RISK MANAGEMENT MINUTE – Navigating the Storm: Lessons from a Chiropractic Billing Crisis
In the complex world of healthcare practice, the intertwining of professional and personal relationships can sometimes lead to unforeseen challenges, as was the case for Dr. Jenny and Dr. Pete, a married chiropractic duo. The discovery of significant billing errors by their office manager, who is also a relative, has thrust their practice into a turbulent situation, underscoring the critical importance of effective risk management and the support of a robust malpractice insurance provider.
A Costly Oversight
Dr. Jenny and Dr. Pete’s scenario reveals a harsh reality: a failure in billing processes can have dire financial and legal consequences. Over the past two years, despite an increasing patient load, their revenue did not reflect this growth. It was eventually uncovered that numerous patients had large outstanding balances, uncollected copays, and deductibles. More alarmingly, some insurance claims, including those for Medicare patients, had not been submitted for over a year. This oversight became glaringly evident when a patient, concerned about their billing, independently submitted a claim to Medicare, leading to a federal inquiry into the practice's billing processes.
The Role of ChiroFutures Malpractice Insurance Program
In such crises, the value of having a knowledgeable and supportive malpractice insurance provider cannot be overstated. While Dr. Jenny and Dr. Pete’s situation may not initially fall under typical malpractice insurance coverage, the potential for escalated issues, such as board complaints or legal actions from Medicare, BCBS, or patients, makes the guidance from ChiroFutures Malpractice Insurance Program invaluable.
Risk Management Consultation: A Path Forward
The first step in the recovery process involved acknowledging the need for comprehensive oversight of all practice operations. This includes understanding and periodically auditing the billing process, regardless of who is in charge of it. Dr. Jenny and Dr. Pete have since dismissed the family member responsible for the billing errors and have started to explore external billing services, coupled with bi-monthly audits of billing and accounts receivable.
Addressing Medicare and Insurance Billing
Immediate action was taken to submit all overdue Medicare billing, with additional follow-ups on the patient-initiated Medicare submission. For other insurance claims, the concept of 'timely submission' was a hard lesson. Due to delays, some claims may now be denied, leading to potential write-offs and inability to bill patients directly.
Handling Large Patient Balances and Unpaid Deductibles
For the significant patient balances and uncollected deductibles, a transparent and empathetic approach was recommended. Patients should be informed about their balances and given options for payment. Sadly, some of the older debts might have to be written off, emphasizing the importance of clear policies regarding copays and deductibles moving forward.
Developing Office Policies and Continuous Auditing
Dr. Jenny and Dr. Pete are advised to formalize their office policies, ensuring clarity in every aspect of their practice management. Regular auditing and a hands-on approach to all practice functions, from patient care to billing, are crucial for preventing similar issues in the future.
Conclusion: A Lesson in Business Management
This situation serves as a poignant reminder that healthcare practices are not just about patient care but also about effective business management. Dr. Jenny and Dr. Pete’s experience highlights the need for vigilance in all areas of practice operations, the importance of separating personal and professional roles, and the invaluable role of a supportive malpractice insurance program in navigating these complex challenges. In the end, the path to stability and success lies in the diligent application of robust risk management strategies and the support of knowledgeable partners like the ChiroFutures Malpractice Insurance Program.
