Healthwise Chiropractic

SUBJECTIVE
Three years out of Northwestern College of Chiropractic, Dr. Chad Nekl had a successful practice in Sioux Falls, South Dakota. His Healthwise Chiropractic office handled about 100 patient visits weekly – 30 percent workers compensation, 50 percent health insurance and the balance Medicare/Medicaid. Dr. Nekl was the sole professional, supported by two front office employee. The practice yielded about $20,000 in monthly revenue, but despite long hours and the engagement of two different practice coaches, growth had stalled.

OBJECTIVE
One of the coaches determined that Dr. Nekl was not billing for all of the services he performed. Lacking expertise in coding, he recommended contacting the ACOM Healthcare Business Consulting Group and one of their certified professional coders.

ASSESSMENT
An ACOM consultant visited the Healthwise Chiropractic office for a two-day engagement, performing an onsite analysis of the professional and the business management activities. He learned that Dr. Nekl was often performing procedures that he was not being paid for, not realizing that they constituted separate and distinct activities for billing purposes: these procedures only needed to be identified and properly coded and documented.

The consultant also found that while Dr. Nekl was a conscientious and effective practitioner, his management skills were underdeveloped. A lack of coordination in the front office often led to redundant effort, poor collection practices and patient confusion: dealing with front office problems was consuming a significant amount of time that would be better spent on patient care.

PLAN
The consultant trained Dr. Nekl intensively on the intricacies of coding and documentation as well as basic office and personnel management. He refined front office practices, starting with concise job descriptions to identify “who does what.” He recommended procedures for smoothing out roadblocks, such as obtaining patient insurance information prior to patient arrival so both staff and patient were clear on coverages, co-payments and deductibles.

FINAL REPORT
Positive outcomes were almost immediate with the implementation of the consultant’s recommendations:

• Front office employees fulfill their responsibilities without overlap or confusion
• “Unknowns” have been eliminated in patient management and scheduling
• If Dr. Nekl performs a service, he bills for it: if he bills it, he documents it

Two years later, Healthwise Chiropractic handles 150-180 patient visits per week. Revenue ranges from $45,000 to $50,000 per month. The clinic has added a massage therapist to cope with increased workload.

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