Practice management, team development, and multidisciplinary care.
390 articles · Page 14 of 20
Anthem’s original plan was to take a 50% reduction when providers reported claims using modifier 25 , it was then lowered to a 25% reduction and has now been fully rescinded, to the relief of providers. The policy was to go into effect March 1, 2018, however, due to strong opposition from the American Medical Association and other groups Anthem decided it was not in the best interest between payers and providers.
Recently, many healthcare providers have begun to experience a downpour of denials when billing therapy services. The states which seem to be experiencing the most difficulty are Illinois, Oklahoma, and Texas, particularly for claims submitted to BCBS plans owned by Health Care Service Corporation (HCSC). Since HCSC also owns Blues plans in Montana and New Mexico, the problems may be extending there as well.
There is a new CPT code for 2018. Anyone who uses Durable Medical Equipment, including Orthotics, and has billed for a “check-out” where the patient ran into a problem and required your attention, or that you re-checked the usage, fit, etc. Delete your Orthotics Check-Out Code effective December 31, 2017: 97762 Checkout for orthotic/prosthetic use, established patient, each 15 minutes.
HARD CAP ON THERAPY SERVICES NOW IN EFFECT.
The result of the increased diversity in practice models means that chiropractic patients have more options than ever before in how and where they access chiropractic care. This presents a significant opportunity for chiropractors who are willing to step out of their traditional comfort zone and collaborate with other health care disciplines. The chiropractic profession has the potential to forge new synergies amongst providers, researchers and policy makers—all to the benefit of our patients.
More and more hospitals are incorporating chiropractic into their programs. This model includes both granting chiropractors’ hospital privileges as well as the establishment of on the premises or free standing hospital-owned chiropractic clinics. As the demand for chiropractic services increases, hospitals have discovered that having a chiropractor on site is a benefit to patients as they deal with pain and transition to post-hospital activities. Hospitals that have added chiropractic have reaped the financial benefits that result from target marketing these services to baby boomers who are the primary consumers of complementary and alternative health care.
The addition of other licensed professional disciplines to a chiropractic practice results in the multidisciplinary practice model. The most common disciplines encountered in this model are massage therapists, acupuncturists, physical therapists and nutritionists. The delivery and coordination of care between multiple disciplines in one location decreases the loss of continuity of care that can result when referring patients to outside providers. This consumer-based model of care results in greater convenience and decreased expense to patients. Multidisciplinary practices differ from the integrative model of practice, which combines the services of chiropractors with medical doctors and other alternative health care providers in one location. In 2011, 56.7 percent of solo DC’s were part of multidisciplinary/integrated practice.
As more chiropractors consolidate into group practices, many have found differentiation through the group multi-specialty practice. This practice model is comprised of a group of chiropractors with specialized training and certification in orthopedics, nutrition, pediatrics, sports, rehabilitation, and primary care to name a few of the most popular specialties. Chiropractors in the group are able to refer patients between specialties based upon an individual patient’s needs. The multi-specialty group delivers a wider diversification of services than the solo practice, which results in access to a broader patient base. This model is appealing to patients who desire to receive comprehensive care outside of the allopathic health care delivery system.
Effective June 21, 2017, providers need to begin using the new ABN form. Be sure that new ABNs are properly delivered for any Medicare patients seen since June 21st.
The new health care economy has created an unprecedented diversity in practice models as practitioners evolve the manner in which health care is provided to the public. Chiropractic has come a long way from its isolated status of the past, entering and leading in areas that were previously not receptive to chiropractic participation. The result has placed the chiropractic profession in the forefront of shaping how patients will access health care in the future.
An accountable care organization (ACO) is a type of payment and health care delivery model established by the Centers for Medicare & Medicaid Services. It ties provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients. While chiropractors are not eligible to form an ACO, ACOs can be comprised of health care providers representing any number of specialties, including chiropractic. Each ACO is accountable for 5,000 or more Medicare beneficiaries annually for a three-year period. During that time, members of the ACO can earn shared savings in the first performance year by accurately and completely reporting across four quality domains; and in the second and third performance years based on their per-year performance relative to the 33 quality measures within those four domains. The quality and cost-effectiveness of chiropractic services makes the participation of chiropractors in ACOs a highly attractive option.
