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Hi, I’m Dr. Mark Studin. First, I’d like to thank ChiroSecure for the opportunity to be able to share this information with you. And today what I’m sharing with you is some very important, I would like to call the groundbreaking, but it should be basics, of what your documentation is either going to do for you or to you.
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Now, interestingly enough, and we’re going to go to the slides now, interestingly enough, I’ve been speaking to a lot of insurance attorneys for insurance companies. I’ve been speaking to claims representatives, a lot of them, and I’m understanding what’s going on inside the industry. I also speak to a lot of people in the licensure board, so this really affects everybody.
Not just insurance patients or personal injury patients, but cash patients as well. And it’s something everyone needs to follow. And really it comes down to your documentation system. Now, too many doctors, and I speak to them all the time, Too many doctors are either working during their lunch hour, after patients, and weekends.
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And I have to tell you, speaking to doctors around the country, I have three doctors this past month who told me that the primary cause of their divorce is them working around the clock. And that’s unheard of. You shouldn’t be in your office around the clock. Your SOAP notes should take you under a minute.
Your EVALs and REVALs, including documentation, should be on average about 45 50 minutes for an EVAL. For a REVAL, maybe half of that. And you also need to understand that you get paid If you follow the rules for the time reviewing documentation before you sit with the patient, whatever they fill out, records, etc, you get paid face to face time, and you also get paid for the time you take to enter into your EMR system.
Now, What we’re going to do, and by the way, you’re going to see me turning because I’m on, I’m a little bit of a nerd, I’ve got four screens in front of me, so when you see this side of my face, I’m looking at the screen. First, usually we fly through this at the end. Please take your phone out, take a picture of that.
If you want to contact me, that’s my cell phone number, that’s my email address. This is the suite of our products. We’ve got consulting, x ray digitizing. An EMR system and academics, but if you want to call me about anything, you just call this phone number or you can tap that QR code. It’s easy. Now, one of the things that I know, how do we know?
How do you know if your documents are compliant? I’m a little bit weird. I read court rulings on a regular basis. RICO cases taken against chiropractors. I look at audits by insurance carriers and I look at their lawsuits. I’m I speak to their claims reps and I do compliance reviews with doctors all over the country and I’ve seen every single EMR system in our industry.
I’ve seen it all. I’ve seen the good, the bad, and the ugly and the reality according to a corporate CFO, and I also am dealing with corporate medicine, which is corporate chiropractic, There’s no real corporate chiropractic other than those companies that want to bastardize our services for 19 a visit and do the bare minimum and even less than that.
I’m not talking about those. I’m talking about the people who use BlackRock, if you understand hedge funds, BlackRock type money, tens if not hundreds of millions of dollars. And you know what they say? There is no EHR system in the chiropractic industry. And they don’t want a 30 or 40 percent return on investment.
They want a thousand percent return on investment. And they’re getting it by using technology. By using technology. And again, I don’t care if you’re in a cash office. I don’t care if you’re in an insurance office, personal injury, workers comp. It’s technology that will drive the day. We talk about AI. It’s winning.
It’s not that it’s taking over the decision making for doctors, it’s trying to, where there’s guardrails to prevent that. But you can’t be staff centered and compete against corporate. And that’s a topic for a whole different conversation. If we look at compliance standards defined by the courts, and the basis for documentation, It’s the Daubert standard, and Daubert is, or Daubert, however you want to put it, Daubert versus Dow Pharmaceuticals from 1993.
It is a federal ruling, and it affects almost everything we do. And the Daubert standing was a systematic framework that the trial courts passed to help the judges assess reliability and relevance of expert testimony. And not just in medicine, It’s about plumbing and electric, electrical work and automotive.
And the best one, if you all saw the movie, My Cousin Vinny, and that, that scene when Marissa Tomei was on the witness stand, this blonde bimbo was a hairdresser. They were confirming her as an expert, an automotive expert. And the district attorney was there grilling her, and that’s, that is a standard Daubert expert witness hearing.
And we all have to abide by that. But that also, when we look at expert, it’s not just the person. It’s the technology being used. So is the technique in theory, has it been tested? Is there standards of control, meaning methodology? Is it subject to peer review? Has it attracted wide set acceptance within our community?
And is there a potential error rate? So all that has to be built in to your EHR systems. Do you have methodology for everything that you do? Do you have a reference for everything you do? And is it a recent reference? Some companies, and I work for the largest, I believe, what I think is the largest EHR system in our industry.
