Academy of Chiropractic’s Lawyers PI Program

Lawyers Meeting & Communications #20

From the Desk of :
Mark Studin DC, FASBE (C), DAAPM, DAAMLP

“Coordination of Documentation”

  One of the prime reasons for referrals  & getting paid


I had a meeting with one of the top legal scholars nationally in personal injury this past week who outlined to me one of the biggest pitfalls for a personal injury lawyer that often eludes treating doctors. It’s the records of the primary care providers and it goes well beyond what I would have expected. Therefore this becomes one area that needs specific and continual attention and in the end, should result in new cases to you from primary care providers, or at the least, open the doors between the 2 of you for future collaborative care. 

NOTE: To learn how to foster a better relationship and maximize your referrals, please consider taking the MD Referral Program with Dr. Owens. 

The lawyer went on to explain that often the opposing counsel files for a motion to dismiss the case base upon treating doctor’s records conflicting with your and it is challenging to overcome. The basis is not YOUR records as the treating doctor, but those of the primary care provider who potentially might have omitted musculoskeletal complaints. In addition, claims examiners, should they have requested the same, will have grounds to not consider paying your claims. 

As an example, the patient enters your office, post motor-vehicle-accident with complaints of neck and low back pain. You institute a treatment plan and 3 weeks into care the patient visits their primary care medical doctor for a “regular check-up” to monitor their insulin level for diabetes. The patient, no longer in acute pain and starting to feel better never comments to the doctor-nurse practitioner-physician’s assistant that they have no complaints and documents what is told to them. 

Patients as a rule often compartmentalize their health issues and usually don’t complain to every doctor of every ache and pain. They often over time accept their pain as “normal,” and will not even consider complaining to their primary care. Other patients do not want to “insult” their primary care doctor by seeing another doctor they didn’t recommend and will go out of their way not divulge any information about the accident or their pain. 

This is severely problematic for both the lawyer and YOU. All of your Colossus preparation, the magic language, the x-ray digitizing, the second opinions (medical validation reports) …GONE. Once the carrier is in possession of this type of report, you have a disinterested treating third party that knows the patient better than any other provider, their primary care reporting who reports there is NOTHING WRONG!

In addition, hospitals often do the same but for possibly different reasons. Your patient will go to the emergency room post-accident either by ambulance or someone drove them. The triage nurse will ask your patient what their primary complaint is in the patient will say (i.e.) my neck and render no other complaints. The ER staff will then only work up the cervical spine as is appropriate. Physiologically the inflammatory process takes 72 hours to peak and as a result many other bodily injuries will not be painful for evident until then. In addition the body also “gates” the secondary pain off for the primary pain and the patient is not able to perceive the secondary pain until the primary pain abates to some degree.

Another hospital scenario is the ER doctor is overburdened with heart attacks, gunshot wounds and snake bites (you get the picture). As a result, the soft tissue (connective tissue) injuries like disc and ligament failures that cause either localized or regional pain get the lowest priority as they are not life threatening (as it should be). These doctors also do not have the time to delve into multiple layers of history in non-life threatening scenarios and simply want to clear out their ER for more serious cases because they are too often overburdened and understaffed. This is usually done at the expense of an in-depth history.


The end result: an incomplete record of all of the complaints. 

SOLUTION:

When you start care, collect all primary care information during your intake procedure and send the primary care provider a complete “type written” report on your patient’s condition, no different than any other specialist so the primary care has a complete record of your visit. Go through the same process for each re-evaluation. In addition, just prior to writing a narrative, I would also request the records from the primary care providers along with all of the specialists for the span of your treatment dates to ensure accurate record keeping and leaving no chance for a surprise. 

Many doctors nationally have employed a “Case/Records Coordinator.” This person is responsible for gathering all old and current records from every provider that treated the patient during the time frame from the accident to creating the narrative. When all of the records are compiled, the Case Coordinator looks for inconsistencies in the records and alerts you to what is deficient in your records to ensure completeness. You then have your records sent to the other providers requesting an amendment in their records to reflect an accurate and compete history. 

One doctor in Georgia over the last few years followed the program and averaged 27 new cases per month. Once the doctor instituted this program he averaged 42 new cases per month for over a year. He started with all of his current cases and made a point for him and his Case Coordinator sit with every lawyer to show them what was being done under the banner of complete and accurate records. Lawyers realize that a lack of coordination of records “bites them in the ass” when it comes to settlement or litigation. 

All the Colossus documentation will mean nothing if the case is summarily dismissed because of inconsistencies in the records. AND… It is not unreasonable for a payor to circumvent (not pay) your bills, or order an immediate IME as a result thereby reducing your ability to get paid for fair and equitable services.

LAWYER COMMUNICATION:

This is a key “talking point” with an attorney in a meeting. Let them know you take these “pro-active” steps to ensure that accurate records are being kept. The lawyer will realize that you understand the process at a much higher level as this is one of the biggest pitfalls for personal injury lawyer. It is also an ethical and “quality of care” step to ensure collaboration at the highest level.  

Script: 

“Our office functions as the “coordinator of documentation.” What that means to you is that we gather all of the records from co-treating doctors as well as records from our patient’s primary care doctors during the timeframe of treatment post-trauma until the narrative is written. Our goal is to ensure accurate and complete accounting of the patient’s complaints. Our office will be sending a copy of our reports to all specialists and primary care providers our patients treated with during that timeframe. Any inconsistencies will be brought to the attention of the co-treating doctors with the request to amend and complete their records.”