Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 1110
Lawyers and Medical 64 L

From the Desk of Dr. Mark Studin
Academy of Chiropractic

Preamble: Many of the issues I bring to you are very 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 more importantly, focus on the bigger issues...a larger practice and more family time. -Mark Studin 2006

"I am having a deposition and I realized I made mistakes in my records"


Dr Studin: So tell me again briefly what's going on and what you found.

Guest Doctor: Well, I have a deposition coming up next week and also I have a phone call today with the attorney to kind of prepare and to go over the deposition. So last night I started reviewing the patient's chart and I have an integrated office, so it was already seen by an Ortho first, then referred for PT, which I have PT in my office. So the patient is doing PT.

Dr Studin: When you say integrated, you have Ortho in your office?

Guest doctor: I don't have an Ortho. I do have a medical pain management and then I have PT and I've Chiro. So this is this particular law firm likes to refer to Ortho first. So it was referred straight, fresh case to an Ortho. Then Ortho recommends physical therapy. So then they come into my office for PT.

Dr Studin: Have they had chiropractic care?

Guest doctor: No, they haven't.

Dr Studin: Why have you evaluated them?

Guest Doctor: Because this particular law firm, I have not educated the value with this particular law firm. They like it to go straight to Ortho right after an accident.

Dr Studin: You are missing my point : The triage went from orthopedic surgery to physical therapy. Why does a chiropractor evaluate the patient when the triage was orthopedic surgery reporting to physical therapy?

Guest Doctor: This particular law firm, they believe that if it's seen by Cairo it devalues the case.

Dr Studin: Still didn't answer the question. You're telling me why? Yeah, I understand that. That's some lawyers, don't get it and they don't understand and I get that and I get that needs to be worked on, educated, that parts of process. But you still didn't answer the question. You're on the witness stand doctor. The patient was first seen by an orthopedist. The orthopedist referred the patient to a physical therapist. Doctor, can you please tell me why a chiropractor was even involved in this process if there was no referral to Chiropractic?

Guest Doctor: The patient was treated in my office, not getting better and wanted to try chiropractic. So then the patient wanted to see me.

Dr Studin: So the patient independently chose to see you because there was a chiropract physically in the physical therapist's office.

Guest Doctor: Correct. And the patient was not improving.

Dr Studin: So the patient independently, because you're in the environment, chose to see you. Now doctor, the patient filled up all new patient forms for you? Yes or no?

Guest Doctor: no.

Dr Studin: So the patient is still on the physical therapy care. But now they're just seeing you, but they're not starting as a new patient with you?

Guest Doctor: Correct.

Dr Studin: So when you saw them on your first day, did you build a 99203 or 99213

Guest doctor: I built a 99203.

Dr Studin: You did start with a new patient, but you did not have new patients documents filled out. Doctor, is that a licensure violation?

Guest Doctor: I'm going to say no because since we have an integrated office, we have the new patient paperwork to the patient fills out one time.

Dr Studin: So doctor, did you review the new patient information?

Guest Doctor: Yes. they filled out in.

Dr Studin: Doctor, Did you sign off on that? Yes or no? Acknowledge it. Doctor, did you make a notation in your notes that you reviewed the new patient documentation? Yes or no?

Guest doctor: No

Dr Studin: So doctor, does it take more time to review new patient documentation?

Guest Doctor: It does.

Dr Studin: And doctor, did you comment on your 99203 and EM report that you looked at the new patient documentation?

Guest Doctor: No.

Dr Studin: There's a lot of issues going on here. So the question really is, is did you look at all the new stuff? So you've got a standard of care issue right now where, you say integrated practice, I'm all for certain types of integrated practices, but this sloppy type of work that will cost you everything you've ever worked for. And if you get an even a slightly good lawyer, these are the things you need to be prepared for. we'll talk about how you prepare for this, at a different time. Now on the first visit when you saw this patient and you build a 99203, did you evaluate the patient? Yes or no?

Guest Doctor: Yes.

Dr Studin: And did you do a complete 99203 evaluation that you build for yes or no?

Guest Doctor: Yes

Dr Studin: And a copy of that report is where?

Guest Doctor: that's in my EMR system, That's in the attorney and the opposing turns, they all have my records.

Dr Studin: So you're 99203, You did, and I haven't looked at this, just asking. I will find chief complaints in your 99203?

Guest Doctor: You will.

Dr Studin: I will find history of present illness?

Guest Doctor: Yes.

Dr Studin: And I will find a pretty robust review of systems?

Guest Doctor: Yes, with past family, social history, all of that.

Dr Studin: So now there's no compliance issues and with full recommendations of what you need, how often, how many times, what modalities, with long-term goals. It's all there.

Guest Doctor: Everything is there except for two things. One is I ordered an MRI on this visit because they were not in prison with PT I did my exam, I made it an idiotic mistake where I kind of finalize the note. I did the exam, but my exam portion is not on the visit note that I build a 99203 for.

