Don’t Put All Your Eggs in One Basket
FEATURE
Ray Foxworth
DC, FICC, MCS-P
When it comes to health care, you most likely have to deal with insurance companies. Insurance is a part of the financial foundation for most clinics across the country, whether they like it or not. There is a love-hate relationship (or maybe hate-hate) for doctors, staffs, and even patients when it comes to the business of insurance. After all, no one likes restrictions of coverage, denied claims, or diminishing reimbursements. Many doctors are starting to wonder why they even participate with insurance anymore.
The truth is, based on several surveys (even one we conducted ourselves), patients want and seek doctors who participate in their health plans. The rule in the 1980s was if you were not in the Y ellow Pages, then you didn’t exist. Fast forward to managed care, and the rule was if you’re not on the provider list, you don’t exist. Today, if you’re not on the online-provider list, you don’t exist. Do some out-of-network patients select us? Absolutely! However, for the masses, they want to work with a participating provider because there is typically better in-network coverage than out-of-network coverage. So it’s a math thing for the patients and a frustrating thing for us.
" Today, if you’re not on the online-provider list, you don’t exist."
While insurance is a great way to grow your practice, for continued growth and stability, it is wise to loosen the dependency on insurance in your practice. Here are some suggestions for where to start.
1. Shopper Calls and New Patients: Often, when new patients call your office, they don’t really know what to ask. So they start the conversation with, “Do you accept XYZ insurance?” We want to answer their question and then quickly redirect the conversation to how we can help them. Over the years, we have become so accustomed to patients asking about our participation with insurance that we often head them off at the pass by asking first whether they have coverage. As a result, we send the message that we don’t really care about the patient; we just care about being paid.
2. Insurance-dictated Care: Are you making recommendations for care based on what insurance will cover? For example, you have a Medicare patient with low back pain who needs therapy, but Medicare will not
cover therapy, so you recommend 10 adjustments over the next four weeks. Is that what is 3. best for the patient? Would the patient have a better outcome and recovery by including therapy? Many patients will only agree to what insurance covers, but there are also many patients who will pay for services that insurance does not cover to get better faster.
We need to remember that we are responsible for making clinical decisions based on what the patient needs regardless of what
insurance will cover.
Financial Report of Findings: Many offices skip this crucial step for practice success. Once the doctor has completed the clinical report of findings, it is imperative that a C A reviews the financial report of findings. Many patients will stop care when insurance runs out for fear of being hit with large balances that they are unable to pay. We have a responsibility to let patients know up front what insurance will cover and what they will be expected to pay out of pocket. Having affordable options for the patient’s out-of-pocket expenses will go a long way toward having patients complete the care recommendations made by the doctor. Using a discount medical plan organization (DMPO) to discount noncovered services and setting up payment plans that offer weekly, biweekly, or monthly payments can help your patients more easily fit chiropractic care into their budgets.
4. Negotiate Contracts: Many providers do not realize that they are able to negotiate fees when they sign provider contracts. When you sign a contract to participate in an insurance plan, you agree to a reduced fee schedule to be on their list. It is important to know the terms of your contracts. Many have an automatic renewal in place. It is important to know when your contracts expire and renew, and how far in advance you must submit proposed modifications. You tend to get better results by asking for small increases annually versus large increases every few years. Arm yourself with data to prove that your services are worth more than the amounts they are reimbursing. A great way to show quality of care is by providing surveys from satisfied patients and from referring doctors about the performance of your practice.
5. Evaluate Contracts Annually: Knowing your clinic’ s cost per visit is essential. What once seemed like a great network with good reimbursement rates may now be costing you money. Without analyzing your cost per visit annually, and checking it against your provider agreements and reimbursement rates, you could be losing thousands of dollars each year. Additionally, insurance networks make changes and may no longer cover the same services in your office that they once did. Staying on top of this information will help you make informed decisions about which networks to participate in and which ones to let go.
All insurance patients become cash patients at some point, and insurance companies can be a good referral source for your practice. Educating your patients about their insurance benefits helps ease their financial concerns when coupled with affordable payment options for care. Staying on top of changes in health care and making it a priority to evaluate those changes against your provider contracts and costs of doing business will help you make the best decisions when it comes to third-party participation.
Insurance is a necessary part of chiropractic practice, and we must learn how to utilize it to our advantage for the financial health of the practice. Maximizing revenue streams in your practice (PI, WC, Medicare, cash, PPO, MCO) creates financial stability in times of change. Who says that you must be all-cash or all-insurance? Why not be a little of both? When it comes to investing money for long-term growth, financial analysts such as Warren Buffet preach diversification. That is how it should be in practice too. When one stream of revenue is impacted by a poor economy or legislative changes, the impact on your practice is minimized when other revenue streams are unaffected. As my momma always said, “Don’t put all your eggs in one basket.” This advice has served me well personally and professionally.
Ray Foxworth, DC, FICC, MCS-P, is a certifiedmedical compliance specialist andpresident of ChiroHealthUSA. As a practicing chiropractor, he remains “in the trenches ” facing challenges with billing, coding, documentation, and compliance. He has served as president of the Mississippi Chiropractic Association, former staff chiropractor at the G. V Sonny Montgomery VA Medical Center, and is a fellow of the International College of Chiropractic. You can contact Dr Foxworth at 888-719-9990, infotif chirohealthusa.com, or visit the ChiroHealthUSA website at chirohealthusa.com. Join usfor afree webinar that will give you all of the details about how a DMPO can help you practice with more peace of mind. Go to chirohealthusa.com risky to register today.
To access a simple report of findings worksheet that will allow you to show your patients how you can help keep their care affordable, whether they have insurance or not. Visit chirohealthusa.com/frof
