Practice Perfect - 10 Criteria For Best Chiropractic Billing Software And Office Management Solution

Information Technology (IT) is a necessary component of a modern chiropractic office," says Dr. Greg Loman, of Trinity Chiropractic and co-founder of Teach The World About Chiropractic. "IT helps maintain patient relationships, control audit risks, and ensure full and timely billing."

Dr. Loman has established one of the most successful chiropractic offices in the world, seeing over sixty thousand patients a year. A world power boat racing champion, Dr. Loman has learned what it takes to be the very best.

Teach the World About Chiropractic, which he co-founded with Dr. Ben Lerner, the author of Body by God, Generation XL, and One-Minute Wellness, helps chiropractors and students across the world. Their clients have the largest, most successful clinics in the profession today.

"Complete practice workflow solution starts with appointment scheduling and includes SOAP notes, and billing," says Dr. Lerner. "Few vendors today offer such integrated packages as they require powerful vericle-like technologies used by trained and skilled personnel implementing rigorous and disciplined service processes."

Chiropractic IT must meet five functional criteria and five technology criteria:

 

1. Clinical Relevance

    

   Technology can only help the healing process if it helps making treatment decisions at the point of care. Therefore, it must be available next to treatment table and it must have intuitive user interface to facilitate simple data entry and helpful online reporting.

    

2. Patient Relationship Management

    

   Successful practice development requires perfectly managed patient relationships, starting with establishing and tracking financial care plans, appointment reminders, balance follow-ups, and avoidance of unbillable appointments.

    

3. Compliant SOAP Notes

    

   SOAP is short for Subjective, Objective, Assessment, and Plan:

   Subjective describes the patient's current condition, including all pertinent and negative symptoms. Document how symptoms impact activities of daily living; Use the Standard SOAP format modified to SOAAP by adding an extra "A" for Activities of Daily Living.

   Objective includes vital signs, findings from physical examinations, and results from laboratory tests. Document functional measurements (e.g., Range of Motion), comparison data, test results, co-morbidities, etc. to paint a picture of what is going on with the patient.

   Assessment is a quick summary of the patient with main symptoms/diagnosis including a differential diagnosis, a list of other possible diagnoses usually in order of most likely to least likely.

   Plan is what the health care provider will do to treat the patient's concerns. This should address each item of the differential diagnosis. Document goals for the patient and establish a reasonable timeline to reach those goals. Update your treatment plan every 30 days or 12 visits or any time there is a significant change in the patient's condition, i.e., exacerbation, new injury, discharge exam. Document the patient's progress toward those goals in the daily SOAAP notes.

    

4. Full and Timely Payments

    

   Revenue cycle management software must help the practice manager to make sure that every service encounter gets paid in full and on time. It must provide full and detailed 24x7 account of all actions on every claim, systematic discovery of denials, patient invoicing, electronic claims submissions to payers, payment posting and reconciliation with charges, HIPAA compliance, built-in tests for medical necessity, and comprehensive online reporting.

    

5. Audit Risk Management

    

   Audit risk management consists of continuous monitoring for potential compliance violations and meticulous management of patient encounter notes.

    

6. Reporting and Transparency

    

   Without transparency billing may not be reliable. To be able to observe every step of the billing process on a continuous 24 x 7 basis, reporting must be available using a secure HIPAA compliant connection over the Internet.

   Vendors that manage their own billing technology typically have better control of reporting capabilities in terms of scope, analysis, frequency, and transparency. At the minimum, the following features must be available:

   Operational Report shows total claims and $ amounts submitted, paid, adjusted, written off, and failed. It allows breakdown by cpt, payer, referral, or a combination of such dimensions.

   Denials Report shows the list of denied claims and a log of followup actions. By sorting it by amount paid, you can tell the smallest payment the billing service will fight for.

   Compliance Report shows the potential for post-payment audit and itemizes compliance violations.

   Reports must allow arbitrary data aggregation and drill-in. Export to Excel spreadsheets for further analysis is a very useful feature.

    

7. Billing Quality Metric

    

   Make a list of metrics available online. Focus on collections completeness and payment delay. Can the system report the differences between payers and between various CPT codes in real time? What is the denial followup success rate?

    

8. Data Entry Protocols

    

   Modern technologies allow the doctor to take over coding and reduce the billing role down to claims processing and followup. Technology-competent vendor will supply your superbill online, along with a separate form for patient and charge entry, EOB posting, and on-line claim editing. Similarly, much of data entry validity, including some of claim scrubbing will be done online at the point of data entry.

    

9. ASP or SaaS Delivery Model

    

   Rapid technology progress results in low return on investment in software licenses, typical of client-server technology. Therefore, monthly leasing arrangements with zero upfront investment, typical of ASP (application service provider) or SaaS (software as a service) delivery models are preferable to license purchase.

    

10. Data Security and Protection

     

    Review data center facilities. Ask for evidence on HIPAA compliance: claims must be viewed only on the "need to know" basis, access to claims and modifications must be thoroughly documented. Data must be protected with redundant disaster recovery measures. Review backup process, backup intervals, and data restore capabilities.

     

 

Summary

Increasing regulatory scrutiny, poor in-house billing performance, and rapid technology progress are key growth drivers in chiropractic information technology. On one hand, thousands of outsourced billing solutions and software vendors ensure continued competitiveness in terms of both service quality and pricing. On the other hand, the lack of standards and uniform metrics among the vendors, combined with their large numbers, frustrates the selection process. Ten effective guidelines streamline outsourced solution selection process and reduce vendor switching costs.

Yuval Lirov, PhD, author of "Practicing Profitability - Network Effect for Revenue Cycle Control in Healthcare Clinic and Chiropractic Office: Scheduling, SOAP Notes, Care Plans, Coding, Billing, Collections, and Audit Risk" (Affinity Billing) and "Mission Critical Systems Management" (Prentice Hall), inventor of patents in Artificial Intelligence and Computer Security, and CEO of Vericle.net - Distributed Billing and Practice Management Technologies. Yuval invites you to register to the next webinar on audit risk at BillingPrecision.com