Academy of Chiropractic Personal Injury & Primary Spine Care Program
Quickie Consult 247
"Coding, Diagnosing, Insurance Carriers and Bullcrap...aka FRAUD"
Yesterday, a young doctor, in practice 8 years who runs a clinic that treats 500 patients per week, retained me to consult him for 1 hour. It's all he wanted and all I would accept as I choose not to stand by this doctor as he will shortly go through the process of hiring health care lawyers and criminal lawyers to keep him out of jail, first, and then keep his license, secondly.
He purchased forms on the Web and needed help implementing them. Prior to me, he retained 2 separate compliance experts for over $10,000 each. I told you I was a bargain! The first thing we reviewed was the evaluation form. He fought me every inch of the way to NOT do any orthopaedic or neurological testing. All he wanted to do was list pain levels and visual range of motions because anything else took too long and he wanted the patient in and out. Then he wanted me to teach him how to only write a focused report, ignoring all of the patient's other "reported" complaints and then diagnosing only the single primary issue. He stated that his previous consultants showed him how to only report 1 issue at a time to "fool" the insurance carriers so they would pay the maximum amount for 1 diagnosis. He would then wait a little time and submit a claim for a totally new issue with the secondary problem as the new primary complaint. One heck of a scheme! My advice to him was to report all findings, add to his evaluation that he was currently treating only one area and on his SOAP note simply diagnose the area treated.
Honesty and transparency accomplish the same things. There is no need to create a fraudulent scheme to get paid. Do it right and fight within the rules. A licensure board will certainly have a field day if you do not document the complete history and clinical findings, including the past and current history of your findings. Do it right and never have any issues because your documentation is complete, accurate and not designed to defraud anyone. TRANSPARENCY is the key which is why I always sent my evaluations and SOAP notes with every claim. No one ever had to question my findings or notes and this is the best way to ensure NOT getting audited. If they have everything, what are they going to ask for?