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Greetings. This is Sam Collins from H. J. Ross, the coding and billing expert for chiropractic, ChiroSecure and for you. As always, we try to keep you updated to make sure your practice continues to be successful. And part of that success comes from running the business end of your practice. And one of the things I like to focus on, particularly at the beginning of the year, is do you have a good understanding of your fee schedule of why you have fees where they’re at?
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What do they mean? How do insurance companies? set their fees. Now we’ve got to be careful. Obviously, some of the managed care plans you’re part of, whether you raise a rate or not, doesn’t change anything because I’m sure many of you are aware a lot of the managed care contracts, ASH and similar, probably have not raised rates in, I don’t know, 20 years.
What I’m talking about though is your rate. What’s fair? What’s reasonable? How do we determine that? What do we really understand as What is my usual and customary? One of the things I emphasize to my H. J. Ross members is once a year, we need to get together to look at your fee schedule to wonder what has updated, what has changed for the year.
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Because if you don’t raise your fees, no one’s doing it for you. Have you ever had an insurance company contact and say, Hey, by the way, we’re paying 20 more. You better raise your fees. Absolutely not. Here’s my rule. If I bill you 50 and your insurance, you’re an insurance and it’s willing to pay 70, but I only bill 50, what are we going to pay you?
50. So if I’m willing to pay you 70, you won’t know that until you start to understand the value. So let’s go to the slides. Let’s talk about relative value units, RVUs. This is what I’m speaking of today. Relative value units are the value of each service. Compared to another. So every single CPT code that you might use has a relative value based on another code or another service.
So by example, if you have one code that is worth 1. 0. And another code that’s worth 1. 5, guess what the difference is? The code that’s worth 1. 5 has a 50 percent higher value. So one of the things you’ve got to start to look at is that, do I really understand this? One of the cardinal problems with chiropractic is, chiropractors don’t understand that.
By example, it’s not often or not in often that I don’t run into a chiropractic practice. I’ll ask them, what do you charge for a 98940? And they’ll say something like 50 or 60. Okay. All right. Then I asked, what do you charge for a 98941? And then they literally give me a fee that’s 10 more. That makes no sense based on the relative value.
Realize 98941, your three to four region manipulation has about a 35 percent higher value than does 98940. That’s why you’ll see that in Medicare rates even. So I want to really start with though, you all looking at. What are your current charges for these four codes? And you’ll see here I have two of the spinal manipulation codes, the 1 to 2 region, 3 to 4.
I have your mid level new patient exam. And I’ve chosen just exercise, 97110. Now if you’re saying, oh Sam, I don’t do exercise. That’s fine, it could be any code. I want to know what your charges are to start to look and make sense of them. Here’s what I’ve learned in teaching seminars for all these years.
I find chiropractors probably use somewhere around 8 or 10 codes pretty commonly as far as treatment codes, exam codes, adjustment codes, a couple of therapies, and so on. What I have found, 50%, sometimes even more of those values make no sense, which means you’re instantly losing money. So I want you thinking of what we’re charging for these, and I’m not here to try to tell you to necessarily raise rates, but just to start to look like, what is it worth?
This is a good example. What if you’ve owned a home for many years, and when you bought the home, you paid 200, 000? I will guarantee every home that you bought 15 20 years ago has double, triple, quadruple in price. If you paid 200, 000, would you just think, hey, look, I’m gonna make 100, 000. I’ll sell it for 300, 000 or 400, 000.
Wouldn’t you do something to look at the value of homes in your neighborhood to know what they’re going for? So let’s say a home down the street sold for a million dollars. It was the same size as yours. Same area. What do you think your house is worth? That’s what relative values do. This is not something Sam is making up.
This is by order of the federal government has been doing it since the 80s. So that every service has a relative value. What they look at are the cost of how it is to provide that service. By example, the chiropractic codes put into place cost of malpractice, cost of education, all of those factors. So I want you looking at what do I charge now on this page?
