Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 290

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time.

"The Slippery Slope of Variable Documentation Standards"

Too many of you still utilize the practice of multiple levels of documentation. Cash patients get a very cryptic note, or none at all, while the managed care patients get better notes because you have to submit them. Those notes, because they are billed at a 99203 or 99213 level, really do not pay much or need much, so you do the minimum. The PI patients...well...that's another story. You are going to get paid so much more money, so you do a really, really good job because the likelihood of those notes being scrutinized are high and you do everything you are supposed to without skipping any steps. In the end, it is a document to be proud of.
Life is good. You do the least work for the least pay and you go to sleep at night happy because you can have more free time during your day with less paperwork, get the letter in the mail from your state board's investigative office requesting your notes on the cash or managed care patient that rendered a complaint. The first thing you do is get that sick feeling in your stomach because you know you didn't practice within your licensure standards and it can be the cause of either writing a very big check or applying for a job at Walmart (not a bad place to work). I am not being inflammatory.
This has been the topic of too many phone calls to me about what the doctor should do. In every case, it took approximately 1 to 1/2 years, healthcare lawyers at approximately $400 per hour and daily phone calls strategizing on how to resolve this. Often, it requires a forensic analysis of the doctor's charts at a cost of $500 per chart (as each analysis requires a full report and takes 2-3 hours) if the complaint is initiated by the carrier. One doctor's lawyer retained me to analyze 73 charts at a cost of $36,500. Get the picture?
In the end, almost every doctor had to write a big check and got a licensure infraction. The lucky ones just got a "slap on the wrist." In the end, each of these doctors now documents all cases utilizing the same standard, which is where you needed to be from the beginning.
IDNGARA (I do not give a rat's ass) what financial class you are treating; everyone gets the same standard of documentation. IT IS NON-NEGOTIABLE. I am not even going to mention Medicare...EVEYONE GETS AUDITED.
The best way to not have problems is to not create them and practice the way I have been teaching you, which is the way you were taught in chiropractic college. If you are not sure if you are doing the right thing, go to the Web site and get the evaluation template. It will protect you from you.

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