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Audit Risk Press

AUDIO INTERVIEW
By Dr. Sigmund Miller. Executive Director of Association of New Jersey Chiropractors (ANJC)

On Billing Compliance and Practice Profitability

PARTICIPANTS:
 Dr. Brian Capra, Director of Advanced Chiropractic and Wellness in New Jersey.  He has experience in the largest practices in the country, which makes him an expert in building large volume practices.  Brian is also a partner at Billing Precision

Erez Lirov, a graduate of Computer Engineering Department at Princeton University, inventor of patents in artificial intelligence and computer security, and partner at Billing Precision.

Jeff Randolph is an attorney and founding partner of Labady & Randolph, LLC, which is a multi-state health care law firm specializing in insurance litigation, health care audits, arbitration of medical claims, major medical disputes, billing and coding compliance, and professional licensure matters.  Mr. Randolph is presently legal counsel to the Association of New Jersey Chiropractors, a member of the National Association of Chiropractic Attorneys, and is licensed to practice law in New York, New Jersey, U.S. District Courts for the 2nd and 3rd Circuits and the Court of Federal Claims

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Outline:

1. Brian, what makes Billing Precision unique?

On average, practice owner adds 10%-20% to practice revenue, making Billing Precision the highest quality billing service nationally.

Billing Precision stands head and shoulders above other billing services because, in addition to outstanding billing performance, it provides two unique extra values:
  1. End-to-end practice workflow technology 
  2. Built-in compliance and audit management tools
I searched for ideal system while I worked for Greg.  Greg Loman is the founder of Teach the World about Chiropractic, which is the largest practice management-consulting firm in the country.   They see hundreds of patients per week.

I was looking for a system that allowed managing patients flow at a high volume office, electronic billing technology, audit proof compliant SOAP notes etc.    When I couldn’t find such a system, I decided to build one myself and I was lucky to discover experts in computer technology and billing to help me.  The patient flow is my expertise.

Additionally, Billing Precision unique in its delivery method. We deliver our service and technology over the Internet.  There is nothing to download, backup, or manage. We use a single central system, eliminating entirely the cost of ownership.  Similar to how online banking is done but on a larger scale.

Billing Precision is uniquely Transparent.  Since the system is online, our clients have 24x7 access to every processed item, you know which claims were submitted, which were paid, which failed, and has been done so far.  You gain unprecedented control over your practice, with all the convenience of an outsourced service.  We also received a seal of approval from New Jersey department of banking and insurance. 

2. Jeff, Brian mentioned compliance management: why is it important and what does it mean for a practice owner?

While standard insurance policies protect the doctor from most business risks, nobody offers protection against potentially enormous penalties in case of billing audit.

A non-compliant practice owner risks his licensure, imprisonment, and significant monetary penalties. 

Monitoring billing compliance is doctor’s responsibility and ignoring it often results in practice ruin.
    2.1  Audit frequency is growing: five years ago we saw 2 audits per year and now we see about 30.

    2.2  Penalties are growing:
    1. Five years ago we saw $50,000 in back payments and now some cases reach as high as $500,000
    2. Triple damage
    3. License suspended or revoked
    4. Imprisonment
3. Erez, Brian mentioned end-to-end practice workflow management.  What does it mean for a chiropractor?
  1. End-to-End practice workflow management facilitates clockwork precision and efficiency between office members.  Workflow management minimizes dead times, no shows, encounter time, and unpaid balances.  Workflow management means that you are effective, efficient, and compliant, so you can focus on growing your practice.
  2. Every person in the office knows precisely what to do next in terms of greeting the patient, delivering care, and processing outstanding balance.  Such a workflow provides the ability to reconcile your office visits with claims and payments in real time.
  3. It means that you always know where are your patients, who is in the office at the given moment, who are the no-shows, what are their outstanding balances, what was your assessment and treatment plan, and what you need to do now.
  4. Workflow management requires integrated appointment scheduling, SOAP notes, claims processing, and revenue cycle management.
Billing Precision is the only vendor selling a completely integrated Internet-based system including all of these services in a single package.

4. Jeff, let us talk more about compliance management. Is there a way to reduce the likelihood for an audit and, if audited, is there a better strategy to handle it?

  1. If you fight, you can reduce the damages by 50%-75%
  2. If you do not fight, in addition to paying all damages, you also go on record for easy mark, provoking a repeat audit in a few years again.
Competent preparation and continuous monitoring is the answer.

First, note management.  Without good notes, a payer may take you out of business or you may even end up in jail.  You need to understand how audits are done, what is your likelihood for an audit, and what kind of actions are available to you once you are audited. 

Next, compare your collections pattern to national averages.  Quantify differences.  Use past audit experience. 

Audit Red Flags
  1. Billing a 98941 or 98942 on every patient each visit because you are a full spine doctor
  2. Full spine x-rays on each and every patient on the initial exam and then again as a re-check
  3. Billing and coding for cervical, thoracic and lumbar x-rays when your intent was to have a full spine performed
  4. Billing out a 97140 manual therapy in place of a manipulation code because it pays more....
You can only do such real time analysis if you have a powerful technology infrastructure with an ability to aggregate and to drill in.  That’s why Billing Precision is so useful.

ABOUT BILLING PRECISION   Billing Precision, LLC is a national Third Party Billing Service, Certified by New Jersey Department of Banking and Insurance, and a Business Partner of Association of New Jersey Chiropractors. Headquartered in Dumont, New Jersey, Billing Precision consolidates billing services, tracks payer performance from a single point of control, shares Medicare compliance rules globally, and creates massive economies of scale. It guarantees improved practice profitability and 100% transparency throughout the billing process. The service leverages comprehensive practice workflow technology, integrating patient scheduling, SOAP notes, compliance management, and billing.
CONTACT
Stephanie Capra, President
866-387-1841
paid@billingprecision.com

www.billingprecision.com
“Billing Precision gets chiropractors paid. It uniquely embraces the vision and system required for successful high volume practices.”
-Drs. Ben Lerner and Greg Loman, Founders
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