Comprehensive Chiropractic Services
Comprehensive Chiropractic Services

 Consulting                            IME                                    Peer Review                         DOT Exam Services

Welcome

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 Chiropractic 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. The Centers of Medicare & Medicaid Services noted that 45% of claims in a recent year had insufficient documentation to support services. An estimated $17 billion to $57 billion was lost due to Medicare fraud in 2012. Medicare spent $359 Million on unnecessary chiropractic care alone in 2013, based on an audit. The investigation found that all chiropractic care after the first 30 treatments was unnecessary, according to a federal review, and that more than 80% of the money that Medicare paid to chiropractors in 2013 went for medically unnecessary procedures. (Wall Street Journal, Oct. 19, 2016)


In 2007, $2.26 trillion was spent on health care, 3 percent of which (approximately $68 billion), according to National Healthcare Anti-Fraud Association (NHCAA) estimates,was attributable to health care fraud. FBI estimates are even higher, placing losses due to health care fraud as high as 10 percent of our nation's annual health care expenditures - a staggering $226 billion each year.

 

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 chiropractic 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 coding is another avenue for a clinic to increase collections.  This can be a “soft fraud” area.  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 Chiropractic Services?

 

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

 

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

 

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

 

  • Immediate Past President of 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 chiropractic benefits that you should, please contact me to discuss how I can help you with your chiropractic claims

Back to top
Print Print | Sitemap
© David Boll