Question:

Hi Edie! I just came across your site and I love it! I just started two weeks ago as a front desk chiropractic receptionist. It's been wonderful helping patients and learning about the value of chiropractic care. However, I feel so overwhelmed with all my duties. I'm trying to learn all the process of making appointments and patient files, but then I get another duty and I quickly forget the next step. What can I do to be better organized and efficient? Thanks Edie!

 Answer:Dear Friend, you will love working in chiropractic.The best way is to always have checklists.  As you are learning a new process write it down line item by line item.  No one can ever remember everything off the top of their head and you are not an exception.  Then keep a notebook of the each new written process.  You will also be developing a very valuable tool for the clinic.  Everyone needs a process manual to make sure everything is done completely.

Edie, we are thinking about doing prepaid payment plans for our patients.  Some people say they are legal and some people say they are fine.  What do you think?...Martha

Dear Martha,  I have had several request for information regarding pre-paid plans for chiropractic services, I have put together these suggestions for handling them in your office.  Please be sure to check with your state because some prepaid plans may be operating in direct violation of the law because it may be interpreted as an “insurance business” and must be registered with your state.  I am NOT an attorney.

Here are some suggestions for pre-paid chiropractic plans.

1.       Make sure everything is in writing.  Clearly outline exactly what services are included.

2.       The written plan should state how many visits, specific services and time frame recommended by the doctor for the patient’s specific diagnosis that is included in the fee.

3.       Specifically state how refunds will be handled if care is terminated for any reason.  If you have chosen a 1 year plan and the patient moves out of town in 6 months, how will the refund be calculated?

4.       State in writing when and how the patient should expect any refunds.  I recommend that all refunds be made within 30 days of the patient’s request.

I am thoroughly enjoying this site. I have worked as a CA for the past (almost) 5 years and most recently as the office manager, with challenges of it's own! I love this job, love helping people and seeing the amazing results we see in our office, love chiropractic! I am in the process of putting together an office manual and find this website particularly insightful. Thank you so much for all of your hard work.

Thank you!  I always love to hear that this site helps.  I developed this site strickly to answer questions and give information that can help doctors, office managers and CAs.  

I have boxes and boxes of EOBs that I have been storing for my office and I want to start shredding them, how far back do I have to keep them?  I live in Pennsylvania.

 Glad you asked.  Each state law is different. This is what I have found about Pennsylvania law.  EOB’s are consider patient records.

 § 5.51. Patient records.

 (a)  A licensee shall maintain a patient record for each patient which accurately reflects the licensee’s evaluation and treatment of the patient. Entries in the patient record shall be made in a timely fashion.

 (b)  The patient record shall contain the patient’s full name, address, date of birth, sex and other information sufficient to identify the patient, the date of every entry in the patient record and the name of the person making an entry if that person is not the licensee.

 (c)  The patient record shall contain sufficient information to document the clinical necessity for chiropractic care rendered, ordered or prescribed.

 (d)  A referral to another health care provider shall be reported in the patient record.

 (e)  A licensee shall retain a patient record for at least 7 years from the date of the last chiropractic service for which a patient record entry is required. A licensee shall retain the patient record for a minor patient until 1 year after the minor patient reaches majority, even if this means that the licensee retains the record for more than 7 years.

 

I am a "New" Office Manager to the Chiropractice field (4 days). Is there an industry standard to how many pts. seen in 1 hour?

Good morning,

No, there is no industry standard.  It really depends on the doctors adjusting technique, the office layout and how much time the doctor wants to spend with the patient.  I know many doctors that see hundreds of patients a day and those that chose to see many less. 

 

If your doctor wants to see more, please let me know and I will give you suggestions on how to serve more patients in a day. 

 

Thanks for asking, Edie

 

 

 

Edie, will you please send me a list of the front desk CA responsibilities?  Dr. Charles

Good morning,

Thanks for asking this question.  It really does all depend on the number of CA’s you have.  The front desk CA might also be the one that does all the billing and follow-up.  But the list here is just about the responsibilities at the front desk. 

Chiropractic Assistant (CA)

Front Desk

            Answering the phone

            Schedules Patients

            Greets Patients

            Missed Appointment Follow Up

            Maintains Patient traffic flow in the office.

