Comprehensive Consulting Services
Comprehensive Consulting Services

Consulting/IMEs/Expert Witness Testimony/Peer Review                     

Welcome-  David Boll, DC CPC PES CKTP

Dr. David Boll

The current status of health care in America demands that companies pay for only those services that are necessary and supported and meets their plan/policy language. Through my consulting and review company, Comprehensive Consulting Services (CCS), I can assist your company in navigating the physical medicine health care arena. 


Headlines and studies show that an unnerving trend in unnecessary health care services are being submitted and your company is paying for these unsupported claims right now.



Why do you need someone looking over your chiropractic claims?


The news stories speak for themselves. Health care fraud makes the news nearly every day. Clinics having unlicensed staff render therapies, billing for patient visits that were not rendered, billing for services not documented and the list goes on. For example, the average improper payment rate for Medicare Part B services has been estimated at between 9.9%-12.9%. For chiropractic services, the improper payment rate has been estimated to be between 43.9%-54.1%. About half of all chiropractic services covered by Medicare were not supposed to be covered.  The OIG has estimated that of the nearly $450 million spent by Medicare on chiropractic services every year, between $257 million and $304 million in improper payments are being made every year for chiropractic services. (CMS’s Supplementary Appendices for the Medicare Fee-for-Service Improper Payment Reports for 2010–2015.) Over a six-year period, $2.9 billion was spent by Medicare on chiropractic services. Theoretically, this means that at least $1.27 billion was wasted over those six years. One can be reasonably sure that this also transfers over in some aspect to standard insurance plans receiving chiropractic claims. 


It’s more than that though. Blatant, pre-meditated fraud does take its toll, but what about those ongoing and unending treatment plans you see from physical medicine offices, without any plan, goals, re-exam findings or any discharge. It’s not unusual to see cases where several adjunctive services are rendered throughout without any proper case management or reduction to support the service was necessary and beneficial.  Those areas need to be addressed.


Incorrect and improper coding is another area that needs attention. Many chiropractors upcode the manipulative service based on their technique choice or professional philosophy, neither of which are valid.  The Office of the Inspector General has examined chiropractic claims and in one study found an 87% error rate in regards to improperly coding the chiropractic manipulation (CMT CPT codes 98940, 98941 and 98942).  Are you getting improper coding billed to your office?  Do the records support the level of service being rendered? 


Unnecessary and unsupported chiropractic care is costing your company thousands of dollars, possibly tens to even hundreds of thousands of dollars.


Recent Headlines:

"Insurance Fraud, It's all over the place and you should care about it"- Omaha World-Herald



Why choose Comprehensive Consulting Services?


Dr. David Boll's Comprehensive Consulting Services, as an independent contractor, is available to aid your company in the implementation of guideline development, processing procedures, internal education and performing medical necessity paper reviews for all aspects of chiropractic health care claims.  Provider network credentialing, thorough screening and ongoing network management services are also available.



Comprehensive Consulting Services/ Dr. David Eric Boll’s Qualifications:


  • Extensive background and experience being a chiropractic provider, researcher, consultant, and reviewer.


  • Certifed in Diagnostic and Procedure Coding (CPC)


  • Former Director of a major insurance company’s chiropractic department.


  • Board Advisor to the American College of Chiropractic Consultants (former VP and President of ACCC)


  • Respect from the chiropractic field by having a position on the faculty of The American Back Society and active membership in the prestigious American College of Chiropractic Consultants. 


  • Received certificates from completing courses in Managed Care and Utilization Review. 


  • Numerous talks and seminars have been given at major national and regional health care conventions regarding third-party payer relationships, case management, documentation, and coding.  This educational resource is also available for your company’s internal instructive benefits.


  • Currently licensed as a chiropractor in Wisconsin and Michigan, both states require reviews be performed by a chiropractor licensed in that state. Many other states require a peer review be completed by a licensed peer.



What does your company reap as a benefit?


  • Effective case management by providers with increased awareness regarding proper documentation and coding of services are all seen as an outcome due to detailed, custom, specific, typewritten, evidence-based reviews.


  • Reviews are completed to exceed the standards normally seen in the chiropractic consulting and peer review profession.  Review decisions are referenced, noting valid, high-quality journal articles, guidelines and peer-reviewed studies utilized for the final decision to be in compliance with all review regulations.


  • A very rapid turn around of claims.  Plan on 24-48 hours in a vast majority of the completed reviews. Rush reviews are available.


  • Reduced utilization, such as the 60% drop in dates of service that has been seen with concurrent case management by several Insurance companies utilizing Comprehensive Chiropractic Services


  • Payment for only those services that are necessary.  You won’t pay for services that are upcoded or lack documented support.


  • Reduced appeals. One company tracked an 80+% decline in appeals due to the specific information contained in reviews from Comprehensive Chiropractic Services. Providers won’t file a “knee jerk” appeal if they see specific, referenced and clear reasons for the decision opinion.


  • Increased internal education regarding the chiropractic profession. This helps your company’s relationship with the chiropractic profession.


  • Increased awareness of the need for proper coding, documentation and case management. Better educated doctors’ results in better cases, which results in easier claims processing.


  • Provider networks will have strict credentialing requirements and will be professionally screened based on prior utilization profiles.  Ongoing management will result in making sure all credentialed providers continue to render effective, outcome-based quality care once they are accepted to the network.



If your company wants to save money and pay for only those benefits that are reasonable, related and necessary, please contact me to discuss how I can assist. 

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