Do You Make These 5 Documentation Mistakes?

by William D. Esteb

As I’ve spent time with Kathy Mills Chang over the last three years developing our coordinated paperwork system, I’ve become increasingly aware of the precarious situation in which many in the profession find themselves. And it’s not because of the shrinking reimbursement amounts!

Instead, it’s often the result of principled, vitalistic chiropractors brushing up against pain-based, mechanistic insurance carriers. This volatile combination, combined with a heaping spoonful of resentment about having to keep meticulous notes (“I just want to help people!”), and a dash of ignorance (“I must be compliant, they’re still paying me.”), and a pinch of third-handed information (“I was told I had to have an EMR.”) and you have a serious problem.

This has produced at least five glaring documentation mistakes. Which one(s) are you making?

1. Still Using a Travel Card

The truth is you can’t capture the information that insurance carriers expect on the typical multi-visit travel card. Can’t be done.

You’ve living on borrowed time if you use a travel card to record daily visit notes.

Maybe you’re getting paid, but it doesn’t mean you’ll get to keep the money. Just ask any chiropractor who has had to return thousands after a post-payment review audit.

2. Unable to Prove Medical Necessity

If you haven’t conducted the proper assessments and haven’t correctly documented them, you can’t objectively prove your care is making the functional improvements that insurance companies (and Medicare) expect.

True, defining what constitutes medical necessity depends upon which carrier you ask; however, most share the view that meeting the standard of medical necessity requires that the chiropractic service performed be "reasonable and necessary" or "appropriate" in light of the patient's condition.

This places a significant burden on you to objectively prove the efficacy of your treatment plan and to employ the necessary assessment tools.

3. Monthly Medicare Visits

The Office of Inspector General has announced that it will be reviewing the Medicare claims of chiropractors. Especially those who have a history of providing monthly visits to their Medicare patients.

Maintenance is defined as treatment that seeks to prevent disease, promote health, prolong or enhance the quality of life, or is performed to maintain or prevent deterioration of a chronic condition. Once the chiropractic care becomes supportive rather than corrective, it’s considered maintenance. Once further improvement cannot be reasonably expected, the treatment is considered supportive or preventive and Medicare will not reimburse.

4. Leaving Money on the Table

Most chiropractors leave enormous sums of money on the table. Ironic, since these are often the same chiropractors who complain about the shrinking size of the checks they get from insurance companies. There is still plenty of insurance money available to help subsidize patient care. But it will require far better documentation than in the past and you’ll want to stop the practice of downcoding.

Typically, you hear about downcoding as a strategy used by an insurance company to unilaterally reduce reimbursement by reclassifying a procedure. Instead, what many chiropractors do is not fully bill for the work they do, or purposely bill for a lessor E/M code, hoping it will avoid closer scrutiny of their charges.

This “slot machine” approach to reimbursement is costly. Some have observed that with what they had been leaving on the table, they could have paid for their personalized paperwork system in a matter of days.

5. Failing to Dismiss Patients

If you’re one to use chiropractic care as an ongoing lifestyle adjunct, akin to brushing and flossing and getting adequate rest and exercise, you probably imagine that some type of ongoing chiropractic care will benefit your patients. Which wouldn't be an issue if Medicare or an insurance provider weren't involved. But because they are, you must be fastidious about transitioning patients to paying cash the moment further functional improvement seems unlikely.

Remember, the purpose of a health insurance policy is NOT to insure the patient’s health!

Instead, it’s designed to help pay for the treatment necessary to return, as nearly as possible, an insured individual’s pre-incident level of function. It is NOT the responsibility of an insurance carrier to pay for the care necessary to reverse years of patient neglect. Instead, their concern is limited to overseeing the fastest and cheapest restoration of the patient’s functional capability.

More simply stated, if you open a case with an insurance company, you must remember to close it.

May we personalize our chiropractic paperwork system for you and your practice? Upgrade your documentation and collect every penny you deserve!