The Collect Don't Borrow Podcast

What happens when a Medicare patient complains that your chiropractic practice is “too expensive” — and that complaint turns into a state board investigation?In this episode of the Collect Don’t Borrow Podcast, Dr. John DeVilla breaks down a real-world Medicare investigation involving a chiropractor, an unhappy Medicare patient, and an investigator who misunderstood the rules governing chiropractic services.The issue centered around what Medicare actually covers in a chiropractic office, what services are considered excluded, and when an ABN is—and is not—required.Dr. John explains the difference between covered chiropractic adjustments, excluded services, the AT modifier, GA, ABNs, and the importance of understanding the Medicare rules better than the people reviewing your practice.Most importantly, he explains how the chiropractor successfully defended himself at a state board hearing by going back to the actual Medicare rules and proving that the investigator's assumptions were incorrect.If you are a chiropractor who sees Medicare patients, this is an important lesson: don't assume an investigator understands the chiropractic-specific Medicare rules. Know the rules, know your references, and know how to defend your documentation and billing decisions.In this episode:• Why a Medicare patient's complaint about cost triggered an investigation• What Medicare actually covers for chiropractic services• The difference between AT and GA• When an ABN is required—and when it isn't• Why excluded services are different from non-covered services• How the chiropractor successfully defended the investigation• Why strong Medicare references can make all the differenceSubscribe to the Collect Don’t Borrow Podcast for practical chiropractic compliance, Medicare, documentation, and billing guidance designed to help you practice from a position of power.

In this episode of the Collect Don't Borrow Podcast, Dr. John Davila breaks down a real-world case involving a cash chiropractor who got into trouble over his documentation—and then discovered that the same documentation system ultimately allowed him to accept an unexpected insurance opportunity without rebuilding his practice.

The key lesson: your documentation should be based on how the patient presents, not how the patient pays.

In this episode Dr. Davila walks through:

• Why cash practices still need appropriate documentation

• HIPAA's code set transaction standards and why they matter

• The relationship between documentation, diagnosis codes, and CPT codes

• How medical necessity connects to the codes being used

• The 98940, 98941, and 98942 chiropractic procedure codes

• M99 diagnosis codes and documenting segmental dysfunction

• Why documentation needs to support the care being provided

• How a properly structured cash practice can be prepared to handle insurance

• The difference between active care and wellness care

• What happened when more than 100 employees wanted chiropractic care at their workplace

The bigger takeaway is simple: build your documentation correctly from the beginning, and your practice doesn't have to be rebuilt every time the way a patient pays changes.

Practice is easier when you have the right reference.

#Chiropractic #ChiropracticDocumentation #ChiropracticCompliance #CashPractice #MedicalNecessity #HIPAA #ChiropracticBilling #ChiropracticInsurance

Description

Are you documenting and coding based on how the patientactually presents—or based on how the patient pays?

In this episode of the Collect Don't Borrow Podcast, Dr.John Davila breaks down one of the most important distinctions chiropractorsneed to understand: active care vs. wellness/maintenance care.

The patient's insurance status, payment method, or whether aservice will be reimbursed should not determine what you document. Yourdocumentation and coding should accurately reflect the service being providedand the patient's clinical presentation.

Dr. Davila shares a real-world expert-witness case involvinga chiropractor who used the same wellness code for every visit—even though thepatient presented with significant problems and symptoms requiring active care.

Then he explains how another chiropractor handled theactive-to-wellness transition correctly, including what happened when a patientreturned six months later and revealed that they had been involved in a caraccident.

In this episode, you'll learn:

• Why you should document based on how the patientpresents—not how they pay

• The difference between active care andwellness/maintenance care

• Why insurance reimbursement should not determine yourcoding

• How incorrect coding can create compliance and boardproblems

• How to properly move a patient from active care intowellness care

• What happens when a patient develops a new problem afterentering wellness care

• Why accurate documentation can protect you when recordsare later requested

• How following the right reference can make chiropracticcompliance much easier

The goal isn't to code for payment. The goal is toaccurately document the care you're actually providing.

