Reining in managed care

Cash may be king, but managed care still rules, according to office manager Deborah Haezebrouck.

Haezebrouck teaches "Front Office Survival 101" to students at Life College of Chiropractic. She says that many students want to have a cash practice and not deal with managed care, but that option is not realistic. "If you don't belong to managed-care networks," she says, "you cut yourself off from a lot of potential patients." The key is knowing how to manage managed care.

She identified three different tools that are essential for keeping on top of claims and requests:

1. Software system. The software system she uses allows her to enter the patient's co-pay amount as well as the number of office visits a patient is allowed under his or her insurance plan. The system then sends an alert each time the patient comes in, so the staff can monitor visits and advise the patient.

2. Bulletin board. The bulletin board is the repository for all types of important and time-saving information. For example: All advisories from insurers (such as changes in coding or procedures), as well as all requests from insurers, attorneys, or others for information are listed on the board, and are prioritized by date due. Also posted on the board are exclusion lists from some insurance companies.

"If a group policy is on the exclusion list, the patient does not have to fill out a lot of patient forms," Haezebrouck explains. This is time-saving for both the patient and the office staff.

3. Paper files. Although the office files claims electronically, Haezebrouck maintains a paper file. "I print out a hard copy," she says. "It allows me to see the claim and write notes on the front of the claim form." She also staples all notes from the insurance company to the claim.

She goes through these paper files regularly and works older claims. "Appealing is often necessary," she says.

In addition to her three key tools, Haezebrouck follows a few more "rules" to manage managed care:

• Always verify coverage. Patients sometimes think they have coverage, she explains. But they are not always correct. A quick call to verify coverage forestalls surprises.

• Collect from every patient. Whether it is a co-pay or a full payment, everyone pays before leaving the office. The clinic does not give patients a written financial policy, but the payment policies are explained upfront to each new patient, she says.

• Get the patient involved. When an insurer denies payment, Haezebrouck first reviews the reason. "If it was because of something we did — or didn't do — we correct it and refile," she says. But if the denial is for other reasons, she gets the patient involved. "I ask them to call the insurance company and clear up the matter," she says. "Ultimately, I remind them that they are responsible for the entire bill."