Do you have a backup plan in case your biller leaves suddenly?

Most doctors have no plan in place if their billing person leaves suddenly. Obviously, having long periods without collections can devastate any practice. Firstly, as a Chiropractor who practiced for over 20 years with multiple locations, I cannot stress the importance of the doctor knowing how to run every aspect of his business, including billing and collection. This is true for any business. Although you need to delegate, you also need to be able to handle any task and function if necessary. I’ve seen too many instances of doctors being held hostage by staff members in one way or another.

So my first recommendation is to always know everything that is going on in your office. One way to do that is to have a good EHR software that can track every possible statistic so you always know in real time exactly what is going on with your billing, collections, missed appts, etc. So if staff is not performing as expected you will know before you have huge accounts receivable and even get claims denied due to aging.

So it is best to know how to jump in and take over your billing if that becomes necessary. It is also helpful to have a top quality EHR company, like SilkOne EHR, to help if necessary. SilkOne have a billing service that can jump right in and help anytime its needed. With top quality customer support everything can be handled for as long as needed, and priced less than traditional billing companies.

Dr Rick

Why has virtually every industry moved to Cloud-based software?

Don’t make the mistake of spending many thousands of dollars buying obsolete traditional, server-based software…

How a Cloud-Based EHR can benefit your practice

• Buying a system outright actually results in more "cost of ownership" because the moment you buy any traditional software it is already obsolete and you have to keep spending more money to maintain it and update it. Not to mention, you have to manage your own server, backup server, network, data backup and maintenance, plus pay for support. This is in addition to the huge up front cost of buying or financing it. And once you've bought it you are married to it. You can't change your mind. You are stuck with it.

• Being cloud based means 24/7 access to your data, anytime, anywhere. And with SilkOne’s design you can access our software with any device, MAC, PC, Tablet, even smartphone.

• The "hosting" or "cloud computing" model is now the "Gold Standard." All major corporations have already converted or are in the process of converting, to the cloud-based model. Corporations are all about the bottom-line, and the bottom-line is a lower cost of ownership and being headache free.

• You never have to worry about doing back-ups or losing your data. Losing your data to a computer crash can be devastating to your practice and your financial well being. SilkOne used 2 geographically separate, Fortune 100 level data centers. We spare no expense in providing you the highest quality infrastructure available. So your data is always safe and secure with no down time and the fastest speeds.

• As we all know, technology changes very quickly. When you buy traditional software you are stuck with it because of the large investment you must make. When updates are required server based software systems will obviously charge you for those updates. You have not choice but to pay it. Conversely, cloud-based software can change and adapt to any necessary changes literally on a day-to-day and week-to-week basis. You will always have the most up to date software. And SilkOne never charges for updates or maintenance.

• Everything we do in our lives now is "online", whether it is buying products, banking, filing taxes, paying bills, etc. Companies even back-up their data online with web-based data centers. Why would anyone in this day and age want to go backward and buy an obsolete client/server system??

New ICD-10 Myalgia codes for 2019

There are changes to CPT codes for 2019 that will directly affect Chiropractors, specifically the Myalgia codes. The newest codes are named ICD-10 2019 but actually went into effect on October 1, 2018. Previously M79.1 covered any type of Myalgia, regardless of location. That codes will no longer be a billable/payable code. The new codes for 2019 are much more specific:

• M79.10 — Myalgia, unspecified site

• M79.11 — Myalgia of mastication muscle

• M79.12 — Myalgia of auxiliary muscles, head and neck

• M79.18 — Myalgia, other site

Always be as specific as possible. The unspecified code remains for claims for services prior to October 1, 2018 and should be avoided for any claims thereafter. The most common code chiropractors will use is M79.12, which identifies and involves the muscle of the neck and head.

Common Billing Red Flags and how to avoid them.

