December 2007

Technology helps avoid payer headaches

For many doctors, having a cash practice is the answer to a dream. By eliminating the dependency on third party payers, they free themselves from much of the uncertainty, tedium and stress caused by dealing with insurance companies. Even some medical doctors are trying this tempting option.

Yet, for many others, the cash practice is not a viable option. Until we can better educate people about the advantages of taking responsibility for their own health (including paying for their own health care), most doctors will feel forced to ‑‑ or choose to ‑‑ continue participating in the third party payer system.

While that decision brings with it a number of challenges, it also has some advantages, particularly when the goal is to bring chiropractic to as many people as possible. Sad as it may be, the fact is many patients will not be able to avail themselves of chiropractic care unless their insurance company pays for it.

This is a problem facing all health care providers, not just chiropractors.

A message on the Nurse Practitioners in Business, website, posted on July 9, 2007, told the story of an NP who opened a private practice and tried to go the cash practice route.

"Her model initially was to be cash only in to see people on a walk‑in basis," the writer explained. "With the number of uninsured people in our community she felt it would be a great service. In addition she is fluent in Spanish and had hoped to reach that community as well. However, what she found was that people still didn't want to pay, even though her fee schedule is far less than an individual would have to pay elsewhere."

We are going through a time of extreme financial uncertainty and many people cannot afford even modest fees for the type of chiropractic care they need. Those who can afford it may be reluctant to make it a priority when insurance covers other options.

So, doctors who wish to provide patients with a full range of choices offer fee‑for‑service options and accept insurance cases.

Fortunately, modern technology has solved many of the administrative problems once associated with insurance processing. High‑quality office management software, for instance, can eliminate such of the work once handled by staff members.

"With the right software, insurance claims can be dealt with as easily as cash transaction," says Aubrey Kesterson, director of Private Practice Technologies, developer of the popular Quixote software system. "In dealing with both insurance and government payers, Quixote handles 70% of claims effortlessly, and arms the clinic with powerful tools to go after the other 30%"

Today, software must do far more than simply fill out claims forms. It should handle all aspects of scheduling, billing from the point of encounter, electronic submission of claims and simple claims adjudication.

In addition, it should automatically generate a "tracer" that demands the payer explain why payment was short or incomplete.

Ultimately, it should also trigger the collection procedure to ensure compensation by either the insurance company or the patient.

One aspect of software often overlooked is the ability of the software to update itself without staff involvement.

"The one thing you don't want to have to face is uninstalling, installing or reinstalling software," Kesterson warns. "A program such as Quixote, written in dot‑net language, allows the system to be upgraded invisibly in the background with absolutely no intervention by the operators."

Such "all‑in‑one" software packages are not inexpensive, but can quickly pay for themselves.

"Adding in the time saved and decreased turnaround time of electronic billing, you will probably see that this is in your best interest," stated Jennifer Behmlander in the article "Electronic billing: How software can make money for you," published in the Journal of the American Chiropractic Association. "With the increased control, decreased time investment, and lower costs that accompany chiropractic software, many offices are finding themselves able to let go of their billing services and regain control of their income ‑‑ another money saver!"

Most important, according to Kesterson, quality office software "allows the doctor to focus on care and lets the technology focus on the method of payment."

(To learn more about the Quixote software, call 866‑778‑4377.)