Under “Obamacare”, also referred to as the Affordable Care Act, providers are being held to a higher standard by insurers and patients. Dr. Robert Pearl, MD notes in his 10/1/13 article on Forbes.com that “patients will enjoy greater transparency – knowing which providers offer the best quality, service and price. And because insurers won’t be able to manipulate the risks involved with insuring more people, they’ll look to providers to improve performance.”
With “Obamacare” now in effect insurers will see a new sense of competition in their market. This competition will force them to bring more value to customers in order to attract more prospective buyers and hold on to current customers. The need to remain competitive will shift the financial burden from the insurer to the provider. Insurers will look to keep the providers who provide care at a lower cost in their network. It is likely that they will also consider providers who have improved efficiency in their care when compared to others in their demographic.
So, how does this affect chiropractors? Well, history has shown that these types of changes lead to an increased risk of network audits. Chiropractors viewed as outliers in their demographic will have an increased risk. Chiropractors who have patient care plans that are, on average, longer than most will have an increased risk. Chiropractors who provide experimental care will have an increased risk. These do not mean for sure that a chiropractor will be eliminated from a network; it only means that the risk is greater than others.
Documentation is the key to combating adverse audits. Ensure that your notes and substantiation for care rendered is clearly and justifiably documented for every visit. It is highly recommended that you purchase EHr software that is compliant and highly rated. In conjunction with this EHr software it is also recommended that you employ the services of an expert chiropractic billing company to assist you in selecting the most appropriate treatment codes for you services.
EHr software that is highly rated, compliant, and well-designed, along with help from a chiropractic billing company will help improve your practice and benefit your business during the transition to “Obamacare” and long after. It will also benefit your patients, which is the ultimate goal.