I didn’t work I worked for them a teeny tiny bit, but I worked with them for a decade. And I know that they’ve got macros in there with references. Folks, that’s what they brought me in to write for them. And I did it. They’re all outdated. They haven’t updated them. They’re outdated. They’re outdated.
They’re just outdated. And when you put it in three, four years ago, the carrier has thousands of people seeing the same thing for three, four years. It’s a cat and mouse game. It’s easy for them to change it. So your documentation is critically important because there are three reasons why, number one, reimbursement.
You want to get paid. Number two, compliance. If you do it wrong, it could cost you your money, your license, or your freedom. And number three, your reputation, which is all your referrals. And that’s critically important to understand. You need to get referrals and your documentation should do that. And by the way, your EHR system should be the center point for referrals.
And there are systems in there, which is why corporates don’t use chiropractic EHRs. They’re very. What’s the word? Skinny or thin or lacking all the basic elements that a robust EHR should offer you. Or they try to nickel and dime you and charge you for other companies to do other things for sending text reminders or going and doing social media reviews.
You pay. You shouldn’t do that. It should be built into the system. If you’re pay, paying for all those ancillary things, you’re getting ripped off. And they’re laughing all the way to the bank because they’re not willing to put those in there if your References if they have them if they have them in there If your references are three four five six eight ten years old you get ripped off.
They’re too lazy to do it They don’t want to make the changes What we do and what my job is to make it incredibly easy and truthfully I created a program called EMR Chiro Which works on the advanced MD platform and how did I get there and you need to understand this I got there through corporate CFOs, the corporations that are putting between 10 and 100 million dollars into these neuromuscular skeletal platforms.
They’re bringing chiropractors in to function, to screen for surgeons. And it’s working. And if they don’t need surgery, they stay in the chiropractic care, it’s working. But what they did was, they said, we invest in technology. If you look years ago, hospitals were going out of business. They’re not going out of business now.
Corporate’s running them now. Urgent cares are thriving. Corporate’s running them. Most medical large practices, it’s run by corporate or a corporate type EHR. Now, I looked at the largest EHR in the world called EPIC, E P I C. They laughed at us, because there’s only 60, 000 or so practicing chiropractors on the planet.
They go, this is hospital to hospital, not interested. Then I went to the second largest, which is Advanced MD. Which is the largest non hospital. They got 125, 000 users. They have more than double the users. We have chiropractors practicing in the whole world. And I believe one of the largest, if not the largest EHR system in our industry, has about 20, 000 users.
20, 000 through economies of scale cannot buy what 125, 000 get. Which is why you get all of this power, but their templates are horrific. So I spent 60 hours a week for eight months learning four computer programs, and I rewrote the program. It is easy. It’s intuitive. It’s simple. It markets for you. It scrubs your claims for you.
It automatically validates insurance on the spot. And it tells you every day when a patient comes in, if their insurance is still good and it’s not been terminated. It automates all these things. It automates putting in all of your ICD and CPTs, and it gives you pick lists of what to choose from, and then it sends it automatically to the billing companies.
You don’t have to do anything. Everything is done for you. It automates it. Can you imagine, and this is something that has to be automated. If you’re, if you want to build your practice, You should be sending your evals and re evals, which have to be done every 30 days by the way, and that’s based upon regulation.
Every 30 days, which says, and by the way, you have to send that eval or re eval to every medical primary, medical specialist, and lawyer if there is one. You can’t have a staff member do that. Oh, I have eFax. I can do it. It’s electronic. Yeah, but someone’s got to sit there. They’ve got to get the record, drag it into the file, hit send.
You do that for everyone. 100 patients a week? You should be doing 20, 30 re evals a week with new patients. Someone could be sitting there for hours and hours. It’s not scalable. It should be automated. No one touches those things. You want social media reviews? You don’t have to pay a company to do it.
The system automatically prompts the patient to do these things. And it gets done. It gets done. It gets done. It gets done. Now, even reporting pain. Is your current EMR’s EHR system helping you or hurting you? It’s about getting paid. Compliance versus fraud. It’s a referral generator and it can be a time killer simply by reporting pain.
