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From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: many of these issues are small, yet each issue is just that… an issue. If you take care of the small issues, then the larger issues often take care of themselves and you can focus on the larger issues… a larger, more profitable practice and more family time.
“Anyone who says money doesn’t matter already has a lot” Mark Studin 2018
Over the years I have spent a significant amount of time detailing the avenues on how to get paid in various reimbursement scenarios in the consultations. However, too many doctors have either not read it (idiots) or don’t fully understand what needs to be accomplished in order to secure payment. Never lose sight of the fact that in spite of what’s going on with the national political rhetoric and who gets away with what, we are a country of laws and no matter how powerful an entity is, both big and small are subject to the same rules.
In this conversation the insurance carriers are big, and we are small. However, the laws of each state provide regulations that level the playing field so that the big do not take advantage of the small provided the small know the rules of the game. As a result, you must know your state collections laws pertaining to the insurance company in order to secure timely payment. It is the understanding of these laws that will be the arbiter of the insurance companies keeping your money or sending you a check.
If you do not understand the laws in your state, you need to call or go on the website of your state’s Department of Insurance where the laws can be learned. When I discuss the laws, I do not mean how many days you’re going to get paid, I mean that section 15.51 (D) (2) in the New York State codes of rules and regulations says that I am to be paid within 30 days or denied and that under section (E) (2) there is a mandate that the carrier pays me 2% per month without the assignee demanding payment hereafter if they haven’t acted within 30 days. Once you understand that level of the law, you now have leverage over the payer to pay your claim.
In the absence of knowing that information, all you will be doing is begging and pleading and the conversation will sound like this: “I sent you a bill now please pay my claim.” That’s what most of you do and why you don’t get paid. The second you pick up the telephone you have lost the game and there’s a high probability you will NOT get paid.
I write a letter that says, “section 15.51 (D) (2) in the New York State codes of rules and regulations says that I am to be paid within 30 days or denied and that it mandates that under section (E) (2) that the carrier pays me 2% per month without the assignee demanding payment hereafter.”
What happens to me is not only do I get paid timely after I write this type of letter, I also get interest checks on a regular basis. This falls under the six P’s. If you are prepared and have done your homework, you will be able to leverage the carriers to work within the law that was designed to protect you and ensure timely payment. Anything else is “begging and pleading” and you have been forewarned to be prepared to not get paid should you not be prepared.
Mark Studin DC, FASBE(C), DAAPM, DAAMLP
Adjunct Associate Professor of Chiropractic, University of Bridgeport, College of Chiropractic
Adjunct Post Graduate Faculty, Cleveland University-Kansas City, College of Chiropractic
Adjunct Professor, Division of Clinical Sciences, Texas Chiropractic College
Graduate Medical Educational Presenter, Accreditation Council for Continuing Medical Education Joint Partnership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences
Academy of Chiropractic
US Chiropractic Directory
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