Documentation: The Easy Button - Chirosecure Malpractice Insurance

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Hi, I’m Dr. Mark Student, and together with ChiroSecure, we’re going to bring you some incredibly timely information that has to do with the documentation and reimbursement world. There are so many things going on and so many changes that if you don’t understand, you could find yourself, one, not reimbursed.

Two audited or three even worse with a lawsuit. So what I first need you to understand is how the system works specifically with the courts. And unfortunately, most doctors don’t understand that we’re a rule of a country of laws with certain rules and the carriers use those rules to leverage you. To neither not pay you or to get your money back threefold.

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I’ll talk about that in a moment. And everything boils down to documentation. And I can tell you when I practice, then I’m not suggesting anyone do this. I saw 650 visits a week. My documentation was not what I would even accept as acceptable today. I wouldn’t do it. It’s what I did was just not right, but I didn’t know any better.

No one ever told me. So documentation as I evolved and grew up as a chiropractor, I realized that for every area you touch in a soap note, you need a symptom, an objective finding, An assessment, which is your diagnosis and your prognosis, and the plan, which is what you did for the patient, or what’s changing.

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You need that for every single visit. Oh, I did the diagnoses on the first visit, I don’t have to do it again. No. That is incorrect. You need a subjective, Objective finding, assessment, diagnosis, prognosis, and plan what you did on every single visit. Non negotiable. Non negotiable. If you want to stay out of trouble, you do those.

And I just did a statistic last Sunday, which is a few days ago, and as three out of four of my kids are returning, I get on the lawyer search engine. And in the past four years, one out of approximately every 60 to 100 chiropractors have been sued in federal court. That is just an overwhelming number. Think about that.

In any industry, one out of 60 to 100, are sued in federal court. This isn’t, oh, the sky is falling or anything like that. But the carriers have a program called Fraud for Profit. And they want your money. And they want it threefold. And they don’t care if they take your house, your office. They don’t care.

They’re heartless. It’s just business. And they’re really good at this and they spend a lot of money to figure out how to make money from you and get it back. If you use my formula for the soap notes and Mark’s hard rule, For every area you touch, you need a symptom, a clinical finding, and a diagnosis.

Symptom, clinical finding, diagnosis for every area you touch. And that goes on every soap note. You will keep yourself out of harm’s way, provided you do all the other things right. Now So what the carriers do, and you have to understand the game, and it’s not just the carriers, it’s the licensure boards.

Oh, I’m afraid of the carriers, the big bad wolf, they’re gonna huff and puff and blow my house down. The number one area where doctors get in trouble is on cash patients, not insurance patients. If someone claims to the insurance company, they’re gonna make a financial calculus. Of what it’s going to take to go after you, and are they going to make enough money?

So you’re insulated there. Especially if you’re, you’re seeing about 100, 120 patients a week. It might not be worth their while. But the number one area of complaint are cash patients. Who’s the only person they have to complain to? It’s the licensure board. That’s it. It’s the licensure board.

And by law, every complaint has to be investigated by the licensure board. They’re always understaffed, and they’re always quick to judgment as a result, and they rarely judge in your favor. So they’re going to come after you with a vengeance. And instead of saying, we want your money, they’re going to say, we want your license.

And that’s what they do. And I’ve been through this with too many doctors where they’ve come after their license and they take your money, they give you a steep fine. So you don’t want to get stuck between anyone’s crosshairs. You don’t want to go to jail. You don’t want to lose your license. You don’t want to get audited.

Look, I’m married 48 years. I don’t want to win the fight with my wife. I just don’t want to have it. That’s it. I just don’t want to have it. And you don’t want to have a fight with anyone in practice when it comes to your license, your money, because. It’s really easy to sorry, my phone was supposed to be on mute.

It’s on mute now. I apologize. Okay, so it’s really easy to get yourself stuck in the crosshairs. It’s really easy and we’re going to ensure that you’re not. So follow the hard rule for every area you touch. You need a symptom, a clinical finding, and a diagnosis. But should you get to the carrier’s crosshairs, Here’s what they do.

The mantra for the carriers is predetermined treatment plans. That’s their mantra. It’s been that way for many years. Because three or four of my kids are lawyers, I get to use their search engine called LexisNexis or Westlaw, just like we have PubMed and Ovid for research articles. They have law review searches and I could look at legal cases and I could read, I actually read them.

