The Collect Don't Borrow Podcast

Episode 1 – The Power of Your Billing Profile

In this inaugural episode of Collect Don't Borrow Podcast, host Dr. John Davila pulls back the curtain on how chiropractic practices inadvertently become targets for insurance audits. Drawing from 30 years of industry data and personal experience, Dr. Davila dismantles the dangerous myth that low billing volume keeps a practice safe from government oversight.

You will learn why post-payment denial rates skyrocketed from 16% to 82%, how insurance companies profile your practice before ever reading your clinical documentation, and the exact steps to audit your own EHR codes.

The "Dear John" Lesson: Why relying on outdated advice or personal opinions about audit immunity can put your clinic at massive financial risk.

Key Takeaways From This Episode:

• The Ideal Code Distribution: A breakdown of the recommended baseline targets for your claims universe to prevent flagging.

• Decoding Medical Necessity: How to properly transition a patient from active treatment to wellness care using guidelines from Chapter 15, Section 240 of the Medicare Manual.

• Clinical Progression & Downcoding: How managing regional adjustments—such as transitioning from a 98941 to a 98940 as compensatory regions resolve—can legally protect your practice.

• Actionable Staff Training: How to pull a 90-day billing profile report and create a signed attestation page to keep your compliance manual active and up to date.