Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 262

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.

"All Documentation is to be Created Equally"

I just received the following today, 8-15-2011, via e-mail:

"I have become a victim of a Board investigation, still pending, brought-on by a "paper" review done by a past Chairman of the Board of Registration of Chiropractors / turned "IME reviewer" for an insurance company. I believe that my documentation in the case meets, at least, minimal requirements and I should not get anything but a reprimand for the complaint. The case is well-documented and uses Yeoman's Outcomes Assessment Summaries even. I have legal representation but it is difficult to find an expert in my favor based on the peer reviewer's past involvement with our state Board. Can you believe it? 
 Do you do expert analyses in these matters? My case could sure use one! I have a perfect record for practicing chiropractic in MA for over 30 years, concentrating in personal injury. I don't want a blemish on my record, nor do I believe I deserve one precipitated by this character."

As a note, this doctor has already hired his lawyer for too many $1,000's. This is a very common theme for many of the communications and requests I get regularly. Many doctors erroneously think that complete documentation is necessary only for personal injury or managed care. The rule of thumb, no, make that a non-negotiable rule is that all documentation is consistently the same, insurance and cash alike.
A board review can be spurred by an insurance carrier or a patient and the board is compelled to review all claims. This is not the first Massachusetts case I have heard about and I have represented too many doctors as expert in their defenses. In the case of Massachusetts, there is an ex-board member who is representing the board and carriers as expert. Not a unique scenario in the country. The carriers and state boards hire credentials and past board members or state officers who have those credentials and want the money!
I have reviewed subpoenaed documents for validity of this ex-board member's opinion in previous cases. I can certify that he has become the "whore" for the entity, paying his fee with sweeping statements citing one example and rendering an opinion that the entire care for the case was not necessary. That is what this particular doctor does. The bad news is that he is entitled to his opinion, no matter how inflammatory or wrong. As a result, this has become a "boom" for health care lawyers who charge $250 (plus) per hour to defend you and the carriers who get doctors to settle for anywhere between $100,000 and $1,000,000 (usually). You are big business and it ALL stems from your documentation. 
In my previous case, the doctor I was defending, in practice less than 10 years, had to pay approximately $500,000 including legal fees not only because of this whore, but because he had holes in his documentation. As a result of the carrier's/board's expert (whore), the judge felt there was enough for the case to go forward and not be dismissed. That is the only wedge the board or carriers need to drag out the process for years giving most doctors little choice in having to settle. If there are issues with the documentation, it simply gets more expensive in settlement.   
Make sure your documentation is complete for every patient with one standard. There are 4 recommendations I make to ensure compliance:
1. Travel cards are out...They are the #1 target as they are the easiest for a carrier to win in via audit as deemed by the carriers lawyers.
2. SOAP notes must be complete with all 4 components on each visit.
3. Evaluations should be performed at a "5" level each time. You can "down code" if you choose (a stupid business move, but too many of you are timid).
4. Get a voluntary internal audit on your documentation. Get the scoop up front of your shortcomings before it costs you $100,000's.
Although there are many very good sources to get templates and services for the above, here is what I recommend.
SOAP notes and evaluation template, go to:
SOAP template: $50
Evaluation template: $150
Compliance audit: FREE...fax your records to me to: 661-843-1062
Each of the above recommendations have saved doctors from themselves and have allowed most to sleep very well at night provided the recommendations were followed. If these are not good options, find one. The only option that is not good is to do nothing! 
As a doctor said to me last week, I have been meaning to get all of this done, but I am now being audited. What do I do because I have issues? Don't be that person next week who calls me.

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