            Over the Counter Collections

            Computer Data Entry

            Keeps Patient Records

            Maintains Filing

            Pulls Patient treatment cards or files

            Prepares new patient files

            Follow-up with patient after first visit/adjustment

            Sends new patient letters

Insurance Verification

            Set up financial agreement with patients

            Prepares Daily Transaction Report

            Reactivation Calls or Cards

Thorough Understanding of Chiropractic and Chiropractic Terminology

            Supports the doctor in their office goals

 

 

Edie, we have been reading about electronic health records.  We take care of a lot of medicare patients and are trying to find out more about it.  The stuff online is very extensive and the law is a huge document.  Do you know where we can find out about what we should do or even what we should consider in putting all of this together.  Dr Katie, Wisconsin

 

Here is an UPDATE for you: Chiropractors and HHS CMS Electronic Health Records Incentive Program Final Rule was posted July 28, 2010 Edie Ruark Hofmann, Compliance Expert and Office Management Coach   This is excepted from an article available on www.ICCOM.org  click here Many chiropractors have asked me to comment on the Medicare & Medicaid EHR Incentive Program.  The final ruling was posted on July 28, 2010.  Although no one knows for sure exactly how this is going to work until the process actually begins.  I am going to try to make this as easy to understand as possible.  Yes, chiropractors are considered an eligible professional (EP) and therefore qualified to receive the incentive payments as long as they follow All of the rules. Background Get ready for a mind twister.  Hope you can keep all of these acronyms straight. The Centers for Medicare and Medicaid Services (CMS) Electronic Health Record (EHR) Incentive program is all part of the Health Information Technology for Economic and Clinical Health Act (HITECH) programs created by the American Recovery and Reinvestment Act of 2009 (ARRA).  It was established to promote the adoption and “meaningful use” of health information technology (HIT) and electronic health records (EHRs).  These incentive payments are part of a broader effort under the HITECH Act to accelerate the adoption of HIT and utilization of qualified EHRs.  Did you get that?  Keep these acronym definitions close they will be used throughout this article and you will hear them more and more from CMS and in other articles.  It does not get any easier, but hopefully I can distill it down for you. The final ruling is 276 pages.  There is much to sift through but these are the highlights. 276 pages cannot be distilled completely into a few pages and I am not going to try it get it all into this article.  Believe me, this is only the beginning and much more will follow as it all moves forward.  My goal is only to give you enough information to make an initial decision concerning participation.  Most doctors I know are mostly interested in how they can get all or at least part of the $44,000.00 they were told was available to each EP.  After finding out exactly what it is going to take, you may or may not be so interested.  Chiropractors Are Eligible. Do You Want to Participate? ….the bullet points!   (Indepth explanation is in the full article www.ICCOM.org  click here) * This is considered a voluntary program; however, if you are not compliant by 2015 adjustments to your Medicare payments will be reduced 1% each year and continue to be reduced by as much as 5 percent by 2018.   * Incentive payments are 75% of your allowed charges not to exceed the maximum amount specified by CMS.   * You must demonstrate “meaningful use” of the health information technology (HIT).  To better understand the term “meaningful use”. Think of it as MEANINGFULLY USING the technology you had to purchase.   * You as an Eligible Professionals (EPs) are required to demonstrate “meaningful use” of 15 of 15 Core Set Objectives, 5 or 10 Menu Set Objectives and 3 of 38 Clinical Quality Measures.  BUT…   * You are NOT required to demonstrate “meaningful use” of any Core Sets or Menu Sets that are outside your scope of practice. i.e. chiropractors are not required to demonstrate e-prescriptions.  You must attest to your “exclusion” of a specific Core Set objective or Menu Set objective.  You will then be required to meet all remaining Core Sets and a percentage of Menu Sets reduction based on number of exclusions.   * You are required to “attest” that you have met the criteria and maintain the documentation for 10 years for audit. You will be required to go online and answer questions of your compliance outcomes followed by your attestation that all information is true.  Attesting to this will be the same as an electronic signature on your tax returns.   * You are required to have certified Health Information Technology (software).  A list will be posted on ONC website by 2011.   * The requirements in the Final Rule are only for years 2011 and 2012 (Stage One).  Stage Two and Stage Three will be determined later.   To read the entire article the explains everything in detail and also includes the lists and tables of Core Set Objectives, Menu Set Objectives, Clinical Quality Measure.  The entire article is published at www.ICCOM.org

The Chiro. Office I went to today wanted me to sign in on an office sheet that is left on a countertop for anyone to see. I felt uncomfortable with this procedure and informed the office manager that I believed the office to be non-compliant with the Hippa law. Basically, I could look on this sign up sheet and see the names/signatures of all clients who had visited the clinic today. Is this Chiro Office in violation of the HIPAA law? Thank you, Linda, RN

Dear Linda, No, it is not a HIPAA violation.  The following link is directly to US Health and Human Services.  The following question and answer comes directly from their statement.  Sorry it bothered you.  Maybe you can ask them if there is another way they could handle it for you.  Thanks for asking and if you have any additional questions, please feel free to ask.