One of the biggest fears for chiropractors and to attract the attention of auditors. Its been described as the equivalent of a full IRS audit or worse !! Unfortunately, your claim forms and billing patterns might be raising all kinds of bright red flags to the wrong people. There are obvious elements for any claim to be payable: medical necessity, billing only for services that were provided, meet coverage rules, full documentation, proper coding to name a few. But there are also many gray areas making it hard to know if you are being compliant or if you are at risk.

A quality EHR system should have systems in place to help you stay compliant. SilkOne offers a full compliance module which helps you step by step to follow all the rules for meaningful use that auditors look for. And this module is At No Extra Charge !!

Here is how SilkOne Keeps You Compliant and Audit Protected:

• It costs insurance companies a great deal of time and money to audit a practice. They are smart enough to choose the most vulnerable practices to audit, knowing they will get a good return on their investment. Our Easy to Use Comprehensive Compliance Enhancements follow all EHR rules for Meaningful Use and the bullet points insurance companies use to search for a vulnerable office. Insurance companies will not waste their time and money once they see how compliant your records are. They know there are plenty of other doctors they can go after for a much greater ROI.

• To be Compliant you need to have the proper information on your History, Exam and MDM forms.  Through the work of our Compliance Experts we have provided every necessary field in all forms.  Our Proprietary Smart Technology makes it very quick and easy for you to fill them out properly.

• History forms are Specially Designed and filled out by the patient online.  The information auto-populates into the system, saving much staff time.

• Proprietary "Smart Technology" auto-populates information from Intake and Exam forms in each step with one click, making the entire process quick and easy, with no wasted steps.

• Increase Collections on All E&Ms and Exams--by using our simple to follow History, Exam and MDM forms you will be 100% compliant and able to bill for the highest level CPT codes for your exams (99205), and have the documentation to back it up.

• Dr. fills out the MDM form in 2 minutes or less.  This is the final and crucial step in the process of being compliant. This form is required yet 95% of doctors do not fill this out !! We make it quick, easy and compliant for you to fill this out.

• Our system will then autoscore your exam to let you know the exact CPT code you can bill for (which will likely be a higher level exam code than you can currently bill for, instantly increasing you collections on all exams usually by 50%.)

• SilkOne can help you with Correct Diagnosing, and the software will auto-order your diagnosis' for maximum reimbursement.

• We will help you implement this Compliant Strategy. Every new client that chooses to use our Compliance Module is given a Free Compliance Consultation by our contracted Compliance Experts. This is a $595 value but we give it free.

Helpful tips about common Chiropractic Procedure Codes 97012 and 98940-98942.

Chiropractic documentation and billing codes can be very confusing for chiropractors and their billing staff. Keeping track of which codes to use and when, why some raise red flags, and why others result in denials can be extremely trying. Fortunately there are many resources available on the internet, as well as books and seminars, to help familiarize yourself with common codes needed for a Chiropractic practice. One of the most common denial issues involved 97012 and 98940-98942 on the same visit.

Some payers are denying Mechanical Traction (CPT Code 97012) on the same date of service as the Chiropractic Manipulative Treatment (CMT 98940-98942) with various rationales, the most common being that they are redundant. Obviously this is not true as 97012 does not require attendance. CMT services are in a different section of the CPT code book and are unique manual techniques that require physician attendance. I recommend refusing to accept the denial and file an appropriate appeal.

Is Instagram a good Idea for your practice?

Instagram has millions of users so it seems obvious it can be use to help you grow your practice. However, there are some things to be aware of before you undertake an Instagram account for your office. If you do not have time to handle the account yourself, then you need to appoint a staff member who is very familiar with social media, and has time to handle this task. You will likely want to strategize with that staff member as far as what to post and when.

Instagram will appeal to a younger audience for the most part. So if a younger audience is what you are trying to attract then this is a great avenue. Decide how much money you want to dedicate to advertising and act accordingly, if it is worth it at all. You want to offer some value in your posts, whether offering a discount on a service or just sharing information.

