Take Advantage of This New Trend and Ramp Up Your PI Practice Segment (Pt. 2)

Editor’s Note: Pt. 1 of this article ran as a web exclusive in the June issue.

Though attorneys might have you believe otherwise, chiropractors who take personal-injury cases on medical lien (lien) or a letter of protection (LOP) are not agreeing to a discount. Rather, taking patients on lien or LOP is like extending credit to a patient. The chiropractor is agreeing to wait for the conclusion of a court case to be paid, but is owed the full amount of the bill, no matter the outcome of the case.

That’s right: Even though a PI attorney is paid on contingency, the patient still owes all of your bill, even if they lose at trial or have a lower-than-expected settlement.

So, while you might offer a cash discount, and insurance adjusters will surely contest at least some of your treatment charges, patients in almost all 50 states owe the full amount of a medical lien bill at your full retail rates, regardless of the outcome of the case. (And if you practice in a “common fund” state, the patient likely still owes the balance of the outstanding amount unpaid after the PI case settlement is paid out.)

That’s why chiropractors who understand PI can expect it to be the best-paying segment of their practice. Long story short: You don’t have to reduce your bills. Period. You may want to, depending upon the individual circumstances, but it is your choice.

The even better news is this: Some of the pressure is about to be lifted. Attorneys (and their clients/your patients) will have a bigger pot of money to collect from. More cases will go to trial as a result, likely increasing settlements and allowing for more successful verdicts, so attorneys might not be quite as threatening when it comes time to pay the medical providers.

First Act: Position and Protect Yourself

If you are not practicing in PI, now is the time to dip your toes in the water and get the lay of the land. Once you understand PI, setting the stage for success is simple. You can and should put things in place that best position your bill recovery and protect your practice. You need to learn how to:

1. Use a rock-solid lien or LOP. This is your foundational contractual agreement through which all rights and obligations flow. Your lien, which you should ask both the patient and the attorney to sign, should make it abundantly clear that the patient owes the full balance of the bill, regardless of the outcome of the case.

2. Communicate transparently with the patient and the attorney. You can do this in writing and via conversations. For instance, during the patient’s intake, you can let the patient know that unless they have talked to you directly and have it in writing from you, they should assume that you expect your bills to be paid in full, and that they should verify with you if the attorney is telling them otherwise.

3. Send monthly statements to the attorney and the patient. Include a fee comparison. (Check out FairHealthConsumer.org as one resource to compare fees.) This fee comparison can support your fees and helps the attorney defend your bills to the insurance adjuster during settlement discussions. Bill support also gives you leverage to push back if the attorney tries to play one of their favorite tricks: Using your bills to force a payout from the insurance company, and then turning around after the case concludes and asserting that your bills are unreasonable. If you have sent regular statements, the attorney had plenty of opportunities to let you know if they disagreed with your treatment or the reasonableness of your charges.

4. Comply with the No Surprises Act (NSA) and include a good-faith estimate (GFE) when you begin treatment in a PI case. This new law might seem like one more regulation that you need to follow, but it’s actually excellent news for chiropractors. Here’s why:

• The patient’s attorney will look at your estimate and say, “Yes! Do that.” Your treatments will help the attorney prove the patient’s claims of damages. The attorney’s endorsement will validate your billing and your treatment.
• During treatment and post-discharge, you will have an opportunity to teach your patient about the many ways chiropractic can help them and those they know treat or prevent other ailmentsA large segment of your business likely consists of per-visit patients, but the NSA’s requirement for GFEs changes the mindset of your patients. A GFE is required for recuring treatments of self-pay patients, and must therefore be supplied for most PI patients, even those with medical expense or personal-injury protection (MedPay or PIP), as those aren’t guarantees of payment. As a result, your patients will be trained to think of you as the “convening” (or lead) provider in most states, since chiropractic is often the first medical specialty seen. When you have successfully treated them for their personal-injury ailments, you will be better positioned to transition these patients to long-term wellness care patients. Wouldn’t it be nice to have a significant number of your appointment slots filled in advance? The NSA lets you more easily turn this dream into a reality, as PI patients are trained in a new habit: term care plans.

The Big Takeaways

The new rise in minimum insurance trends across the country [see Pt. 1 of this article] is going to lift an already profitable practice segment even higher. The takeaways, then, are this:

• If you aren’t in PI, get in. The business rule of thumb is: Follow the money, and the money is in PI.
• If you are doing some PI, ramp it up! PI is going to get even busier, with higher payouts in many states.
• If you are doing a lot of PI, use your PI practice segment to increase the wellness side of your practice by taking advantage of the NSA and the wonderful synergy between injury and wellness care.