Personal Injury


Personal Injury–EHR Wins the Case
Personal Injury
Written by Paul B. Bindell, D.C.   
Wednesday, 11 May 2011 15:54

personal-injury

A
uto accidents, falls and other personal injuries happen regularly. In order for your patient to benefit from your care, and for you to get paid,you must have substantial documentation in your SOAP notes that justifies the care you provided. Due to insurance rules and policies, State Board regulations, and Federal legislation, the depth of detail in SOAP notes must be very extensive. And it must be legible and understandable to claims examiners and insurance auditors as well as attorneys. Many SOAP notes that were considered excellent as recently as 2 years ago would be considered mediocre, at best, and inadequate, possibly indicative for fraud with the new standards that have been established. The answer to this bureaucratic nightmare is an Electronic Health Record system. The bottom line is that Electronic Health Record (EHR) systems are critically essential to the long term survival and growth of your practice.

EHR uses a computer instead of pen and paper. It empowers you to produce a dictation quality SOAP note in a matter of seconds, just by pointing and clicking on the necessary items. The result is a SOAP note that is in English with correct grammar and spelling and contains all the points of information required by law, statute, and policy contracts. Keep in mind that, in most states, and under Medicare, the SOAP note is supposed to be created at the time you are providing the service to the patient, not at a later time. EHR minimizes the time you must spend documenting, so you can concentrate more on patients.

ehrmayHow does this help your practice? A complete EHR system streamlines your practice in many ways, leading to increased income, higher patient visit averages, and greater productivity by your staff. A patient, signed in at the front desk, automatically appears on the doctor’s computer in the adjusting/treatment area. Entering a diagnosis in the documentation end of the EHR instantly places it in the billing area. The services the doctor documents generate the charges for the day as the patient checks out. Since the EHR system is producing the charges based on the SOAP note, the documentation and billing always match. When the patient signs out electronically, the patient’s signature shows that the patient witnessed that the services billed have been provided and that the patient is ultimately responsible for the charges. This provides both audit and collection protection for you.

And, in a personal injury case, you will need narrative reports for attorneys and insurance. EHR systems produce narratives in seconds, pulling the information directly out of the patient file. Thirty-five years ago, when I first began my practice, narrative production was a major challenge, sometimes taking hours to compile all the material. Now, from the time I receive the request, produce the report and send it to the attorney (either fax, e-mail, or printed and stuffed in an envelope) takes 5 minutes or less. EHR systems typically come with narrative templates already built in. Some EHR systems provide you access to the templates, so you can edit and modify them or create your own. Since you get paid for the narrative, and it is the narrative that will make or break the case for you and your patient, it is critical that the narrative provides the substance that enables the attorney to win the case.

Many doctors, when they get busy, will postpone the completion of a SOAP note until a later time.

Many doctors, when they get busy, will postpone the completion of a SOAP note until a later time. For some doctors, “later” never happens. The result is that the note is not produced, even though charges were entered for the patient. If you are one of those “later” doctors, you must now get caught up on your notes ASAP. In order to be sure the SOAP notes are completed, it is imperative to have an EHR system that generates a report listing every patient that has charges but no SOAP note for that specific date of service. This report should be run at least once daily so that the notes are created in a timely manner, while the information is still fresh in your mind. It is important to note that certified EHR systems include an audit log required by the federal government. The audit log tracks every entry, modification and deletion. In the future, when you are using certified software, an auditor or claims examiner will demand to see the audit log. If your notes were created weeks or months after the visit, they will know and charge you with fraud.

When you use EHR as it was designed, it improves the efficiency of you and your staff, eliminates duplicate entries, minimizes the chance of human errors, and increases your income and patient visit average. EHR gives the attorneys the meat and potatoes to win PI cases, and this builds your reputation and practice. The benefits of EHR are available today. Take advantage of them.

Dr. Paul Bindell is a 1975 graduate of Palmer College of Chiropractic, in practice in Rockaway, NJ, since 1976.  Dr. Bindell is a past Chairman of Public Relations for the Northern (NJ) Counties Chiropractic Society. In 1991, Dr. Bindell and his family began Life Systems Software so that the profession would have reliable computer programs based on real chiropractic practice. Dr. Bindell is available to speak to your group or organization and can be reached by email at This e-mail address is being protected from spambots. You need JavaScript enabled to view it , or you can call Life Systems Software at 1-800-543-3001.