You want to have a general schedule as to when posts are done, whether daily, every other day or weekly, etc. Stick with your schedule and perhaps set reminders in your phone or desktop to be sure. And remember, if you are posting anything about a patient you must get full permission in writing to avoid HIPAA violations.

Can Email Marketing Help Grow Your Practice?

After practicing for over 25 years I now devote my full efforts to growing SilkOne Cloud Chiropractic EHR and to spreading the word about this top level software. One of the tools we use very effectively is email marketing. How can you take advantage of this channel to help grow your practice?

Email marketing has the highest return on investment (ROI) of any marketing, averaging returns of $38 for $1 invested. Patient retention, ensuring patients make their scheduled appointments, and generating referrals are keys to a thriving practice. The use of email can help greatly in all of these areas.

The vast majority of patients have smart phones and check them multiple times per day. Using email appointment reminders are extremely effective in keeping patients compliant. A quality EHR like SilkOne will offer free automated appointment reminders. We also offer free text reminders, which are actually handled via email to the patient’s cell carrier.

Newsletters are another valuable use of email marketing. By sending periodic newsletters you can stay in touch with your patients and offer them valuable information as well as special discounts, or perhaps referral bonuses.

Birthday greetings are also a great way to show you care about your patients. SilkOne sends automated birthday greetings. You can create as many templates as you’d like and choose what is to be sent and when. The same can be done for Holiday emails. You can send holiday gift cards as a way of getting patients in during a normally slow time of the year.

How to Grow Your Practice and Get More New Patients

I practiced Chiropractic for over 25 years and had multi-location high volume clinics. There are no easy short cuts for growth and success, however, there are many daily practices that combined will help you develop a steady stream of new patients.

Make Sure Your Website is up to Date

Your website should be updated every 3 years or so. And I’m not just talking about changing the layout. You need to clearly differentiate your practice and explain why someone should choose your practice over another one. If you specialize in treating specific conditions or patients, your website should appeal to those types of patients. You should also make sure your site is optimized so that it looks good on different electronic devices and formats, including desktop computers, tablets and smartphones.

You should also include professional photos of you, your staff, and office building. Be sure there are many “call to action” buttons as well. You should also include a blog with varied, informative content.

Try to Get as Many Online Reviews as Possible

Please refer to my other blog about the Importance of Online Reviews. Someone in your office needs to officially be responsible for monitoring and responding to online reviews. Setup your business profile on review sites such as HealthGrades, Capterra and Yelp. If you already have reviews, make sure you have claimed your profiles on those sites, and be sure they show complete and accurate information. Thank or acknowledge any positive review or comments. if you have a negative review, respond in a positive way and address any issue or concern, or resolve an outstanding issue.  

Improve Your Brand

The overall message you convey to your customer is your “Brand”. Elements of your brand include your office logo, website and promotional materials, explanation of services…who you are and what you have to offer. Make sure you logo is professionally made and complements the message you are trying to convey.

Social Media

Being active on social media is a must these days, especially for patient retention and referrals. Regularly posting new information and interacting with your patients on Facebook and Twitter keep your practice visible. You can post health and wellness tips, details about services, special offers, photos of office activities, etc.

Get Involved in Your Community

The more you are involved in supporting local events or charities, the more your chiropractic office is recognized within the community. You can do things like sponsor activities like sports or academic groups. You can also volunteer in activities that improve the community, like clean ups or helping the homeless. There are any number of things you can do to get involved. Any community events can in turn be promoted on your website.

These are just a few example of ways to get your practice noticed. If you are not already doing so, try to implement each. The results can only be good !!!

The Most Common Chiropractic CPT Modifiers

Chiropractic codes and modifiers are their own language. You need to use them correctly to get your bills paid. Chiropractic modifiers tell insurance companies that there is something different about the services related to the CPT code being billed. If you’re inaccurate with your modifiers, then it will negatively affect your reimbursement rate – and your bottom line. Below is a list of the top 10 modifiers and how and when they should be used. We hope this will help your billing team !!