Now, here’s what most of you do, and a lot of you do. Sally reported pain as 6 on a scale of 1 to 10. Now, by the way, number one, never use a familiar first name. It renders the perception of prejudice. Who’s Sally? And what’s the name of the pain scale you’re using? Is it VAS? Does that stand for Vast Deference?
If you use an acronym, ensure you have a key. And you wrote, here’s what my acronym meant, but never use acronyms. And if a visual analog scale, did you show the patient anything or just ask them? Is it verbal? Is it visual? And on top of that, which gets even worse, if you’re using a visual analog scale, where does it start?
It starts at zero. But you said Sally, which is horrible, Mrs. Jones, Reported a payment of six on a scale of one to ten. It starts at zero. You just perjured yourself. Punishable by a loss of license and potential jail if a judge wants to get real hard with you. Is your current EHR system helping you? Or is it hurting you?
And you’ve got to think about that. If you’re dealing on certain desktop programs, You’re still reporting on a scale of 1 to 10. That’s fraud if you’re doing a VAS, Visual Analog Scale, and you should not use acronyms in anything. All of these EHRs, which are they cut a lot of corners. Oh, it’s easy.
It only takes me 10 minutes. If you’re spending less than 30 minutes on a new patient, including documentation, you’re in trouble. You’re cutting corners. I promise you, I’ve done thousands of compliance reviews. You are cutting corners. You, it’s just, you just are. And when you cut corners, it lends itself to fraud.
You’ve got to be careful. So what I recommend that you do is cut, go to Google, get a picture of the visual analog scale, cut it out, paste it on your wall somewhere, have your patient refer to it. What I do in EMR Chiro is I actually put those images right in the report and say, this is the visual analog scale my patient is referring to.
It’s simple, it’s easy, it’s compliant, and it’ll save your butt. The other thing that we do is, do your documents, wait let’s see what I had here, nope, same thing, duplicate. Do your documents all look alike? If you hold your documents up to the spotlight, and shine the light through, are all the words the same except maybe a pain scale?
Now, this is an issue, and this is a big issue, and I had a conversation with an attorney From some of the largest insurance companies in the United States. They represent actually a lot of them and they’re in New York, New Jersey, and Florida, they represent. And it’s indicative of the nation because all the lawyers, all the carriers do the same thing.
So I said to him, I said, listen I said, John, I just made that name up. I said, John, listen, you’re a chiropractic patient. You come to me all the time. I adjust the same regions all the time. Now you’ve got bone, Ligament, Disc, Muscle, Tendon. That’s about it. So when I analyze what’s going on and I’m adjusting you, I’m adjusting the same area repetitively, because the muscles are pulling back, the meniscoid, which I don’t have time to explain today, goes out of place, we’re receding that.
It all messes up. But now all of a sudden you’re coming back, the next thing I’m doing the same thing. And the only thing that might change is a pain scale. And by the way, you shouldn’t use pain scales, you should use same, better, worse. And EHR, EMR Chiro, by the way, actually automates all of this. We’ll get to that in a second.
So he said to me the following, he said, listen, I have a responsibility to my client, the insurance company. I know what you’re saying is true. I’ve done the research, but you know what, on the witness stand, when I hold up 20 reports to the light and every word is the same, not a reasonable jurist will believe that.
No one on the jury will believe that this is a patient centered unique note. It looks cookie cutter, or what we call a predetermined treatment plan. So you’ve got 30 treatments, all you do is change a number. There’s nothing unique on there. They all look alike. He said, you know how often we lose? Zero. We win 100 percent of the time on those cases.
Please don’t change anything. We love it. In actuality, here’s what it looks like. Mrs. Jones was seen today for neck pain that was a scale of 8 out of 10. Mrs. Jones was seen today for neck pain 5 out of 10. Mrs. Jones was seen today for neck pain that was 6 out of 10. On and on. This is a winner.
A winner. I can tell you factually for State Farm Liberty and Geico, Blue Cross Blue Shield, Aetna they’re all right behind. They love this stuff. It’s a winner because they’re not losing. And if you get sued in a court of law, I don’t want to hear, oh, I’m a healer. This is what they reported. Boo hoo.
You’re going to lose. You’ve got to randomize your text. A single variation SOAP note is the shortest way for the scales of balance to be tipped against you and not get paid. Because they’re going to call it a predetermined treatment plan. So text randomization. And I wrote coming soon because I’d love to do a demo of what’s out there.
