ChiroHealth USA is a network designed to provide:

  • Discounts for cash patients and others with non-covered services.
  • Discounts are not restricted to “time of services” discounts.
  • No claims, forms or limits on number of visits.
  • Membership of $39.00 is for the year and covers legal dependants.

 VERMONT CHIROPRACTIC ASSOCIATION WEBINAR

CLICK HERE

Remember, there are no joining fees, no credentialing fees and YOU get to set your own fee schedule and discounts. This is the best way to clean up those dual fee schedules, improper time of service discounts and avoid the OIG inducement violations.

 

 

Doing the Right Thing the 

Wrong Way Can Cost You!

By Dr. R. A. FOXWORTH, D.C., FICC, MCSP

Yes, I know. Sounds strange doesn’t it?

Strange as it sounds, it is far too familiar to those of us who work with doctors on a daily basis to help improve their documentation, billing coding and collections. We see examples of doing the right thing the wrong way every day in chiropractic clinics across the nation. It happens when doctors attempt to do the right thing in helping patients with no insurance or limited benefits by “tweaking” their documentation and coding to result in an overall lesser charge for the patient.

Be honest. Have you ever had a patient that required more than a routine workup but you used a lower level exam code because you knew they had no insurance coverage? Perhaps a 99202 instead of a 99203? No big deal right?

WRONG!

Or, as long as we are being honest, have you had a patient that you adjusted full spine, 4-5 levels, and you only charged a 98940 for 1-2 levels? No big deal right?

WRONG!

Ok, let’s try one more. How about this scenario? Have you ever had a Medicare patient that required a detailed workup and x-rays and you charged a lower level exam code or just billed for 2 x-rays when you actually performed 4, because you know Medicare doesn’t cover your exams or x-rays? No big deal right?

WRONG!

All of these are examples of down coding your services in an attempt to strike a balance between what insurance coverage may allow and what you feel your cash or underinsured patients can afford.

We all know if you don’t perform a service you should not bill for it…it is called fraud. However, few may be aware that if you DON’T report what you did and DON’T charge for services you would normally bill to insurance because you are seeing a cash patient, there is also the potential for fraud because of a dual standard of care and a potential dual fee schedule.

Not to mention, down coding or failure to bill Medicare patients can be considered an inducement and subject to serious fines and penalties according to the Office of Inspector General and CMS.

The bottom line is that down coding can be perceived as illegal and inappropriate just as up coding is when it is used to allow you to bill differently based on whether the patient is insured or a cash patient. It is “gaming” the system pure and simple. It is doing the right thing to help the patient, but it is being done the wrong way and it can cost you.

What drives doctors to down coding or not charging for all their services? It’s really quite simple. There is the need to maximize reimbursements by billing your UCR fees or contract rates to insurance companies, but you haven’t found a good way to make care as affordable as you would like for your cash and underinsured patients.

So the only tool you have is to “tweak” the documentation, coding or billing to allow you to do what you would like to do. It really is that simple, but it can REALLY be very costly if you are audited!

So how can you document as you should, bill as you should and code properly for maximum reimbursement when there is insurance available and still be able to help the cash patients? You MUST join and encourage your patients to join a cash discount program.

It really is one of the most logical, legal, and ethical ways to allow you to accept a lower fee than your normal UCR clinic fees. It allows you do what you are attempting to do now…help the cash or underinsured. But, with a network contract, you can do it without “tweaking” your documentation, coding and billing and you avoid running afoul of dual fee schedules or illegal inducements.

So, do the right thing! Document properly. Code properly. Bill properly. And, consider joining one of the cash discount plans that allow you to “contract” with cash and underinsured patients.

The contract model is not new. The contract model is what allows you to contract with multiple insurance companies for different rates for the same codes without it being considered a “dual fee schedule”.

Cash discount plans simply provide you the protection of a “contract” and allow you to document, code and bill properly and still pass on some savings to your cash and underinsured patients.

If you are documenting properly, coding properly and billing properly, good for you! Just make sure you don’t do the right thing the wrong way by trying to use a “bookkeeping reduction” or Time of Service discount that can be open to interpretation as to what is a “reasonable” discount. Far too many clinics use these tactics or strategies improperly in trying to help cash and underinsured patients.

Most all patients are familiar with “buying clubs” like Sam’s Club and networks. Experience shows they don’t hesitate to join these to save money! Our network doctors have already enrolled over 40,000 patients! A good cash discount plan solves so many of the potential problems for you and really helps the patient…the

RIGHT WAY !

THE MAIN THING IS.... Doing NOTHING is not an option! If you don't use ChiroHealthUSA, use another plan! But for goodness sake, take a look at this area of your practice!

While I can't say one company is "BEST" over the others, I can tell you we are different. I have done my homework to make sure we offer everything in a contract I would want as a provider.

For example, we don't dictate how much you must discount your fees. We allow you to set your discounts and give you more latitude than most others. The patient enrollment fee is only $39.00 and there is NO set up fee, no credentialing fee or any other fees associated with your participation. And most importantly we are designed to be used IN CONJUNCTION with health insurance plans or coverage for NON COVERED service, not just cash patients.

Questions? Call us at 1-888-719-9990 or send an email to info@chirohealthusa.com.

We are the Network that Works for Chiropractic! 

Vermont Chiropractic Association

30 Lang Drive Essex Junction, VT 05452 

Phone:   802.233.3912   Fax:  802.878.1209  vtchiroassoc@gmail.com

Vermont Chiropractic Association, All Rights Reserved

Powered by Wild Apricot Membership Software