As I started through my volume of e-mails, it came to me, that realization we all eventually get, that we really are getting our just rewards, that we are actually reaping what we sow. We want, want, want and don’t want to do, do, do.

What are you sowing? Are you planting the seeds of a cheapened ROF, yet expecting to reap patients who accept lifetime chiropractic care and prepay it with a smile? The seeds of improper SOAP notes should never expect to yield us a safe audit when an insurance company or the OIG comes knocking. Stacks of unanswered requests and neglected reports will not sprout out healthy final payoff checks. No, I’m afraid to say, we are reaping exactly what we sow, and truthfully, we are not taking it so well.

In these troubled times around us, advice flows freely and blame is thrown around like a hot potato. It doesn’t take a rocket scientist to know many of us certainly are having trouble knowing the difference between a need and a want. Who are you blaming? What is it you want from your office? What are you willing to do to get it? My company is offering a two day event that is practically guaranteed to transform the financial department of a practice. And yet, all I hear is…I’m busy that day, I have a concert to attend, I have to be in a race, I wash my hair on Saturday. But, answer my 15 questions in an email because you’re the goddess of reimbursment. Imagine my frustration.

I love the scripting so many practice management groups ask us to use in our Report of Findings when a patient tells us they just cannot afford the care plan we have told them is necessary. Maybe you recognize it: “Listen Mary, I want you to go home, and think about your priorities. This decision may affect the rest of your life. I know you would agree that your health is more important than that vacation you have planned next month. I also know, that if this was the transmission in your car, you would certainly figure out a way to get it fixed.” Sound familiar?

So, I ask you. Where are your priorities? Are you really just reaping what you sow? And, if so…, what are you willing to do about it? It’s your health (your office), and as much as I want you to get better (have an office that runs like clockwork with great returns), the decision is yours. I ask you to go home, and get your priorities in order, and come back tomorrow (get on track) so you can get started on getting you better. I’ll get back to my stacks and get my own priorities in order.

Skip ahead to this Sunday’s class of chiropractors learning about documentation. We were in a part of the country where you have a lot of “old timey” DCs who have been in their small little town doing the same thing, the same way since who knows when. They were not so happy about this Denver girl coming in and explaining how Medicare works and that it’s NOT ok for them to just get around Medicare and make all those patients pay cash. Even after I laid out all the rules and regulations, there was defiance in some of their voices when they explained that they really didn’t have any intention of doing anything differently; regardless of what the government or the law says.

So I got to thinking about our government and the dictates of Medicare. Often, I’m asked about why the government would even CARE if a doctor has a patient pay cash because it’s just saving taxpayer money anyway, isn’t it? The short answer is that it’s because the government wants to protect the Medicare beneficiaries (patients) from unscrupulous doctors who will mislead them into believing that they HAVE to pay cash. Because of this, we’ve swung 180 degrees the other direction and are forced to bill EVERY CMT code to Medicare, maintenance or otherwise. The defiance in these doctors’ voices was clear: Don’t tell us what to do! We’ve done this for 40 years.

So, I’m mentally caught between the loyal and obedient soldier who “just does his job” and the doctor who defies Medicare rules and, yet, I can understand both sides. And still I find myself asking why these doctors don’t have a similar attitude as my soldier friend: “this is our profession and we knew what we were getting into”. I’m not a proponent of the status quo, and blindly following, never questioning. In fact, I think we should always speak our minds and fight for the right. But, Medicare has its rules and regulations. We should support and lobby ACA to change what doesn’t work, but compliance is necessary along the way; a necessary evil, but necessary nonetheless.
Who is right? Which way is best? I look forward to ideas and thoughts in both directions.

Why, then, do you think that as a profession, we’re so willing to extend credit to complete strangers (ok, relatively complete strangers) with no collateral and wait to be paid until some distant third-party insurer decides to pay us?

After 25 years in the profession, most of it behind a desk billing and collecting insurance, I’m more convinced than ever that without balance we can’t survive. I’ve watched over these years as doctors with all the eggs in one kind of basket, like Personal Injury, or Managed Care, have seen it dwindle to the point where I get a call saying, “throw me a life preserver!”. It breaks my heart to watch it.

Even though I’m known in the profession as the “coding queen” and “reimbursement goddess” (both titles I’m honored and humbled to hold), I still believe that balance is the name of the game. In this blog, we’ll explore all the options for reimbursement, and look at the various angles and ideas which we need to explore to achieve perfect balance. Insurance can and should be a part of practice. However, building your cash profit centers, like nutrition, pillows, braces, massage, decompression, spinal pelvic stabilizers, and most importantly, wellness care, will help assure that your practice will always have a cash foundation. What if we could call the money we get from insurance “bonus checks”? Strive to meet your monthly overhead with that money collected over the counter. In this blog, we’ll look at all the ways to do that, insurance billing and collection secrets, how documentation figures into the mix, compliance tidbits, staff training and more.

Reimbursement really does rock. Just ask anyone I’ve ever worked for about the Kathy Dance. Remember that obnoxious little dance Pee-Wee Herman did on his Saturday Morning program. Well something like that! When a check I’d been fighting especially hard for made it in the door, I would do the Kathy Dance around the office, and my doctor always knew it was a win.

Stand tall comrades! And visit back here often for fun and frolic in reimbursement land.