But let me give you an idea. It’s out there now. It’s already working. And it works great. So watch. Mrs. Jones was seen today for a scale of 8 out of 10. Mrs. Jones was seen today for neck pale scale. Here we go. It’s dangerous, but it’s also confusing when you report symptoms. Because carriers don’t know that 8, 5, 6, 4, 3, 5, pain waxes and wanes.
So when you look at all this, it waxes and wanes. 4, it waxes and wanes. Who knows? And I know. So I urge you with the highest level, when you do your pain scales, reserve that for your evals and re evaluations every 30 days. Just reserve it. That’s best practice to do. And in best practice, here you go.
Mrs. Jones was seen today for pain, neck pain, that was the same as last visit. Mrs. Jones was seen today for neck pain, that that was better than the last visit. That was worse than the last visit. That was the same. Same, better, or worse. Now you’re consistent. But now you start getting into text randomization.
So this is just using say, better, worse. Now you’re randomized. Mrs. Jones was seen today for neck pain that was the same as the last visit. Today, Mrs. Jones neck pain was better than the last visit. Since the last visit, Mrs. Jones reported the neck pain was worse than the last visit. Mr. Jones reported the same neck pain.
You see that? It’s all randomized. And when I show this to the insurance companies, they go We won’t touch that. We won’t touch that. Because it looks different. It’s patient centered. And by the way, what we’ve done in EMR Chiro is we have 21 variations. You just pick which one you want. Truthfully, they all say the same thing.
I know it, you know it, and the carriers know it. But when the carriers are shoved down the jury’s throat, Or in court papers against you is they’ll tell you that, Oh my God, that’s all the same. And you’re going to lose. This is a winning formula. And by the way, again, you need automation to do this because without automation, you are going to be up late days, long days, sleepless nights, weekends away from your family with all the pitfalls that brings.
Folks, you’ve got to be real careful. You’ve got to work smarter, not harder. The corporates know that and they’ve spent tons of money in order, tens of millions, to get this down. You can have it for pennies, okay? So your EHR systems are not working properly. for you. And that sincerely. You need to protect your income, protect your family, and a soap note that’s done in under one minute.
I spent two months getting this randomization up and a soap note that’s done under a minute. There are other, there are three prime pitfalls. And a SOAP node. I just showed you one. The other two we handled with a simple click. And very soon, AI will be taking care of that. You’re just talking, it’ll all be in there.
But we’ve resolved almost all of those issues. Listen, I’m in the game 44 years. And I made a promise to myself that I wouldn’t do this. And I don’t, I want to be with my family. I want to enjoy my time and I don’t want to sit and doing notes all day long. And it’s a problem. So we fixed it and it’s really good.
And we vetted it with carriers. It’s really good. We vetted it with the courts. It’s really good. We’re protecting you and your family. And we do it under a minute. For the evals and revals with the research, there’s all new research in there. And guess what? Within a year, there’s going to be more research.
We’re going to swap out the old for the new. Because whatever research you have, and it sits there, and you sent it in 5, 10, 15, 20 times, 30 times. The carrier all of a sudden is going to hire someone to say, Hey, here’s one that’s a little more recent to overturn yours. So all we do is keep swapping them out and moving forward.
And it works really well. So when you get to reporting pain and personal injury, I’m really not going to get into this right now. Because our time is just about up, but I’ve got to go through, and I’m not going to do it now. I got to go through imagery. I got to go through diagnosing with you and talk about throwaway codes.
I’ve got to talk about how many diagnoses to use, how to pick them. We’re going to talk about chiropractic versus medical outcomes. We’re going to talk about a whole bunch of different things, pain generators, but we’re going to do that in our, we’re going to start that. And our next series when we talk about reporting pain and personal injury and diagnosing pain generators.
So for today, I think we’re going to cut it. It’s been it’s been, God, it went so fast. Again, as I started, if you want to contact me, here’s my phone number. If you want to go to EMR Chiro, which I urge you to do, there is no better in the industry. It’s right here. So with that being said, again, I’d like to thank ChiroSecure.
Bye bye. For giving us this platform for helping move the profession forward. And I want you to know that my parent company, the Academy of Chiropractic, we just had a recent milestone. We’ve had over 2 million additional referrals into the chiropractic industry because of doctor’s credentials, reporting, proper language.
It’s something I’m so proud of, but for now, thank you so much. And we’ll see you next time.
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