And then there’s something called PACER, which is federal complaints you get to read. The full context of the complaint and the predetermined treatment plans are the mantra of the carriers, meaning 98 percent of your patients get x rays, 97 percent of your patients get cervical lumbar adjustments, 94 percent of your patients get cervical thoracic lumbar, 92 percent get e stem and on and it’s considered predetermining and not patient centered.

So if you’re using muscle test and range of, oh by the way, if you’re not x raying your patients. Then they get to say it’s basically upon palpatory or subjective findings, and when you’re using static emotion palpation, that has failed intra and inter rater reliability. So therefore they’re saying it’s purely investigational, subjective, and it has nothing to do with being patient centered of what you found on the patient, and you’re doing this as a scheme to defraud the insurance companies.

So the insurance companies will typically have an 80 to 100 page complaint against you. They file in federal court. Now you have to have an attorney admit it to federal court, which is sometimes double Those admitted to state court, so then you’re gonna, and by the way, fraud is not reimbursable by your malpractice character.

They’re not doing a retrospective audit, they’re suing you for fraud. under the Organized Racketeering Act known as Federal RICO. So they’re going to give you 100, they’re going to have 100 complaints against you. 99 are going to be pure nonsense. But one’s going to have some reasonable doubt from a normal person looking at this.

So they’re going to submit it to the courts. The first thing your attorney is going to do is they’re going to submit a summary judgment for dismissal. It’s nonsense. Get rid of it. This is just 99. 9 percent nonsense. They’re going to file to get rid of it, but the carrier is going to render an objection to the claim.

You know that one little complaint out of the hundred that might have some reasonable doubt for a normal person? The judge is going to say, you know what? These 99 complaints are nonsense, but that one complaint, I think we should have a jury here because I can’t make a decision from the bench. It’s just too, on the border.

Once you do that, the carriers have won because now you’re looking at three to five years. Of attorneys, of paper depositions, and documents back and forth, and interrogatories, all this legal mechanism. You never even have an opportunity to say, hey, I didn’t do that, or hey, I did this. You don’t get to say that for two to three years.

Once the carriers do that, you’re looking at hundreds of thousands of dollars in legal fees. Because the carriers just want you to settle. Guess how many motions the carriers have lost since the January 1st, 2000. Okay? And we’re now right in the middle of 2024, in four and a half years. The carriers have lost ZERO motions to dismiss.

And I don’t like talking in absolutes, but they’ve won 100 percent of them. You don’t want to get into that fight. Because when you do, after hundreds of thousands of dollars of legal fees, And they don’t care if you have to sell your house, your office, they don’t care what you have to do, your retirement plans, cash in your insurance policies, they don’t care.

It’s a financial calculus on their part in their fraud for profit scheme and they win. So you don’t want to get there. So how do you create, how do you create, A patient centered, objective, demonstrable scenario. There’s a piece of technology called Synverter, which I’ve talked about many times in this platform.

And what that does is through x ray, you get a biomechanical study of showing you exactly where the biomechanical pathology is, which we call subluxation. Why do I call it biomechanical pathology? It’s not a philosophical issue, it’s not that I don’t love B. J. or d. or history. Great. Because it’s something that the entire medical, and no I’m not a medipractor, I mean I’ve been accused of everything, I don’t really care.

But, who’s reviewing these things? It’s usually ortho’s, neuro’s, neurosurgeons, or maybe other chiros that the insurance companies have hired. But usually it’s ortho’s, neuro’s, neurosurgeons, and when they bring their experts in, they don’t understand subluxation. But when you say biomechanical pathology, they understand it really well.

They don’t know it really well, and they don’t like to challenge you on what they don’t know. It’s not a subluxation, because they’re thinking in terms of medical subluxation. So by talking in terms of biomechanical pathology, and yes, we do a chiropractic adjustment, not a manipulation, but when you talk in terms of that, And you’ve got an x ray validated piece of demonstrative documentation.