 
Personal Injury Collections by State: 2010 Comparison of Collections vs. Cost of Living Analysis
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Personal Injury
Written by Mark Studin, D.C., F.A.S.B.E.(C), D.A.A.P.M., D.A.A.P.L.M.   
Monday, 21 February 2011 13:24

W
hy is a life in Tennessee, South Dakota and Texas worth more than a life in Hawaii and New York? There is really no reason other than the insurance companies and state politici ans that you have elected into office allow it to be. We are a country of laws and regulations and it is these laws that dictate the marketplace and how doctors are reimbursed for their services. In most states, it is based upon the usual and customary fees of the doctors, the carriers paying a percentage of those fees. However, in other states, like New York, the state sets the doctors’ fees and they are driven by politics at their ugliest.

Table_1The collections listed in the following table depict what chiropractors are collecting in their offices as of November 2010, on a per-visit basis for a typical treatment. The numbers exclude examinations, X-rays, supports and any other ancillary services or testing. The sampling taken, although not 100% accurate for a statistician, is an accurate representation of what doctors are collecting today.

Logically, one would think that the higher the cost of living, the higher the level of reimbursement. That is not the case. In fact, New York and Hawaii are two of the most expensive states to live in, yet have the lowest levels of reimbursement nationally. New York, which, in spite of its ranking 46th with regards to cost of living, undoubtedly a result of its vast rural areas, pushes it out of the highest ranking. A 500 square foot office in downtown New York City can cost $7,000 per month to rent, yet the maximum reimbursement a chiropractor can receive is $33.70 per visit and has been so for 16 years, no matter what services the doctor provides. In addition, the carrier sends for an IME after a few visits in order to limit the amount of care, further reducing the doctor's ability to receive fair and equitable reimbursement.

By law, the State of New York sets a doctor’s personal injury (no-fault) fees, as they are tied into the workers compensation fee schedule. After a 16 year absence of any fee increase, chiropractors in New York were just given a pay raise to $46.24 per visit. Over the last 16 years, while chiropractors were reimbursed at $33.70, physical therapists were reimbursed $61.60 and medical doctors were reimbursed $67.60 for the same services by CPT code. The new fee schedule in New York was created without a chiropractor being able to contribute to the political process, yet the American College of Occupational Medicine and large labor unions in New York played major roles in shaping the future of chiropractic in New York.

As a result of the low fee schedules in New York, doctors of chiropractic are emigrating and relocating to other states. Considering that the average chiropractic case, according to Chiropractic Lifecare of America (2009), is $3,799, while the average non-surgical hospital stay is $15,059, spinal surgery averages $77,107 without complications and ranges from $117,901 to $260,584 with complications, not including any doctors’ fees, according to Virginia Healthcare and Hospital Association (2010). For every chiropractor that emigrates in any state, the cost of healthcare is rising.

In addition, a 2004 study by Legorreta, Metz, Nelson, Ray, Chernicoff, and DiNubile compared more than 1.7 million insured patients seeking treatment for back pain. The outcomes showed, when chiropractic care was utilized in comparison to the standard medical approach, the cost of treatment was reduced by 28%, hospitalizations were reduced by 41%, back surgery was reduced by 32%, and the cost of medical imaging, including X-rays and MRI’s, was reduced by 37%. Furthermore, 95% of the patients that received chiropractic care reported in the study that they were satisfied with their treatment. Utilizing chiropractic care as the first treatment option for back pain was estimated to have the potential to reduce US healthcare costs by more than $28 billion annually.

Fair and equitable reimbursements for any provider will determine if a doctor can afford to live in any community nationally, and wise legislators will take into account the above statistics, so as not to be "penny wise and dollar foolish," unlike those elected officials in New York. There are solutions to ensure that this scenario does not happen in your state, but that is a topic for a future article.


References:

1.American Chiropractic Association. (2010). Back Pain Facts & Statistics. Retrieved from https://www.acatoday.org/level2_css. cfm?T1ID=13&T2ID=68.

2.Chiropractic Lifecare of America. (2009). The MESTAT Project.
Learning. Retrieved from http://www.clahealthcare.com/ learning/ index.html.

3.Russo, A., Wier, L. M., & Elixhauser, A. (2009, September). Hospital utilization among near-elderly adults, ages 55 to 64 years, 2007.
Agency for Healthcare Research and Quality. Retrieved from
http://www.hcup-us.ahrq.gov/reports/statbriefs/sb79.jsp.

4.Legorreta, A. P.; Metz, R. D.; Nelson, C. F.; Ray, S.; Chernicoff, H. O.; & DiNubile, N. A. (2004). Comparative analysis of individuals with and without chiropractic coverage: Patient characteristics, utilization, and costs. Archives of Internal Medicine, 164(18),1985-1992.

5.CNBC. (2010). Cost of Living – 2008. Retrieved from
http://www.cnbc.com/id/25501974/.

 
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