Click here to download the transcript.
Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors. We suggest you watch the video while reading the transcript.
Greetings to my friends. Greetings of course, to members of the network, and greetings to all of you, and welcome into our. End of the year program talking about what’s going to be going on for 2025. How do we get prepared? And I really want to talk about it being proactive. So let’s go and go to the slides.
I’m Sam Collins. I’m the coding and billing expert for of course, the H. J. Ross company and chiropractic for that matter. I’m used by a lot of resources, whether it’s going to be the world health organization or for that matter, United healthcare or department of justice. Anyway, I’m that expert, but I want to talk to you today about beyond just running your practice, but really a safe and effective and frankly, a practice that makes more money for 2025.
Click here for the best Chiropractor Malpractice Insurance
So I look at this as being proactive. I think too often offices are reactive. They wait for something to happen. They make a change. What I’d like to do this time around is start to think of now it’s early in the or latter part of the year, early new year to 2025. What do we have to be prepared for?
What should we be doing? I think always we have to think of. What is your definition and how do we define our practice success? What do you define it as? And that could be many faceted. Keep in mind it’s not always money, though for me that’s gotta be part of it. Obviously the success of what you do is helping your patients, but ultimately we have to be paid for it.
Get a Quick Quote and See What You Can Save
So you have to start to define, how do you define that? What do you see it as? What have you planned? to be for your practice. Where do you want to make the next step? Remember, if you’re not growing, you’re shrinking. Because remember, economy changes, prices go up. So if you’re doing just the same as last year, frankly, you’re going to be getting behind a bit.
So we’ve got to define it in a way that starts to really be, again, in that proactive stance. But here’s the thing. Whatever you define it as, what are those barriers to your practice? Is the barrier just you’re not out there enough? Are you not successfully getting new patients? All those things. But I want to think along these lines.
Barriers often to what are the barriers for a patient to come into our practice? I think a barrier for them is always is it going to help me? So I think we have to start to do more there to make sure people know what we can do. Think of it. If someone were looking for a chiropractor to treat their condition, how are they going to find you?
Is it we base it on a referral from a friend? Is it from a Facebook ad? Is it from how we advertise or market our office? Think, what if someone were Googling in your area for a chiropractor that treats sciatica? Is there anything on your site that does that? So you want to start to think of, how do I be proactive in that way?
I know my father who practiced for many years. Heath realized that personal injury was a good place to have really good high paying patients that needed help and it paid more. So he therefore marketed it that way. His business card had personal injury. His yellow page ads, because yeah, it was that long ago, had that emphasis, but it’s something that we emphasize.
Realize chiropractors are very good about that. We have to really do our own marketing, our own way of attracting patients. So think of what is the Do they know what you do? So that’s something to think of. But you know another barrier is the cost. So how are you defining your cost? How do you make it that someone can come in?
How do we make it affordable or to achieve that there is the value? So I want you to think of what is your model and how does it create value? Because one thing that’s for certain is people will always beg for what they need. And buy what they want. So you got to start to think of your model as setting up something that people want your care.
And, but we still have to make it and think of it. Is it affordable? So you got to think of that’s all good, Sam. I get that. We want to start thinking there. Where are my patients going to come from? Have you really thought, where am I getting my patients? Have you really done a review of 2024?
Where were the bulk of my patients from? How did they get into my office? How did they first see me? Are you doing anything that indicates, how did you find me? Was it something through a Facebook ad? Was it something through social media? Or was it a friend that referred? Or was it through their insurance?
Did they get a referral that way? So start to think of where do they come from and start to look at how do I maximize that? Because you’re going to get patients really, in my opinion, 12 different ways. There’s three ways for cash patients. There’s just simply people are going to pay cash. There also could be a setup though.
Have you ever thought of, how about, do I offer a prompt pay discount? Would that make it more attractive? What if someone pays cash, do you give them a little discount? That’s something to consider. Would that make it more attractive and maybe take away a barrier? But what about another way that you can even discount maybe potentially further, but also commits the patient to care with prepaid plans?
