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Hi everyone. This is Samuel Collins, your coding and billing expert for chiropractic and ChiroSecure for HJ Ross. This month’s program, we’re going to try and give you something. Or this week I should say is getting something a little bit more practical. Hopefully something you can use because of course it’s the new.
But the new year has come and gone. Heck it’s February 1st, today. So let’s talk about what are you doing about your fees? What should be my charges? Were there any updates for this year? I’m sure you’re aware that Medicare made some changes. I’m not saying it went up a lot, but at least it didn’t go down as much as they have, which means it does affect other fees.
So we want to start to look at what’s happened with Medicare work comp, but also with relative values, but more importantly, how do you set up a good common. Fee schedule that’s fair to you and fair with the patient. So let’s go to the slides. Let’s take a look at what’s going on and let’s focus in on here.
Please take special note. Of course, here is my email address. Our company address HJ Ross company. You need help with coding and billing. We’re the place to go, but let’s talk about fees. I think the one thing that we have to always focus on is what do patients want to know? I think it’s common.
Your staff probably has to answer it all the time. How much does it cost? What is the fee. And so I think we need to look at what is our fee, how much should I charge? What is actually reasonable? What’s fair. What is the value though? And this is something I want to focus in on think of it this way.
There are offices who charge more and get paid. Why? Because they deliver a value for it. So you have to think along the lines of, am I delivering a 99 cents store, which is nothing wrong with that? Or am I delivering something more high-end so in other words, put the value to it because that’s certainly going to change what you can try.
So you’ll hear this term UCR or usual customary and reasonable. What does that mean as the amount paid for medical services in your area? What is usually, what is customarily and reasonably payable or charged? It’s usually what’s charged for a doctor or service in your area. It falls within a range. And again, that’s going to vary bit by bit and it’s considered necessary.
The issue here is who determines that what is usual customer and reasonable? There’s the insurance model. And as you’re well aware of the insurance model is something that an insurance company determines what they feel is necessary. I We’ve all seen this, you call an insurance company and you say to them what do you pay?
And they say, oh, we pay 80%. Think of that for a moment. When they say they pay 80% 80% of. And so what if you bill a hundred dollars and they allow only 50, that means they’re going to pay for 40, regardless of what you built. So always keep in mind what they think is allowable may not be what you’re billing.
So that’s going to vary office by office geographic region, state by state. So we definitely want to have some type of a formula where we can start to look at what is honestly, usual customer and reasonable. How do we figure that out? What partly I think we have to figure it out from the patient value.
The patient value models. What does a patient value? Here’s something interesting. I’ve practiced with my dad for many years. I’ve been teaching seminars now for 24 years. And the thing that I find interesting lecturing across the country, doctors who charge more, make more. And I know that sounds of course, Sam, they’re charging more.
What I find interesting. They charge more, they have more patients. It’s not that they charge them or they have more patients because I think they put a greater value into the service. In other words, the patient value model, what does it mean? Is it, does it feel like a $25 treatment or does it feel like a hundred dollar treatment?
Am I really getting the value out of it? And a lot of that comes back to making sure the patients understand what we’re doing and why. So one of the ways to do this to start to judge a fee is not just based on usual customer, but what is the relative value of one thing to the other? And I think this is where we, as a profession often lose out.
I will say unequal. Chiropractors on average, probably use about six to eight codes on a regular basis, a couple exam codes, adjustments, therapy codes. And I’m going to say to all of you, I bet you, half of those codes you have at the wrong or incorrect value than other words, let’s say you’re billing $30 for a service, but the insurance company is willing to pay 70.
How much are they going to pay you? Now, how would you know if they’re going to pay 70? This is one of the ways through relative value, starting to understand that relative value. Is there something developed by the federal government? In fact, it started in the early eighties at Harvard where, what they took as all the expenses of practice.
So every CPT code has a relative value and it means the value of one code to another kind of like a house. If in your neighborhood, they sold a house for a million dollars. That’s the same size, lot size, same amenities as yours. What is your house? What relatively a million as well. And so I want you to use this kind of in that way.
So this is updated every year. CMS takes it over and it just gives the value of one coach to the other. Here’s. What I want to do is I want to do a little exercise for you to look, to see whether or not do my fees actually makes sense for what I’m doing. So I want you all to think that if you want to do it right now, just take a piece of paper, pencil, pen, whatever, write down.
What is your fee for a 9, 8, 9. Or just thinking about what is your fee then? Conversely, what is your fee for a four one? What is your fee? Four or nine and two or three mid-level exam, new patient. And let’s do one more code. Let’s just do massage. Now. I’m just picking these four as an average. These are fairly common codes, but here’s where I want to start to look as what’s the value of one to the other.
