Ray Foxworth, D.C., FICC, MCS-P
I hear it every weekend from new graduates to veteran chiropractors who have been working in the trenches for over 20 years. They are tired of all the red tape and regulations that make them feel like they must choose between quality patient care and hours of paperwork to stay compliant. From that perspective, I see the benefits of a cash practice, however, there is more than one way to be compliant and maintain the ability to see insured patients when care is covered, and help your cash patients at the same time. It doesn’t have to be one or the other.
As a cash practice, you control how much or how little you will be paid. You can set your own price and have patients pay you directly for the services they receive without the hassle and expense of arguing with, and trying to get paid by, insurance companies. There is a common misconception that being a cash-based practice eliminates the hassle of insurance verification and hours spent on billing and documentation. This is just not true. Even as a cash-based practice, you will be treating patients with health insurance coverage. This means your billing, coding, and documentation must be done correctly to ensure that your patients can submit claims to the insurance company on their own and be reimbursed for their expenses.
In 2016, the Henry J. Kaiser Family Foundation reported that 91% of the US population had some form of health insurance coverage (Henry J Kaiser Family Foundation, 2016). To be honest, with health care costs rising over the last decade, it is a huge expense for most families. Thus, many of them are reluctant to spend additional money to be seen by a provider that is outside of the insurance system. With only 10-15% of the US population seeking chiropractic care regularly, this can narrow the pool of patients coming into your office significantly (Gallup-Palmer College of Chiropractic Inaugural Report, 2015).
Another one of the drawbacks to an all-cash practice is the restriction of no longer being able to see federally-insured patients. Although reimbursement for Medicare patients is minimal, they pay quickly and make up one of the largest revenue streams in the country. Outside of the medically necessary adjustments my Medicare patients receive, every other service in my office is paid for out-of-pocket by the patient. There are 10,000 people enrolling in Medicare every day (Diamond, 2015), and the idea of no longer treating the fastest growing demographic in our country, doesn’t seem like a good business decision.
I know how you feel, and I have been where you are. Multiple times throughout my 33+ years in practice, I thought about throwing my hands up and switching to a cash-based model. I changed my way of thinking when I realized that the bulk of the revenue flowing through my practice was, in fact, from cash patients who had come to me through some form of insurance. You see, insurance coverage is diminishing and is, in many cases, non-existent for patients with high deductibles. Through a thorough financial report of findings (FROF), we educate patients on what insurance will, and won’t, cover and present them with options that make care affordable and still keep our practices compliant.
As one of nearly 4,400 ChiroHealthUSA participating providers, you can reap the benefits of a practice with a variety of revenue streams by maximizing reimbursement when it is available and reducing patient drop-off by offering affordable options using CHUSA. To date, over 630,000 families have gained access to affordable chiropractic care because of providers like you. If you need help refining your financial report of findings (FROF), click here.
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Why is the Discount Challenge prize amount $15,024? Because that is the average “per-occurrence” fine for Medicare inducements. That’s not $15,024 per patient, that’s not per provider, that’s PER VISIT. Stinks, doesn’t it? To us, the prize amount is worth the investment if we can help our profession better understand proper discounting.