Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 577
Compliance & Audits 44 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. 

“Abbreviations – Audits – No Payment”

I TOLD YOU SO!!!!


I just received a call from a doctor who was audited by a Blue Cross splinter and they denied payment based on an extensive audit. The auditor was a coder for the company and after requesting a few files, followed it up by requesting dozens. This company follows strict Medicare guidelines as to E & M codes (see forms and communications, the last section for a tutorial) and denied care based upon the doctor’s evaluations and re-evaluations. I directed the doctor to request in writing why every case was denied.

 
The doctor was upset because he has been using the same note format for 20 years and never had a problem before in his solo, modest practice. He was angry, frustrated and mad because no other carrier had any issue, especially the personal injury carriers.

 
After a review of the reasons for the denials, it came out the doctor, according to the auditor was deficient in numerous points required for his “3” level E & M examination, therefore they denied ALL treatment. Upon review the doctor was incensed because it was all there…however in abbreviations and internal codes!

 
My conversation with him was “I told you so” and that he had been lucky that other carriers haven’t taken the same audit pathway. Hospitals are now mandated in many states NEVER to use short-hand and that everything needs to be legible and transparent because people were dying due to illegible prescriptions and wrong doses administered. Medicine has been long-held to the standard I mandate you use in order to ensure you get paid…. You do want to get paid? 

 
If… you have a templated form, on that form have a key in an immediate area (a work-around). However, most of you now utilize EMR systems and that should NEVER have abbreviations… EVER!!!  And if it does, change it. If you use paper, then please consider going EMR… The time to do that was last year, or 5 years ago… It is not that expensive or daunting. 

 
The doctor in question thankfully gets to submit a clarification of his reports and explain all of the shorthand and abbreviations because the auditor is simply a “lay-person” filling in boxes and earning money on every denial. They usually do not hire doctors to review these claims and this action has become the norm.
 
NO ABREVIATIONS… EVER!!!!!

NO INTERNAL SHORTHAND ON ENCOUNTER FORMS

 
This is non-negotiable!!!!!


 
Respectfully,



Mark Studin DC, FASBE(C), DAAPM, DAAMLP

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
US Chiropractic Directory
631-786-4253
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