Dr Studin: So in other words, you did everything you needed to do, but you don't have the examination in there. So you said you did an examination, but you don't have the examination there?

Guest Doctor: That's correct. That's this until I have a deposition.

Dr Studin: it's a very easy question, but it's a process to get to the answer , then that process you're going to find the solution. So you did so doctor on the first visit and the 99203 visit your first encounter with the patient, you did a physical exam on the patient, correct?

Guest Doctor: Yes.

Dr Studin: And so you're telling me you did not document that on the first visit?

Guest Doctor: I did not.

Dr Studin: So you billed for something you didn't do ,because all that matters is what's in writing. Does it rattle what you said? It doesn't matter what you did, it only matters what's in writing. So technically you built for something you didn't do. Now, from what I understand that our prior conversation is, you actually did for some strange reason, it got posted on the subsequent visits. Yes or no?

Guest Doctor: Yes.

Dr Studin: The entire physical examination got posted on the subsequent vision visit. Doctor in your procedure who you or your staff enter the information in the EMR?

Guest Doctor: My staff

Dr Studin: Your staff does. So what you're telling me doctor is your staff took this piece of documentation And answered it on the second visit. Doctor, do you physically sign, you'll reports?

Guest Doctor: I do.

Dr Studin: Doctor, did you sign the 99203 without this, the examination on the first visit?

Guest Doctor: Yes.

Dr Studin: And you missed it?

Guest Doctor: I missed it.

Dr Studin: The easy fix is you tell the lawyer that there was a database, there just a data entry error from one of your staff members that you missed it. The staff put the examination on visit number two ano not on the visit number one. So what you want to do is Re-do that document now. Make a note that in reviewing your notes you found a data entry error. None of the information is changed. It was just posted on the wrong visit, the current report and you make on the actual first visit report. the current report dated Today May 9th reflects the encounter or what happened during that encounter and also send it to the insurance company, saving fraud issues at that level and let the lawyer know that you found an error. he might not be able to get it entered into evidence. What you're letting him know right now that there was a data entry error and you found it, none of the findings have changed. Zero finders have changed. They were just placed in visit number two vs visit number one. And you're also letting the insurance company know it was on visit number two vs visit number one. Now that's not your biggest problem. This is just the data entry error, your biggest problem is that you are not memorializing that you review the information and your EMR, your new patient information, all the stuff that do, how does anyone know you looked at it? You don't electronically sign it. You don't comment in your report, in your report you should say I have reviewed the patient's information, the intake but, I would also like you to sign off on it and initial because when we have our doctors work in the transcription service, they work off a paper and take the patient or some offices have electronic and there's a place for the doctors to check on there. it's like touchscreen. You need that. That will protect you. Cause right now this is not your biggest exposure. This is I made a mistake. It's a technical error, database. You have to let the carriers know because if not it becomes a fraud issue. You didn’t do an EM you left the E out, you've got to get that done and then the lawyer can fix us in deposition. Nothing has changed. You'll have an embarrassing moment with a defense counsel. Doctors is your normal practice doctor, He could say you offer them the sloppy you signed your name to it and your answers. I made a mistake. The exposure again was with the carriers right now in this patient, because you didn't do the work that you say on paper, even though it's done, but moving forward, you've got to ensure that you memorialize somewhere that you've looked at that initial information. The regulations say you don't have to Re-do a review of systems. You can rely on what the patient reported, but you need proof that you looked at that.

Guest Doctor: So I'm on my patient intake, I need to be able to write the initials to show that I review the actual paperwork of new patient paperwork. Then in my EMR is reviewed intake paperwork somewhere in my EMR system as well.

Dr Studin: Correct. What EMR you use?

Guest Doctor: Practice studio by micro four.

Dr Studin: The first thing you do, Compliance review that you see. Again, this would all have come out in a compliance review. I only care if you have to give everything back and then threefold. I met with the lawyers for Geico and state farm yesterday. They had a meeting with them. I'm going really in depth meeting is we're still a family contact. Geico now has a huge amount of Rico lawyers and you don't hear about that, they're really playing at a much higher level right now. And they found out how to get money from us at a much higher level and the reason they do Rico, which is under the Federal Racketeering Act, is you get trouble damages three one, I've been involved in Rico cases defending other doctors. If you are being brought down for Ricoh racketeering charges, how many friends would you tell? Zero. And the carriers are banking on that. So the point is that the compliance review is number one, it takes three to four years of going through trial to get there and losing sleep and having your practice destroyed. We solve it with compliance review.

Guest Doctor: I will actually fax, I'll follow your instructions I promise.

Dr Studin: You don't have to cross the patient's name out. I'm a under the HIPAA umbrella also, so we're all covered and faxing is good, but I have the HIPPA compliant fax portal. If you're going to scan an email, which you can do, you have the HIPAA compliant email.

Guest Doctor: I do.

Dr Studin: Excellent. Then scan an email versus faxing. It's easier for me. Listen, call me if you have any other problems. 

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