What I have here are the 2025 relative value units of all the common codes you’ll see in the upper left. I have CM the CMT codes, adjustment codes, all the physical medicine codes. I’ve included your acupuncture. Dried needle link is, in some states you can do that. Telemedicine codes, ENM codes, prolonged service, even some of the x-rays.
And what you do with this though, is start to look at it from a standpoint of how is one relate to the other. So by example, notice 9 8 9 4 0 has a value of 0.82 and 9 8 9 4. One has a value of 1.19. And you might think how do I use that? Here’s a simple way to think of it. What if you charged.
$82 for 9 8 9 4 0. What would be the price of a nine eight nine four, one a hundred nineteen? Pretty simple math, because that’s the difference between the two. Now obviously if you’re gonna break that down into an exact fee though, we have to do something a little bit differently. So what you wanna look at is that, let me look at these codes from that standpoint.
Here’s a good example. If you look at that difference is roughly we’re gonna say here, what is that? About 36%. I said 35. You can see right in that range. But notice this too. Notice 98940 has a value of 0. 82. And I see this commonly. Someone will say what do you charge for a 98940? And they’ll say, oh, I charge 50.
Then I’ll ask, what do you charge for a 98943? And they’ll say 30. And my question to them will be, why? Why did you choose a 40 at 50? The four three at 30. That’s cheaper. No, it isn’t. Notice the difference. 9 8, 9 4 3 has a value of 0.77. That’s 5% less. So I won’t say it’s the same price, but if I’m charging 50 for a 9, 8, 9, 4, 0, what would be the commensurate price for a nine, eight?
9, 4, 3. I’m going to argue right around 45. Why? Because that’s about that 5 percent difference. In fact, I’d say 47. 50 if you want to be very exact. So what I’d like you to do is to start to think of when I’ve chosen the value of a code, in relation, what should other codes cost? By example, you might think Sam, how do you come up with a 50 price for 98940?
I will say to you, there’s lots of ways of working that, but I’m just going to say, what do you charge now? That’s all. I would think most of you, a 98940 price, you have at a fair price. You have it something you say, this is what I bill. It’s fair. Then I want to look at everything relative to that. Here’s what I commonly find.
Most often, chiropractic offices undervalue the 98941. And I will say that undervalue is about 10 to 15 per code. That means if you’re doing 100 patient visits a week, More than half of those are going to be for one. So realize you’re losing 15 per visit just on 98941 alone, start to do the math there and you’re going to go Sam, that’s two to 3000 a month.
Exactly. Because you have undervalued. Let’s take a look though across the board. So if I look at 98940 at 82, you may wonder what should I charge for a 99203? Here’s an easy way to look at that. Notice 98942. 82, 99203, 3. 37. Now, this is a little bit of math here, but would we all agree 4 times 8 is 32?
If 4 times 8 is 32 and this is 33, wouldn’t it be reasonable to think the price of a 98940 would relate to a price for an exam, a new patient, 99203, about 4 times that rate? And I can’t tell you how many times I’ve seen people undervalue. You might think, okay, Sam, that sounds good, but is that really true?
We’re going to take a look at something here at relative values. Let’s just say, for example, say you charge 60 for a 98940. You have determined that’s the fair and reasonable price for it. I’ll say great. Then what do we charge for other things? Here’s the best way to do it. Use some easy, simple math.
If I know the price of one code, I can tell you the price of any in relation to that price. So I’m going to take 60 and divide by its RVU. which is 0. 82. 60 divided by 0. 82 is 73. 17. Now 73. 17 actually isn’t the price of anything, it’s what we call a conversion. I then take 73. 17 and I multiply it by any other code’s RVU.
So you’ll notice if I take 73. 17 multiplied by 1. 19, which is the value of 98941, it gives me 8707. Now I’d probably round that up to 88 personally. But needless to say, if my price is 60 for a 9, 8, 9, 4, oh, what should be the price for a four one? Rounding up actually about 90 notice about a third difference.
What I want you to start to see is that have a reason I wanna be able to defend this. If as I’ve gone to court as an expert defending fees, I always use this and I always win. ’cause tell me what an insurance will pay for one code. And I’ll tell you what they’ll pay for any, particularly when you’re looking at personal injury and similar.
