There’s a potential Achilles heel in chiropractic documentation that I’ve pointed out over the years in my seminars and webinars.
Though this oversight is a huge one, it’s been a “theoretical” crack in the pavement…until recently.
The trouble is your chiropractic technique and it’s ability to get you in a whole lot of hot water.
To be specific, I’m not talking about malpractice concerns or your technique’s ability to get people well according to research, peer-reviewed studies or the common opinions of your chiropractic colleagues.
What I am talking about most urgently is how your technique can turn into an audit trap that can cost you thousands in post-payment demands.
Background
As many of you know, my background as chiropractic’s first professional medical auditor (CPMA) has given me a substantial amount of perspective and, with it, work assisting chiropractors who are in all sorts of audit trouble (as well as their attorneys, at times, who are attempting to help them fight the battle).
To date, the majority of my chiropractic audit defense work is focused on chiropractic billing concerns, improper coding issues, insufficient documentation and unfortunately, allegations of fraud.
In these contexts, chiropractic technique does not come up much, if at all.
Yet, over the last several months, an increasing (and disturbing) trend is emerging during my chiropractic audit consults with chiropractors who are trying to strategize how to respond to their audit concerns.
The Disturbing Trend
Here’s the disturbing trend that’s emerging:
Insurance payers are starting to demand their money back if you use the “wrong” chiropractic technique.
Your next question probably is: what defines a “wrong” technique?
In the days long gone by, the determination of which techniques were “approved” by insurance payers and which were deemed “experimental” or investigational (and therefore, non-reimbursable) was relatively simple. If the technique was taught at a chiropractic college, it was generally approved as an “accepted” technique.
Over the last several years, payers started changing policies and narrowing the definition of investigational. Some payers state that the technique must be taught as a required component of chiropractic education; thus making techniques taught only in elective courses subject to the “experimental” label.
And progressively, some payers have tightened the belt further than that by labeling certain techniques as investigational even though they meet the above requirements. Their rationale is typically that these techniques are not substantiated by research and are therefore “experimental.”
What’s Really Going On
This “experimental” label is quite ridiculous, especially when you look at the list of techniques that get put on the investigational list.
In this elite group you have techniques such as Chiropractic BioPhysics® which is arguably the most researched chiropractic technique in the world and easily has enough research to choke a cat.
And let’s not forget the Activator Methods® technique whose mountain of research dates back decades and includes studies analyzing the effect of Activator adjustments on (not cats but) dogs and, of course, humans too. But alas – you guessed it – Activator gets deemed “experimental” in the payer’s perspective.
The “experimental” list goes on: Active Release Technique? FAKTR? SOT? Atlas Orthogonal? Yep – all investigational!
Worse, the investigational list also extends to procedures, instruments and other devices as well: Kinesiotape? Wobble chair? ProAdjuster, PulStarFRAS? All experimental!
In fact, a quick look at the list of investigational techniques and procedures from some payers will reveal that just about every major technique or procedure used by 90% of the profession is on the list.
Here are a few examples:
Aetna’s Chiropractic Policy & Investigational List
Optums’s Policy on Kinesiotaping
Premera BCBS Chiropractic Policy
What’s going on here?
Besides boiling the blood pressure of the researchers and founders affiliated with these techniques, what’s really going on with payers labeling these techniques as investigational?
If you examine the list of techniques you will quickly find one common element: they are “brand name” techniques with an identifiable process or set of procedures and an even more identifiable band of loyal followers who go to their seminars, obtain certifications and/or build their business on the backs of these brands.
Seen from another perspective, they are easy to target. After all, there’s no convention nor conference nor credentials for “diversified” doctors (beyond the DC initials), but there is for those who utilize these brands.
And that’s where the madness and the mistakes begin.
The Insanity of Investigational
As you study this issue, what quickly emerges is the fact that these techniques are no more investigational than any other chiropractic technique – and, in many cases, are much more rigorously studied. This is, after all, why many of these technique brands thrive.
What’s even more ridiculous is that some of these brands do not actually have a proprietary adjusting technique; instead, they incorporate various adjusting styles into their protocols. For example, a CBP doc will undergo training to use their methods of postural and x-ray analysis, but they have the freedom to incorporate diversified, drop-table and other (apparently non-investigational) techniques into their toolkit. But in the end, their work gets labeled “CBP.”
And for many “brand name” technique-heads, they wear this label as a source of pride. It differentiates them from other docs and distinguishes them for their accomplishments, certifications and additional study.
When the Label Turns Into An Audit
But the technique label can also quickly turn into an audit threat.
An insurance company can declare your label “experimental” and slap your label on a list of investigational techniques that do not qualify for reimbursement and whammo — now you are suddenly at risk.
There are at least two fundamental flaws in this audit attack, however:
- The “experimental” label does not truly apply in all cases: as mentioned above, some common techniques that get labeled investigational have a ton of research. In some cases, they may have more research than “non-brand” techniques.
- The label is not actually a documentation requirement. In other words, you are not required to document the “brand” of technique in your notes. You do because you are proud of the label and because you may identify with the label; but again, it’s not mandatory. Think of it this way: if you were to purchase a gym ball / exercise ball, would you have to write that it is a “Swiss ball” a “Valeo brand ball” or (heaven forbid) a ball you purchased at WalMart (that is serving you just fine!). None of you would document to this level of detail, nor would it be sane to do so. Well, what’s the difference with the technique?
Avoiding the Technique Trap
Here’s my quick and easy solution to solve the technique trap:
- Be aware of payer policies and their investigational list. Research your top payers and find out who or what labels are on their “bad list.”Ignorance is no excuse. And if you are armed with this information, you have choices to either not utilize the technique or…
- Do not document “brand names.” At best, using the brand name in your documentation is only something payers can use against you. At it’s worst, it’s manipulative hogwash which is inconsistent with other requirements for proper documentation.
- Describe the service, not the brand – If you are providing a service, using a procedure, instrument that is somehow listed as “investigational” describe the service you are providing. Back to our gym ball example, it’s more important to document that you are increasing lumbar ROM, increasing flexibility, etc than describing what brand of tool or technique you used to do it.
Why You Need to Do This Now
Here’s the bottom line. Once you understand the problem, the solution is very simple. But I know some chiropractors are reluctant to change, unless forced. Well, as I mentioned at the start of this article, up until this year, the “technique trap” was a theoretical problem that I routinely warned my fellow chiropractors about.
But unfortunately, here are a few quick cases (names withheld) to illustrate how deadly this trap can be:
- A California chiropractor received a post-payment demand of $85,000 for services determined to be investigational because of the use of Active Release Technique.
- An Illinois chiropractor received a post-payment demand of $59,000 for services performed with Kinesiotape
- A Washington State chiropractor received an audit due to his use of the “Wobble Chair” in his practice and a request to repay $213,000.
Fix this fast so you won’t be the next chiropractor calling me for chiropractic audit help for this potentially messy, but easily fixable problem!
