Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 164

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.

“What Documentation Insurance Companies Get”


Many of you are confused as to what to send to the insurance companies. I have heard the argument that, “I speak to the carriers all the time and they want everything,” or “The patient doesn’t have a lawyer and I want to get paid, so I will do a full medical-legal narrative and send my bills in with my CV,” or “I want to get paid, so I will send my narrative to the insurance company along with the lawyer.”

 

For those who believe that sending any narrative or CV to the carrier will get you paid quicker or at a higher rate, you are delusional. What the carrier needs to make a determination on paying your claim is a full evaluation report. You must include all of the elements required for the level you have billed and you must have the report available for review upon request.

 

NOTE: I never subscribed to that theory. I always sent in my evaluation report with my claim. If I sent it electronically, I always mailed my report separately to the carriers. I believe in transparency and when I started this practice, my denials were less, my inquiries from the carriers were less and my income increased. This was in a high volume office and it was the norm for every financial class with the exception of Medicare.

 

The reasons you don’t get paid or payment is delayed is not that the carriers do not have your narrative or CV, it’s because your evaluation reports are incomplete, as a rule. Do you have all of your recommendations, including x-rays, MRI’s, and referrals to specialists? Do you have a prognosis, short term and long term goals and a precise treatment plan? Do you have disability status and a complete diagnosis for every area that you are going to treat? If you don’t, create a document that satisfies all of the above. If you can’t figure it out, purchase one on the “Forms and Templates” section of the Web site at: http://lawyerspiprogram.com/index.php?option=com_content&view=article&id=295&Itemid=60.

 

When you send in a narrative report to the carriers, you are doing the job of the lawyer and that is not appropriate. A narrative should be done at the request of the lawyer for the purpose of a legal action against the offending party that will be defended by the carrier. With that being said, the next question you should ask is why do you create a narrative for the lawyer without a request in all of the previous consultations? The answer simply, if there are injuries and the patient has a lawyer, they will need the narrative and you are efficiently providing them with one, as you understand their needs.

 

NOTE: In order to give the lawyer any documentation, you must have a records release from that lawyer on that specific patient in your files. Be sure to ask the lawyer for the document to be faxed over immediately. Without the record release, it is improper and you can have confidentiality issues.

 

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