Articles August 1, 2014

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.