 

http://www.hhs.gov/ocr/privacy/hipaa/faq/incidential_uses_and_disclosures/199.html

May physicians’ offices use patient sign-in sheets or call out the names of their patients in their waiting rooms?

Answer

Yes. Covered entities, such as physician’s offices, may use patient sign-in sheets or call out patient names in waiting rooms, so long as the information disclosed is appropriately limited. The HIPAA Privacy Rule explicitly permits the incidental disclosures that may result from this practice, for example, when other patients in a waiting room hear the identity of the person whose name is called, or see other patient names on a sign-in sheet. However, these incidental disclosures are permitted only when the covered entity has implemented reasonable safeguards and the minimum necessary standard, where appropriate. For example, the sign-in sheet may not display medical information that is not necessary for the purpose of signing in (e.g., the medical problem for which the patient is seeing the physician). See 45 CFR 164.502(a)(1)(iii).

 

 

Thank-You so much for your e-mails. They are so informative.

My Question is: I am selling my chiropractic  business what is the legal way to be responsible for the transfer of patients files and records?

Sincerely, Dc Pc

Good morning,

I am not an attorney and cannot give you legal advice.  I would have a Business Associate Agreement signed with these other doctors stating how you expect these records to be maintained according to HIPAA Privacy and HIPAA Security regulations.  These doctors have no right to use this information in anyway because that would be considered marketing and patients must give one the right to market to them using their specific PHI. But  you are be responsible for leaving the records vulnerable and unprotected. You are responsible to see that these records are protected forever so get an agreement signed.  This really falls under HIPAA Security and the new Breach Notification Regulations.  

 Thanks for asking, Edie

I left an office with my patients name on the billing software. Can the other doctors make a mailing list and contact my patients to continue care at the facility? We shared an office and were not partners. I have contacted my patients to tell them that I had moved. I just wanted to know.

Thanks

 Good morning,

 I am not an attorney and cannot give you legal advice.  I would have a Business Associate Agreement signed with these other doctors stating how you expect these records to be maintained according to HIPAA Privacy and HIPAA Security regulations.  These doctors have no right to use this information in anyway because that would be considered marketing and patients must give one the right to market to them using their specific PHI. But I think that you would be responsible for leaving the records vulnerable and unprotected. You are responsible to see that these records are protected forever so get an agreement signed.  This really falls under HIPAA Security and the new Breach Notification Regulations. 

 Thanks for Asking, Edie

Hi Edie, we are using 2 web based programs 1) for billing and 2) for documentation.  Do you have any specific training in your program to help us better understand are responsibilities?  Since my staff can access from any computer (anyone with ID and passowrd) how can we create security meansures to protect the data?

Goodmorning,  I wish there was an easy answer, but basically, you need to purchase both of the HIPAA manuals on my website. There is not a simple answer to what you ask.

 HIPAA Privacy is for all protected health information, paper or electronic. Every health care provider needs this manual if they are treating patients. (compliance date requirement, April 14, 2003)

 HIPAA Security is for protected health information maintained, stored or transmitted electronically.  This has specific information for your question. (compliance date requirement , April 20, 2005)

 You need both manuals. Most doctors do.  These manuals are both customized for you office with all the policies and procedures you need to be compliant with HIPAA Privacy and HIPAA Security.  They are both updated for the Breach Notification Requirements (compliance date requirement, 2/20/2010).

 This is the link:  http://www.iccom.org/index_files/ICCOMProducts.html

 If you have more questions, please feel free to ask.

 Thanks for asking, Edie

I am a new office manager in a chiropractic office.  I seem to get caught in the middle between the doctor and the CA's.  If I ask someone to do something they go to the doctor and then the doctor comes back and tells me I should not have done that.  I am not sure why I am even here.  I know that my doctor ran it alone for a long time and there are issues that I was hired from the outside and some of the CA's wanted the job.  I was an office manager before in a chiropractic office, but it was much smaller group and I had been the one that hired the other staff person.  Please help me figure out how to get this all started off is a good direction for everyone.  Thank you, Cathy

 Cathy,  I am impressed that you understand the difficulties here so let's get started.  First of all, you are the Office Manager.  But, your big problem is that you and your doctor have not defined your job as the office manager.  As the office manager, do the CA's and other staff members report to you?  Do you set the schedules and work load of the CA's? What are your responsibilities as the office manager? With the responsibilities that you are given are you also give the authority to see that it all gets done? I would start with that. If you can clearly define your role as office manager, then you can deal with this and all situation.

