Accepting Your Patient’s Liabilities
Recently, our company asked the doctors we are working with one simple
question. Do you understand the definition of LIABILITY?
Liability is defined as an obligation that legally binds an individual or
company to settle a debt. When one is liable for a debt, they are
responsible for paying the debt or settling a wrongful act they may have
committed.
Over the past few years we have seen an increase in the amount of doctors
who are being asked for notes from insurance carriers to defend what they
were paid earlier. As a direct result of what was documented, doctors of
chiropractic have been pushed into a corner. Unfortunately, most doctors I
have spoken with about this issue maintain that this is an unfair business
practice put in place by insurance companies to further torment
Chiropractic. Unfortunately, this is not the case. The number one issue
that our company sees as a reason for a chiropractor getting audited and
having to return money to a carrier is the patient’s visit frequency.
Frequency is the most important issue of all because regardless of the
quality of the daily notes. This is because insurance carriers feel it is
impossible to show medical necessity for a patient to be seen once every
two weeks for an extended period of time.
The most common cause of this is that the doctor works as an advocate for
the patient and tries to get as many visits as possible for the patient to
be paid for by the carrier. At times, this goes on for months and even
years. But, by then the liability the patient should have taken for the
financial portion of their care has been accepted by the doctor. Why is
this problem an issue for the doctor? Because at the end of years of this
type of activity in which the doctor has tried to help his patients, the
practice is held financially accountable with no way to balance bill the
patients for services they received over the years. In essence, the doctor
accepted the financial liability for the patients and now, the doctor is
left “holding the bag” when the insurance company shows up to check
everything out.
The good news is that there is a simple litmus test you can use to judge
if someone should have their insurance billed or ay cash. It’s called the
treatment plan!
Either the patient is following a treatment plan that is set up to measure
objective improvement or they are not. If the patient is following this
treatment plan, it is because they have a neuromusculoskeletal problem and
be able to show significant improvement of this condition. If not, then
the patient should be asked to assume their own liability and pay their
out of pocket portion for non-covered services such as wellness or
maintenance care.
CSSi is a professional consulting company that specializes in assisting
Chiropractors in protecting their practice from non-compliant procedures
that cause retrospective reviews by Medicare, Medicaid, and private
carriers.
Dr. John Davila specializes in documentation requirements as they relate
Federal standards and how to work those standards into the doctor's
current note format. His experience working with insurance companies and
managed care networks to train review nurses and create audit procedures
allows him to add a special emphasis on how the doctor's documentation
will eventually be appraised and evaluated by carriers to determine the
viability of a future action. He re-wrote the SC Medicare Policy for
chiropractic reimbursement and created the current documentation course at
Logan College of Chiropractic.
www.compliantusa.com
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