Nothing like stating the obvious, but the most effective way to keep your accounts from requiring professional chiropractor debt collection services is to prevent them from going delinquent in the first place! Easier said than done, right?

According to Life University Chiropractic Sciences Department Chair Lydia Dever, the key is to be proactive and not reactive. Owning and operating a private practice for the past decade, Dr. Dever has utilized chiropractor debt collection help only once in her career. “You need to make sure your patients pay every time they come into the office,” Dr. Dever says. “That way things don’t get out of control.”

Dr. Dever makes a good point. This is business, not charity. To keep your books up-to-date, you must assure that your patients pay their office visit fees before they leave every time. Being an industry deeply rooted in service, chiropractors are notorious for not being firm in this area. Subsequently, many doctors get taken advantage of, but this happens needlessly.

5 Steps to Ensure Payment

Of course, you can’t force anyone to do anything. When your patient attempts to laugh off their bill by saying, “Get ya next time,” simply don’t do it. Instead, employ these methods:

1. Transparency – Be upfront with your office fees and payment policies on Day 1 before you begin care. Over-communicate so you don’t miscommunicate. This way, everyone is on the same page before care begins, and patients understand that their account will be sent to chiropractic debt collections if they fall behind.
2. Staff support – Train your staff to be firm, but polite, in regards to settling an account before a patient leaves your office. Staff members are your gatekeepers and set the tone for your office. If they are no-nonsense about finances, your patients will respond accordingly.
3. Do not bill – Although some patients will request for you to send them a bill, don’t do it. If they forgot their wallet and have no way to pay, then (firmly, but politely) let them know that payment remittance is expected by the time of their next visit. If they try to pull the same thing next time, nip it in the bud right away. This person could be a predatory patient, and you don’t want him or her in your practice.
4. Be the authority – It may be easy to pawn off the “enforcer” role to your CA, but you are the doctor and it is your practice. Step up when needed and discuss with the situation with your patient next time he or she is in the office.
5. Having “The Talk” – First of all, be non-confrontational and gracious. Remember that people are innocent until proven guilty, right? People steer away from confrontation and you may lose them as a patient if you come off too strong. Your patients will generally have good reasons for what they do, so ask them why they didn’t pay their bill. For instance, you may end up learning that they are in dire financial straights and that they are willing to sign on to a payment plan.

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IC System Quick Facts

• For more than 40 years, Chiro Collect, Powered by I.C. System, has worked with hundreds of Chiropractic Practices nationwide, collecting millions of dollars on their behalf. I.C. System is a BBB Accredited Business with an A+ Rating.
• We are among just a few dozen agencies worldwide to be ”certified” for Best Practices through ACA International, The Association of Credit and Collection Professionals, Professional Practices Management System (PPMS) program.
• We leverage comprehensive skip-tracing efforts to find “missing” patients.
• We offer Chiropractor Clients Online Tools to easily submit debts, view our work effort (number of letters mailed, number of calls made, etc.) on debts, report payments, and generate reports.

See more at: http://chirocollect.com/

Sometimes, doctors wonder if utilizing chiropractic debt collection services are worth the time and money. Unlike other independent health care practitioners, chiropractors generally do not deal with massive delinquent debt loads because their services are traditionally affordable. Typically, the average debt chiropractic patients accrue is around $250.

You may be asking:

• Is it worth my time and money?
• Will this burn bridges with current patients and potential referrers?
• What are a couple hundred bucks in the grand scheme of things?

