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Justifying Care and GETTING PAID


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Unless you have been living on a remote planet in a distant part of the solar system, you have noticed that the healthcare industry is getting tougher by the minute, forcing everyone to really look at their practices and collections. The GOOD news is those that are preparing, stand to grow and prosper. The BAD news is those that choose to ignore the obvious and not prepare themselves will suffer…and suffer…and suffer…

One MAJOR problem area is in justifying care and getting paid. Besides using the laws of the state that you practice in to collect service fees from the insurance companies, there is a second and often overlooked method to ensure that you get paid. That is co-management of patients with their primary care doctors or their medical specialists. Referrals from primary care doctors are no longer needed where I practice; that goes for traditional health insurance, workers compensation and personal injury/no-fault. Although this has been a blessing from an administrative and marketing standpoint, it has pulled chiropractic farther away from the co-management of patients with primary care doctors.

The time has come to take advantage of this “loss of communication” by being the first in your area to reach out to primary care doctors and their patients. Whenever I am treating a patient that is also being monitored by his/her primary care doctor and/or a medical specialist, I make sure that in the treatment notes the doctor renders an opinion on chiropractic care. I NEVER want to put words in a doctor's mouth, but properly communicating the “RESPONSE to CARE” to the MD is a key component for him/her to be able to document continuation of care. I do this with EVERY patient, including the managed care patients. Who do you think is more prepared to justify care and ultimately get paid, the DC that is an island or the DC that has documented everything properly AND has a spine surgeon and the primary care doctor documenting in their notes, “Mr./Ms. ______ has responded well and should continue with chiropractic care as long as he/she is benefiting long term?”

This is beneficial for a few reasons:

1. The patient is cared for properly and is receiving the best management possible.
2. The MD is realizing that chiropractic works and is actively involved in promoting it.
3. You are gaining the respect of professionals in your area that are a HUGE source of referrals.
4. You are arming yourself with solid case specific information that will help you justify your care, refute IME’s and PROVE that the patient should be treated. You are not the only one saying this…

Therefore, when it comes to JUSTIFYING care and GETTING PAID, notations about chiropractic care should be found in as many providers notes as possible. This only comes from communicating effectively and CONSITENTLY with the MD regarding the patient’s case. In today’s healthcare environment, there is strength in numbers…Make sure you are NOT on the outside looking in…Your livelihood depends on it!

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PLEASE TAKE NOTICE: © Copyright CMCS Management, Inc - Dr. Mark Studin 2015 - This information is intended for educational purposes only. Any review, retransmission, dissemination or other use of, or taking of any action in reliance upon is prohibited.