If you are "stuck in the middle", as you say, between the doctor and staff, that is a real problem. Your job description should address who the CA's are to report to. What your authority and responsibilities with the CA's are to be? If the CA's are to be reporting to you, then they should not ever go around you and nor should the doctor be circumventing your authority. If you are not given that authority, I question that he really wants an office manager. If you have a job description, I would like to see what it says.  If you do not have a job description get one written. 

Go about it in a very positive way to deal with what is best for the clinic.  Edie

Question: As a Chiropractic Office Manager, I'm sure you have dealt with all kinds of employee/employer issues. My problem that I can use advice for is this: The Chiropractor I work for is a great person and a great chiropractor, but there is one employee who seems to get away with doing whatever she wants...she pretty much sets her own schedule and until about a month ago was really good at looking busy (still sometimes seems to be). One of the other girls that works in the office until about three months ago had to scramble to get hours, now if she needs to leave early the boss gets pretty peeved...she is a hard worker, but often does not have a lot to do because the other employee keeps taking her work and doing it. I am kind of stuck in the middle, I know that he is giving the first one too much slack and giving the second one too much flack...how would you suggest I broach the subject with him without tearing anyone down or making him think I am trying to tell him how to run his business? Thanks, Jeanne

Dear Jeanne, I think that this might best be approached by the employee, that you feel is not being treated fairly, speaks with the doctor.  As you say, you do not want to get in the middle and you should not. 

However, having said that, there is an approach that I think could be very beneficial to the entire group.  If you feel your ability to do your job is being affected by whatever is going on, that is different.  Clarification is a good approach.  Always approach it in a positive manner.  Maybe you could just say that you do not understand how decisions are being made with regard to time off and scheduling or workload distribution. What is the policy?  If there are no policies ask if you could assist the doctor in writing them up for his approval so everyone in the office is on the same page.  Always question the policy or the procedure not the person or your feeling that the doctor is treating someone unfairly.  Get the personalities/people out of it or you could find yourself on the wrong side of things and without a job. 

It is a good thing to have things in writing for everyone to follow and very little favoritism can go on.  You should have a complete Human Resources Policies and Procedures manual.

Hope this helps and keep me posted. Edie

Edie,
(Red Flag) I was contacted by another company as I had known about them through another office and I had told them that I purchased this manual and they were telling me that it is not sufficient enough to be compliant. Do I need to pay to have someone train us?
Dr. Kevin

Dr Kevin, my manual has everything in it to be compliant.  The manual itself, the Q and A, and staff testing is all you need to actually train your staff and verify that they have been trained.

You are a chiropractic office and your risk is very low. This was stated by the FTC themselves that offices that know their patients are “low risk”.  Keep it simple and logical.

Edie,

Edie,
(Red Flag) Quick question. I am thinking of having a stamp made that we can use on the patient files to indicate 1- id obtained 2- no id given by patient, with a spot for them to sign. Is it okay to indicate that we personally know a patient and therefore did not obtain an id or do we need to do it on every single patient.
Dr. Connor

Dr. Connor, Yes it is OK.  Red Flag Rules, Identity Theft Prevention is about what to look for and how to identity possible identity theft, and how to handle it when you do.  If you know the person, there is no suspicion of possible identity theft. It is about your prevention procedures to protect you and your patient and if you know them that has prevented it…J

As my manual explains the first visit is the main problem.  Making sure they are who they are saying they are.  That simple!

As all of you know, the deadline for the "Red Flag" Rules mandated by the FTC has been extended another 60 days.  If you do not have your Indentity Theft Prevention Program ready email me at edie@iccom.org.  This is another mandatory law.  Just like HIPAA. 

As an Office Manager of a Chiropractic practice, I am left with two years of accounting errors, payments not posted, tons of work that was just piled, and ignored. Lot of money that could have been collected, and my frustration has me a little frazzled. I am not even sure where to start? Any suggestions on where I may begin? Secondly, with all this back work it has been a huge headache trying to find a place for all these EOB's (3 years worth). The current years work I have covered, I just don't know how or what to do with all the rest. Being that the majority of the EOB's are multiples and dates well there is another issue. Should I file them by Carrier, or by month? Should the date they are filed be the date we posted or received or the DOS? Any help will be terrific! Take care. Desiree

Edie Said: I am sorry you have inherited a big mess.  Many doctors find themselves in this kind of problem so believe me this is not uncommon. First of all, never allow cleaning up the past to interfere with keeping the current clean.  Getting the billing out is always the most important.  Sounds like you have that handled. 

