But My Consultant Told Me It Was OK
by Ron Short, D.C., MCS-P
How many times have you heard of the case where a doctor hired a consultant and was told to implement a marketing plan? The plan worked and the doctor got lots of new patients until an inspector from the OIG looked at his ad and fined him for inducement of beneficiaries in a Federal Health Care Plan.
You don’t hear of these much but when you do, they are spectacular. The problem is that numerous laws, rules and regulations that we have to follow in our everyday practices tend to become background noise. We know that they are there but we lose track of them in the day-to-day necessities. In fact, the only time that we notice is when a neighboring doctor is fined and/or arrested for something that sounds suspiciously like what we were doing only yesterday.
Obviously, you need some help. But who? Then you remember that flyer that you got in the mail last week about that consultant. Then you remember your old college roommate and that he was using the same guy and really liked him. You’ll give him a call this evening and see when their next seminar is scheduled.
You go with your friend and you like what you see. You sign the contract and get your materials and are assigned your coach. You start to look through your manual and there it is. The same procedure that got that doctor down the street fined several thousand dollars. You check with your coach and, yes, that is what you should do. Most doctors see at least a 25% increase in patients because of that one little trick. You ask about the legality of this and are told that their Medicare expert, a CA in a very busy office that has been a client for years, assured them that this was a perfectly correct and legal procedure. And you faint.
The point of this little story is that there are a lot of people who are willing to take your money (sometimes large amounts of it) in return for telling you what to do. But here is the problem, who is qualified to give you answers and who isn’t? You are responsible for what you do, not your consultant. If you are advised to send all of your patients birthday cards offering them a free adjustment for their birthday, it will be you who is fined $10,000.00 for each Medicare patient that gets a free adjustment, not your consultant. “But my consultant told me it was OK to do this” is never a valid defense.
That brings up a really good question. Just who is qualified to answer those difficult questions that arise in the day-to-day course of practice? How do you know that the answers that you get will be accurate and timely?
The first step is to ask questions about the person. Are they a chiropractor? The importance of this qualification varies with the type of question. If it were a question about technique or diagnosis then asking a non-chiropractor would not be useful. If the question were about patient communications then the perspective of a non-chiropractor who is familiar with chiropractic would be uniquely valuable. Questions about coding, billing and compliance are usually best answered by a chiropractor because they have the perspective of having implemented the procedures into a practice.
The next step is to determine if the person is certified in the subject matter. Office Compliance Programs have become a big deal within the past few years and, thanks to the healthcare act, are about to become mandatory. There are a lot of people offering information about compliance but only a Medical Compliance Specialist is certified to set up such a program. Certification says that the person cared enough about getting it right to spend the time and money to educate themselves about the subject matter.
The next step is to determine if the person is published. Have they had articles published in the literature of the profession? Take some time to read those articles. This will give you a good idea of the quality of the information that the person provides. Have they written a book? This is even better and provides you with another avenue to judge the quality of their advice.
The last criterion is experience. I put this last because it can be good or it can be bad. Some people have twenty years of experience and some have one year of experience twenty times.
You are the consumer of information. It is up to you to communicate with your state and national associations and demand that they provide only the best and most accurate sources of information. Demand that your state association executive directors and practice management consultants use only certified speakers and consultants. When they do, vote with your feet and pocketbook and attend the seminars. You are legally responsible for what happens in your office. Make sure that you have the most accurate information on which to base a decision.
Dr. Ron Short is a certified Medical Compliance Specialist, a certified Peer Review Specialist and a certified Insurance Consultant. He consults with doctors regarding Medicare and office compliance programs as well as presenting seminars on Medicare, documentation and compliance. You can send your question or comments to Dr. Short or join his mailing list at [email protected].