It’s now patient centered. So I’ve taken that report to the insurance company’s lawyers that work with State Farm, Liberty, and Geico. I’ve sat with them and I showed it to them. I said, you know what, if we had this, we would never bring a lawsuit. Ever. If in fact, on your soap notes, if you have a diagnosis, a symptom, and a clinical finding, rarely would we bring a lawsuit against you.

Those are simple, easy things to do. And by the way, x ray, oh, I can’t take x ray, it’s dangerous. That’s nonsense. You need 500 cervical x rays in one sitting to have less than 1 in 100, 000 negative or adverse effect in the human body. 500 x ray. 57 lumbar x rays or thoracic x rays in one sitting to have less than 1 in 100, 000 negative effects or adverse effects.

Thanks. Because you need a hundred milliserves of radiation, which it takes 500 cervicals or 57 thoracic lumbar. Now, when’s the last time anyone took 57 lumbar x rays in one sitting? Never! I teach in multiple chiropractic colleges, medical schools. Never! Ever! And radiation’s not cumulative.

That’s not my opinion. That’s not my opinion. That’s based upon the American College of X ray physicists, I think, I believe that’s the name of the organization, and the published research, which has been out for years and years and years. So it’s all nonsense. Oh, you can’t take an X ray without weeks of conservative care.

That’s another bunch of crap. According to the American College of Radiology, X rays for just simple low back pain is now recommended. Forget the ancillary pathologies. Forget the choose wisely nonsense put out by the American Board of Internal Medical Providers, Internal Medicine Providers, and which the ACA’s adopted.

It’s all nonsense. It’s all politically motivated. It just has no validity in our industry. None whatsoever. How many times have doctors picked up agenesis of the posterior arch of the atlas, or arthritis which created a host of problems with bone spurs that are pointing in, if you adjust the patient, you can hurt them.

Along with a myriad of other diseases that we see, okay? That’s like saying to a breast cancer patient or a bre a woman, we’re not going to be doing a mammogram on you because you don’t have symptoms of pain in your breast or you don’t feel huge lumps. That’s absurd. That’s going backwards 50 years.

Going back to the dark ages. So we need to look at these things and be responsible. But by doing that, you’re making yourself bulletproof. Now, a couple of other things that make you bulletproof. One is timed elements. When you report modalities. A lot of doctors are reporting the whole minute units. In other words, one unit is 15 minutes.

You need a minimum of 8. Two units is 15 plus 8, which is 23. Three units is 15, 15 plus 8, which is 38. So you’re writing 23 minutes, 22 minutes, 16 minutes. Carriers right now have stopped paying unless you give them clock time. You got to give them clock time. So if you don’t put the clock time down and you just put the whole minutes, carriers are already instructing their claims reps and they’re programming the computers not to pay it.

And I guarantee you that’s going to be a future, not right now. It’s going to be a future center for fraud. So you need to get ahead of it. I’m keeping you ahead of how not to get in trouble. Because I speak to the carriers and what’s going on in there all the time. I read their AOBs. I speak to the claims adjusters.

I speak to the lawyers. They’re always looking for tomorrow’s great fraud for profit scheme to get money back from you that you deserve. All of these things are important. You need to get software that can do those things. The other problem, when you take your soap notes, and you do 20 in a row, and you hold it up to the light, the words are identical.

There’s no change in words, they’re all the same. To me, that is a predetermined treatment plan. That’s an issue. And a matter of fact, there’s a software program out that’s relatively new to the industry that’s called EMR Chiro. I actually wrote it. It took me months. It took me about six months to write that from scratch.

And one of the things we’ve done is make sure that they’re all not the same words. It’s really cool by the way. I’m really excited about that because it’s the only, let me rephrase that. It’s the only program or the first program that I know of that was written and coded and programmed by a chiropractor for a chiropractic.

I had to learn four component languages, four computer coding languages and applications to actually write it up and deliver it. So I’m really excited about that, but nonetheless, There’s a lot going on in the industry, a lot. And you need to, there are many triggers in your reports and your reports have to be great.

Things like vitals are vital. If you have someone that their blood pressure was 200 over 160 and they had a stroke and you didn’t do perhaps a vascular analysis test, like a BRLU or a mains test or a declines test, and they have a stroke. You know what, just might cost you your license.

