Recently, a chiropractor approached us. quite distraught. He liad been watching his reimbursements drop, slowly but surely, from $15,000 to $12,000 to $ 10.000 per week, and he was frantic about what was clearly a trend. His longtime CA had recently moved on to another job. and he admitted that he wasn't very "hands-on" with his practice's billing department. How could he find out where the money leaks were, he begged us. and more importantly, how could he fill the holes in? We see this happen a lot. In fact, reimbursement detective work is one of our favorite things to do. You'd be amazed at how much money doctors unknowingly leave on the table, or allow to slowly leak from their reimbursement "bucket." In many cases, it's just like a leak}- pipe. Until the damage starts showing on the drywall. you may not even be aware it's happening—and by then, considerable damage may be done. We recommend you start like we would, in triage mode: the holes have to be plugged up before the practice can hold water. That can look like anything from a thorough, in-depth review of even single aspect of billings, collections, and patient finances to a relatively simple interview. Either way. take a hard look and ask lots of questions. Because experience has shown us that most practices have the answers to their financial difficulties—if they know where to look. For example, if you're worried about leaks in your patient or insurance reimbursement bucket, here are some questions you should be asking yourself: How often do you mail patient statements, and when was the last time? Do you print and reconcile aging reports, and if so. how recently? How much time do you spend each week on insurance follow-up? Patient follow-up? Do you use a payment plan system and/or auto-debit? How often do you bill, cither electronically or by paper? Interview the team members you have working in this area about how they perform tasks. Your questions might include: How do you know if a patient has a balance when they come to the front desk? What do you say when a patient tells you they can't pay today? How do you check out a new patient at the end of their visit? How mam- actual hours did the team member responsible for insurance payments put in over the last seven days calling insurance companies about unpaid bills? • How do you explain to patients what their benefits arc after the ROF? If you don't get satisfactory answers to questions like these. it's time to raise your game. Have you been devoting enough time to training and documenting the process that you want to sec in the practice? We might suggest that you role play, with you taking on the part of the insurance company, and a team member giving you a follow-up "call" to see how it's being handled. Another area where missed reimbursement opportunities exist is Cash Profit Centers (CPCs). For example, many practices may say that they're selling Foot Lcvclcrs orthotics. but when we take a closer look, they actually only sell two pair per year. Sure, we sell pillows ... but on closer examination, we've sold five in a year, despite the fact that one is being prescribed to every cervical case that walks in the door. Boosting revenue-generating areas like this is a relatively easy way to get some cash coming in fairly quickly. Taking an inward look and self-assessing is tough, especially when you don't know what to look for. If you really get stuck, call us. We're great at this. But in the meanwhile, here are the most common ways we find to plug up leaks and generate income being left on the table, so at least start here: 1. Your aging report is a gold mine—but only if your team actively wields that pick axe. That means sorting outstand- ing items into reactive calls and actions, items waiting for the doctor's report, etc.. and working week by week to chip away at outstanding balances. Make sure this is a priority! Send patient statements immediately. Make scripted follow-up calls within the next 14 days after statements go out. Consider hiring a collection agency if necessary. Although we prefer that your practice operates with payment plans, which are better for you and better for your patient, when you"re behind the eight ball with collections, you have to do what you have to do. This means that your policy should be (even in the short tenn) that every patient pays, every time. That means every patient pays at the time of sen ice. or you have a payment plan, ideally with auto-debit, installed that actually works. This will positively impact your bottom line. Curb your spending wherever possible. Which contracts can be renegotiated? Can bottled water delivery be suspended for a while? Can cleaning staff be replaced by office staff temporarily? What about cheaper supplies? Look for ways to increase services for existing patients. Is everyone up to date with rc-cvaluations? Can other therapies be recommended and billed, where necessary? Arc there durable items the office is missing out on. like belts, lumbar support cushions, nutriceuticals. orthotics. etc.? Consider adding a "product of the month/week" about which you educate patients. As for our distraught friend, it turned out that in the wake of his CAs departure, his replacement hire was simply not up to speed and allow ing aging reports to slip and slide. Longstanding patients were being treated with kid gloves about outstanding bills: new patients weren't being properly educated about "paying every time" or getting onto payment plans. Make sure every member of your team is on the "bucket brigade." It takes every staff member on task and on track to make sure those leaks in your reimbursement get and stay plugged. Kalliy \ tills Chang is a Certified A tedical Compli- -cmce Specialist (MCS-P) and, since 1983, has been providing chiropractors with reimbursement and compliance training, advice and tools to improve the financial performance of their practices. Kalhy is known as one of our profession sforemost experts on Medicare and can be reached at (855) TEAMKMC or infodpkmcuniversity.com
