There comes a time when it’s very clear that, no matter how comfortable and familiar something might be, a change is needed.

For the chiropractic industry, technology has not kept up with the growing demands of consumer expectations. As a result, the majority of patients still have to schedule appointments by phone. Leaving practice managers scrambling to play catch up.

Providing online scheduling is a simple way chiropractic practices can reinvent themselves, revolutionize the way they run, and provide an exceptional patient experience.

Keeping up with consumer demand

Online scheduling is a huge differentiating factor when searching for a chiropractic practice. It’s not enough to be the nearest practice to that person’s area anymore.

When given the choice between doctors with a similar experience, proximity, availability and patient satisfaction ratings, 80% of patients reported they’d switch providers for convenience factors alone.

Patients will choose whoever can make booking and attending the appointment the fastest, simplest process for them. Patients are people and people are busy. Expectations have been raised. Rules have changed. And, instant gratification is in high demand. 

People want to reserve their appointments when it’s most convenient for them. In today’s busy and fast-paced environment, that can often mean booking appointments after hours or on the go. Self-service is the way of today. Not offering online scheduling directly results in lost leads and a backlog of work to come back to in the morning. 

This is why technology is the key to pushing this industry forward because millennials, Gen Z, and beyond are not only the most tech-savvy generations, but they’re the most tech-dependent. Emerging generations do not know a way of life without smartphones, iPads, or laptops. And they will choose whoever can make it the fastest, simplest process for them. By making it easier than ever to take charge of their health, more patients will come and keep coming back.

Creating a captivating patient experience

There’s a reason the hospitality business has boomed in the last couple of decades. People crave experiences.

The patient experience goes beyond what happens at the physical appointment. What happens before they get through the door is just as important.

Turning the process of finding and booking a regular old patient visit into a patient experience that caters to the needs of the patient will create an unforgettable memory. Leaving people wanting more.

No one wants to sit on the phone for 20 minutes trying to schedule an appointment, much less leave a message and wait 24 hours for a returned call.

No one likes to wait. Online scheduling gets the practice staff off the phones and present in the moment. When they don’t have to deal with scheduling changes, appointment reminders, paperwork, etc. they can get patients in and out as quickly and smoothly as possible.

Adapting to the changing landscape requires a shift from “business as usual.” Deploying the right type of tool that facilitates the experiences modern consumers crave, like convenience, is the critical piece of the puzzle that must be solved to create the ultimate patient experience.

Increasing your bottom line

Every business owner has a bottom line. Far too many practices focus on reducing costs to increase their bottom line when it really comes down to two simple priorities. For a practice owner, it has to be the perfect blend of investing in patient satisfaction to grow their practice which increases the bottom line.

Eliminating back and forth communications and reducing wait times will create happy patients, and happy patients will refer their friends, family, etc.

Online scheduling is the fastest and simplest way to reduce no-shows and cancellations and save your practice thousands, if not millions, of dollars per year, while simultaneously attracting new patients.

People are busier than ever these days, they don’t have time for phone calls, and neither does the chiropractic staff. It’s a research-backed fact that automated reminders like these are far more effective for getting people to show up, and show up on time.

A digital transformation will help practices reach more patients and improve the quality of life for their community by giving them the opportunity to take charge of their health.

There’s no doubt that online scheduling and the patient experience will shake things up in the coming years. Those willing to prioritize these two areas will give their practices a competitive advantage. 

To learn more about online scheduling, check out a fully-customizable scheduling tool like Review Wave.

