[This is Part 2 of a series, for Part 1: How to Save Yourself From the 3 Chiropractic Documentation Downfalls]
In the first installment of this series on chiropractic documentation, we focused on the fact that Treatment Plans are considered by payers to be the #1 reason chiropractic documentation is inadequate. We also addressed the fact that your Treatment Plan has the potential to sabotage all your claims and your notetaking efforts quickly. In this respect, Treatment Plans are perhaps the most “deadly” part of your documentation that could lead to a downfall.
But if the Treatment Plan is viewed by payers as our biggest problem, in my experience, most chiropractors wrestle with Downfall #2 the most. In fact, the reason #2 is a downfall is that some chiropractors struggle with this issue their entire career as they never address the two sides of the same coin.
The problem is elusive because it is really about the “why” of the problem itself. In other words, downfall #2 exists because chiropractors never address whether the challenge with their documentation is a “Quantity” issue or a “Quality” issue.
The Documentation Quality vs Quantity Issue
If documentation quality is ignored, it has the ability to miss medical necessity and get a patient’s care denied. Worse, if documentation is reviewed in an audit, poor notes can result in post-payment demand. In extreme cases, a slew of documentation errors combined with unusual billing and coding practices with no apparent safety net in place for compliance can even lead to allegations of fraud and potentially, a stint in prison. For some DC’s the fear of all of this keeps them awake at night and can cause them to have quite an unpleasant experience in practice.
For others, documentation quality is not the issue. But even chiropractors who believe that their notes are fairly solid can still suffer “notetaking neuroses” by what I call a “Quantity” issue. In other words, their notes take too long. These docs feel like they produce a good note, but at a painful cost.
Chiropractors who labor with documentation “quantity” issues always seem to be behind on their notes. They spend hours per week in between patients catching up. And their documentation projects have a great tendency to come home with them at night or on weekends as well.
Diagnosing the Problem
The first step to avoiding the quality/quantity downfall is to accurately diagnose the problem. Put simply: do you suffer from denials or medical necessity mishaps or audits that you can’t appeal successfully? If that’s the case, you need to work on improving the quality of your documentation.
On the other hand, you have a quantity issue if any of the following are present:
- Your notes are driving you nuts because they take way too long
- You are always seem to be running behind on your documentation
- You complete notes after hours – at home or at the office, nights or weekends – which restricts your free time or cuts into family time
Of course, it’s also quite possible that you have BOTH a quality and a quantity problem with your notes which is obviously a serious issue.
Once you’ve admitted your problem and diagnosed it accurately, the next step is to get to solving it. Here’s help:
Solving the Root Documentation Problems
Unfortunately, some quantity problems are the result of a quality problem (you’re not quite sure exactly what needs to be documented, so you over-document) AND the result of a bad system for documentation that is inefficient.
So yes, it’s possible to have BOTH a quality and a quantity problem in your documentation and when you do, it’s highly likely you know it because on your bad days, your documentation drives you insane, causes you to contemplate quitting chiropractic and keeps you up at night worried.
Fixing Quality Issues
It’s unfortunate that the folks that you are attempting to fix your notes for (payers) are generally completely unhelpful in improving the quality of your documentation. If your claims repeatedly (or even occasionally) get denied for “lack of medical necessity” or “insufficient documentation” or any other such reason, it doesn’t take you long to figure out that these statements are not actually that helpful.
After all, if your patient feels the treatment necessary, what does the payer feel is NOT necessary about it? If your documentation is insufficient, what part of components are missing? Sadly, few payers ever reveal these answers so you must look elsewhere and get feedback from the experience of others who have reviewed much more documentation than you and who have a broad perspective from a wide swath of payers.
1. The single best way to do this is to get out of your office and away from your own perspective and to take a course that addresses documentation issues. I’m partial to seminars like mine that teach documentation as well as other chiropractic billing, coding, compliance and business strategies all in one day – but the reality is that you need to fix what goes into your notes and you aren’t going to fix them alone (else you would have done it by now).
2. A second way to do this is to consume any available resources payers put out on documentation. In this regard, Medicare is probably the most helpful payer as the carriers regularly hold webinars and “Ask the Contractor” calls which address chiropractic documentation issues. Here’s a recent example on Improving Chiropractic Documentation from Medicare. Be on the lookout for similar one from your carrier.
Part of the challenge and the downside about these methods for improving your documentation is that seminars may not be specific enough to help you derive a unique solution for your office. After all, even if the instructor helps you hone in on specific requirements, fitting it into a format that works for you is impossible for them to to when there are dozens of chiropractors who practice differently in the room. Similarly, relying upon payer information to improve your documentation can be hit and miss, as well as generic.
3. In this respect, the third way to improve your documentation is to have a “Preventative Audit” or Documentation Review performed whereby an expert reviews your notes and makes specific suggestions for improvement based on your treatment and documentation style that will help quickly you increase the Quality of your documentation. In the corporate world they call this “Quality Control” but most small businesses like chiropractic practices operate without any such department or controls in place…to our detriment (which is exactly why 99% of our coaching clients take advantage of our documentation reviews!)
Obviously, this method is the most comprehensive and it will require the most investment. As my coaching clients will attest, the investment is quite small compared to the cost of a single post-payment demand for your services. If you view it from another angle, you are literally a set of eyes away from defeating a documentation monster that has been plaguing you for years!
Finally, whatever method you choose to fix your Quality issues will be better than what you are doing now by avoiding them. 🙂
That’s it for Part 2 – next we will address the 3rd Documentation Downfall which is about the QUANTITY of your notes – how to produce better notes in less time!