Academy of Chiropractic Personal Injury & Primary Spine Care Program

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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.

“E & M vs. S.O.A.P. Format”

“I know think you are amazing… but you look like shit and changes what I know!” Mark Studin 2017



You not only have to be the expert based upon your knowledge, you must look the expert on paper. One without the other is not part of a winning strategy.

Too many in our profession succumb to the default formatting of our electronic medical record system and believe it will take care of itself because you paid a lot of money for it. NOT!!! Remember, these are algorithms written by NON-PROFESSIONALS wanting 1 thing, your hard earned $$$$$$$$$$. 

When I do compliance reviews the #1 mistake doctors are making is using a S.O.A.P. note format in an E&M encounter. This is not usual and customary and makes you an “outlier” to the reader. Let’s recap who your readers are, the carriers (who will consider auditing or suing you), lawyers (who will or not refer to you) and co-treating doctors (who will or not refer to you). That is quite a line-up and all of it involves your referrals, payments and legal fees, therefore it is imperative that you do it right. 

First, let me be clear that if all the information is in the report, no matter the format, you do NOT have any compliance issues. However, carriers will consider you part of the “easier pickings” because they realize you simply “don’t get it” and more likely than not will be deficient in documentation, which can spur an audit.

Lawyers… FAHGETABOUTIT… they carefully consider every word in your reports and will be concerned that you are not consistent with a level of expertise they are demanding for their cases. Never lose sight of the fact that is getting harder for the lawyers as time progresses and they in turn will demand more from you. 

Co-treating doctors. It is this type of documentation that is 50% of the reason why we are not in every hospital, urgent care and the recipient of every mechanical spine care from primary care providers. They have the EXACT SAME requirements for E&M documentation and they know that you just “don’t get it.” Although many chiropractic colleges teach you to do an E& M report in SOAP format, if you look carefully you will find that under the “S” there are all the components required for an E&M report. The same applies to the OA and P. I do not know why this is taught in that format and currently all CCE accredited chiropractic colleges (to my knowledge) no longer teach in a SOAP format for E&M. Again, it doesn’t matter for compliance as long as all of the components are there, however it matters greatly when you are considered an “outlier” by your referral sources.

S.O.A.P note formatting is intended for subsequent visit encounters and not an initial evaluation or a re-evaluation based upon Federal standards and that is what the rest of the healthcare community utilizes. These are the little (or big things) that tell your world that you are NOT expert and are an outlier. Your goal is to be part of the system and be the FIRST referral option for spine beyond fracture, tumor or infection. That is the winning formula. 

All it requires is to re-format your EMR system and if it takes long-days and sleepless nights, then you are part of the rest of us who realize what it takes to get there!

If you go to consulting section #14 on the homepage of the Web site, and scroll to the last item, you will find an E&M full tutorial on what constitutes a 2-3-4-5 level evaluation and the sections required to be there. 

P.S. That other 50% is your knowledge and credentials, but you will never get the referral sources to go there if your paperwork is upside down!!



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

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