Bottlenecks in the payment process slow transactions in the medical industry on all sides. People who are in need of medical attention are less likely to seek out a qualified professional. This is especially prevalent in the industry of chiropractic. However, scams around the industry also place a stigma on the offices of chiropractic who do good business. It is in everyone's best interests to understand the chiropractic billing challenges and scams that currently move throughout the chiropractic segment of the medical industry.
Performing Non-Routine Tests
Every patient is different; every situation is unique. However, offices that take advantage of the trust of patients to run unnecessary tests are putting the pressure on many viable offices in terms of testing. Make sure that you inform your patients of the tests that are usually run based upon a potential diagnosis. Keep records of all tests run so that you can show a trend of certain tests being run - this tends to legitimize your practices, even if your methods are different from your competitors.
The Canned Diagnosis
On the other side of the coin, the canned diagnosis is also a tool that more unscrupulous offices will use to run patients through the motions quickly in order to fill queues and raise revenues on pure quantity. No viable office will engage in this practice. You may actually have a marketing opportunity here - if you feel as though your competition is providing canned diagnoses to patients, you can offer them a more personalized service.
Extending Treatment for Certain Conditions
Many offices will extend treatments in order to bilk more money from patients. This could include unnecessary treatments or simply extending the treatments that are qualified. Keeping a paper trail will shore up most of the problems here. Make sure that every aspect of your treatment plan has a purpose. Explain that purpose to each patient, and provide an estimate for treatment up front so that your patients go into the process knowing exactly what to expect.
Downcoding is a practice that many offices who are engaged in other bad practices will employ to distract attention on medical records. Watchdogs over the industry and insurance companies have caught up to this trick, however. Any company that engages in downcoding will likely attract more scrutiny to other records, improving the possibility of non-payment from an insurance company. There is no need to modify any record to make it look better for anyone involved in a transaction - no matter your intentions, it will likely be taken as a negative in the current environment.
Attempting to confuse an insurance company or a patient with unnecessarily complex coding is the other side of reporting to watch out for. Some offices may try to describe routine care as something more significant or complicated to increase a payment from an insurance company. It helps if your office has at least a simple description of common procedures on hand for patients to look over when they are diagnosed.
Related Article: 5 Tips for Successfully Onboarding Medical Billing Staff
Failure to Demonstrate Necessity
Every procedure, no matter how small, should be justified medically. This can be more difficult in the industry of chiropractic, in which many conditions are not common or unique to an individual. Keep records of similar instances so that insurance companies will know exactly how you routinely do business. The more of a paper trail you have, the better you will be if you are scrutinized later on.
As a result of some of the unfortunate chiropractic billing practices detailed above, offices of chiropractic are being scrutinized more closely than ever before. Steer clear of the dirty underworld of the industry and everyone in it to ensure the safety of your office and the maximization of your revenues!