Resource Centers:(News, information, and tools to support your practice)
January 2010
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The truth about insurance practices vs. cash practices
Here is a view concerning insurance practices and “cash” practices that is different from what you might traditionally hear.
You might not agree at first, but at least read it and think about it before getting mad. Don’t be defensive.
1. Insurance isn’t what it used to be. Gone are the days of $250 deductibles. The only ones who have insurance like that are people in large unions or government-funded employees like teachers. Most of us are in small businesses with $5,000 deductibles, which means most patients are cash patients anyway. They know they have to pay cash for everything until they pay $5,000.
Secondly, over half of these employees with high deductibles have health savings accounts. This is a great way for them to pay their high deductible and they are happy to pay. They have to spend it on healthcare and it is pre-tax dollars. You are already more cash than you think!
2. Your staff can bill insurance and collect it. They are smart. Give them credit. Besides, billing insurance isn’t as hard as you think. There is work to billing and collecting, but you are paying them to work, and it’s called work for a reason.
There are two reasons why your staff may gripe and wear you down with insurance war stories: They are trying to increase their value in your eyes or they are trying to excuse not getting the money. Don’t get involved with that.
Your billing person doesn’t need a “university” or 10 years experience in insurance to do this job. Expect them to be able to collect 95 percent of net services. They can do it, and if they don’t, you get somebody else. Unemployment is currently over 10 percent — there is a long line of people out there willing to do the job.
Many of you say you want to go all cash because you are tired of the insurance hassle, but you shouldn’t be involved. You are paying somebody to do that for you. If they were collecting like they were supposed to you wouldn’t be frustrated.
The degree of difficulty in collecting goes up in direct proportion to the trick billing and coding you are trying to get away with. Don’t try to get paid for something you are not supposed to
3. “If I go to a cash practice, I can do whatever I want.” A cash practice still has rules and ethics. Your recommendation should be the same whether you are cash or insurance. Ethics has nothing to do with method of payment. Examine them. See what they need and recommend that — not one visit less (because they are cash) or one more (because they are personal injury (PI).
It doesn’t matter if they are PI, workers’ compensation, or cash, the solution is the solution. Examine the patient, determine the need, and recommends only that — exactly what you should do.
4. There is really no such thing as a cash practice. When a patient comes in they either have insurance or they don’t. A cash practice merely means you give the patient your billing information so they can bill the insurance company themselves.
You provide one less service for the patient than an “insurance” practice provides. If they base how much care they get on what insurance pays, they will still do that, so you are not “safer” as a cash practice.
Conclusions
1. You are already more cash practice than you think. Enjoy the ease of health savings accounts to help you with collections.
2. Bill insurance for them. Be a full-service clinic, and don’t let any clinic out “service” you. Isn’t full service what you want — including healthcare? Would you like to have surgery and the hospital demand payment upfront and expect you to bill and collect from the insurance company yourself?
3. Bill ethically. Stay within your scope of practice. Stay within an ethical recommendation of care. Be a doctor not an insurance interpreter or manipulator. You cannot trick bill yourself into prosperity. If the insurance company doesn’t want to support your ethical recommendation of care, fine, get out of that one.
4. Stay out of the hassle. Expect your staff to do the insurance work because they can. You be the doctor.
“Wait a minute. Not one word has been said about national healthcare. What does that mean to us?” Truthfully, nobody knows — but here’s what is known: HIPAA was passed in 1996.
That is more than 14 years ago, and we were supposed to go to one “standard” record system then.
We are still waiting.
Keith Maule, president and owner of Integrity Management and a nationally known speaker, has made it Integrity Management’s mission to reach 80 percent of the population with quality chiropractic care and in the process impacting the face of healthcare in the United States. He can be reached at 800-843-9162 x20.
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