Maximizing And Protecting Your Income: A Winning Combination
Monday, July 12, 2010 at 7:11AM 
Tom Necela, DC, CPC, CPMA
Founder of The Strategic Chiropractor
Dr. Necela teaches chiropractors better billing, coding, documentation, collections and business strategies to improve their practice and work smarter, not harder. He can be contacted at www.StrategicDC.com.
Editor’s Note: Dr. Necela is one of the featured speakers at the upcoming 32nd CBP Annual Conference on Sept 24-26th, Scottsdale, AZ. See center page of this issue and www.idealspine.com for details.
INTRODUCTION
Most chiropractors would love to get paid better for what they do. If they are honest, most would also admit that they don’t necessarily want to work harder to increase that income! Similarly, few chiropractors intentionally engage in risky or questionable activities that put their assets at risk, regardless of the size of the potential gain.
If you can identify with these three statements, there is a winning combination available to you. In fact, it’s right under your nose! This combination will allow you to increase reimbursements without increasing your patient volume or working harder AND it will allow you to reduce your exposure to risks that could potentially rob you of your livelihood. It is an improvement which you can utilize every day of your career and an investment that can pay off for years to come, multiple times over.
In a recent article, health care consultant Keith Borglum plainly states one way doctors can do this: "The most cost-effective improvement is usually in improving your coding." Here's his reasoning why:
"An extraordinary number of physicians fail to stay current in their knowledge of coding, resulting in reduced reimbursement or delayed and denied claims. Many physicians purposefully under-code out of fear of penalties for up-coding or unbundling. Others leave their coding to support staff - an inappropriate approach virtually guaranteed to result in errors."
In my experience, his comments are right on the money. In chiropractic school, we were taught examination procedures so that we could accurately assess the patient's condition and create an appropriate plan of care. In many respects, our exams were also about protecting ourselves from malpractice resulting from potential hazards that could go undiagnosed.
But I have yet to meet a chiropractic graduate from any school who was taught how to properly document an exam for purposes of correct coding and billing. Unfortunately, the requirements are not necessarily the same. Upon learning what they are required to document to appropriately bill a certain level exam code, most DC’s are stunned because they are either way off the mark or they are performing many unnecessary tests that gain them nothing extra in the way of income or billable services.
As a result, most chiropractors fall into one of the two camps mentioned above. Conservative chiropractors tend to under-code or under-bill, thus denying themselves reimbursement for procedures they actually performed. More aggressive chiropractors tend to over-bill or up-code in ways that may not necessarily match up with coding or documentation requirements.
The worst news is that these same trends do not only apply to exam coding, but to all billable services we perform in our office. In this respect, most chiropractors can reliably improve income by making sure they are being paid for what they are already doing. Because most chiropractors lack proper training in this department, they are literally robbing themselves of potential income because they don’t know what they don’t know!
By learning proper billing, coding or documentation strategies, you have a fantastic return on your investment that allows you to both increase income AND save money. Here’s why:
The cost of attending a seminar such as the upcoming CBP Annual (hint, hint!) could easily uncover at least one item that you could help you improve your billable services. Even if that one item resulted in a $25 increase for a service or procedure you performed just a few times a week, it could add up to a $5,000 increase over the course of a year – better than a 12:1 ROI! Previous seminar attendees have confessed to me that one coding strategy I gave them would equal a $25,000 increase for their practice that year – how’s that for a ROI?!
In the wake of insurance audits, denials and payment delays, utilizing proper billing, coding and documentation can save you money and help protect your biggest asset – your practice! By helping you avoid post-payment demands, fines, legal costs to defend yourself, trouble with your state board and by helping you save the time it takes to jump through all the hoops to get yourself paid, doing things right the first time goes a long way towards keeping you out of trouble and protecting your money.
CONCLUSION
Regardless of what technique you use, what school you went to, and how big or small your practice, the reality is the same: looking outside your practice to increase your income potential makes little sense when you are already leaving plenty of income on the table through poor billing, coding or documentation procedures.
Sure, you can work harder and try to make up for it in volume by seeing more patients. But why not work smarter and make sure that you are getting maximum reimbursements from the patients you already have? In the process, you can slow down a little and make sure you are doing everything correctly so that you also protect your income from exposure to audits, delays and denials.
Finally, if you’re ambitious and willing to learn new strategies, you can do all of the above simultaneously and improve your practice exponentially!