Academy of Chiropractic Personal Injury & Primary Spine Care Program
Quickie Consult 1166
Narratives 92 N
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
"When do I report functional losses"
Dr Studin: what was your question again?
Guest Doctor: What is the time when that functional loss paperwork should be filled out?
Dr Studin: from my perspective, it all depends. The timing for me to insurance carrier, the lawyer reports to me, it all, everything's a little bit different. So when you're treating a patient, first thing you need to do is establish baseline. And that's important for the insurance companies because it tells you it helps set treatment goals and parameters in do they hit that benchmark, are they progressing and getting better, So you could use that and a necessity for long-term care. In other words, the lawyers in the courts, the courts want to see progression. So therefore, the ecosystem for what to satisfy the needs of the court, you really should get a baseline on day one. And then all of that really matters. After that is after a reasonable course of care. [inaudible] what are you EMI the patient, where are they? And again you want to get that to duties under the duress and loss of enjoyment of life, meaning that which I could still do to a lesser degree or a loss of enjoying the life bit and I can only do it after a reasonable course of care and that's the Colossus Algorithm, lawyers and it's interesting because this is something I'm actually lecturing on next, the day after tomorrow I'm going to start at 125 lawyers and I just came up with this for the first time. We can do this with you when we do it with the next time, lawyers actually have to have four practices or four paradox in their business. Number one is initial settlement with the claims Rep. Number two is the claims or supervisor to bump that up to bring it into a level. Level number three is with the attorney pretrial it's still settlement and then for his verdict. So they have to actually prepare themselves for poor levels of encounters to earn money. So when we look at persistent function loss and we were looking through these on the direct and loss of enjoyment of life, that's great for the first shoe paradigms dealing with the insurance companies, which is the claims are up in the supervisor cause that's pure colossus. But once you get into the opposing counsel, this has nothing to do with those things, it's pure courtroom drama, and what really matters is, hey, my guy used to be a mechanic, now he's a service where either we cut his pay 50%, this lady, she can't go to school anymore. She had to drop out cause she can't carry your books or anything headache when she sits there or her back puts too much to sit in class. So when you're looking at functional loss, it's all for the timing of it is all for different purposes. So if you could have baseline on day one you are Golder, what can I no longer do? me personally, we'd be getting middle and end. It's not necessary. I just like to have that extra level of documentation more for The insurance carrier to see, the patient's progressing, but there's more. I hope I answered that question.
Guest Doctor: So once you have that information, does it need to be written into the salt water report separately?
Dr Studin: Here's the interesting thing, once your fizzier dose, and this has been a real challenge for a lot of doctors from a compliance the sentence, you only get paid for the work you do. You don't get paid for the work that patient does. So therefore, you have two choices now. Number one is if a patient writes up and you should have the assumption was watch, if the patient writes that up, you could give it to a staff member and enter to your notes and then it's electronically signed by you about them or you could write it into your notes. And if you do it in the middle of the care, it should be during a Re-evaluation, the other thing you could do with the patient writes it up. You can review it with the patient and sign off on their document. If you don't have the signature on that document, what's your verification that you actually looked at it? That she did the work. So you've got a sum that you do a hundred percent electronic paper with notes?
Guest Doctor: Yeah.
Dr Studin: So you're not going to physically sign anything.
Guest Doctor: I could sign that and then scan it in.
Dr Studin: I'm going to make it easy, you can dictate it in or you could sign it and scan it in or you can even fallback, which is just as good. You can even say in your note and counter in that day, I reviewed the patient's functional loss more with them, please see us patch. But I would still sign with a scanner. Then I like a physical signature because this way some of them don't look at your notes. They can't accuse you of not looking at it, anything a patient fills out, I sign. If they do it electronically, I want them electronic signature or a note in my file, in my report, it might be soap notes, eval, re-eval it says I looked at that. Now what did we do Transcription for doctors? what we do it and we make it super easy, what we do with this transcription services, we give the patients paper forms to fill out. And then on the sheet it says, I have reviewed the patient's intake with the patient. The doctor checks it off and then I have signed the patients form and the doctor checks it off. So if for everything you're looking at that you don't sign, or even if you do sign, you should say, I've reviewed the document reputation check and signed the document always that really covers you. Because again, for instance, like the review of systems, lets get away from functional losses. If you're doing review of systems that are 99203, which is mandatory. If you don't do what it's constitutes insurance fraud because you go for it. If you just look at the patients, this take form and you don't sign off on it. If you don't do your role and don't sign off on it, that's insurance fraud. Your bills will work that the patient did not you did, I looked at it, oh, prove it now give me a hundred report. Give me a hundred of those documents and a hundred those signatures and a hundred, at least somewhere along the way you're going to make that. You're going to put up a note on it. Take more, you’re going to ride over at something and remember, what would it be Reasonable jury with awkward, no more than a high school education belief that you actually looked at every single one has ever made a note. No, it really is simple, easy stuff to prevent yourself from getting into trouble. let's take it to the next step. If you want to look at your functional loss for long-term chiropractic care And that was interesting one. Oh, well there's no more pain. Why are you still treating the patient? Well, the cancer patient has no pain. And how could they have been treated? You're not going to treat them unless they have pain. that argument's stupid. But that's the insurance model. Now you say, all of a sudden there's not many clinical findings, but they still a functional loss, but you notice from biomechanical perspective, now we know that it really is a biomechanical failure. Now you have to document that biomechanical failure in conjunction with function loss, now we'd get into spinal of biomechanical and analyzing that, from a segmental perspective. You could document, and I'm not talking AOMSI on because even the software act this stuff is nonsense, that's just an small stuff. If you could take a whole spot and model and look at that's functional loss and you can document that whole spine model from the function was you get laxing your living. Just show it into biomechanical pathology. Keep that word in mind. And now you've clinically correlate that with, well let's just give it a scenario that the lumbar spine has hassled by mechanics for the Vertebra Demonstrably I could show you the mantra x-ray computer model showing that it's advertly position. My patient can't lean over, so with boxers have lost your job or she has to be out of work and unless I get that file mechanically back, but now they've got the functional loss to tie in with that. You see how it all ties there now?
Guest Doctor: Yeah. And that's another question a couple of attorneys have asked me to write the future care letters. So what happens if you write this letter This patient needs all this care for so many years and then they don't do it. By the time it goes to trial, they never got treated…
Dr Studin: They’re screwed. And you should take the testifying part 2 course, forensic talking to the patient. Three things extensively in that course. One is how to create the documentation that's invisible and lawyer will know that from day one. Number two, how to really handle cross examination, but number three, how to talk about care in terms of timing with trials or depositions if they're not following your recommendation, I guess would problem isn't so bad after all.
Guest Doctor: Yeah, that's what I thought.
Dr Studin: You're a hundred percent correct. you're bringing up a lot of incredibly good points, but hopefully you're starting to see all the dots connected. They're all connected and it just, I honestly could hope a three weeks symposium and all we do, we never leave the room, talking about this stuff. the more you know, the more you realize you don't know, it's just incredible.