Have you ever thought of, have I incorporated, similar to the joint model, one visit might be a hundred dollars, but if you buy 10 visits? It’s only 500. So therefore, is it more attractive for a person to buy 10? Now there’s barriers to that to make sure you’re doing it legal within your state, but certainly allowed because this is three ways of a cash patient.
And in one way, you’re going to try to make it maybe more affordable or attractive to be discounted because you can’t do much with a prompt pay discount. Except of course if you’re in California. Now what about other places? Realize there’s nine other places for other types of patients that come in and let’s face it, do people use health insurance?
They do. So I’m not going to turn away insurance patients that are good. Now here’s what we have to be careful of. Not all insurance is good insurance and realize you do not have to accept all just because you accept the one. So you can be a little bit picky. By example, I don’t accept all cash patients.
If you want to pay me 25, I don’t accept you. That’s not my fee. So keep in mind the same for insurance. What type of insurance? We have our standard 80, 20, 200 deductible policies. But are those typical anymore? Not really. Very few people have those high end type policies. Many will have a PPO, Preferred Provider Organization.
But do you have to be a member? Here’s something interesting. Many of you have the thought that you must join an insurance for it to pay you. And I’ll give an example. UnitedHealthcare. com. And Cigna and Aetna generally will pay more money to out of network providers than they do in network providers.
And you’re thinking, what? Yes, exactly. In fact, it’s funny to those plans. They make in network providers have a shorter timeframe to send a claim. So before you join something, start to think of, am I joining because it’s helpful to bring me a lot more patients? Because when you join, does it reduce your fee?
It always does, but maybe if the volume is there. I’m going to suggest though, check to see if the policy is exclusive. If it’s not, it may be better not to be part. And this is something to start to think of at this time of year, whether or not you want to remain in some of these and really have they set up the value, particularly when it comes to an HMO.
Now an HMO, I will say, if you join one, that means you’re going to get a patient you otherwise would not be able to see, at least under their insurance. However, is it worth it? When you join these plans, like at American Specialty Health, and I’m not putting it down, I just don’t think they pay enough, is it worth it to you?
Can you afford really treating a patient and getting only 26 a visit? Does the volume make up the difference? So that’s something to consider that. Is it worth it? And I think this is where most people get sour. If you’re starting to think of a change for 2025, let’s be proactive and see, was this really worth it?
Did you really break down the numbers? But what about making sure people know they can use their health savings account? Those plans obviously can pay for their care. It pays out of pocket. Some of the plans are tied to their insurance and it pays their co pays and co insurance, but some are not. So worth looking into.
Have you ever really looked into patients that have those? What about a personal injury practice? Have you done anything to maximize that part of your practice? Do you work with people with referrals? Have you set up anything for people to find you? Do your patients even know that they can treat with you under personal injury?
How about the same for workers comp? Have you ever thought of, how is a workers comp patient going to find me if I don’t let people know I treat workers comp? Maybe you don’t even want to treat them. Bottom line though, is those can be pretty good, but people have to be aware that they can see you. In most states, chiropractors can be, or excuse me, acupuncturists, chiropractors and acupuncturists can be, Now, what about the VA?
Now, some people are sour on the VA. Oh, you have to join? I think the VA patients could be pretty good if you understand the system. It pays well over 100 a visit. Would that be worth it? Could it fortify your practice? It may, and realize these have no co pays or deductibles. They’re veterans, they pay their co pay by being in the military.
But what about Medicaid? Medicaid can be one that’s a little difficult. It’s not my favorite. Doesn’t pay enough for me. I wouldn’t accept it. But in your area, that could work. And then what about Medicare? Goodness, Medicare is big. Realize that it’s everyone over 65 and sometimes people who are younger that are disabled, but realize how many people turn 65 every day with Medicare.
A lot. According to the census, 10, 000 a day because baby boomers are aging. Keep in mind too, that’s regular Medicare Part B. What about these Part C plans? Those have more direct access. There could be some limits with these though. Some of them can be quite generous. They’re Part C plans or Advantage plans, which means.
