The Collect Don't Borrow Podcast

Custom ChiroSolutions
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Welcome to the Collect Don't Borrow Podcast, the definitive podcast hosted by Dr. John Davila of Custom ChiroSolutions. Designed for healthcare providers, compliance officers, and office staff, this channel provides the vital strategies, expert insights, and compliance based references needed to protect your practice from audits and regulatory scrutiny. Each week, Dr. Davila breaks down real-world compliance stories, analyzes shifting insurance landscapes, and translates complex coverage policies into actionable staff training protocols.

Episodes

  1. 3d ago

    The $30 Mistake That Turned Into a $10,000+ Medicare Problem

    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 info@customchirosolutions.com for more information.

  2. Aug 24

    The Growth Paradox: Why Pruning Your Business is Secretly the Best Strategy with Billy Sticker

    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.

  3. Aug 19

    From Ear Infections to Subluxations: Navigating Non-Musculoskeletal Complaints

    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: info@customchirosolutions.com

  4. Aug 13

    The "Impossible Day" and How a Compliance Manual Saved My Practice

    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 info@customchirosolutions.com

  5. Aug 6

    How to Audit Your Profile Before Insurance Companies Do

    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.

  • 5 Episodes

About

Welcome to the Collect Don't Borrow Podcast, the definitive podcast hosted by Dr. John Davila of Custom ChiroSolutions. Designed for healthcare providers, compliance officers, and office staff, this channel provides the vital strategies, expert insights, and compliance based references needed to protect your practice from audits and regulatory scrutiny. Each week, Dr. Davila breaks down real-world compliance stories, analyzes shifting insurance landscapes, and translates complex coverage policies into actionable staff training protocols.

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