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“Meeting the Minimum Standard”
A formula that has ended in disaster
“Reputation is everything” Mark Studin 2018
Many of you feel the pressure of documentation and have independently concluded that meeting a minimum standard will suffice to allow more time for patient care vs. documentation. Your decision to follow that path almost always meets with disaster, destroys your reputation, writing big checks in refunds, fines and to lawyers and too many sleepless nights.
This is a common theme I hear from doctors when I do compliance reviews and when I explained to them that they are committing fraud and in too many cases, committing RICO federal racketeering violations their excuse is “it is not my fault because the carriers want so much information and I can’t focus on my patients.” There are many Walmart employees who used to be chiropractors and had this excuse as well as billions that have been repaid by doctors to carriers thereby increasing their stock value. If this is you, you are their perfect “cash cow!”
Last week one doctor told me that he has worked very hard to meet the minimum standard because he is a healer and volume practitioner and this tactic was the only solution for a successful practice. That was after I completed a compliance review and informed him it was by far one of the worst in the nation and will cost him his license and much more should the carriers investigate. This was a new client, who joined the program to increase his personal injury sector of business as he is a pure cash practitioner. As I dug deeper and asked the tough questions the doctor finally broke down and explained that his licensure board had acted against them in the past for advertising issues and subsequently for document failures when the license investigators look deeper.
He explained that he added a few minor items to appease the investigators so that he could get his license back and maintain the practice. I explained to him that if an insurance company had looked at his records based upon the codes he used, there is a high probability he would be financially ruined for the rest of his life and possibly have ended up in prison as a result of the pattern of fraud he perpetuated. Because this fraud was perpetuated only on patients, the only recourse was a licensure board action, which occurred, and he was found guilty of multiple gross misconduct charges. As a result, licensure board sends an investigator into his office every 45 days to look at what they choose to ensure he is compliant both in his advertising and documentation. He still has another year and a half to go before he has a full board review (this is what I remember from the conversation).
NOTE: This doctor is very lucky as most licensure boards would have taken his license for years and fined him until it hurt. Perhaps that is coming as he is still in the process, but as of now… he has “dodged the bullet.”
My reaction to this doctor was as follows; “if you do not change your documentation, I will not work with you because I don’t want to hear you complain about you losing your license in the future. I only want to help people who want to help themselves.” He answered that he was all in and will do what I tell him because he realizes his solution has cost him dearly and he wants to build his practice inclusive of personal injury. More importantly, he wants to be able to practice.
I directed him to section #14 Forms & Communication, the last item titled “evaluation and management” which has a full tutorial on what is required in the 99212 – 99213 – 99214 – 99215. I explained to him that meeting these requirements is the minimum standard and is non-negotiable. Also, I explained to him that his reputation fully depends on what’s on paper not only with the carriers and licensure board but referring lawyers and co-treating physicians. I continued; when was the last time you had a handwritten note from an orthopedic surgeon or neurosurgeon about your patient that was so cryptic and poorly written you could barely read it? The answer is never.
I want to share with them that he must have an EMR system or use our transcription service, which is the most efficient in the industry so that he looks on paper as good has he is in the treatment room and meets not the minimum standard, but the maximum standard. Please don’t misunderstand these words as saying you have to “over – document,” as that is not a compliance issue but a reputation issue that will be burdensome to the reader and will prevent your referral sources from spending the time to read extraneous information. Also, do not try to lecture or educate in your evaluation and management reports. They should be concise and literature-based macros can be utilized for both reimbursement and compliance issues, but not as an educational tool.
It is a very fickle balance between having a complete report & meeting all the requirements of the E&M level billed without cutting corners or over-documenting. It is for that reason we created a program that is inclusive of oversight and ensures you meet the maximum standard in a very short amount of time. Your license, money, and reputation are dependent upon not what you say and not what you do… But what is written in your documentation.
Mark Studin DC, FASBE(C), DAAPM, DAAMLP
Adjunct Associate Professor of Chiropractic, University of Bridgeport, College of Chiropractic
Adjunct Post Graduate Faculty, Cleveland University-Kansas City, College of Chiropractic
Adjunct Professor, Division of Clinical Sciences, Texas Chiropractic College
Graduate Medical 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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