As a chiropractor, you face ethical and moral decisions on a daily basis in clinical practice.
While what you do for patients ought to be moral and ethical, there is much more that should go into your decision-making—you can’t just stop there. Voltaire said, “If you wish to converse with me, define your terms.” With that in mind, a definition of the terms “morals” and “ethics” is warranted.
What are ethics? Ethical practices are usually the rules of conduct recognized as appropriate for a particular people or group. They are determined by social systems and are usually objectively created by others. Most professions have a code of ethics that outlines what the group determines to be ethical versus unethical behavior, and there are usually repercussions for violating the code.
What are morals? Morals are distinctly different from ethics. They are one’s internal principles or habits with respect to right or wrong conduct. Morality is ultimately a personal compass for behavior often influenced by family, heritage, or higher covenants or beliefs. For many, it’s what their parents said they should or shouldn’t do.
Enter the patient
You’d like to think that most doctors are moral and ethical, but the reality is that some are not. And you’d like to think that if what you are doing to help patients is moral and ethical, it should also be legal, compliant, and permissible. But sometimes it’s not. Good intentions, without adequate knowledge of the rules and regulations you must follow in practice, increase the risk of complaints to boards of examiners—and often result in fines and penalties from state and federal regulators.
As a chiropractor, you have a moral and ethical obligation to recommend all the care that patients need to achieve their health goals and to educate them on the benefits of not only corrective care, but the importance of prevention and wellness for an improved quality of life. What patients need in the way of clinical care has nothing to do with whether they have insurance or not, or who is paying the bill.
But unfortunately, over the years, insurance coverage has gained influence over what doctors recommend for patients. What has become evident is that, at some point, patients bought the lie that insurance should pay for everything they need and if it doesn’t cover it, they don’t need it.
Many in the profession also bought into this and started making recommendations based on what insurance does or doesn’t cover. The result has been an overall weakening of the profession and the ability to truly communicate the benefits of chiropractic care. As third- party reimbursements change and patients are increasingly self-insured with high deductibles, it’s time to collectively up our game and get back to telling the chiropractic story and how it can improve the quality of life for your patients and their families.
When arrogance and ignorance collide
With that in mind, consider what happens when arrogance and ignorance collide. As an example of arrogance, some doctors think “I’m the doctor and nobody is going to tell me how to practice or what my patients need.” While some might see this position as heroic and based on high moral principles, when it comes to the patient’s right to receive chiropractic care, it completely ignores the requirement of operating within the guidelines of medical necessity (especially if a third party is paying the bill).
One doctor I read about was so convinced that patients are entitled to all the care they need, or that is available under the policies they paid for, that he hired an attorney to pursue payment in cases where it was denied. While that may sound admirable, it demonstrates a less-than-adequate knowledge of the rules and regulations that govern practice.
Just because a patient’s health plan may allow 15 or 30 visits a year, that doesn’t mean that every patient you see is entitled to the maximum number of visits under their plan. You must follow medical policy and make sure the treatment you render meets the definition of medical necessity as defined by the plan.
This is a prime example of what happens when arrogance, “I’m the doctor, nobody tells me what my patients need,” collides with ignorance of the rules, regulations, and medical policy. Unfortunately for the doctor mentioned above, it resulted in a federal prison sentence.
The broader picture
Once you are clear on your ethics and morals, you must then determine whether what you are about to do for the patient is also in line with the rules and regulations you face in practice.
For example, not only what you treat, but how and what you bill for are often determined by:
- The board of examiners; is the treatment in your scope of practice?
- Your provider agreements; is it a covered service and does it truly meet the definition of medically necessary? (Not what we think the patient is entitled to morally as a chiropractor, but according to the medical policy guidelines.)
- Your coding; are you using the proper codes for the procedures rendered, or are you up-coding the coding to increase reimbursements? Or, for that matter, are you down-coding to fly under the radar? Note: Up-coding and down- coding are both fraudulent.
And finally, your business practices come into play with the billing and collection of services. Are you mindful of the rules against dual fee schedules? Are you avoiding inducements by not giving away services or waiving deductibles or copayments, which can trigger anti-kickback and false claims act violations?
If you have done all these things properly, then you can, with a clear conscience, sign box 31 of the claim form attesting that the information is true, accurate, and complete, and that the services rendered were medically necessary.
Ethics and morals are critical in practice. But so are adequate knowledge and understanding of the rules and regulations that govern your practice. Ask yourself whether your decisions are ethical, moral, and medically necessary, and whether you are handling the documentation, coding, billing, and collections in a fashion that meets all the layers of regulations you face. If so, rest well. But if not, take steps now to gain adequate knowledge, training, and understanding to start practicing with peace of mind. or tweaking
Ray Foxworth, DC, president of ChiroHealthUSa and a certified medical compliance specialist. He maintains his practice on NewSouth Professional Campus, home to a large multidisciplinary spine center, offering services ranging from chiropractic to neurosurgery. He can be reached at firstname.lastname@example.org or through chirohealthusa.com.