Quickie Consult 1202
Infrastructure 251 I
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
"The Plaintiff IME Process"
"Get paid with a right for settlement information"
Dr Studin: you requested to do a flight divided me, and there are few types of scenarios that come up. Is that correct?
Guest Dr: That is correct.
Dr Studin: this is where you're actually evaluating the patient. It's not just the paper review, is that correct?
Guest Dr: That is correct.
Dr Studin: so give me scenario number one.
Guest Dr: So scenario number one is where the patient is not getting better. They call up the attorney and the attorney gives them my name and I have no records that come to me. It's just the patient shows up and in some of these cases they end up becoming patients underneath my care. But usually there's diagnostics that need to be done. So that's scenario number one.
Dr Studin: Stop right there. You have an issue, because you're licensed in your state demands that you gather all records. So you've got to gather the directives are either from the lawyer or previous providers in order to render a diagnostic conclusion and or make treatment recommendations. So why isn't the lawyer sending records when they recommend this patient over?
Guest Dr: Well that's irrelevant. I can always order the records myself. I'm just saying that's one of the scenarios that works out. These are attorneys, they're not doctors. They don't know what they're doing some times, then the second scenario is where the patient has already concluded all of their treatment and the attorney packages all the records, sometimes even the imaging on CD-ROM and sends it over with a narrative format where there are several questions to do. I know how to examine and manage the patient from a diagnostic and or treatment standpoint. My question for you is using my EMR system, is it appropriate to put the attorney's questions in scenario number two into a separate document that does not go into the EMR?
Dr Studin: When you evaluate the patient, you're going to do a 99245 or 44 or 43.
Guest Dr: Are you talking about the consult codes or the evaluation and management codes because they document a little bit differently.
Dr Studin: It's a consult code. It's an evaluation of the patient with no treatment, so you're going to do that and you could put that in your normal ENM system normal because it doesn't change from your ENM. However you need to generate a narrative A fork. Did you take The testifying course?
Guest Dr: I purchased it and I haven't done it yet.
Dr Studin: You need to do that because then you'll understand this language. You need to do a four corners report or a narrative and the four corners report is the right way to explain it legally, but you need to do that report your narrative report and that's what you're communicate back to the attorney. You save that but you have in your ENM system your normal process of what you did and then you're going to start compiling all of the other documents and everything else that goes in your normal narrative. Now in your first scenario where you evaluate the patient and they might stay on as a patient, then you let the lawyer know if the patient is or is not going to stay on as a patient if they're not going to stay on as a patient, they fall into category two. If they are staying on as a patient, all you do is generate your normal 9920345 whatever you feel is clinically indicated, you will report and send that to the lawyer and let them know that the patient's MMI after you finish all of your diagnostics and treatment and then you will get your narrative of four corners, report to them as soon as you're done. Does that answer your question?
Guest Dr: That answered my question.
Dr Studin: So just to hit the easy button for you and your staff, Anytime a patient is referred over from an attorney, they almost all except if it's a fresh case and any type of PI and EME 2nd opinion, which is synonymous, they're always going to have documents and it's just easy because the lawyers gathered them already. Just request that the documents sent to you just from a logistics and it makes it easy as long as you have that release from the patient.
Guest Dr: you brought up one other thing I want you to clarify. When you talked about making it easy on the staff, When you were doing this in private practice, was there an easy way to figure out on the front end before the whole thing was done, whether or not this was going to be a consult, essentially an evaluation only visit or whether it's getting an evaluation and management?
Dr Studin: Yes. When we got the call in, I will call the attorney a personally I said, listen, I'm calling for two purposes. One to thank you for the referral and two, do you want me just to do a second opinion and render an opinion or if this patient needs additional care, do you want me to treat the patient additionally and then MLI them when I'm done? What are you looking for because you're ordering this. So I want make sure I meet your needs. Now, ethically, it's perfectly fine for me personally want to treat every patient if they need more care, how can I not do that? But that's not the purpose of that person coming in. That person's not coming in for you to help them get better. That person's been sent in for a second opinion on the disposition of their case and their health at that point in time. So you have to ask the lawyer up front, what's their goal? What are they looking for?
Guest Dr: the one that I just had yesterday, I called the attorney up and said, what did you want? He said, I don't know. The patient called me complaining about their doctors. So I sent them to you. You figure it out.
Dr Studin: That's 100% fine. Then you treat as need and then if the lawyer said back to me and he says, I don't know. The patient was complaining. You want to say, listen, I respect our relationship. And I don't want to overstep my boundaries, which is why I'm making this phone call out of respect for your office, and all the warriors going to hear us three times is I respect you, this is a great doctor.