Examples of doing the right thing the wrong way happen every day in chiropractic clinics across the nation.

It happens when you attempt to do the right thing for patients with no insurance or limited benefits by “tweaking” your documentation and coding to result in an overall lesser charge for the patient.

For example: A patient comes to see you and requires more than a routine workup. Since this patient has no insurance coverage, you decide to use a lower level exam code, perhaps a 99201 for the initial examination instead of a 99202 or higher.

How about a patient you treated in four spinal regions, but only documented one or two levels and charged for a 98940? What about a Medicare patient that required a detailed workup including x-rays and you charged a lower level exam code and a two-view x-ray series when you actually performed four, all because Medicare doesn’t cover exams or x-rays? No big deal, right? Wrong!

Documentation faux pas

Down coding your services in an attempt to strike a balance between what insurance coverage may allow and what you feel your cash or underinsured patients can afford are actually documentation faux pas.

If you don’t report what you did and don’t charge for services you would normally bill to insurance because you are seeing a cash or underinsured patient, that creates the potential for fraud because of a dual standard of care and a potential dual fee schedule.

Even worse, the Office of Inspector General (OIG) and United States Department of Health and Human Services (HHS) considers down coding or failure to bill a Medicare patient’s accurate services an inducement and is subject to serious fines and penalties.

Because you must document what is done and bill for all the services provided in order to stay profitable and in practice, you’re often out of compliance when trying simply to do the right thing. Be sure to document what you do, everything you do, and then code and bill it properly.

Ultimately, down coding and under-documenting is perceived as illegal and inappropriate, just as up coding is when it is used to allow you to bill differently based on whether it is an insured or cash patient.

Documentation of necessity means just that. Don’t let your perceived need to maximize reimbursements by billing your UCR fees or contract rates to insurance companies, but not to cash or underinsured patients. Don’t presume the correct way to make this right is to downplay your service by