• Due diligence – Have you given your patients a fair opportunity to respond? Typically, the best practice to collect from an unresponsive patient is to leave two voicemail messages and send one (final) written notification concerning a delinquent account. After two weeks with no response, the assumption is that your patient is avoiding the situation and you are best served by utilizing a chiropractic debt collection agency.
• Count the cost – The debt has to be worth your investment. Discuss your situation with a certified chiropractic debt recovery professional to see if utilizing their services makes sense for your bottom line.
• Is this a new or perpetual problem? – If this is a first-time offense with a long-standing patient, then think twice about sending him or her to a chiropractic debt collection company prematurely. People usually have a good reason for falling behind, and this is especially true with patients who have proven their loyalty and timely payment ability in the past. On the other hand, if this is a new patient and you suspect that he or she may be predatory, then having a no-nonsense approach will probably serve you well.
• Was it your fault? If you didn’t set the tone, neglected to deliver proper expectations up front or were lackadaisical in your fee-for-service procedures, then can you really fault your patient for falling behind? In this situation, to save your reputation and credibility, use chiropractic debt collection help only after fully addressing the situation with your patient and giving him or her ample time to respond.

Chiropractor examining a charming woman's backDepartment Chair at Life University Lydia Dever tells the story of a situation in which a patient fell behind on a considerable amount of money and then just disappeared. Giving her the benefit of the doubt because this patient was a loyal patient in the past and didn’t seem too malicious in her actions, Dr. Dever forgave the debt and forgot all about it. Two years later, completely out of the blue, the patient came into the office and handed her a check for $300. She thanked Dr. Dever for her understanding and told her a touching story as to why she wasn’t able to pay. Evidently, the patient was so embarrassed that her bill got behind that she avoided the office, but after her account got current she resumed care. Does this sound like a referral source or what?

Of course, not every story ends with such a happy feeling, and you will be required to utilize chiropractor debt collection services at one point or another. This is particularly true for doctors who specialize in personal injury and high profile insurance claims. Thankfully, chiropractor debt recovery options are readily available to help in these situations so that you can focus on what you do best.

When your staff has been unsuccessful in reaching a patient who is past due on his or her account, the pressure is on you to have “The Talk” before you send them to chiropractic debt collection help. As much as it pains you to do it, you must. However, your interaction doesn’t have to be miserable. In fact, if done correctly, it may even prove to be quite fruitful!

Here are 10 Key “Do’s” and “Don’ts” to familiarize yourself with before you approach your patients:

1. Do be a soft place to land – Most people are embarrassed in discussing financial troubles, so it is vital to provide a welcoming situation where they will discuss the situation with you. When approaching a patient who has a delinquent account, try phrasing your initial question something like this: “[Patient Name], I noticed that you’ve gotten behind on your bill, and was just curious – is everything okay? Is there some way I can help you?”
2. Do be genuine – A facade can be spotted a mile away. If you come across as only wanting their money and don’t show that you still care about them as a person and as a patient, then they will tune you out immediately. From a patient’s point of view, if you don’t care about me, why should I care about you and pay my debt?
3. Do give them the benefit of the doubt – This is vital! Be intentional in believing that your patient will pay his or her bill. It has been proven that your beliefs do_dont2will determine your actions, especially unconscious facial expressions and mannerisms. If you believe that the patient is never going to pay up no matter what you say or do, then it will inevitably slip out in one way or another.
4. Do be upfront and clear – If your patient is unmoved by your attempts to reach a financial agreement, ensure (verbally) that he or she knows the bill will be sent to chiropractic debt recovery as part of the process.
5. Do have them sign a letter of advice. To confirm what you have stated above, have your patient sign a document affirming that you advised him or her that the account will be handled by chiropractic debt collection help if he or she is unable to pay. Remember to give your patient a copy.
6. Don’t make it personal – Since this is your business, you may have the tendency to take things personally when people fall behind on their financial obligations. Don’t! Business is business, and those that survive the emotional turmoil and refuse to get personally attached to these types of situations will always come out on top.
7. Don’t take a knee-jerk approach – Remember that people generally have good reasons for letting their account fall behind. Find out why they are not paying their bill – You may be surprised by what you learn!
8. Don’t scare anyone away – Being non-confrontational is key. Most people avoid uncomfortable situations like the plague, and certainly you don’t want to create a rift in your doctor-patient relationship. If people get spooked, they won’t come back.
9. Don’t forget that this person is still your patient. The person you’re dealing with has a history with you and is still a potential source for referrals. The way that you handle this situation can determine if he or she lambasts you on Facebook or refers all his/her friends and family to you instead!
10. Don’t lose hope – Not only can a delinquent account easily – and quickly – become a current account, but there’s still a good chance you’ll get your money even if patients don’t respond to your efforts. Send the account to your chiropractic debt collection agency and let them worry about it!

