Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 75

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time.

"Review the Claims"

For the third time this week, a doctor informed me that the HCFA billed did not reflect the work performed. In two instances, a partner was greedy and committed fraud without the partner being aware. In one of the two situations, the authorities are involved in a fraud action and both the fraudulent partners, including the unsuspecting partner, face possible jail time. The reason the unsuspecting partner is in trouble is that he signed the HCFA’s in “blind faith” of the fraudulent partner, making him equally responsible.


The other doctor stumbled upon the situation with a staff member enlightening him to the situation. However, this doctor has the luxury of undoing the problem and divorcing himself from the offending doctor. This doctor must also arrange to refund the money immediately, citing clerical errors, or the carrier can prosecute for fraud if they so choose. Thankfully, the doctor had the luxury of finding out and pre-empting any action by refunding the money.


In the third situation, a doctor had a very inefficient staff that made data-entry errors and billed for services not performed. The difference between the first two situations and this one is that this one was an accident. However, at the end of the day the doctor received money for services not rendered and if retrospectively audited, as over 25% of the profession is currently, this doctor can be charged with fraud. This puts this doctor in the same category as the first in this consult, facing charges, paybacks and possible felony charges.


The solution is very simple and requires only a little of your time. I have shared this with you previously, but apparently it has fallen on deaf ears to many and I hate to get those phone calls and e-mails because I have to bite my tongue when I want to say, “I told you so.” Prior to any claim being sent, either on paper or electronically, print a billing report with the ICD’s, CPT’s and dates of service. Pull your charts and compare that list to the actual chart to ensure you have billed accurately. Do not have a signature stamp in your office. They are incendiary and will get you in trouble. It’s only a matter of time. Do not let anyone bill under your name without checking for accuracy. Greed and stupidity can cost you money, your license or your freedom. I mean that seriously!


In addition, I continually found 10%-15% in data entry errors that could have caused my billing to go out incorrectly and would have resulted in denial. My income increased immediately by correcting these errors prior to submission in a chart review. The difference between success and failure is paying attention to detail. The difference between success and ultra–success is paying exquisite attention to details.

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