I see commonly a lot of chiropractors say, oh, I charge 64, 9, 8, 9, 4 to zero. And I charged 70 for a 9, 8, 9, 4 1, and Franklin it’s like stepping me in the heart of like, why did you choose $70? And they go that’s what I think it’s worth not understanding the value. And there is no way a 9 8, 9, 4 0.
At 60 should have a 90 at 9 41 at 70, that matches nothing about the relative value. So by example, the relative value for a 9 8, 9, 4 0 is 0.81. Now you might look at that and go, what does that even mean? Sample that’s relative value to other codes. So until you see it in context with other codes, it doesn’t have as much meaning, but let’s take a look.
The RVU for 99, 4 1 is 1.16. So let’s make this the simplest way. If I say 9, 8, 9, 4 0 is $81. What would be the value of a nine eight, nine four one a hundred and sixteen. So the essence I want you to see here is that whatever charge you have 4 99, for whatever that amount is the price for a 99 41 should be about 35%, maybe even a little bit higher than.
So if you’re charging 64 at 9 8, 9 4 0 and charging 70 you’re undercharging by about $25, meaning using 25 per visit, let’s take that to a bigger way. I find often doctors undercharged 10 to 15, let’s assume you’re doing even a hundred patient visits a week. And about half of those patients are probably four ones.
That means you’re losing somewhere around 600 to $700 per week, just off of the one code, because not understanding the value, the same applies with 9 9, 200. Notice 9, 9, 2 or three is roughly four times the amount of what you’re billing and adjustments. So if you can tell me what you charge for an adjustment.
I will tell you what the fee is for a 2 0 3 or one, two for a slightly higher than an adjustment, one to two regions, but lower. So you might think Sam, how do I use this? What does this really mean to me? And where do I start people? I think what fee do I start with? Here’s what I would suggest.
There’s a code you probably build on most all patients, which is an adjusted. And I would pick the one that’s most common that you seem that insurance companies pay and allow and make that your starting point or your basis. By example, let’s say you’re charging $65 for an adjustment. One to two region.
I take my 65 and you’ll see here, I divided by 0.81 and it gives me 8 80, 24. Now 80, 24 is not a price. It’s my conversion factor. So I’m now going to take 80, 24 and I don’t multiply by any other codes, RV. To tell me the price. So in simple terms, if you can tell me the price of one code that an insurance it’s outside of ones that are course managed care, I can tell you what they’re going to pay for every other code because everyone uses RVU.
So here’s the example. I then take 80, 24 and I multiply it by the RVU of 99 for one notice it’s 93 0 3. So the example I gave earlier, if you’re charging 60 and 70, notice the difference in price. They’re losing probably about 20 to $25, but not understanding if the insurance is paying you 65 for four oh.
Before one would be 80 again, outside of managed care, personal injury and other. How about for an exam? Take a look at this 80 24 times 3.29 and you go to 6,300. You may go, wow. That’s way higher than I want to charge. And I was certainly saying, I’m not here to try to tell you to charge more. I’m really not, but I’m saying start to look to think what’s reasonable.
If you say to me, Sam, I know based on the reasonable charges RVU, I could be charging 260 for an exam, but that’s so far above what my area would allow. Maybe you charge 200. I would say that’s fine. Because you’ve made a conscientious choice to choose it. Not because you thought that’s what it should be.
You made a decision on the value of the area and let’s do just the last 1, 80, 24 times 0.8, 8 70 61. So notice the price of a massage is slightly higher than a 9 8, 9, 4 0. And I looked at guarantee. Most of you don’t know. I consult so many offices. We have a network service. We’re one of the things I do with them is to go over their fees once a year.
And I invariably find particularly for new offices, they have probably three or four codes that make no sense. By example, exercise code has a value of 0.87, which means higher than 9 99, 4 0. And I bet many of you charge your exercise fee below a 99 40. Not understanding the value. So I’m going to give you an example further of this, where this works now, I’ve just chosen Illinois.
Why not Illinois? I just pick that’s a state. We go to quite a bit and I’ve chosen. This is the Medicare rates for Illinois. Now specifically the areas 16 is cook county. So I wanted to pick Chicago, maybe the more expensive area. And you’ll notice they allow 29 0 3 for a 99, 4 0 and 4,100. 4 9, 9, 4 1.
So let’s do the RV with that. Notice I take 29 0 3 divided by 0.81. It gives me 35, 84. I then take 35, 84 divided or multiplied by 1.16. And notice that gives me 41 57. Now you notice it’s off a few pennies, but do you notice how close that is? If you did that with every. You would find that you will find it within pennies.
So I’m going to suggest let’s start taking code you commonly build and do that. Now here’s a way of also thinking of it. I picked Illinois for this reason. This is the company blue cross blue shield of Illinois, specifically for employees. Boeing. And if you look here in that fourth paragraph down with the last one, before it was says questions, notice it says starting January 1st, 2021, the Boeing health plan is updating the predetermined percentage of Medicare allowed charges to the percentage listed in the order to align more closely with market standards.
