Knowing how to run an integrated clinic is very important issue and it is very dependent on the state in which your clinic operates. There are networks in some states that are very aggressively going after integrated clinics.
The reason for this is because an integrated clinic’s profile, when the network gets the claims and analyzes the claims, looks very different than a strictly medical clinic or strictly chiropractic clinic.
There’s a mixture of both medical and chiropractic going on at an integrated clinic and that immediately sends up a red flag to the networks because the clinic looks like an outlier. It doesn’t look like a medical clinic, it doesn’t look like a chiropractic clinic, it looks like an integrated clinic and a lot of the networks simply just don’t know what that is.
So they try to jam your clinic into the chiropractic model or the medical model and it doesn’t fit either of those models so something looks off to them.
If you run an integrated clinic you have to be very careful and as yourself, “What’s going on in your market? Are these clinics being attacked?” It takes a lot of management skills by the owner to properly run these clinics. There needs to be a lot of attention to detail on coding and on supervision.
You really need to keep an eye on those things. Regarding supervision, for instance, are you coding this incident 2 under a general supervision? Is the chiropractor doing the work with the medical doctor simply overseeing the work? Is this done generally by stopping in once in a while, is it direct supervision by being in the building, or is there personal supervision with the medical doctor actually in the room?
This issue can get really tricky and you need to make sure you have a good healthcare attorney and coding specialist to guide you through this. You need this specialist because, if you get aggressive with this you’re going to find yourself on the wrong end of a post payment audit review and you may be dealing with hundreds, sometimes millions of dollars that the network claims they need to be reimbursed.
So keep a real close eye on your coding and keep a close eye on your supervision and be sure that you have someone who has been down this road before to help protect you and keep you safe. You should do your best to avoid some of the modalities that will trigger audits as well.
For instance, if a chiropractic clinic or a medical clinic does a lot of neural evoked potentials these are kind of a red flag in a lot of areas. If the network sees a bunch of those they are probably going to really scrutinize your claims.
You want to keep an eye on some of those modalities that cause red flags in the network you work in and avoid those. In essence, try not to be an outlier even though the model of integration makes you into an outlier.
Try to keep your head down and be more conservative than aggressive in your coding.
To view this blog as a video click this link – Chiropractic – Integrated Clinics and Post Payment Audits video.
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