What is involved in going ‘green’?
By Steven Conway, DC, DACBOH, JD, Esq.

Is it true that if I dropped my insurance-network affiliations to go “cash,” I could reduce my documentation, which takes a lot of time to complete? Can I just go “green” or are there things I should consider first?

Many doctors are going to a strictly cash practice to remove themselves from the insurance-reimbursement system and the headaches they get from dealing with it. Going “green” is a major decision. You should consider several potential issues before making the total transformation.

1. State laws. Investigate if your state has any laws prohibiting you from charging or accepting money directly from the patient for services rendered.

For example: Many state workers’ compensation laws prohibit the direct collections of covered services from patients. Thus, if you currently have a caseload of patients based upon workers’ compensation injuries, you may not be able to immediately change your policy and directly collect from them.

You would need to complete their current treatment program; release them; and then evaluate if you could collect from them directly based upon other contractual agreements you may have with them via insurance network agreements.

If you intend to make your cash-only policy for all patients in a state that has prohibition laws indicated above, then you would not be able to accept new patients or current patients who suffer an injury covered under workers’ compensation laws.

2. Network-provider agreements. Many network-provider agreements have specific clauses regarding the ability to terminate the agreement. You may not be able to immediately get out of your agreements.

Most network agreements also contain clauses that outline specific responsibilities the provider assumes for patients enrolled in the network who are currently receiving care with the provider. You may be required to continue the contract agreements until the patient is released from care.

3. Notifications. Many network agreements contain a clause for proper notification of the change in status of the provider to prospective patients who have the network plan.

Thus, before you make any changes in payment policies, you must handle your responsibilities under the current contract agreements and comply with proper notice to your patients of your status change.

You must also provide notice to all of your other patients before making the change. You can place signs at the front desk and in treatment rooms, have your staff hand flyers to patients, and talk with each patient personally so he or she can make the necessary financial arrangements to continue treatment at your office.

If you fail to notify your patients and continue to treat them — and then tell them they are responsible for the payment — you open yourself to being reported to your state exam board. 

4. PI agreements. Many doctors have financial agreements with attorneys who represent patients involved in personal injury (PI) accidents. Review your PI cases and contact your patients and their attorneys before making any changes in your collection procedures involving their cases, so everyone understands and agrees to your new policies.

5. Medicare and Medicaid requirements. Medicare and Medicaid have specific requirements. Recommended: Hire a Medicare expert to guide you through the change process.

6. Documentation. Poor documentation is the primary reason for denial of insurance claims. It is also a primary frustration, other than poor reimbursement, for chiropractors to leave the insurance system and go to a cash-only program.

Even if you are not submitting forms for reimbursement, you need to properly document your patients no matter what type of payment system you use. The two should not be directly related.

A cash patient can file a malpractice claim as easily as an insurance patient. Keep your documentation level at a high standard to allow for proper care of your patient and to protect yourself should a malpractice or regulatory investigation occur.

Steven Conway, DC, DACBOH, JD, Esq., is a partner in True North Chiropractic Consultants LLC, which provides guidance and ethical solutions to the barriers found in chiropractic practices. He can be contacted through truenorthchiropracticconsultants.com or by e-mail at chirolaw@aol.com.

DISCLAIMER: This column is provided for educational purposes only. The accuracy or timeliness of the information presented is not warranted. The information is not presented as legal advice and no attorney-client relationship is established.