59 — If the service provided is distinct or independent from other services provided on the same day. (should only be used when more specific modifiers, like X modifiers, are not appropriate).

XS — a service that is distinct because it was performed on a separate organ/structure.

XE — only used to describe separate encounters on the same DOS

XU — this service is distinct because it does not overlap usual components of the main service

XP — this service is distinct because it was performed by a different provider/practitioner

(note that XS, XE, XU and XP provide greater reporting specificity where 59 modifier was previously reported and each may be used in lieu of 59 when possible.)

AT — Used when patients are in active or corrective phase for Medicare contracted care when using CPT codes 98940, 98941, or 98942.

GA — Tells Medicare you don’t expect coverage as R&C, and the pt signed an ABN for that service, Upon denial Medicare will automatically assign liability to the beneficiary.

GY - Item or supply is not covered by Medicare but you intend to bill secondary. Not to be used on bundled or add on codes.

GZ — Tells Medicare you expect denial of R&C and pt has NOT signed ABN for this service. When denied, pt will not be responsible for payment

25 — If you perform and E/M service on same day as a procedure. The 25 goes on the E/M svc not the procedure. Do not add any other modifiers on the procedure in this case.

Importance of reviews online for any business.

Whether a Chiropractic clinic or any other type of business, having reviews posted by satisfied clients is the key to growing your business.  Reviews set you apart from the competition and play a crucial role in determining success.  There are several companies that make the process much easier, one being Review Wave.  SilkOne EHR is fully integrated with Review wave and therefore makes it extremely easy to get more reviews from your patients.  The system simply runs in the background.  You don't even know its there.  But your patients get contacted after visits and asked to provide reviews.  I highly recommend this for any office that wants to grow and increase their online presence.

Dr Rick

Stability Is Extremely Important When Choosing an EHR Company

Many, many doctors of Chiropractic have experienced or are experiencing the unpleasant task of being forced to change EHR systems.  When EHR systems became mandatory almost all doctors had to go through the exhausting process of integrating their practices and all of their records from paper to an EHR system.  Over the past several years numerous doctors have made the inadvertent mistake of choosing to use an EHR system that had not been developed in a sustainable way. 

There have been dozens of EHR systems that have come and gone over the past 10-12 years.  Many, as is typical in the software development business, chose to offer very low pricing (and usually low quality infrastructure and support structure), hoping to attract a lot of customers and therefore more investors anticipating further development.  When that model proves unsustainable they have no choice but to close their doors, leaving their clients scrambling to retrieve their records and find a new EHR system.  Other systems, whether because their product is just not very good or because of mismanagement, simply prove to be unprofitable.  This has led to many systems being bought out by the largest player in the Chiropractic software market, Chirotouch. 

Being such a big player in the industry, Chirotouch (which is not an EHR but a server based product with obsolete technology), has apparently embarked on a program of buying up failing EHR companies with the sole intent of getting their client lists and trying to convert those client to their product.  They usually support the EHR they buy for a period of time, then let the clients know they will no longer be supporting that EHR in hopes of converting them to their server based product.  This has happened to clients of at least 3 EHR companies that I know of, and is currently happening to Smartcloud/Future Health users.

I have spoken to literally hundreds of DCs who are panicking at the thought of being forced to change EHRs again.  It is not a pleasant task and often takes months to fully transition.  The chaos in the office inevitably affects staff and doctor alike often causing dips in office productivity. 

So what can I suggest?  Research the stability of the EHR you are choosing.  There are many new EHRs on the market showing a lot of flashy features to catch the eye.  But as has happened so many times in the past, here today, gone tomorrow.  SilkOne EHR is the original Cloud Chiropractic EHR.  We were the first and have built a stable foundation for continued year over year growth.  Our data centers are paid years in advance as we continue to thrive.  Our clients so not have to worry about us being bought out or going out of business.

