The complaint path to a well-functioning practice
Is your practice in compliance with federal and state regulations as well as insurance companies? If not, its growth is being impeded.
Contrary to some practitioners’ belief, compliance is not costly. In fact, noncompliance is costly. It can result in investigations, audits, and the necessity to pay back money.
When Dow Jones & Co. opened in 1882, the average was 40.94. Back then, there were few regulations that affected the operation of businesses. Today, regulations abound. But the Dow hovers around 13,000. Businesses have learned to grow despite having to comply with red tape. Chiropractic, on the other hand, has not.
Practices that resist compliance seem to stem from three scenarios:
• Inappropriate delegation. In this case, doctors do not learn about compliance issues and assume their assistants or office managers can handle situations, even though they have minimal background in compliance.
Even worse, the delegation is inappropriate because the time-crunched billing staff is already responsible for dealing with collection issues from insurance companies and patients.
• Denial. Some doctors believe problems experienced by other offices will never happen to them.
These doctors do not establish office rules to ensure regulations are followed. What results are billing problems and misuse of current procedural terminology (CPT) codes, either knowingly or unknowingly — both of which invite audits.
• Ignorance. Doctors who run cash practices often feel insulated from having to follow insurance rules because they do not process insurance claims. Although they do not take payment directly from insurance companies, their patients, however, process claims for reimbursement.
When this happens, the insurance process commences, and the practice becomes insurance-based.
These are all precarious positions for doctors. If an audit takes place, all compliance issues are 100 percent the doctor’s responsibility. One thing that can eliminate this incredible risk is establishing a compliant, bulletproof practice.
So why are so many doctors still choosing to ignore the facts?
Excuses abound. Some doctors feel if they adhere to the rules, it will ruin their patient relationships. Even worse, some believe following insurance regulations will hurt their practice’s bottom line. Most, however, just don’t know where to start.
3 STEPS TO COMPLIANCE
If mainstream businesses have come to realize huge profits while obeying federal regulations, chiropractic can too. It’s a matter of taking three steps:
1. Learn the rules. Research the rules and take them to heart. Visit the Office of Inspector General’s (OIG) Web site (www.oig.hhs.gov) for advice and tools to help make your office more compliant.
Next, go to the Centers for Medicare and Medicaid Services’ (CMS) Web site (www.cms.gov) and review the National Chiropractic Policy, requirements for documentation, and the definition of medical necessity.
Finally, visit the Web sites of insurance companies you do business with. These sites can serve as key resources for your practice.
2. Accept the rules. Rules are not hard to follow, and they provide a safeguard from problems that can threaten the wellness of your practice.
Post the basic rules and make them available to your staff so they can better troubleshoot issues before they arise, or even help provide solutions to prevent the possibility of a future audit.
Creating a collaborative work environment will help maintain compliance and office morale.
3. Understand medical necessity and how it affects your practice. The use of wellness care offers great benefits to patients and increases their ability to live to their fullest potential. But, look at the rules insurance companies use to govern the way they pay for care.
For example: Cigna asks doctors to incorporate active therapy as soon as possible in place of continued patient dependence on passive therapies. However, many doctors avoid active rehab because it is easier to push a button or turn a knob on the traction table than it is to work with patients.
An old proverb states, “A journey of a thousand miles begins with a single step.” It is time chiropractic stops standing still. Chiropractic practices can experience growth the same as companies of the Dow Jones. It is time to take the path to compliance and start working toward building a bulletproof practice.
John Davila, DC, is an expert in documentation and medical necessity and an authority on compliance issues as they relate to chiropractic practices. He can be reached at 877-322-6203 or by e-mail at daviladc@compliantgrowth.com.