Delineating and clarifying the CA’s position make for an efficiently run practice

What is the secret of a successful chiropractic clinic ? A dynamite staff, of course. This is not to shortchange the wonderful doctors whom we work with, or to slight their skill and expertise, but in chiropractic health care, doctors provide the "health," while the chiropractic assistants (CAs), supply the "care." It is a special combination of compassion, commitment, and teamwork among the staff that makes the difference between an ordinary clinic and an extraordinarily successful practice.

Teamwork does not just happen—it is forged and nurtured. Each member of the team must understand the important roles other members play. Without respect between coworkers, turf wars, pettiness, and proprietary tendencies create stress and loss of harmony.

To create a dynamic team, employees need guidance and direction. A written office policy with job descriptions and a procedural manual will develop an efficient workflow for each position and will decrease staff politics. A balance of responsibilities and duties will create the dynamics of a proper work environment.

Each office has its own unique personality. While some offices operate with only one or two CAs, others require four or five. Although there are three main areas of assisting in most offices—front desk, back office, and insurance—most CAs are crosstrained and capable of assisting wherever needed.

The Front Lines
The front desk CA is a primary staff member who works in the reception area and is often the person in the office with whom all patients have contact.

Front desk CAs are responsible for:
     • Appointments—making, confirmation, and missed;
     • Patient records—creating and maintaining;
     • Reception area—telephone and greeting; and
     • Administrative—mailing patient information, data entry, bookkeeping, bill collecting fees, and filing.

A front desk CA is the main hub that all activities go through and an integral part of the patient’s experience with chiropractic care. This individual must be the public relations, the traffic control, the information, and the practice builder contact. This CA has more influence over patients keeping appointments than any other person in the office, including the doctor. The speed and efficiency of the office depends almost entirely on front desk CAs.

Some offices have two staff members assigned at the front desk when the patient volume generates the need to share these duties: the check-in and check-out side.

Behind the Scenes
While CA is a generic term for an individual who works with a chiropractor and is used for all assistants, the title of chiropractic technician (CT) is generally reserved for those individuals who complete a 2-year course to become certified. CTs usually work in areas of radiology or back office procedures.

Back office CAs are sometimes referred to as CTs to denote the difference between the administrative assistants and technical "hands-on" assistants. The term CT may also refer to a CA with advanced training who can do almost everything except adjust the patient. Regardless of the training level or responsibilities, a back office CA has more clinical interaction with patients than the front desk CA.

The back office CA or CT is the right hand of the doctor and must be fluent in anatomy, terminology, and physical medicine procedures.

Back office CAs are responsible for:
     • Patient contact—escorts patients in the office, prepares them for treatment, discusses outside testing procedures;
     • Patient records—may take patient history, assist patient with paper work, may fill out the "S" portion of the SOAP daily record, may scribe for the doctor (take notes while doctor is with patient);
     • Assisting doctor in treatment—one-on-one procedures and rehabilitation;
     • Treatment without doctor—applies modalities, takes blood pressure and vitals, performs limited exams, takes and develops X-rays and reloads cassettes, and schedules outside tests such as blood work or MRI; and
     • Miscellaneous duties—keeping the treatment areas clean, maintaining supplies and inventory, laundering gowns and towels, and assisting the front desk and insurance CAs with filing.

The back office CA is the most clinical in knowledge and nature. While these individuals may work with patients in therapy, they are never referred to as therapists or physical therapists, who are licensed and specially trained.

Ensured of Constant Change
The insurance CA position is vital to the survival of the business. This person may be responsible for collecting more than 80% of office income. The position also requires knowledge of CPT and ICD-9 coding, accounting, and anatomy. Computer and communication skills are also important. The insurance CA’s role is not a position for someone who does not like change. Insurance rules, PT codes, workers’ compensation rules, and Medicare are constantly changing.

The primary responsibilities of an insurance CA are to call and verify insurance coverage, explain benefits with patients, and file and follow-up on insurance. As simple as those duties may sound, they demand a great deal of attention to detail. No one can know everything about insurance because of its fluctuating nature.

The insurance CA is responsible for:
     • Insurance companies—verifying coverage, filing claims on a weekly or daily basis, insurance correspondence;
     • Patients—arranging payment plans, patient correspondence;
     • Patient records—ensuring that all proper forms are signed, verifying diagnosis with treatment plan, making sure the diagnosis is updated as needed, aging accounts (30-,60-, and 90-day), final narrative report completion; and
     • Administrative—attorney correspondence; filing required accident reports, required workers’ compensation reports, and initial medical reports; timely progress reports; monthly statements to patients; ensure all codes are current; and following Medicare, Medicaid, and workers’ compensation rules.

As in each of the other positions, the insurance CA’s position is vital to the team. Usually, this person has the most experience in chiropractic, the highest seniority in the office, and may also serve as the office manager.

When everyone understands the responsibilities of each position, team members have a greater respect for each other. And importantly, workflow and efficiency will produce a vacuum for growth and profit.

About the Author
Ces Soyring, CA, is one of the founders of the National Academy of Chiropractic Assistants (NACA) and a chiropractic consultant. She can be reached at: 888-218-7757 or via email: naca_csoyring@yahoo.com.