Being compliant is easy. You just need the right reference.

Learn more at Custom ChiroSolutions:customchirosolutions.com

#Chiropractic #ChiropracticCompliance #ChiropracticBilling#ChiropracticCoding #MedicalNecessity #ChiropracticDocumentation #WellnessCare#ActiveCare

Episode #8 A chiropractor went to jail after being accused of insurance fraud—but the claims in question were submitted by someone else.The problem? He had no way to prove it.In this episode of the Collect Don't Borrow Podcast, Dr. John Davila shares a disturbing real-world story about false insurance claims, shared login credentials, falsified documentation, and how a chiropractor ended up taking the blame for actions he says he didn't commit.But there's another side to the story.Dr. Davila also shares how a different chiropractic practice faced a remarkably similar investigation—and was able to prove that the fraudulent claims were not submitted by the doctor. Because the practice had clear compliance procedures, individual logins, and documented processes, a forensic review of the computer system provided the evidence needed to show exactly who submitted the claims and when.The lesson is simple: compliance isn't just about following the rules. It's about creating a system that can protect you when someone else makes a mistake—or deliberately does something wrong.The Key Takeaways:• Why chiropractors should never share login credentials• Why documenting compliance issues can protect your practice• What “if you see something, say something” really means in a chiropractic office• How a compliance manual can create an audit trail• How forensic computer evidence can help identify who actually submitted claims• Why having policies in place before an investigation can make all the differenceIf you're a chiropractor, practice owner, or member of a chiropractic staff, this is a story worth hearing before you find yourself trying to prove something didn't happen.Collect Don't Borrow is about helping chiropractors practice from a position of power—with better compliance, better documentation, and better systems.For more resources, training, and compliance support, visit www.CustomChiroSolutions.com

What happens when your chiropractic office gets paid for a service you never actually performed?

In this episode of The Collect Don't Borrow Podcast, Dr. John Davila shares a real-world compliance story involving a coding error that caused an insurance company to pay claims for toenail removal—a service the chiropractic office never performed.

The doctor discovered the problem after several claims had already been paid and immediately wondered: Could this be fraud? Do I have to pay the money back? What should I do?

The answer provides an important lesson for every chiropractic practice.

Dr. Davila explains how proper staff training, compliance procedures, documentation, corrective action, and putting employees in the right position can make a major difference when a billing error occurs.

The episode also examines the False Claims Act and why identifying and addressing a mistake quickly can be critically important.

In this episode, you'll learn:

What to do when staff discover an incorrect claim

Why mistakes should never be swept under the rug

How to document a billing or coding problem

Why your compliance officer should create a paper trail

How staff training can prevent recurring errors

Why putting the right person in the right position matters

What to do when an insurance company has already paid an incorrect claim

How one chiropractic office identified, corrected, documented, and resolved a serious billing mistake

The lesson: Mistakes happen. The real compliance question is what you do after you discover the mistake.

For chiropractic compliance tools, training, and resources, visit www.customchirosolutions.com

3 Key Takeaways

• If you request a specific number of visits, be prepared to defend that number. Continually accepting fewer visits without appealing may signal to the insurer that you don't actually believe the patient needs what you originally requested.

• A denial isn't necessarily the final answer. The 2025 findings are showing that pre-authorizations that were denied can be successful overturned.

• Create a repeatable appeal process for your staff. Log every denial, get the procedures all set to follow up. Get examples from this episode on how consistently following this process eventually led to the insurer approving the appropriate number of visits without continued resistance.

You can reach out to us at [email protected] to get more information on how we can help your practice.

Three Key Takeaways:

1. You can’t simply opt out of Medicare by choosing not to bill it.

The episode explains that a chiropractor who is considered a non-opt-out physician cannot privately contract with a Medicare beneficiary for active chiropractic care simply because the doctor doesn't bill Medicare.

