www.njchiropractors.com I 15 It’s a part of our industry now, and it’s a shame that we have to get used to it…. Carriers continue to increase audits, reduce fees paid, complicate the claims process, and often just simply refuse to pay – even when you do everything by the book. Adding insult to injury, while they continue to pay us less and make us jump through hoops, audits are on the rise, and if you’re not in perfect compliance you could end up losing a ton of money through recoupment. These type of tactics shouldn’t be tolerated, and while you may feel somewhat helpless to change how carriers boss you around, there are a few things you can do as a chiropractor and business owner to get paid for all the hard work you put in. Identify your biggest areas of reimbursement weakness Of course you’re an excellent doctor and respected for the work you do from your patients and community, but it’s worth looking at the brass tacks of the business to discover if there are any spots that can be improved. When consulting for most practices, I most frequently find fixing the following areas makes a big difference in profitability: • Fee Schedules • Coding • Claims Submissions • Compliance • Billing Software While each of these areas are intercon- nected, let’s look at each separately. Fee schedules Fee Schedules may seem like a simple thing, but if they’re not set up properly or updated, you could be losing a ton in revenue and profitability. Did you simply accept the fees that were given? Have you checked to make sure the codes you’re using are matched properly to set fees? Maintaining all of this can be a hassle, especially when you’d prefer to be seeing patients. However, it’s vital to you succeeding in getting paid for your efforts and continuing to help more patients in need. Find an expert in fee management and carrier protocols to review your fee schedules and CPT codes you use. There may be a few areas that can quickly be fixed to get you back on track, and paid for the work you performed. Coding Oftentimes there’s a big difference in how you treated, and what staff is billing out. The wrong codes may be entered and modifiers may be missed, most times due to the disconnect between your treatment documentation and billing processes. This is why I always say that “Docu- mentation has to drive your Billing,” and NOT the other way around. There have been too many cases where billing services or support staff added a modifier just in case so they can make sure the claim won’t be denied – only to eventually get your practice red-flagged for audit. Proper coding and use of modifiers that is strictly based on your documentation might take a little more time, but you’re more likely to get paid, AND avoid having to give it back if you are audited. It’s worth it a few times a year to attend seminars and/or webinars on proper coding and documentation to make sure you get paid and stay compliant in the process. As well, do periodic review of how your billing department is submitting your claims – and if it matches up to the treatments provided in your documentation. Claims submissions The insurance companies love making things so complex that you lose time, and money, and likely the joy of owning your own business, just trying to get claims completed and submitted properly to get paid. If you don’t get it right, you get to do it all over again and wait another several months in hopes to see the revenue you need. There are two main aspects of the claim that typically cause it to fail: 1. Incorrect or incomplete data 2.  Improper coding for services rendered Fixing the incorrect or incomplete data aspect can be easy, or difficult to fix. Much of this often comes down to the chiropractic software you use to produce and submit the claim. The easy fix is to make sure you’re using fully integrated software that minimizes or eliminates the need for additional data entry. This is where most mistakes occur. If your software automatically populates the patient information, notes, codes, and all relevant data for you – then you have a distinct advantage. If your software isn’t automating the claims generation for you (including notifying you of correct modifiers), then the fix should be switching to newer, By David Klein ANJC Coding and Compliance Consultant GETTING BEAT UP BY INSURANCE PAYERS? The Best Ways to Get Paid