There has always been a sense that unity would help our profession – to express our views with a single voice, so that the public and the legislature could fully comprehend our desire to serve in our own unique way, as our contribution to the greater good.

The problem was that everyone wanted the one voice to be their voice, and to move aside those who felt differently. Political forces across the spectrum, fundamentalists and progressives and everything in between wrestled to have their opinions be heard, and sadly, none really were, since the energy was too diffused to make much impact. Needless to say, that cannot work, and it didn’t – and that’s where the efforts stalled, with everyone feeling they had the right answer and no one willing to consider compromise and teamwork.

Until now.

For the first time ever, the chiropractic profession is unifying, in an unprecedented demonstration of solidarity. Over the last two and a half years, behind closed doors, the top influencers in the chiropractic profession – leaders of key organizations, colleges, publishers, vendors and consultants – have formed The Chiropractic Summit, an organization dedicated to unifying and advancing the chiropractic profession.

Leaders of the ACA, ICA , Association of Chiropractic Colleges, and the Congress of Chiropractic State Associations sit on a steering committee, whose purpose is to guide and oversee the coordinated work of over forty member groups, including almost all the major players in chiropractic.

In nine meetings over the last thirty months, the last of which was held in Kansas City at Cleveland Chiropractic College , tremendous progress has been made toward identifying the most important issues our profession faces, toward a strategic initiative to position chiropractic effectively in the marketplace. In fact, The Summit worked closely with legislators to sculpt the non-discrimination language in the new health care reform bill, which will ultimately prove to be pivotal in establishing professional parity, paving the way for us to help millions more people.

You will be hearing more and more about The Summit, as we are now ready to provide a form of leadership that both represents and transcends each organization, each of which is important in its own right. This is not designed to usurp anyone’s authority, but rather to offer an overseeing perspective that helps to enroll and engage all teammates who support chiropractic, and coordinate our efforts so our profession flourishes. The ultimate beneficiaries are the people in our communities, who will finally have chiropractic care available for them and their families.

For more information, and to see a listing of all the member organizations comprising the One Voice, please go to www.ChiroSummit.org.

The Center for Medicare and Medicaid Services (CMS) employed a Recovery Audit Contractor to run a 3 year demonstration project from 2005 to 2008 in California, Florida and New York. AFTER paying the contractor and including all other associated costs, CMS had a NET return on investment of $373.00 for every one dollar spent on audits. This program has been so successful for CMS that, by the end of 2010, it will be permanent and expanded to all 50 states. It means that, if you work with Medicaid or Medicare, the auditor is coming.

But this is NOT the end of the story. The rest of the insurance industry has seen the benefit of doing post payment audits, so they are jumping on the bandwagon. Both CMS and the private insurance carriers have been hiring and training an army of auditors.

The auditors are going to be looking for discrepancies between your billing and SOAP notes. First, they check to see if every date of service that was billed has a matching date SOAP note. If there is no SOAP note with the same date, you will be accused of fraud for billing for services that you did not provide. Then they will look at the SOAP documentation to determine [1] if it complies with the insurance company policies, managed care contracts, State law, and Federal regulations and [2] if it substantiates "medical necessity". If anything is not the way they think it should be, you will be told to give back the money they already paid you.

The bureaucrats have gone wild with their requirements, and all of us are stuck having to live up to their standards. It does not matter if they work for some part of the government, were elected or hired, or work for an insurance company. On a daily basis, they are dreaming up new rules and regulations that every practitioner must live by.

Cash practices are NOT exempt. All the State boards have regulations that dictate the contents of your SOAP documentation, and those regulations are revised frequently to agree with, and sometimes exceed, the demands from CMS and the insurance industry. If you give a receipt to your patient, and the patient submits it to an insurance carrier, that insurance carrier has the right, not only by state law but also by court rulings, to audit your practice and demand money from you.

The depth of detail required, and the clarity of understanding the documentation must provide, make it extremely difficult to produce a handwritten record. A proper and bureaucratically approved handwritten record will take a minimum of 15 minutes per note per patient to produce. How many patients can you treat every day if you need to spend 15 minutes per patient on documentation?

Electronic Health Record (EHR) computer programs come to your rescue. The same quality of SOAP note that would take 15 minutes by hand can be produced electronically in a matter of seconds. The right EHR system gives you audit protection. It does not stop the audit from taking place, it just makes sure that you are compliant with all the rules, regulations, laws, and bureaucratic depth of detail requirements in the SOAP note.

Note that the term EHR refers to a complete integrated system that merges SOAP documentation with office management. This is critical to get the maximum audit protection. In a full EHR program, SOAP notes can generate the billing, insuring that the documentation and billing always match, and there is an internal audit report that lets you know if any SOAP notes are missing for specific dates of service. A single entry places data throughout the system, and duplication of effort, such as copying a diagnosis from documentation to billing, is eliminated.

The terms Electronic Medical Record (EMR) or Electronic Clinical Record (ECR) program refer to only the clinical documentation. In the event that EMR/ECR is all that you have, or just separate EMR/ECR and billing programs, then you lose the integration and interactivity that comes with a full EHR system. The result is that you and your staff need to do a lot more work, duplicate many entries, buy and use paper (fee slips, travel cards, etc.), and do not have the audit and collection protections that are built into the full EHR system.

Protect your office today. Use a full EHR program and benefit from all the features it provides. You may not avoid an audit, but you will more than just survive it.