And notice it says professional prices, 175% of Medicare. So now if I go back here and if you think of what’s 175% of. At $29. It’s not quite double, but that’s going to be like 55. So that’s certainly still well above the Medicare rate, but it’s going to give you a good starting point, which would mean if my rate is $58 and I’m just doubling it for simplicity for a four.
Oh, what will be the price of a 4, 1 8. Or excuse me, 82, actually. And so you can start to see how this works. What I’d like you to do is if you’re not familiar now, for those of you who have the digital code information, Jay Ross, or have access to it, these are the common RV use for the codes that we use commonly.
And you’ll see here at listings of chiropractic codes, if there would be codes, exams, but I’m going to say focus here on the code. You bill commonly evaluation management chiropractic, and probably physical medicine codes or whatever code you use commonly, you really don’t need to have. And no hundreds of cones need, you need to know the 10 or 15 used commonly.
So here’s my suggestion. Put together a sheet like this. I’d love for all of you to do this year. Put your common code. You’re going to notice here. I picked two of the exam codes, new patient established patient, lower level. Oh two and oh three. I put the adjustment codes and then two therapy codes with use that way you can start to know, okay.
If I’m going to charge. A 9.940. You can see a four, two is going to be not quite double but close. So what I’d like you to do though, is put columns together. As you’ll see here, where it says our view, then notice the next price is going to be your time of service. Maybe you’re doing cash, at the time of service discount.
Okay. Put that price. But then the next row, I want your regular insurance price. Cause I’d like you to see, let’s make sure that these fit within our view. And if they’re not. But then the next column, do you notice? I put all the common insurances and these may not be common for you. I just threw some out there at know, blue cross blue shield, Cigna.
And what I’d like you to do is to list what do each of these pay now, the work comp in Medicare, easy. If your state has a mandate, a fee schedule, and then the other ones, because what I’d love to know is which plans pay me better than others. Most chiropractors aren’t aware of. Sometimes you think an insurance is good and your staff has been, oh my God, doc, it’s horrible because you’re not looking at the actual rampant.
This way, you have a good sheet of what’s going on. So when someone calls you and they say, Hey, I have Cigna, you’ll be able to go to this sheet and immediately tell them what’s going on. Now, remember we did it last month, where I talked about the no surprise billing, how easy would this make this to make sure patients are aware of what they charge, but more important than that.
I want to know what I’m getting, because if I’m getting better payment from one of these, I want to figure out how do I market to those people? How do I get more of those patients in my. Ultimately though, again, I want to highlight about using our views and conversions. Here’s just some examples. Notice in Texas, the work comp fee schedule takes 61 17 to multiply by the RVU.
Now, remember the work comp one is about 33 to about 38, depending on your state. Notice Utah 56 and 50 to get this look at the third one, Michigan. If you’re at Michigan, how do you figure out your fee schedule for people? It’s 200% of Medicare. How simple is that double Medicare prices? I would suggest most of you at the very least should probably go 1.5 of Medicare or higher.
And if you did that, it would follow our views, but you can see all the examples here, how this follows up California, work comp, Pennsylvania, Oregon, and so on. Start to make a fee schedule. That makes sense. And when someone disputes your fee schedule, you’re going to say no, I am building usual customer. In fact, here is.
How I developed it. I’m using relative values with specific conversions, hard to push back on that because you now are speaking with knowledge and information that has to be followed. Now I do want to make one statement, though, if you belong to a company like Ash or some of these other plans, they have a proprietary fee schedule, and frankly, that’s what you signed up for.
So they don’t follow our views. They’re just going to say, take it or leave it. I get that. But should that. Your fees for other services to other payers? No. Remember I’m not going to take my lowest paying insurance to assume that’s the usual fee while I may not take the highest one either. I want to be somewhere in the middle because I will tell all of you, you are probably undercharging.
And so how do we get information to you? This is our news page. You’ll notice your have stuff on vaccine mandates, things about chiropractic. Please take a firstname.lastname@example.org. Go to our news. That way you always get the most up-to-date information. That news section is updated weekly on what’s going on.
We’re here to make sure you’ve got the right information. We are your advocate, ChiroSecure and HJ Ross. And to do that, if you’re looking going, God, that was a lot of information. Say, I’m going to short time. We do seminars on this, go to our website, or even better. We have a service where I work with you.
One-on-one called the network, go to our site, look at this page. It allows me access to you or you to me on any type of question. In fact, if you’re a platinum. You get a weekly or excuse me, a monthly seminar just designed for you. And one-on-ones all the time. We’re here to make sure that your practice is continuing to thrive and expand and understand the fees.
If you’re having a hard time with that, reach out to us, we’re here to help. Now I’m going to say thank you all very much. Again. I wish you the best and I will say next week’s program is going to be Mike Miscoe. So stay tuned. And I look forward to working with all of you in the future to take care of.