2. An inactive or deactivated Medicare number doesn't eliminate your obligations.

The transcript emphasizes the importance of reactivating Medicare enrollment information when required and warns that going six months or more without billing can potentially lead to deactivation. Being unable to bill doesn't mean you can simply charge the Medicare patient as self-pay.

3. A small billing mistake can become a much bigger compliance problem.

The episode's most powerful lesson is that incorrect billing can lead to overcharging a Medicare beneficiary, with potentially serious financial consequences. The Florida audit example reinforces the point: accurate documentation and billing can dramatically improve audit outcomes and prevent a relatively small mistake from becoming a major financial liability.

You can reach out to us [email protected] for more information.

Key Takeaways

• Redefining Success Through Impact and Service: True success is not a final destination or a benchmark you achieve; rather, it is the continuous pursuit of a worthy goal that serves and benefits others.

• Embracing Growth Through Subtraction: Strategic pruning and corporate restructuring—even when it involves letting go of high-performing, phenomenal staff—are essential components to natural business growth and maintaining a healthy organizational environment.

• Prioritizing Intentional Presence and Family: Financial wins are ultimately empty without family to share them with, making it essential to actively celebrate success through travel, time away, and being 100% present by disconnecting from technology.

Episode 3:

When a pediatric patient walks into your clinic with an ear infection or stomach issue, what goes into your note? In this episode, Dr. John Davila breaks down a common compliance trap: altering documentation to satisfy insurance companies or accidentally practicing medicine without a license. Featuring a real-world case study of a chiropractor targeted by a state medical board, this episode reveals why hiding a child's true primary complaint can trigger fraud flags and how an insurance reviewer evaluates pediatric files. Learn how to leverage Chapter 15 Section 240 of the Medicare guidelines to safely document any pediatric case, maintain your in-network compliance, and prove the clinical necessity of your adjustments.

Key Episode Takeaways

• The "Complicating Factors" Protocol: Never hide non-musculoskeletal complaints (like ear infections or digestive issues) or omit them because "insurance won't pay." Instead, list them explicitly under a "complicating factors list" to show you are tracking the child's overall health while establishing that you are not directly treating the medical condition itself.

• Subluxation is the Standard: Under Medicare manual guidelines (Chapter 15, Section 240), reimbursement and clinical validity hinge entirely on treating a neuromuscular skeletal condition. You must prove the physical presence of a spinal subluxation, turning a non-musculoskeletal presentation into a valid chiropractic case.

• P.A.R.T. Applies to All Ages: The diagnostic framework to prove a vertebral subluxation complex—Pain, Asymmetry, Range of motion, and Tissue tonal changes—uses the same diagnostic criteria whether your patient is 8 or 80 years old.

• In-Network Obligations Exist for Kids: If you are an in-network provider, you cannot arbitrarily refuse to bill insurance for pediatric patients just because they are children. If a covered subluxation exists and the parent requests reimbursement, you are contractually obligated to document it properly and submit the claim.

If you would like more information on how to do this in your notes, you can reach out to us via email: [email protected]

Episode 2

In this episode, Dr. John Davila shares a deeply personal "Dear John" story detailing the exact moment a federal investigator in a black suit walked into his office with a badge and a list of compromised billing names.

Discover how a compliance mistake happening across town triggered an audit under his billing number for an "impossible day"—a mathematical profiling metric used by investigators to catch unperformable volumes of daily services. Dr. Davila breaks down how his custom, staff-signed Office of Inspector General (OIG) compliance manual completely vindicated him, shifted the liability to the true bad actor, and saved his career.

Key Takeaways from This Episode:

• What is an "Impossible Day"? Understand how modern auditors use background data and mathematical algorithms to flag fraudulent billing activity.

• The Danger of Boilerplate Policies: Why copy-pasting a friend's compliance manual creates an immediate legal liability if you aren't strictly following their specific office protocols.

• Actionable Staff Steps: How to collaborate with your team to hammer out ironclad internal rules, including establishing legal write-off and collection attempt policies.

• The Power of Signatures: Why having your staff and external partners sign off on your compliance manual is your ultimate line of defense.

For more information you can reach out to us at [email protected]