If you are a current Smartcloud user, or are worried your current company is not providing proper support and feel they many be the next to be bought out or go out of business, do your due diligence before jumping to your next EHR system.  Although the transition to another EHR can be very trying, SilkOne provides you with a personal trainer to help with each step of the transition.  We make the process as painless as possible.  You will find, as our current clients have found, that our product has top level features, infrastructure and support.  The goal is always to find one system that you can keep for the rest of your practice life.  I know our clients feel they have found just that system !!  

The importance of high quality infrastructure in cloud computing.

In this day and age virtually everyone sees the value and convenience of cloud computing.  Whether its banking, paying bills, buying anything from cars and houses to groceries, cloud computing has become an integral part of all of our lives.  There are numerous reasons for this, which I don't need to go into here. 

Chiropractic office software is no exception.  Anyone who uses a cloud based EHR system knows the great benefits and conveniences this platform provides.  That being said, are all cloud based products alike?  The answer is clearly NO.  There are many cut-rate products out there that keep their prices low by providing limited or no support, and by using lower quality infrastructure.  Its obvious what limited support can mean to your practice.  But how does a lower quality infrastructure affect your practice on an everyday basis?

Most EHR companies don't mention infrastructure.  They will tout features and price alone, but use low budget infrastructure options to lower their pricing.  However, a poor infrastructure can make your life miserable.  Users of such EHRs experience frequent interruptions of service such as being logged out and having to log back in frequently, slow speeds and a lot of dead time waiting for pages to load.  Does anyone really have time to deal with such annoyances??  For a doctor seeing 4-5 patients per day, maybe this is not such a big issue.  But for any busy practice this is intolerable.  I can't imagine anyone would say that saving $25/month or so is worth the constant hassles.

If you are in the market for a new EHR system, be sure to question the companies you investigate about their infrastructure.  Look at their testimonials and, if you even see one complaint of slow speeds or spotty service, stay away !!  It is just not worth it if your goal is to focus on seeing more patients and to be efficient and profitable.

Dr Rick

Why is fully customizing your EHR software so important

There are literally dozens and dozens of Chiropractic EHR options on the market.  Some are very functional while others are very limited in what they offer.  It is obviously most efficient to choose an EHR that has the most functions to avoid having to use 2 or more different software products to carry out your normal daily tasks.

Many products are very general in what they offer, some meant more for medical doctors than for Chiropractors.  In my opinion, if you want to be the most efficient, choose a Chiropractic only EHR system.  Especially, choose one that can be fully customized to the way you practice.  Your goal as a doctor is to treat and help as many patients as possible.  No one needs to be slowed down by inefficient software, nor needs the headaches of an unhappy, inefficient staff.  Although your EHR is is the nerve center of your practice and profitability, you want it to be an afterthought, something you don't have to think much about and just use efficiently.

If your EHR system does not go to great lengths during the integration process to fully customize the system in order to make every process, from billing to soap notes to patient relationship management, easy and efficient for everyone in the office as well as for patients, then you are not getting the most EHR for your money.  Customer support begins at the point of integration and should carry through every day you are using the system.  If you are not getting that level of support you should know there are other options available !!

Dr Rick

Sample Blog Post, October/November '17

Rick,

Here are some best practices for writing content like this:

• Try to find an hour or so each month to put some thoughts together here. Something will always be better than nothing and I'm always available to give thoughts/feedback.
   
• You should be able to get just 2-3 paragraphs out -- not much more, because you'll lose attention, and no less because it won't be considered worthwhile by Google.
   
• You can choose whatever topics on which you have any sort of subject matter expertise. It's important to note this doesn't have to be necessarily related to the software -- consider things like how to run a practice, thoughts about resources for office managers, maybe case studies, etc.
   
• Don't be salesy here -- the rest of the site does this.
   
• Tag and categorize your posts!
   
• Use a title that briefly, but accurately, describes what the post is about.

Again, please reach out with any questions, especially about how to use the site.