Turn No Surprises Act documentation into a wellness opportunity

Doctors of chiropractic are no strangers to documentation, processes or red tape. And so, when Congress passed the No Surprises Act (NSA) a couple of years ago, many DCs rolled their eyes and thought, “Sigh. This is more paperwork on top of even more paperwork.”  

Still others have not yet heard of the NSA, but they will. Visit cms.gov/nosurprises and your eyes will open, your heart will beat faster and visions of government interference, administrative burden and exposure to patient disputes may cause overwhelm and frustration!  

But I’m here to tell you: Don’t let them. The truth is this, the NSA paperwork works in your favor, big time.  

Background: The No Surprises Act

The No Surprises Act is an anti-balance-billing mandate, but the heart of it is a requirement that providers give prospective patients something called a good-faith estimate (GFE). A GFE is exactly what it sounds like: the provider’s best guess as to the full scope of estimated treatment, detailing the what, when and how much of a treatment plan, with specifics related to dates, codes, prices and more.  

The NSA applies to all uninsured and self-pay patients. “Self-pay” is far broader than you think, as it applies to most every personal injury (PI) patient on lien or letter of protection, any cash patient who isn’t using their health insurance coverage and even in-network patients who have deductibles.  

As to PI, where chiropractic is the lead medical specialty, the NSA applies to every PI patient, even if medical payments coverage (MedPay) or personal injury protection (PIP) is available. There is no guarantee those auto benefits will pay you or your full bill. And no PI case is a guaranteed winner. Consequently, the patient has a real chance to be “surprised” by their bill at the end of the case.  

Don’t worry: The fact the NSA applies to every PI patient is a good thing. Estimates, of course, can be wrong, and the NSA accounts for this. If your GFE is off by $400 or more, you can merely provide a new updated estimate. What you can’t do is bait and switch patients, starting off with a partial GFE knowing treatment will eventually be larger in scope or higher in cost. That would go against the spirit and intent of this new law, which is all about “good faith.” Beyond that, being fully transparent and NSA-compliant is to your business advantage.  

The compliance advantage

When you fail to comply with the NSA, the patient can initiate an NSA dispute within 120 days of their direct receipt of your bill, which means the patient potentially has an opportunity to get out of paying some of or the entire bill. If you were already paid, the patient may get that money back, and with interest. Got your attention? 

Thus, NSA compliance is important. And since compliance isn’t optional, you might as well use it to your advantage. For chiropractic, that advantage is potentially a game changer. Sure, the NSA results in more documentation, more transparency and more exposure.  

But on the upside, and directly related to “wellness,” the NSA also results in more patient interaction, more patient involvement, more trust and more care.  

The NSA’s “wellness” and business advantage

NSA compliance, if approached the right way, deepens the provider-patient relationship and patient involvement in their own care. When you are forced to give the specific details as to what you do, when you do it and how much it will cost, the patient understands why the treatment is important. This is where chiropractic shines brightest. After all, every great DC enjoys educating their patient on the “why” as to the treatment plan. Chiropractic care offers a myriad of benefits, which often feel magical to an educated patient.  

The NSA, in a large way, forces more of a transparent, trusting partnership with your patient. This should lead to higher treatment plan compliance (which PI already has due to the patient’s own financial interest in their care and cost of care), which leads to improved patient outcomes. That’s already a wellness and business advantage, but there’s more. 

The wellness and business advantage goes further for those who have a PI segment. Specifically, the “injury care” side has the NSA creating a new patient funnel to the wellness care side of a chiropractic office. Let me lay this out a little more. 

PI patients are training in a new habit: Injury care plans

At the end of the day, what the NSA mandates is simply a detailed term injury care plan. The problem with most chiropractic practices is the “per-visit” model, where DCs see a patient for one visit, then determine if they are to see the patient again. Then, the DC hopes the patient shows up. PI is about term care, over time, in pretty much every case: sometimes weeks, but most of the time months. 

When you provide a GFE to the patient, you will also provide it to the attorney, who can then use it to aid in settlement with an insurance adjuster, even during treatment. Estimates of care were not considered in the past, but since the NSA is a mandate, now they can be, and the GFEs are being used for earlier settlements. So when the attorney gets a GFE and even larger total bill estimates, they are telling their client (your patient), “that’s great.” You will have a third party, the patient’s own attorney, affirm your treatment plan and the cost of that care when done the right way. If you are presenting the same GFE to a non-PI patient, the patient may run. Not in PI; in PI, they stay, comply and often get money out of it, and they are happy with the process.  

The patient often develops a new habit: following a term injury care plan without paying the cost and while enjoying the benefits of compliance. 

PI and the NSA turns term injury care plan patients into term wellness care patients

This leads to a business advantage on the wellness side. You have moved the patient into a new habit: term care plans. That was injury care. Every injury care patient leaves injury care at some point. All PI cases resolve. So at some point, you can take the same NSA process, the same forms, the same detailed GFE and provide a “term wellness care plan.” The habit of “term care” is moved from injury care to wellness care. 

That term wellness care plan will be lower in cost, so agreeing is even more enticing given the prior positive health outcome. PI term injury care won’t move every patient to term wellness care, but far more than prior. That fills patient visit slots ahead of time. That gets you out of the “per-visit” model for a larger segment of your practice.  

That’s a huge business advantage for chiropractic because of both the NSA and PI.  

Final thoughts

Comply with the NSA. Use it to your advantage when combined with a PI segment. Gain the business advantage both the NSA and PI present by moving term injury care patients into term wellness care. They benefit. Your business benefits. Grab onto all the advantages you can get! 

MICHAEL COATES, Esq., is a national authority on personal injury medical lien recovery and the founder of PIMadeEasy.com, which educates, coaches and trains medical providers and their staff to accelerate their success in personal injury. If you have questions, please contact michael@pimadeeasy.com or through his free Facebook group, PI Made Easy Insiders, at facebook.com/groups/pimadeeasy.