They cover more than manipulation, like Part B, cover exams and therapies. It may be worth checking into. Don’t be afraid to start to look and really research, where am I going to get these? This is something that we go over in depth in our programs, in our CE programs, to make sure you’re maximizing access.
Because what makes a practice successful, of course, are getting a number of patients. But I really think one of the things to look at for 2025 is your bottom line. Have you really thought of what does it cost to treat a patient in your office? Have you really broken that down? Does it cost me 30, 40?
When you start counting, how much does it cost with my staff? My rent, all the things that take it up. Here’s something simple to do. And it really allows you to start to look at, is it worth it to join something like ASH or similar that have these really low payments? What is your overhead?
And all of your related costs. I would, in fact, for some of you that are younger that have student loans, frankly, I would count student loans as part of overhead. I really would. But what you’re going to do is take that cost, whatever it might be, and divide it by the average number of patients you’ve seen per month.
And what I’d like you to do is do something over the last three months. Maybe four months. Don’t do something for the last five years. I want to see what’s really going on right now because we know things can ebb and flow and change. So let’s just say your office cost is 6, 000. By the time you pay your office rent, your staff and so forth, it’s 6, 000.
And let’s say you see a hundred patient visits a week or 400 per month. That means your cost to treat a patient is 15. So that means everything over 15 is money that you make because the overhead is met there. But here would be a way to think of that though. If you’re getting paid 15, or it cost you 15, but you’re getting paid 26, Does that mean you’re getting 11 of payment when it comes to an ASH?
Yeah. Does that sound really good to me? Not really, but what if the volume is there? But something I want you to really look at is because a lot of offices often, you’re busy, but you’ll say, gosh, I’m not making as much as I thought I would. That’s something to consider. Something also to consider is this.
Many times, your billed amounts, you’ll say, My God, I billed out 30, 000, but I only collected 11, 000. How come I’m only collecting a third in your manager billing staff? Maybe it’s not your billing staff. You know what it is. Are you a member of some of these plans that yes, you’re billing 30, 000, that’s your rate, but your agreed contracts with them bring it all the way down to 11, 000.
So you have this fantasy. You want to know what’s really the amount. So I want you to really start to think of is it worth it with these and really do a review, pull up the hood, because bottom line is you got to start to look at what do you charge? What is it worth to you? Think of it.
When was the last time you made an increase in your rates? I see offices commonly five, ten years. We do a service called The Network where I work one on one with offices on fee schedules. That’s what we do first of the year always. And it’s shocking to me how many people have had the same fee for ten years.
So the only way your success is there is when you get more people. That’s good. However, doesn’t there reach a point that you can only see so many? When was that top out? Because think of it, when was the last time insurance increased the rates they allow? Now, I’m going to say here and there we’ll see little changes.
Blue Shield made some changes a few years ago, but ultimately, don’t you notice it’s really flat often what they allow? Oh, wait a minute. It’s flat for plans you are in contract with, but what about the things you’re not? How about personal injury? What about workers comp? Those all increase generally yearly or certainly have some changes that if you’re not changing, you’re just going to be stagnant.
So something to start to think of, have I really reviewed this? Do I know what’s fair and reasonable? That’s what I do one on one with offices. Because have you reviewed your rates based on relative values, if nothing else? Do you understand the value of one service to the other for 2025? Don’t start the year backwards.
Started forward thinking. Now these are going to update beginning 2025. I don’t have the new numbers yet, but they’ll change in the sense of they’ll get higher, but the ratios will probably be the same. So by example, how would we use an RVU or relative value unit? In this example, I’m using 98940 and let’s just say your office is charging 60 for your 98940.
I’d say Mid level range, I know some areas are higher, maybe even some are lower, but let’s just use that as a number to know whether it’s fair. Because what I’d like you to do with this is, if you’re charging 60 for 98940, I would like you to use that as your base fee to know what the relative price is for other things.