Malpractice will defend you, but then if a licensure board gets it, so you’ve got to take vitals. And it’s funny. I had a patient back in the early 90s when I first opened up at a home office. She came to my, she called me up. She said, Dr. Mark, I have a brutal headache and my neck, I can’t turn it and I don’t feel well.

And I said, something’s just not right. She was a little bit overweight, not in great shape. I said, go right to the emergency room, then come to me. She says, no, I’m coming to you. I said, no. She hung up, showed up on my driveway. I ran out to tell her to leave, stood up in her car, foamed at the mouth, fell on my arms and died.

On my arms in my driveway at a home office. She had a dissecting aneurysm in my driveway. The ambulance came, they took her to the hospital. The next day, I got a call from the medical examiner. Dr. Student, did you tell her to come in? No. I told her to go to the emergency room. If I did, if she didn’t walk in my office, and if I didn’t do vitals, and then she died there’s a good chance I would have been accused of wrongful death.

And by the way, this was in the 90s when people really hated chiropractic, okay? And the reality is in today’s day and age with so much going on with stroke, if someone dies in your office, you stand that chance. For me, thank God, I had someone listening on the phone who said, go to the emergency room, don’t come to my office.

And the medical examiner called me up and exonerated me. I thought I was going to be arrested, to be frank with you. But if you don’t take vitals and someone has a stroke and dies, that’s irresponsible on your part. You’re a doctor. Being a chiropractor does not exonerate you from being a doctor of chiropractic.

We’re not bone schleppers. We’re chiropractors. Yes, what we do is magical when we adjust a patient. It’s incredible. It’s wonderful. We do all these great things. However, we’re also doctors and you need to protect your patient. You need to know what’s going on. And here’s another thing. If you don’t know, don’t touch.

If a patient has pain radiating down their arm or their leg what’s causing that? Oh, subluxation, bone on nerve. There is no bone on nerve at the root level. We know that. It’s at the facet level. That’s a conversation for a different topic. Let’s just talk about that. Where’s the bone on nerve?

There’s a meniscoid which separates the two facets. When that meniscoid or like a disc between the two facets separates, the facets approximate. The nociceptors on there fire into the lateral horn. When it dislodges, it also affects the joint capsule, which are ligaments, where there’s basidian corpuscles, which are your stretch receptors, urofiti corpuscles, which are your crimp receptors.

And then you’ve got more nociceptors and then gogi tendon apparatus, which all feed into your lateral horn. Then it spills over to the deep deep paraspinal muscles, or which are your appropriate receptors, which then through the pizo ion channels go back into the lateral horn up the spinal thalami tract.

Through the peri ductal greater hits. The thalamus ping pongs off the anterior signal to prefrontal cortex and motor cortex. The cingulate the hypothalamus goes back efer to the spine, to disparate areas across spasm in different places, which is why you can’t. Adjust regionally. You have to find the primary lesion.

Subverter will do that to you. And that creates biomechanical homeostasis. That’s where the problem’s coming from. So the issue is I forgot what the issue was. , radiculopathy. Where’s it coming from? We know it’s not bone on nerve. It’s not the root. From what we’re looking at in biomechanical lesions or subluxation.

We know it’s not that because that’s not the bone on the nerve. So I’ve gone through this litany with a myriad of doctors. If there’s pain radiating down the arm, what’s causing it? Oh, it’s radiculopathy. I didn’t ask you if it’s radiating. I said, what’s causing it? What is causing it? Do you know? How do you know unless you look?

You can start with an x ray, but you’re probably going to need an MRI. Since you don’t know, you’re just guessing. So when you want to send your family member, your mother, father, brother, sister, husband, wife, kids, to a doctor who’s just going to guess what’s wrong with you. Oh, I’m just going to guess, take these drugs.

We’ve castrated medical doctors for years. Just horribly. Oh, all they want to do is drug them up to shut them up. Just give them drugs. What’s the difference between the doctor who’s giving them drugs and you delivering a high velocity, low amplitude threshold of chiropractic spinal adjustment when you don’t know what’s causing this?

Is there a space occupying lesion or herniated disc? Is there a varices? Most of you don’t even know what that is. Is there a myelomalacia? Is there a chorded dema? Is there? You don’t know. Is there epi or is there an intradural epidural tumor? You don’t know. So if you don’t know, what do you treat it?

