by R. J. Hammett, D.C.

 

            Dr. Hammett is a chiropractor in private practice in Kenosha, Wisconsin. After graduating from Life College in 1979, he completed several post-graduate programs in Physical Impairments, Diagnostic Imaging and Rehabilitation. He completed his Juris Doctor in 1995. He has written articles for several Journals and has lectured to numerous Chiropractic groups on the topics of Practice Management and Risk Prevention.

 

And now a word from our sponsor, “The Insurance Industry.” Can’t live with them, can’t live without them. Right? Insurance and collection procedures in your clinic must be a non-negotiating point from the minute you put your fees together and meet your first patient. Many, many chiropractors play numerous financial games . . . losing most of them!

            First, you must have all your financial policies in writing. I suggest one for cash (PATOS, pay at time of service), medicare, insurance, worker’s compensation, personal injury and HMO/PPO. Each of these categories must have a policy that the patients and staff can understand and follow with no exceptions. No exceptions. There is nothing wrong with giving discounts for payment at the time of service, as long as everyone is invited. But, are you giving your services away? A recent survey found that it now costs $19.75 per patient to process them through your office.

            If you’re charging $25.00 per visit, it means your gross net is $5.25 minus 50% for state and local taxes, which lowers your profit $2.63. per $25.00 office visit. Pretty sad for a person with eight or more years of education! Think of it this way, 50 patients a day at $2.63 per patient, real net equals $131.50 profit per day! Plug in your present dollar visit average (number of patients adjusted divided into collections that day and see what you really collect).

            Collections are as simple as “This is our financial policy.” Make sure that all of your initial patient intake forms have the general office policy, as to who is responsible for payment of services. It is recommended, at the end of your report of findings, that you, and the patient agree upon the payment for services before you begin your care. This will let you know the true commitment of your patient before you start their care. With non-insured patients, it is recommended that you have a minimum of 5 to 10 different payment programs to fit their budget. Remember, all financial agreements must be in writing, signed by the patient, and witnessed by a staff member or the doctor.

            Insurance; some major med-insurance companies still cover chiropractic. I suggest that these patients are informed at their report of finding’s visit, of all of their insurance’s limitations and specific payment arrangements should be made for care beyond those insurance limits. The key here is to let the patient use their insurance as long as it pays, but have arrangements in place before it stops. In my opinion, any insurance that carries a deductible of more than $500.00, or limitations of less than 20 visits, the patient is considered a cash patient. Submit the insurance for them, but have them pay you. Remember, if you offer them a discounted rate, you must also render the same fee to the insurance company when billing them.

            Worker’s compensation varies from state to state, so I will not discuss it in this article.

            Personal Injury; Ahh, the heady days of the 80’s when a P.I. was a P.I. It is no more! P.I. cases in the 90’s and today, have changed. Insurance profiling and record keeping have paralyzed most, if not all soft tissue cases. Unless, your patient has long term, permanent impairment, not just loss of range of motion, expect your case to be limited to pain relief and some rehabilitation. Attorneys in the P.I. business, generally do not like long (12 months or more) claims on soft tissue cases, without substantial improvements, that are objectively provable and strong permanency. Those patients without legal representation should be made to pay weekly towards their care. It is my recommendation that you never reduce your bill if at all possible. If the attorney will not settle, go to the patient for the rest of your fees. Remember, your contract for services is with the patient, not the attorney. So, if the attorney wants to play financial games, go directly to the patient with your demand of payment for services rendered.

            Medicare; What can I say? These folks need the care the most, and have the worst coverage of all! Many of my peers have stopped taking any medicare patients because of the related paperwork and hassles. I myself still play the paper chase game, even though I am not a “participating” medicare chiropractor. With medicare, make sure you are keeping to your limiting fees. Dot your i’s, and cross your t’s.

            Welfare cases; well, if you’re into losing lots of money, but having a lot of patients — this is the place for you.

            HMO’s and PPO’s!!! Personally, I belong to no HMO’s and only to a few select PPO’s. There has been so much written on these two plagues of society that my recommendation is this . . . . . Look at your cost per patient (overhead), subtract your taxes, look at their paper chase and reimbursement rates and ask yourself . . . . is it worth it? If it is, then sign up, if not, why bother. If you want these kind of headaches. . . .go pick a fight with the A.M.A.

            Some final thoughts. Insurance companies that string the patient and the doctor along, promising payments for weeks and weeks, and then denying the care, should be taken to small claims court by your patient and you. Since the insurance contract is with your patient, they must file the suits. Make friends with a local attorney doing small claims court work and refer your patients there. Make sure your records justify the necessity of the care first. Chances are, you will win most of the cases.

            Lastly, when was the last time you had your car repaired, or some part of your home repaired? What were the financial arrangements or agreements? How much per hour were you being charged for that last repair? When you buy groceries, how did they ask for their money? Act accordingly!!!

            You provide a service. NOONE else does. So get paid for it. Did you see any of your patients sitting with you for 4800 hours of chiropractic college? Sweating the National and State Boards? Take required post-graduate education? Do not over charge, but do not be stupid. Charge a fair fee (1/1000 of your town’s median income) and render a great service.

            ‘Til next time. . .