folly.

No. Fantastic! It’s obvious you explain chiropractic powerfully and see it as a way of life, not merely a short-treatment for episodes of back pain.

4. Do you believe that better coding would reduce the amounts by which insurance companies cut your claims?

Yes. These days, this is merely an adult version of a summer camp Snipe Hunt. Better coding simply prolongs the inevitable.

No. It was great while it lasted. But that was then. This is now.

5. Have you added services or procedures in the hopes of offering something that would still enjoy decent reimbursement?

Yes. Whether these services are good or bad, helpful or not, what’s your plan when these services are no longer paid for?

No. Good for you. The “dark side” can be very enchanting...

6. Have you signed a “gag order” as part of an HMO agreement that prevents you from telling patients how useless their coverage is?

Yes. Begin extricating yourself from agreements that demote you from a doctor to a mere “provider.”

Don’t know. Many are surprised to learn they’ve surrendered their free speech rights in exchange for the promise of a constant flow of bargain-hunting patients!

No. Great! You either read those agreements or didn’t sign any.

7. Are you confident with how your staff responds when asked on the telephone, “Are you on my plan?”

Yes. Just make sure it doesn’t involve tap dancing, playing coy or a version of “You’ll-need-to-come-in-and-talk-to-the-doctor.”

No. Start here. Any attempt to free your practice from the bondage of third parties begins on the telephone with a prospective new patient.

8. Do you feel so uncomfortable talking about money that you’ve delegated this to someone else?

Yes. When you were working for insurance companies and getting well paid, it made sense to delegate this task to someone else. But not now.

No. Excellent.

9. Are you carrying so much personal debt that you’re only making the minimum payments?

Yes. Getting your own financial house in order is essential. It’s a spending problem, not an earning problem.

No. Excellent. You have the maneuvering room necessary to make changes to your practice financial policy.

10. Do you think chiropractic has such marginal value that patients will only come in if someone else pays for it?

Yes. Then you’ve either been attracting “the wrong crowd,” believe what the detractors of chiropractic have been saying or both.

No. Then there’s hope!

* * *

This is not a drill. You have limited time to make some overdue changes. More research, lawsuits or better coding are not solutions. There is hope, but you must begin the process now. Consider Converting to Cash to help you on your way.

Comments (1)


Question #1 When going cash, do we still have to use the 739 dx codes and others to explain. These are needed if the patient wants to get reimbursed from the statement that we gave them to submit themselves. I know another doc who only documents 98940 and one 739 code for those patients who want to submit. It seems we are still working within the insurance system.

WDE: You don't HAVE to do anything (except pay taxes and die). The key is to do what you can to support patients in their efforts to enjoy the benefits of their policy and get reimbursed. Quite different than showing up, hat in hand, accepting what their insurance company will pay you!

Question #2 What all is needed for these particular patients to submit. What procedure should I educate them to submit there own.

WDE: I don't know. Seems to vary from policy to policy, carrier to carrier.

Question #3 Another question I have is whether to prepare statements for patients who want to submit themselves 1X per month or per request. I know some who do it per visit, but it seems that could be simplified quite a bit by doing it monthly.

WDE: Seems to me you'd want to group it together once a month or twice a month (for intensive care) to improve efficiency.

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From December 8, 2006 9:59 AM

This page contains a single entry from the blog posted on December 8, 2006 9:59 AM.

The previous post in this blog was Would You Like Cheese With That?.

The next post in this blog is Going Spineless.

Many more can be found on the main index page or by looking through the archives.