• Codes in the Physical Medicine and Rehabilitation section of the CPT code book are not limited to any particular specialty group.  That is, they are not just for physical therapists.
• These codes require one-on-one contact, usually with a licensed provider, but some state scope of practice and some payers allow for delegation to unlicensed individuals.  Check with your insurance plans and state board to be sure.
• These codes are time-based, in 15-minute increments.
  • Per the Medicare 8-minute rule, which is the accepted standard for most carriers, a minimum of 8 minutes must be completed to bill for the first unit.  Less than 8 minutes is not billable.
  • To bill for two units of either of these codes (or both of them at the same encounter), the total time must be at least 23 minutes (8 + 15).
  • Some payers require modifier GP to be added to this code on the claim form.  This tells the payer that there is a therapy plan in place for the code.  If your records are reviewed, and you used the GP modifier, make sure you clearly have a plan around the service, and it was not just arbitrarily added to an encounter with no clear purpose.
  • Therapeutic procedures are often billed as part of an ongoing series of encounters.  It is essential to periodically document progress.  It might be wise to tie a goal to each procedure and comment on the progress of that goal as it relates to the service billed, every 2-3 visits, and in greater depth at a re-exam or discharge exam.
  • The specific exercise or activity needs to be documented.  Think of the record as a script for a play.  If it contains enough information to re-enact the encounter, then it is sufficient.  Otherwise, it may be lacking.
  • Each service must include documented functional progress at reassessment and discharge. If no progress, document the reason for lack of progress documented and/or alternative treatment strategy.

  CODE DIFFERENCES

  Though Medicare does not pay chiropractors for 97110, we can learn from Medicare policies.  LCD L35036 tells us that:

  “Therapeutic exercise is designed to develop strength and endurance, range of motion, and flexibility and may include: active, active-assisted or passive (e.g., treadmill, isokinetic exercise, lumbar stabilization, stretching, strengthening) exercises. The exercise may be medically reasonable and necessary for a loss or restriction of joint motion, strength, functional capacity or mobility that has resulted from a specific disease or injury. It is considered medically reasonable and necessary if an exercise is taught to a patient and performed by a skilled therapist for the purpose of restoring functional strength, range of motion, endurance training, and flexibility. Documentation must show objective loss of joint motion, strength or mobility (e.g., degrees of motion, strength grades, levels of assistance). This therapeutic procedure is measured in 15-minute units with therapy sessions frequently consisting of several units.

  Many therapeutic exercises may require the unique skills of a therapist to evaluate the patient’s abilities, design the program, and instruct the patient or caregiver in safe completion of the special technique. However, after the teaching has been successfully completed, repetition of the exercise, and monitoring for the completion of the task, in the absence of additional skilled care, is non-covered.”

  The takeaway is that if the documentation shows that the patient has a loss of strength, range of motion, endurance, or flexibility, then 97110 can be justified.  However, the goals for exercise should clearly document improvement in those same parameters.

  If we look at CMS policies (see LCD L35036) around 97530 we learn that:

  “This procedure involves using functional activities (e.g., bending, lifting, carrying, reaching, catching and overhead activities) to improve functional performance.

  The activities are usually directed at a loss or restriction of mobility, strength, balance or coordination. They require the professional skills of a qualified professional and are designed to address a specific functional need of the patient. These dynamic activities must be part of an active treatment plan and directed at a specific outcome.”

  For 97530, the record needs to document some sort of loss of the ability to perform activities and explain how the procedure restores that loss.  The activity description would often include a verb ending in “ing.”  The patient’s condition should be such that he/she is unable to perform therapeutic activities, except under the direct supervision of a physician or physical therapist.  Related diagnoses might include:

  • Loss of strength (M62.81)
  • Loss of balance (R27.0)
  • Loss of coordination (R27.8)

  CONCLUSION

  97110 focuses on one parameter, such as strength.  97530 takes things to the next level and focuses on some activity that may be dependent on multiple parameters in addition to strength.  For example, shoulder strengthening exercises might be billed as 97110,  but tossing a ball against a trampoline and catching it would be 97530.

  In a clinical setting, a patient may begin care with stretches to improve ROM (billed as 97110).  After four weeks of stretches, and the goals are reached, perhaps care starts to focus on strengthening exercises due to findings of weakness in the initial exam.  This would also be billed as 97110.  Once the strength goals are reached (maybe after another four weeks), the new procedure could focus more on the dynamic activity of lifting boxes, which would then be billed as 97530. When deciding which code is more appropriate, make sure the documentation includes objective findings that line up with the code description and goals that focus on the parameters that are outlined by the code and the guidelines above.

Dr. Evan Gwilliam is a certified coder, auditor, and compliance officer. He trains clinicians on how to create rock solid records with PayDC, which is a dynamic cloud based EHR software. If you would like to learn more, email him at evang@paydc.com.
Dr. Gwilliam will be a speaker at the ACS Golden Anniversary Convention October 6-9, 2022.