There are a lot of practice management consultants you can turn to, and insurance-relations seminars you can take, where you will learn how to see your patients more times, provide more services at each visit, and charge more for the care you provide. Overall, these consultants do very well, and the seminars they teach are well attended. So I have decided to jump on the bandwagon and offer my own advice to chiropractic practitioners. I think I will call my practice management seminar, "How to Develop a Bad Relationship with Insurance Companies." I'm sure this will be very popular.
- Make sure that your diagnosis is sufficiently obtuse. Use lots of $50 words such as enthesopathies, as in "chronic, moderate, lumbosacral, segmental joint dysfunction with associated paravertebral myalgia, and concomitant sprain/strain with subsequent enthesopathies." (Be sure to use the nebulous diagnosis "sprain/strain" because it keeps the claims examiner guessing -- which one is it?)
- Report lots of positive examination findings. The more positive findings, the more you are justified to treat that patient frequently over a prolonged period. Just rattle off a whole long list of positive tests such as Kemp's, SLR, Braggard's, Ely's, Hibb's, Nachlas', Neri Bowing, Lewin Standing, Soto-Hall, Thomas, foraminal compression, etc. Add a few really obscure ones like Demianoff's sign, DeKleyn's test, Hautant's test, and Rossolimo's sign which will make that claims person rush to his medical dictionary. It is immaterial that SLR was positive for right shoulder pain or that foraminal compression elicited pain in the big toe; if it's painful then the test is positive and should be reported as such.
- Report the prognosis as guarded after seeing the patient for the first time, especially if the condition is a simple strain or sprain. We know that strains should heal in three or four weeks and sprains in six to eight weeks. We also know that 50 percent of people with back pain will be better in three weeks without any treatment. Therefore, for the sake of your own credibility and a poor relationship with that insurance carrier (after all, they are out to get you!) let them know right away how pessimistic you are about the outcome of your treatment program.
- Keep that injured worker off work! He will get two-thirds of his regular wages anyway, and since this is tax-free income he's probably earning more than he did after his payroll deductions. If the worker is on compensation, he'll have more time for all those office visits you have planned, and he'll tell all his buddies at work what a great guy you are, so they will also want to be injured at work and come in for care -- they need some unearned paid vacation, too. Since studies have shown that someone who has been off work for six months has only a 50 percent chance of ever returning to gainful employment, the longer you keep him off work, the more likely you will be to establish that lifetime chiropractic patient we all want in our practices.
- Remember, no one is medically stationary if they still hurt. Since chiropractic gets 'em well when nothing else can, if the patient is still in pain, then we haven't seen him enough times or he has not yet received quite the right adjustment. It does not matter that insurance companies must place large amounts of funds in reserve for that injured patient until he is stationary, or that if too much is tied up in reserves, the insurance company will no longer be able to write new policies. No, claims personnel don't mind if the claimant does not become medically stationary for months or even years, because these people understand that chiropractic care gets people back to work sooner and at less cost than other types of treatment.
- Because everyone needs lifetime chiropractic care for their mental, social, and spiritual well-being, most injury cases will probably be left with a definite permanent impairment requiring ongoing palliative care two or three times weekly for at least the remainder of their lives. (However, if the patient hurt himself lifting up the garage door at home and the insurance doesn't cover chiropractic, you had better get that person well in just a few treatments because they won't want to pay for more, and there probably will be no residual or permanent impairment.)
- Finally, a word about your billing statement. It's important to use current procedural terminology because insurance companies have large computers that analyze your bill since claims people are not smart enough to figure it out. If you use the right codes, the computer will automatically pay you. So it's okay to provide lots of redundant services at each treatment visit because, by using a separate code for each procedure or modality, you will be increasing your overall fee for each visit. Here are some examples of codes commonly used by successful graduates of my insurance relations seminars:
97260 First adjustment (e.g., lumbar spine)
97261 Additional area (e.g., thoracic spine)
97262 Third area (not in CPT4)
97010-22 Hot pack, extra time (the modifier, -22, indicates more than the usual treatment time, as when you have forgotten to take the pack off before it became cold.) I always conclude my seminars with a few words about attitude. It is important for the successful doctor of chiropractic to maintain a positive attitude. Your attitude should be: "The insurance companies are positively out to get me! Remember, they hate chiropractors, they are run by the AMA, and they would rather pay for 10 MRI scans, 20 myelograms, and 30 laminectomies than one Band-Aid applied by a DC.
So, let's get out there and really create a positive image for our profession. Good luck!