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IC System Quick Facts

• For more than 40 years, Chiro Collect, Powered by I.C. System, has worked with hundreds of Chiropractic Practices nationwide, collecting millions of dollars on their behalf. I.C. System is a BBB Accredited Business with an A+ Rating.
• We are among just a few dozen agencies worldwide to be ”certified” for Best Practices through ACA International, The Association of Credit and Collection Professionals, Professional Practices Management System (PPMS) program.
• We leverage comprehensive skip-tracing efforts to find “missing” patients.
• We offer Chiropractor Clients Online Tools to easily submit debts, view our work effort (number of letters mailed, number of calls made, etc.) on debts, report payments, and generate reports.

See more at: http://chirocollect.com/

A New Jersey federal judge has ruled that a doctor of chiropractic (DC) may pursue his overpayment allegations against UnitedHealthcare (United) even though his patients are no longer insured by the company. The ruling says patients are still subject to the health insurer's overpayment recoupment procedures.

United stands accused of retroactively reducing the amount of money owed to doctors of chiropractic as reimbursement for their incurred expenses. The litigation, filed on Jan. 24, 2011, represents a nationwide class of health care providers who were subjected to United's improper recoupment of payments for services provided to United subscribers. ACA joined the lawsuit in April 2011 when it added a host of injurious practices perpetrated upon practitioners by Optum, United's subsidiary.

Learn more about ACA's insurance advocacy work in the Chiropractic Network Action Center, www.acatoday.org/CNAC, which provides helpful resources and the latest information regarding network concerns for providers and their patients.

As per the recent ACA press release, thanks to the longstanding and ongoing efforts of the ACA effective 1/1/2014 there will be an increase in the RVU for CMT codes in the Medicare fee for service system. The increase amounts to slightly over 2% for code 98940, 9% for 98941 and 10% for 98942. As we know many other systems look to Medicare as their fee schedule base, theses increases may have far reaching impact. In addition there will be upcoming decreases in the fee reduction penalties due to the expenditures from the demonstration project. However please be advised that there is still a 20% reduction pending if the SGR remains in place. Although every year Congress acts at the last minute to repeal the SGR one never knows and a last minute grass roots effort may be necessary to hold off this reduction. Watch your emails for how you can help!

PQRS

It still isn’t too late to start for 2013, start now and you can avoid penalties in 2015! There will be some changes for 2014 and we will get those out to you as soon as they are available. Don’t wait start reporting appropriate G codes today. Visit www.acatoday.org and search PQRS2-13 toolkit for details.

Railroad Medicare Update

The ACA continues to dialogue with administrators from Palmetto GBA regarding their blanket denials and excessive documentation requirements. CMS prefers that this gets handled between Palmetto and the ACA but will step in if necessary. If you receive a denial on Railroad Medicare please appeal, it will be important if CMS has to intervene.

2014 Medicare Deductible

The Medicare deductible for 2014 is $147, unchanged from 2013. Medicare Part C (Advantage Plans) copayment for chiropractic services cannot exceed $20 or 50% in the case of co-insurance. If you have evidence of non-compliance with this please send it to the ACA. If patient is in a Part C plan that does not have a chiropractic panel and there is no out of network benefit you may charge the patient the appropriate Medicare limiting charge and are exempt from sending a claim.