The medical home also known as the patient-centered medical home (PCMH), is a team based health care delivery model led by a physician that provides comprehensive and continuous medical care to patients with the goal of obtaining maximized health outcomes. The PCMH has been proposed as a model for transforming primary care and improving efficiency and effectiveness in the health care system. Chiropractors have the opportunity to play a fundamental role within the medical home model. By integrating chiropractic care, medical home care teams are able to effectively care for patients, and therefore meet the criteria and goals of the PCMH—improved overall health outcomes—affordable healthcare, better access and increased patient satisfaction. The Foundation for Chiropractic Progress has prepared a white paper entitled, “The Role of Chiropractic Care in the Patient-Centered Medical Home,” that provides the essential tools needed to get involved in this next phase of health care delivery. The white paper is available at www.yes2chiropractic.com .
Without proper management, the increased overhead associated with additional professional staff members can drain your bottom line and tax your ability to produce a return on your investment. In the area of financial management, it is essential to seek professional advice. Before considering a multidisciplinary practice, a consultant should help you perform a careful analysis of your patient flow and demographics, the healthcare needs of your community, and the availability of professional staff for hiring, all in the context of your current financial circumstances. Do not undertake a multidisciplinary practice without capital sufficient to see your practice through start-up and into the growth and development phase. Don’t wing it.
The coding rules for both chiropractic and multidisciplinary practices are regulated by a Federal Agency, the Center for Medicare and Medicaid Services (CMS). They leave no room for creativity or practice-specific interpretation. CMS oversight views these regulations in black and white, with no shades of gray. While CPT coding is an ever-changing process, the ACA Official MDP Policy Statement clearly provides that only services provided by a chiropractor may be billed under the provider number of a chiropractor. Likewise, services provided by other professional staff members (MD and PT) must specifically identify the provider of those services both on CMS-1500 insurance claim forms and in written documentation.
The professionals most frequently associated with chiropractors in a multidisciplinary setting are Massage Therapists (21.3%), Medical Doctors (12.3%), Physical Therapists (11.2%), and Acupuncturists (9.0%). State-specific Chiropractic, Medical, and Physical Therapy Practices Acts regulate the scope of practice of each of their respective professions. In addition, the Stark Laws define Federal staffing and referral requirements. In some states. it is actually illegal for a chiropractor to employ a medical physician or physical therapist. In others, professional staff can be hired by a chiropractor with the same ease as lay staff members. An experienced consultant should be able to clarify the specific staffing requirements for your state.
On October 18, CMS opened the 30-Day Preview Period for the 2016 performance information targeted to be publicly reported on Physician Compare starting in December 2017. The preview was scheduled to end on November 17 at 8pm ET. Due to a technical issue preventing the data from properly displaying in the preview portal, the Provider Quality Information Portal (PQIP) , all data were not viewable for the first week of preview. This display issue has now been resolved. We are extending preview through Friday, December 1 at 8pm ET to provide more time for clinicians and groups to preview their performance data as a result of this technical issue.
As multidisciplinary practice has increased in popularity over the last few years, I have become aware of a troubling trend. More and more chiropractors are undertaking the conversion of their chiropractic practice into a multidisciplinary practice without the legal and managerial assistance of professionals experienced in this highly regulated area. In a recent survey performed by Chiropractic Economics, 28.7% of chiropractors responded that they practice in a multidisciplinary setting. Only 24.7% of these reported that they worked with a practice-management/consulting group. I call this winging it.
One way to grow your practice is by offering new products services. There are many services that are compatible with chiropractic care. Nutritional supplements, orthotics and supports are natural compliments to chiropractic care. Massage therapy, acupuncture and exercise therapy are high demand procedures that fit well in a chiropractic setting. Research the services that are in demand and determine whether they will be profitable for your practice to offer them. Be aware of the services that other health care providers are offering in your community to be sure that your practice remains competitive. Review the pages of this and other chiropractic publications on a regular basis to keep up to date on current practice trends.
Although it is normal to lose some patients, you can advance yo ur chiropractic practice by maintaining as many as possible. According to expert practice builders, twenty-five percent of your marketing efforts should be focused on attracting new patients to your practice. Your main focus should be on retaining your current patients. Make sure that your current patients are satisfied with your service so they won’t think about finding another chiropractor. Build strong relationships with your patients. Chiropractors who focus on their patients and establish strong relationships increase their revenues, even during financially hard times. Make an effort to remember each patient’s personal information and family members’ names to show that you value their business and see them as an important part of your practice. Solicit your patients’ feedback about their experience with your practice and use the information to realize your strengths and fix your weaknesses.
During National Chiropractic Health Month (NCHM) 2017 this October, the American Chiropractic Association (ACA) will share back injury prevention and strengthening tips as well as information on the value of a conservative approach to back pain treatment with the theme “Back to Basics.”