By example, if an insurance company is paying me 60, For a 9, 8, 9 4, oh. I will tell you exactly what they will allow for any other service based on relative values, and here’s how to do that to kinda help you set that fee schedule. The value of 9 8 9 4 oh has a relative value of 0.82, so that means that code has that value, and other codes have different values to know the relative price from one to the other.
So by example, if you’re charging 60 for a 9, 8, 9, 4 oh, this is how you find out what should be the charge for 9 8 9 4 1. If 60 is my charge, what you’re going to do is take 60, divide by its relative value. It gives you 73. 17. This conversion is what we then use with every other code’s relative value to multiply it out to tell me the relative price for that service.
based on the 60 price for 98940. 7317 times 1. 18, which is the RVU for 98941, tells me 8634. Now, I’d probably round that up to 87, but bottom line is it means that it should be 87. What I often find is offices go, oh, I charged 60 for 4 0, 70 for 4 1, and I immediately hit the no button. Because you’re well below relative, meaning you’re losing 15, 20, particularly for personal injury.
But here’s a funny one. Now think about what do you charge for a 99203? Mid level exam. You’ll notice immediately 0. 82 to 3. 35 relative value means this is about four times as much. So notice at a 60 rate for a 4. 0, it’s 2. 45 for an exam. Wow. Now you’re thinking, where did this come from? This is federal government.
By the way, this is exactly. How fee schedules are determined. Now, not your HMO garbage you belong to, but real fee schedules, whether it’s Medicare, WorkComp, or otherwise. By the way, in many states, they simply use these ratios with a conversion. By example, in Michigan, it’s 200 percent of the Medicare rates, along with Florida.
California, I would generally say you’re doing probably 1. 5 to 2 times that depending on work comp or PI. So you can really see Oh my goodness, I may be well below because I can’t tell you how many times I’ve seen someone say, Oh, my adjustment is 60, my exam is 90. Excuse me? The difference in that price is not that.
Now, if you’re saying I do that because I’m trying to make it very affordable for everyone, that could be a reason. But I think it’s one that’s suicide when you consider it for real relative value. By example, let’s just take something as simple as exercise. Most chiropractic offices generally charge less for exercise.
Then they do 4 by manipulation 1 to 2 region and you’ll notice that shouldn’t be the case because the relative value of 98940 is 0. 82. The relative value of exercise is 0. 88. So you may want to start to rethink. You want to do something positive for 2025? Start to make a fee schedule that actually makes sense.
If someone is willing to pay you 70, But you only bill them 40, guess what they’re going to pay you? 40. So make sure you understand the pricing, and this does review and change yearly. Now, some things to keep in mind also for 2025, what are going to be some plan changes? If you have an insurance that you’re currently seeing, I would suggest Getting online, checking availability, or any other resource you have on what type of changes they’re going to have.
I’m noticing, for instance, some of the Medicare Part C plans will now limit chiropractic to 30 visits a year. It used to be unlimited. 30 visits is still a lot, but that’s different. I want to be aware of that. By example, is there going to be changes to fee schedule? I can tell you, Medicare, as of now, is going to reduce their rates about 3%.
And you’re thinking, Oh my God, realize that doesn’t mean other plans. That’s a Medicare thing. And likely Congress will vote and it may go up, but these are things we want to be aware of. I can tell you what I know is going to change for 2025 for Medicare. Their deductible is gonna go up to $254. So be aware of that type of change.
What is happening with deductibles. Keep in mind some people’s deductibles, if they saw you in the latter part of the year, may roll over, but they start again for the new year. So you wanna make sure you’re aware of, okay. Has there been any update there? Has there been a family deductible that’s been met, or do we start over?
’cause I don’t wanna be caught behind going, oh shoot, I didn’t collect it. Now the patient doesn’t wanna pay it. What about updating things like assignment of benefits? Some of you may have gotten a letter from TriWest or Optum about assignment of benefits for VA patients. Now, what is the assignment of benefits?
That’s part of the form where it says signature on file, if you will, for the payment to go to the provider. Now, that means you should have one of those on file. But the one thing the VA requires is that you update it yearly. I would suggest to have a new one. Now, other plans probably aren’t going to be as strict, but why not update these things at first of the year if you’re reviewing the policy?