Proper Use of an ABN Form

There is NO OPTING OUT of Medicare, you may be participating (accept assignment) or not. If you choose to not obtain a Medicare provider number you CANNOT see Medicare patients, the choice is yours. Having them sign an ABN on the first visit, declaring them maintenance with instruction to select Option 2 is not appropriate. As this is becoming a trend in some states with some groups many state boards are looking into this to sanction doctors.

For a properly delivered ABN, whether the patient selects Option 1 or 2 you may collect your full fee without Medicare fee restrictions. If the patient selects Option 1 submit the bill to Medicare, if Option 2 is selected a bill is not submitted.

CERT Reviews

Changes being made to CERT reviews, the time frame to respond was 75 days with 4 reminders by letter. Effective 1/1/2014 CERT review timeframe response has been shortened to 60 days with the initial letter Day 1 and reminders Days 30 and 45. As with all audits, read the letter carefully and send documentation as required by the letter, for assistance and guidance visit the ACA website at www.acatoday.org/Medicare.

Respectfully submitted,

Mariangela Penna, DC
NY CAC Representative

An article in the Medicare MLN Matters from National Government Services on April 9, 2013 indicated that the restriction of chiropractors referring to radiologists as the ordering physician on Medicare beneficiary x-rays was changed. An inquiry was sent to the ACA regarding this policy change.

According to the ACA Medicare committee, research into the MLN Provider Bulletin on April 9, 2013 indicates that the article is incorrect. The reference cited in the article related to the ordering of diagnostic tests did state there was a change. HOWEVER, the ACA checked the Code of Federal Regulations, which are current as of October 28, 2013, and the citation related to the Chiropractic Exception (42 CFR 410.32(a)(1)) has been REMOVED. We recommend that you do not use the radiologist as the ordering physician until the ACA confirms the changes. The ACA is following up with CMS for further clarification and will keep us posted.

CMS announces major savings for Medicare beneficiaries

Part B premiums will see zero growth; billions of dollars saved in donut hole

The Centers for Medicare & Medicaid Services (CMS) today said that health care reform efforts are eliciting significant out-of-pocket savings for Medicare beneficiaries, pointing to zero growth in 2014 Medicare Part B premiums and deductibles, and more than $8 billion in cumulative savings in the prescription drug coverage gap known as the “donut hole.”

According to CMS, since the Affordable Care Act provision to close the prescription drug donut hole took effect, more than 7.1 million seniors and people with disabilities who reached the donut hole have saved $8.3 billion on their prescription drugs. In the first nine months of 2013 nearly 2.8 million people nationwide who reached the donut hole this year have saved $2.3 billion, an average of $834 per beneficiary. These figures are higher than at this point last year (2.3 million beneficiaries had saved $1.5 billion for an average of $657 per beneficiary).

The health care law gave those who reached the donut hole in 2010 a one-time $250 check, then began phasing in discounts and coverage for brand-name and generic prescription drugs beginning in 2011. The Affordable Care Act will provide additional savings each year until the coverage gap is closed in 2020.

CMS said the standard Medicare Part B monthly premium will be $104.90 in 2014, the same as it was in 2013. The premium has either been less than projected or remained the same, for the past three years. The Medicare Part B deductible will also remain unchanged at $147. The last five years have been among the slowest periods of average Part B premium growth in the program’s history.

“We continue to work hard to keep Medicare beneficiaries’ costs low by rewarding providers for producing better value for their patients and fighting fraud and abuse. As a result, the Medicare Part B premium will not increase for 2014, which is good news for Medicare beneficiaries and for American taxpayers,” said CMS Administrator Marilyn Tavenner.

People with Medicare don’t need to sign up for the new Health Insurance Marketplace, as they are already covered by Medicare. The Marketplace won’t affect Medicare choices, and no matter how an individual gets Medicare, whether through Original Medicare or a Medicare Advantage Plan, they still have the same benefits and security they have now.