You need a conclusive diagnosis before you treat. That doesn’t make you anything but an incredibly good doctor of chiropractic. I’ve gotten more new patients as a practicing chiropractor. More new patients. My patients saying, Oh my God, Mrs. Sally Jones told me that you found out what her problem was, that you did all these tests, you did x rays, MRIs, you ordered a nerve test.

No one else did this stuff and you knew exactly where it was. That was the core of my being busy. Along with being good at what I did, but all of us are good at what we do. If you don’t know, you don’t touch. Is that easy? You don’t know, you don’t touch. What’s causing the pain? You need a definitive diagnosis.

You need a diagnosis, a prognosis, and a treatment plan, then you touch your patient. All of these things set you up for predetermined treatment plans, for fraud allegations, for licensure issues. I can’t underscore this enough. And you need to understand how to interpret MRIs. Right now, according to the evidence in the literature and a 2017 research article from Spine, there is a 43.

6 percent error rate in general radiologists interpreting the normal morphology or the morphology of the pathology And by the way, according to myself and multiple neuroradiologists from Harvard, there’s closer to a 95 percent error rate from general radiologists. Yet, you’re relying on it to be correct.

Because general radiologists are not neuroradiologists who spend an extra 1. 5 to 2. 5 years studying only brain and spine. So you should only have a neurorad reading your image. And you also probably don’t understand the requisite slice thickness is needed. There’s protocols in ordering, and imaging companies cut the corners so that you don’t have to so they can get your patient out quicker.

They’re doing less work. It’s a blind item. So all of these things are tantamount to you being a better doctor, getting a more accurate diagnosis. I can tell you since 2012, let me just look on my computer, which is on this side of me. I’m sorry. I’m a nerd. I’m in front of four screens. As of today, from January 1st, 2012, that’s 12 years and six months, we’ve gotten 1, 954, 730 additional referrals into the chiropractic industry because of concluding an accurate diagnosis, because of knowing how to interpret a proper MRI.

And if there is a mistake and explaining and teaching. Where the primary lesion is coming to lawyers, to medical primaries, to medical specialists. And I love reaching into the medical field because they see 95 percent of the population. We see between 7 and 10 percent of the population. A medical primary will get about 25 spine cases a week that they don’t know what to do with.

They’re sending them to PTs. If a PT is the first provider, opiate use goes up 82%. If chiropractic is the first provider, opioid use goes down 55%. If a PT is the first provider for spine, disability goes up 313 percent versus chiropractic. If opioid use goes up, surgery and injections and all of those things go up 56%.

PT is great. I love PT. For spine, they should be the second provider to rehab, if you don’t want to do it. For extremities, they’re incredible. Let them work. They should be, they can be the first provider. Chiropractors do great work. But I send all my extremity work to PTs and I keep all my spine work for me.

The stats are important, the research. There’s so much evidence in the literature sharing all of that information. There’s so much. So what you’ve got to do is know the evidence in the literature. There is a site called the US Chiropractic Directory, www.us chiropractic or https, US Chiropractic directory.

It’s a really bad name for a research portal, but it’s the most frequented website in our industry. It’s gotten almost 23 million hits where people have looked at pro chiropractic literature and it’s all housed there and it’s free. Just go read everything I’m telling you. It’s all evidence in the literature.

It’s all there. So there’s a lot going on folks. There has never been a better time to be a chiropractor. If you’re willing to take your head out of the sand or out of your butt, okay, and really look what’s going on. If you’re struggling with getting new patients, give me a call. I’ll put you on the right path.

It’s just easy. And it’s about becoming a better doctor, not a better chiropractor, because chiropractic works so well that even the worst of adjusters get almost everybody better. It works incredibly well, but it’s being a better doctor and how to position yourself and how to communicate and explain it.

And do not get caught in the crosshairs of the carriers of a licensure board with predetermined treatment plans. Follow my rules for every area you touch. You need a symptom, clinical finding, and a diagnosis. Hey folks, listen, I’m Dr. Morik’s student. Thank you so much for spending some time with me and listening to me ramble about what’s going on in today’s marketplace with respect to chiropractic reimbursement, compliance, documentation helping people, preventing people from having really bad things go on.

And I look forward to bringing it to you more and more. Thank you so much and have a great day.