Dr. R. A. Foxworth, FICC, MCS-P
You’ve heard the question before: “Do you know of any doctors who’ve gotten audited and penalized?” The answer your members are hoping to hear is no, you don’t. Or if you do, it’s very rare.
The thing is, you probably don’t hear about it as often as it actually happens. Doctors who’ve run afoul of the Office of Inspector General (OIG), a private insurer’s auditors, or the Centers for Medicare and Medicaid Services (CMS) don’t usually brag about it, especially if they incurred fines, penalties, and substantial recoupments. You know, just as we do, that there are many, many doctors in hot water out there that we just haven’t heard from yet.
That’s why so many of your members are coasting along with a false sense of security. They’ve never been audited, so their logic goes, and they don’t know anyone else who’s been audited, and therefore, it’s no big deal. Sure, they should clean up their documentation and understand compliance regulations, but they’ll get around to it someday, when they have time, or after they hire a new front desk CA, or after the holidays. In the meantime, why worry?
We worry about doctors who think like this, and you probably do, too. OIG, CMS, and private insurer audit rates have never been higher, and the government agency is willing to spend a great deal of time, effort, and even money to correct what they consider to be the worst documenters in the medical profession: chiropractors. You’ve even heard the stats: the OIG believes the chiropractic documentation error rate, based on audits and records reviews, to be between a whopping 90 to 94%.
Loose chiropractic documentation and a fuzzy understanding of compliance regulations and the importance of avoiding dual fee schedules, excessive time-of-service discounts, and inducements, is like speeding down the highway. Sure, lots of people do it, and they do it without thinking twice about it. Until, that is, they get caught.
You can help your association members by recommending that they put a compliant financial policy in place that includes ChiroHealthUSA. ChiroHealthUSA is a provider-owned network that works in conjunction with a Discount Medical Plan Organization (DMPO) offering a simple way for your association members to offer legal, network-based discounts to under-insured, cash, and “out of network” patients who become members.
It’s easy for your members to join as providers. There’s no cost to the chiropractor or the practice and it’s easy for your association members to explain to their patients. The patient cost is just $49 per family per year in exchange for network discounts on chiropractic services. It’s a win for patients, because the cost of their memberships is usually more than made up in their first visits. And it’s a win for doctors, because they have a way to offer legal discounts to patients in need and stay in compliance while doing so.
Urge your members, especially those who are blindly speeding along “just like everyone else,” to join ChiroHealthUSA, set their practices on cruise control, and then settle back to enjoy the ride. They can find out more about how becoming a ChiroHealthUSA provider allows them to help patients get the care they need at a cost they can afford by visiting chirohealthusa.com.
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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.