OIA Chiropractic Billing Motivation and methodology

In its January 2007 issue, examines today's Chiropractic unprecedented growth of post-payment audits by insurance companies. Growth of this audit is evident in terms of both frequency of audits and lawsuits.

The study was conducted by Brian Capra, doctor of chiropractic and chiropractic clinic owner, Yuval Lirov, PhD, inventor of patents in Artificial Intelligence and Computer Security and author of "Managing Mission Critical Systems", and Randolph Jeffrey, Esq., Legal Adviser of the Association of New Jersey Chiropractors.

The increase in audits is motivated by a combination of three factors, namely, continuous pressure to turn a greater profit for the insurance companies, the impossibility of increasing insurance premiums, and the laws of time of payment. Premium Wars preclude them raising rates, and the recently enacted prompt payment law limiting the time you can withhold reimbursement to earn interest as they had done in the past. To meet earnings expectations and still play within the new rules, insurers have decided to go after the refunds after they are paid.

The means for identifying audit objectives easier and more profitable is facilitated by a Big Brother system, built automatically during claims processing. As providers submit claims to pay, insurers simply add each claim to its growing database. The system automatically detects providers are doing something different from the rest.

Although the motive is money and the media is a huge statistical database, all suppliers is an opportunity. To manage audit risk, providers need a Big Brother of ours. This system, inspired by their own insurers, stores claims data and reports for the benefit of participating providers.

"With teamwork, discipline, and infrastructure of the state of the art, chiropractors unite and transform different billing operations independent of the many in the powerful and become a powerful and cost-effective management community centered care support the patient and the growth of the practice, "says Dr. Brian Capra.