Perhaps the biggest source of frustration and potentially the greatest achilles heel for many chiropractors is their chiropractic documentation. I have yet to meet a single chiropractor who actually likes taking notes or would acknowledge documentation as a highlight of their professional responsibilities. In short, NONE of us got into chiropractic to take notes but all of us realize that it’s just a requirement of what we have to do.
The documentation monster is not unique to the chiropractic profession. Medical doctors, dentists and other health professionals all have to document their services as well. And all have felt a general increase in the notetaking burden due to increasing scrutiny by insurance payers and higher standards of care of held by state board entities.
Chiropractic’s Unique Perspective & Payer Target
But chiropractors appear to be unique in our approach to handling the documentation dilemmas: we are still spending more time kicking and screaming (i.e. whining) about the requirements than seeking solutions to fix the problems and move on. And payers seem to know this because we are getting more audits than our fair share compared to other professionals. Thus, our perspective actually becomes part of our target.
Put another way: a payer has no financial incentive to audit a chiropractor performing a service that will be reimbursed for $35 when a claim from another professional is also submitted for $3500, $35,000 or even $350,000 – UNLESS it is so simple to audit chiropractors that a payer can literally take back 100 claims for $35 with less effort than it can take back one single claim for $3500. A scarier thought is the bigger extremes: that a payer can take back 1000 or 10,000 chiropractic claims with greater ease than a single medical claim.
Now the sad reality is that a payer can actually do both. They can audit us chiropractors AND they can audit others. But the audit process does need to be profitable, so payers target areas where they can win. So in this respect, our biggest chiropractic documentation nemesis is that we just make it too easy to take back (or deny) our reimbursements.
But enough talking about the problem, let’s discuss fixing it. While preventing audits and securing success in post-payment demands is a multi-faceted issue that goes beyond documentation alone, there are three big chiropractic documentation mistakes that we can avoid that will drag us down. Here they are:
Downfall #1: Treatment Plan Troubles
In a recent Medicare training on chiropractic documentation, a representative for the carrier Palmetto (who handles all Railroad Medicare claims nationally as well as regional claims) noted that Treatment Plans were usually “the number one problem area we see in the Medical Review Department.”
This statement astonished me because treatment plans are relatively simple. But it also makes great sense because essentially EVERYTHING you do hinges on establishing a valid treatment plan.
In fact, some auditors can (and do) save massive amounts of time by simply looking at the documentation of your treatment plan (or lack thereof) and denying all of your subsequent visits when your treatment plan is missing or not up to standards. After all, if there’s no treatment plan in place, there’s no rationale for approving any subsequent visits and poof! – all your work goes down the drain.
Fixing Treatment Plan Errors
So step one in fixing treatment plan errors is to simply have one documented at the start of care.
Baby Step 2 is to then make sure that your Treatment Plan has all the required components.
For most payers, these follow a simple format:
- Treatment Type: (what your care will include – ex: chiropractic adjustments, modalities, etc)
- Frequency: (how often you will see the patient – ex: 1x/week; 3x/week, etc)
- Duration: (how long the plan will last – ex: for 4 weeks, for 30 days, etc)
- Goals: (what the purpose of your care is – ex: to reduce pain, increase ROM, etc)
- Measures: (how you will measure the achievement of that goal)
Honing in on the Danger Zone
Over the years, I’ve lost count of how many chiropractic treatment plans I have reviewed as part of audit defense or proactively for clients, but it’s easily in the thousands. In my experience, most chiropractors are adept at the first three elements of a treatment plan: they say what they will do, how often and for how long.
After that, the majority of chiropractors unfortunately fail to list any goals. Even fewer document objective measures for those goals.
And for the chiropractors who actually do regularly include goals or measures, the chief shortcoming appears to be the fact that their goals and measures are dangerously generic or static. In other words, the goals are always something like “decrease pain, increase function.” Yes, technically speaking that’s a goal (and better than none at all) but, picky payers want you to do better.
So again, Baby Step 2 in improving your Treatment Plan is to make sure you’ve got all the parts together.
Admittedly, the parts of a great treatment plan are not complex, so for some chiropractors, there’s another problem emerges: how to assemble those parts in an efficient and effective way so they get documented all the time. We’ve been using a system called The Three Tiered Treatment Plan™ with my private coaching clients to make sure that Treatment Plans are solid and set to help you achieve medical necessity and I will be teaching this framework at my upcoming Smarter Chiropractic Seminars.
In the meantime, tune up your Treatment Plans to make sure you are not committing Chiropractic Documentation Downfall #1 and keep an eye out for more posts this week where we will dive into more details to conquering your notetaking nemesis!