The question of how to file the eob’s?  File them by date posted into the computer.  Always use your practice management software as your information source.  Handle each eob completely before moving on to the next eob..  Enter all information into the computer on the same day.  Keep  a chronological filing system for everything you do by date and attached any notes for those eob’s also.  Write or stamp the date on the eob as it is entered.  If you need to deal with it again, you can find it and re-file it if needed. On most management software systems, there is a place to enter notes.  Keep a note in the patient file on the computer system of anything you want to remember and date the note the same day the eob was handled. If the eob is not ready to file away completely, place it into a Tickler System for future handling.

A Tickler System: Purchase 1 set of months tab separators and 3 sets of 1-31 tab separators.  You can buy these at any office supply store.  Hanging file folders works best to use with the tab separators. Place them in a file box or a filing cabinet.  If you find that you must follow-up on an eob or anything else at a later date, place that information or notes behind the date that you will next need to deal with them.  Each day when you come into the office, you will pull everything out of today’s current date and handle it.  No follow-up worries.  You will have it covered.  A tickler system is simple but I have yet to find anything better, easier or more effective in keeping follow-up under control.  You can use this tickler system for all reminder needs.

Keep in touch and let me know how it is going.

Name: Judy 
I was told when HIPAA laws were first instituted that I was not required to be HIPAA compliant because I do not bill nor store patient notes electronically. Is that true and can you document that for me? How about if I were to start using a debit/credit card machine for payment, would that change my status?

 

Dear Judy,

You are talking about HIPAA Security Compliance.  You are still required to be HIPAA Privacy Complaint as of April 14, 2003.  That is two different things.  HIPAA Security is about electronic data storage and transmissions.  HIPAA Privacy is about how your patients personal health information is protected in your office. You were misinformed.  If you currently do not have a HIPAA Privacy Policies and Procedures Manual, you need to purchase mine and get it implemented.  It is not difficult.   There is not a cheaper or easier way to get this done.  If you have any more questions you can email me directly or call me. 

The April "TIPS" was an outline of the process to follow when hiring a new CA.  I always dreaded starting over and hiring new staff.  Most of the time it was wonderful for the practice when it was completed.  New energy brought into the office seemed to help everyone.  But I always had to remind myself that hiring someone just because there was no one better to hire was a big mistake.  So my #1 TIP is to take your time and enjoy the process. 

I talk about a skills test in the April "TIPS" and had several doctors ask if I had a skills test so I posted the skills test that I have used for years on this website.  If you want a copy of the CA Hiring Process, sign up to receive my monthly "TIPS" and put in field "Comments" that you would like a copy of the April "TIPS".  

Hello Edie, I really enjoyed looking over your website! I came upon it when I was researching how to explain the activities I completed as an office manager. I went from an office manager to graduating this june with my D.C. degree! I am opening my own office and of course trying to get a bank to lend me some money to help with start up. My question for you is how to make the bank understand that i did not just answer the phone and show people to the rooms. For my resume my loan officer said I need to "make it sound good"...i dont want to exaggerate or lie, however i dont want them to think i did nothing. Do you have any suggestions on how to word my following activities that i completed at the office?? Answered phone, made appointments, spoke with new patients about what chiropractic is (before dr. came into room), took dr.s notes and entered them into an electronic system for insurance, entered all NP info, collected cash, check and insurance payments, made sure patient accounts balanced every night with daily intake of money, processed films, took notes for the doctor (instead of him writing it down i did it) Thank you for any assistance!! Amanda

Dear Amanda, Glad you asked.  These are two sample resumes, the first one is for a CA and the other one is for a medical assistant:
http://www.esampleresume.com/Chiropractic%20Health%20Assistant.htm  http://www.sampleresumesamples.com/sample_medical_receptionist_resume_sample1.html
I like to use another resource when putting together great resumes from How to Write a Bio.  The free download you can get from her web site www.howtowritebio.com  will give you many ideas for word choices that can make your resume explode.  Check it out.

Also, check out my article "The Ideal COM": http://www.iccom.org/articles/article.aspx?id=2  on my other website www.iccom.org
 Hope this helps, Edie