What about at 99203? It’s the same coding, 7317 times 3. 37, 246, or roughly, notice, oh wait, 4 times 6, 240, notice the math here, but here’s one that puzzles me. I’ve seen people charge things like exercise, massage even, and they value those. at a rate that’s below what they’re worth. By example, a 97110 has an RVU of 0.
89. Do you notice that’s higher than 98940? So should your price of 97110, for one unit at least, be about 7 percent higher? Yeah, do the math. 7317 times 0. 89, 6512. By doing this, you’re going to save yourself a lot of headache or make a lot more money because personal injury is the one place That they actually pay you fair fees.
Oh, wait, let’s think what states do that michigan? What do they take double the medicare rate? Oh, what about Florida? Double the Medicare rate or RVU. So I’m going to give an example here. This is for California, and I’m just showing California only. It could be any state. If you’re a network member with me, please contact me.
Let’s go through this in detail. Let’s make sure you understand what to do. But I’m going to take you with the Medicare rates. You notice here for Southern California, L. A., Orange County areas, the value of 98940 is 2925. Now, we’re just simply going to do the math here. 29. 25 divided by 0. 82, and I apologize I put one extra digit, is 35.
67. That’s the conversion. So notice what I do is I take 3567 multiplied by 1. 19 and notice it gives me 4244. Now let’s look at these prices. 98940 2925, 98941 4231. Now I will admit I’m off by about 12 cents, but you can see that’s a very small amount because there’s a little bit more to the conversion.
But you can see how simple this is. So let’s do it this way. What if you told me, Hey, Sam, I charge. $60 for a 9, 8, 9, 4 0. Would we all agree that 60, at least for this schedule is double Medicare rates? So if I charge 60 double Medicare rates, what’s double the Medicare rate for 9 8 9 4 1? If it’s at 42 30 or 42 50, it realize again, that’s gonna be about $85.
So notice here it’s not a $10 difference. I want you to start to go through and realize. By doing this, you’re going to start creating a fee schedule that makes sense, that’s defensible, but it’s not also undervaluing because notice if I take 35. 67, multiply by 3. 37, this is the value of 992. 03, it gives me 120.
20. Notice the value, 00. Again, a dollar or two off here, but I want you to start to realize this is how fee schedules are done. By example, in Arizona, the conversion in Arizona. For workers compensation, the conversion value here for Medicare, I’m showing that it’s going to be 3. 37. For them, it’s going to be what?
68. 58. So realize these conversions begin to help you understand, how do I make sure I’ve established a fair fee schedule? There’s nothing worse when I see a provider billing something. I have the example, I have one this past week. He was billing neuromuscular education at 35. And they were paying it, of course.
And I thought he was billing a 98940 at 65. Okay, fair. They paid that also. 97112 has a value of 1. 0. They’d have paid 20 percent more, would have roughly paid about 80 for that. Do not undervalue what you’re doing. Take some time to go through. Now I’m gonna give you a little tool here. Take your phone out.
Do this QR code. We’re gonna do an example just based on your value of 98940. All you’re gonna have to do is plug in your value of 98940, then based on RVUs, we’re gonna send you back an email that’s gonna say these with these other three codes are gonna be, and I think it’s gonna be obviously 4 1, an exam and a therapy.
What I want you to start to look at is understanding that You need to help create a fair fee schedule if you undervalue it No one’s going to tell you and I would say a good starting point. Take your medicare rates Look at your medicare rates and do a percentage by example. Many states just do 1. 5 of medicare two times 1.
75. I’m going to suggest by doing that though, however, it allows you to make sure you’re not undervaluing because I will guarantee if you all look through this, you’re going to find Oh my God, I’ve undervalued at least half of your codes. Again, I’m going to implore my HJ Ross network members, get in contact with me.
Let’s do a one on one zoom. Let’s go through this to make sure you’re doing it the right way. That’s what the network service is here to do. I want everyone though, to take a moment to look at what I’ve presented, go through here. And begin to make sense of your fee schedule so that you’re not undervaluing and throwing away money until next time my friends.
Take care
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