You should update, do I have a current assignment of benefits on file, with a patient knows. The payment’s coming to me. What about your other consent forms? Realize if a patient signed a consent to treat two years ago, that was for what they saw two years ago. If they’re coming back for a new thing, I get a new consent.
I don’t want there to be any issue when it comes to risk management for someone saying, I wasn’t aware. Now we can bring up the old one, but I want to keep something new. The same would apply with financial agreements. Just because they signed a financial agreement a year ago, six months ago, Are they understanding what’s currently going on?
Realize the No Surprise Act is important because it makes sure that patients are aware of what their costs are. Think of, what’s the number one thing most people want to know? How much does it cost? Let them know. Get a new financial agreement. If you’ve changed your fees, update it. Frankly, you don’t have to, Oh, by the way, I raised my fee.
Just raise them. Does anyone warn you when they’re going to raise the fee for AIDS? Gas? Just raise your rates. You don’t have to wait for some magical period. It doesn’t mean you have to post a notice. Just do it. Most people are aware of it. And if you really feel the need, I think often you can simply tell patients, I haven’t raised my rates in 10 years.
And that’s a problem. Because when you raise them, all of a sudden it’s you’ve raised them 20%. If you haven’t raised them in two years, you haven’t even kept up with the cost of living. Because generally the cost of living is 3 percent a year. So you’re already behind. The only way your practice survives is because you’re good at getting more people, but at some point that’s going to run out.
Financial agreements. Make sure people know what’s going on. What about this? Have you looked at, what are my credit card fees? This is something that I’m really pushing right now because credit card fees are starting to get expensive. Because more people use it. I know, wherever I go. If you don’t take basically Apple Pay or similar, I’m not coming in, which means I am using some type of card payment.
However, there’s a fee to us. Can I pass it on? Realize that most people, oh no you can’t. You can’t pass on a percentage, but in most states you are allowed to charge a processing fee. I’m going to suggest just disclose such things. Say, oh by the way, if you use a credit card, debit card, or similar, there’s an additional two dollar fee, three dollar fee, something like that.
Too expensive and it can’t be based on how much they are using it for, but it’s a fee. What is that helping you do? Offset some of those extra costs because otherwise we’re eating that. And again, that cuts into your bottom line. But really at the end of the day, please take a look at your fee schedules.
Have you really gone through it? Unfortunately, most chiropractors have sat back and go, no. And then you think it’s an unwielding task. You think, I don’t want to go through every code. Realize most chiros. Bill maybe six to ten codes on a regular basis. When I’m dealing with network members, that’s the first thing we do at the beginning of the year.
Let’s go over your fee schedule. Let’s look at what an average fee is for your zip code. Realize that many of you are using outdated information, things you had from your friends many years ago that really no longer fit. Start to look at real costs. Start to look and go what is really a charge for my error?
Have I really looked at my zip code? What does work comp allow? What does personal injury allow? What do other plans allow for that matter? Often we’re left in the dark because you just don’t go out and get information. So take a chance to really sit down and review. And here’s the good news. It’s 6 to 10 codes.
You’re not worried about 25 codes, 50 codes, because you don’t even build that many. Let me give an example, and this is very typical for me. When I teach a course in continuing education or deal with it from a stance of network members one on one. I will find that out of the six to 10 codes, and I kid you not, 50 percent to 75%, they have an incorrect value.
And it’s astonishing because they’ll go, I didn’t know. And that’s it exactly. Often it’s just out of plain ignorance. So get some time to educate yourself. Start to really look and say, have I really looked at what I’m doing, how I’m doing to make that work? And that’s what we do at H. J. Ross. So if you want some help like that one on one, come and see me at a seminar, really join the network so we can work together one on one.
Otherwise, I’m going to say to all of you, I wish you a good new year and a successful 2025. See you again, my friends.
Click here for the best Chiropractor Malpractice Insurance
Get a Quick Quote and See What You Can Save