Summary: Objective: The relationship between nonverbal behaviors and patient perceptions of clinicians has been underexplored. The aim of this study was to understand the relationship between nonverbal communication behaviors (eye contact and social touch) to patient assessments of clinician (empathy, connectedness, and liking). Methods: Hypotheses were tested including clinician and patient nonverbal behaviors (eye contact, social touch) were coded temporally in 110 videotaped clinical encounters. Patient participants completed questionnaires to measure their perception of clinician empathy, connectedness with clinician, and how much they liked their clinician. Results: Length of visit and eye contact between clinician and patient were positively related to the patient’s assessment of the clinician’s empathy. Eye contact was significantly related to patient perceptions of clinician attributes, such as connectedness and liking. Conclusion: Eye contact and social touch were significantly related to patient perceptions of clinician empathy. Future research in this area is warranted, particular with regards to health information technology and clinical system design. Practice Implications: Clinical environments designed for patient and clinician interaction should be designed to facilitate positive nonverbal interactions such as eye contact and social touch. Specifically, health information technology should not restrict clinicians’ ability to make eye contact with their patients.

Keywords: Clinician-patient interaction, communication, relationship, empathy, nonverbal behavior.

Citation: Montague E, Chen P, Xu J, Chewning B, Barrett B. Nonverbal interpersonal interactions in clinical encounters and patient perceptions of empathy. J Participat Med. 2013 Aug 14; 5:e33.

Published: August 14, 2013.

Competing Interests: The authors have declared that no competing interests exist.

The Health Insurance Portability and Accountability Act (HIPAA) is comprised of two overarching parts--the Privacy Rule and Security Rule. The HIPAA Privacy Rule provides federal protections for personal health information and provides patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes. The Security Rule specifies a series of administrative, physical, and technical safeguards for covered entities to use to assure the confidentiality, integrity, and availability of electronic protected health information.

IMPORTANT UPDATE:

On January 25, 2013, The U.S. Department of Health and Human Services (HHS) published it’s long awaited Final Rule entitled “Modifications to the HIPAA Privacy, Security, Enforcement, and Breach Notification Rules under the Health Information Technology for Economic and Clinical Health Act and the Genetic Information Nondiscrimination Act; Other Modifications to the HIPAA Rules” (Omnibus Rule).  There are three (3) specific areas that physicians will need to focus on to comply with the new Omnibus Rule:

1. Privacy, Security, and Breach Notification policies and procedures;
2. Notice of Privacy Practices (NPP); and
3. Business Associate (BA) Agreements.

• *NEW*  HIPAA Resources for Members 
• *NEW* ACA In Touch Article HIPAA Gets an Update - What you Need to Know: Part I (March 2013)
• *NEW* ACA In Touch Article HIPAA Gets an Update - What you Need to Know: Part II (July 2013)
• *NEW* ACA In Touch Article HIPAA Gets an Update - What you Need to Know: Part III (September 2013)
• Disposing Patient Records and HIPAA
• ACANews Article--The Golden Rule of Privacy (April 2008)
• HHS HIPAA Frequently Asked Questions
• HIPAA and Social Media
• HHS HIPAA Resources
• HIPAA Training Materials

The NYSCA Executive Board and Board of Directors are profoundly saddened to announce the passing of Dr. Ivan Abelson on Friday, October 11, 2013.

Dr. Abelson served the chiropractic profession and NYSCA in many capacities, recently as a District 7 delegate. He was the immediate past president of District 7.  Additionally, Dr. Abelson served on the NYSCA Board of Directors and was co-chairman of the membership committee

Current District 7 President, George Rulli notes the the District Board "is in shock at the great loss."

Memorial services will be held Monday October 14, 2014 at 12:00pm at Gutterman's Chapel in Woodbury.

Gutterman's Memorial Chapel
8000 Jericho Turnpike
Woodbury, NY 11797
Telephone: 516.921.5757

The NYSCA Executive Board and Board of Directors wish to express our deepest sympathy to Dr. Abelson's family.