Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 573
Compliance 42 CA

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: many of these issues I bring are 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 focus on the larger issues… a larger, more profitable practice along with more family time. 

“Compliance Alert 2015”

When I reported compliance issues to you it is more than an observation in an isolated instance. I look for patterns and trends in the industry and it helps determine where the current and/or future levels of exposure are in your practice.

1. E & M codes: I have now had three doctors in the past two weeks share with me that they are going through deposition and they were informed that they need to be able to justify their level of E & M code. One doctor said that his defense was going to be his staff erroneously posted the wrong code. That is a plausible explanation however, the attorney has an opportunity to subpoena any number of records randomly and see if this is a pattern. My advice to this Dr. as in every situation is you now need to hire a defense lawyer specializing in healthcare (usually $500 – $600 per hour) to ensure that you do not memorializing transcript show that you committed fraud. This is the type of behavior if there is a pattern, that can force you to sell your primary home to pay back the carriers. I say that not to create fear but sharing with you what some doctors have had to do in order to get out of the mess they created either out of ignorance or greed (both render the same results).

Last month I posted “evaluation and management guidelines” in section 14 of the consults title “forms and communications templates.” I urge mandate you to read this and follow these guidelines with extreme attention to detail as you do not need an attorney to do it properly, you simply need to focus and follow the guidelines. You only need the very expensive lawyer when you do not do it right.

2. E & M treatment plan: 50% of all evaluations I critique do not have accurate treatment plans. Doctors are ordering treatment to areas that have no complaints, clinical findings or diagnoses. I have long held that you must have a complaint or symptom, a clinical finding and a diagnosis in order to touch any area of the spine or any other part of the body.

It is not unusual for a doctor to order treatment of the cervical, thoracic and lumbar spine. The problem is when there are no complaints or findings or diagnoses in all three areas. I have detailed extensively the process of eliciting a complaint of an area which is taught in today’s academia to ensure proper documentation. It is also not unusual for a doctor to perform x-rays or order them with no clinical rationale for that recommendation. It is for that reason that we created the EMR macro program to give you evidence-based macros to protect you against an aggressive insurance carrier and to ensure that you get paid.

These are two common exposures for many of you in practice. According to the insurance companies attorneys, there is another word for it: fraud, which carries fines, penalties and felony charges.

The best way to defeat any of these accusations is to do it right in the beginning.



Adjunct Assistant Professor of Chiropractic, University of Bridgeport, College of Chiropractic
Adjunct Professor, Division of Clinical Sciences, Texas Chiropractic College
Educational Presenter, Accreditation Council for Continuing Medical Education Joint Partnership with the State University of New York at Buffalo, School of Medicine and Biomedical Sciences 

Academy of Chiropractic 
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