Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 817
Clinical Information 189 CI

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: many of these issues are small, yet each issue is just that… an issue. If you take care of the small issues, then the larger issues often take care of themselves and you can focus on the larger issues… a larger, more profitable practice and more family time.

“Compliance Checklist”

“It will get you where you least expect it” Mark Studin 2017

After a bit of a “high profile” hiatus, the carriers are now aggressively utilizing their SIU (Special Investigative Units) in a more aggressive posture. Perhaps it is just that my clients get investigated less than the rest of the profession because we aggressively work hard on being compliant and take affirmative action steps NOT to get screwed while the carriers pick on the “weaker population” within our profession. Personally… IDGNARA as long as it is not you!!!!
I have been seeing this trend on the newer doctors in the group, however I do not want to be “cocky” and say don’t be vigilant in doing it right. Therefore, the following checklist should be adhered to without compromise. These are Mark’s rules and are non-negotiable!

In addition, I urge you not to take any crap form the carriers, but never forget the adage, “people in glass houses should wear clothes” (I just made that up!!!)

The HARD Rules:
  1. For every “body part” treated have a:
    1. Symptom
    2. Clinical finding
    3. Diagnosis
  2. Always do your own review of systems
  3. Always initial every paper document the patient filled out
  4. Always comment that you have reviewed all the patient intake information in every EMR report
  5. Have an approved (or my lawyers) Staff Office Policy and signed by every staff, yourself and your spouse included
  6. Have a compliance review by me (you need an appointment, you just can’t send your documents to me)
  7. NEVER talk to a carrier if they call or write that they want to
    1. Do an office inspection
    2. Audit records
    3. Request multiple records
             i.    These requests are handed directly to your HEALTH CARE LAWYER (not a general lawyer) and you NEVER speak directly to the carrier or their representatives… NEVER… NEVER… NEVER
  1. Always have a treatment order for everything you do… including in-office x-rays
  2. Always have a prognosis
  3. Always order a re-evaluation in 30 days… not 12 (or any other number) visits
  4. Always specify what spinal regions are being treated in your orders
  5. Always use evidenced based macros for all care
  6. Always use necessity macros to certify treatment orders
  7. Always re-evaluate your patient every 30 days during ongoing treatment
  8. Throw away “travel cards” and ALWAYS use full SOAP Notes
  9. NEVER abdicate the responsibility of assigning a diagnosis to your staff
Should you get any investigative requests from the carrier and you are not sure what to do… CALL ME!



Adjunct Associate 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
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