As you know firsthand, chiropractic schools offer little (if any) Personal Injury–specific training.
This is true across all healthcare specialties and professions. This lack of training in clinical documentation, case management, and general procedures can become problematic, however, when dealing with Personal Injury (PI) patients.
These issues can also become a problem for providers who have not kept up with current PI trends.
With that in mind, here are five simple yet effective tips that can be implemented directly into your next PI case. Doing so can immediately improve your PI outcomes and success, while reducing your risk and liability.
1. Develop a new PI patient–specific telephone script
Right from the initial telephone call, it is crucial to begin the process of obtaining and gathering important documents and information. PI documentation is quite different than that for your other classes of patients. Getting the necessary documents and information can have a significant effect on your outcomes.
Create a PI script that asks for items that are important to you as a doctor, such as the patient’s medical records and relevant injury photographs. In addition, capture other information that can assist in protecting and assessing the case. This can include the first- and third-party insurance carriers, claim number(s), adjustor’s name and contact information, and attorney name and contact information (if applicable).
Once you have designed your new script, implement accountability measures to ensure your staff completes it in its entirety. This will provide you evidence of consistency in obtaining this critical information.
2. Obtain post-collision medical records
If your new patient has already been to another provider before seeing you, a vigorous attempt should be made to obtain all of those medical records. It is vital to know exactly what injuries and symptoms your patient was experiencing immediately after the collision, as you would record in your office on the initial visit. You also want to know what treatment and recommendations were offered by other providers.
If you identify any symptomatic discrepancies, these should be addressed in your clinical notes along with a detailed explanation. This type of discrepancy is a common argument made by the liability carrier. For example: If your patient reported only two to three symptoms at the ER or urgent care clinic, but is reporting an extensive list of complaints to you, it can give the appearance of embellishment or exaggeration.
You know that physiology explains this, but being proactive and addressing it early with excellent documentation will go a long way toward helping eliminate that potential argument for those settling the case.
3. Document your patient’s symptoms during the history
The initial patient history is crucial to PI success. And a critical part of your initial history is documenting the patient’s collision-related injuries. This is true even if they fall outside your scope of practice or you do not plan on treating them.
Early and complete documentation of injuries and conditions is paramount to any and all future treatments. This includes both in your office and with other providers.
Far too many healthcare professionals focus on documenting only the symptoms that fall within their specialty. But failing to document other presenting injuries and symptoms can make it difficult for your patient to subsequently receive care from other caregivers.
Symptoms commonly missed or improperly recorded include; anxiety, confusion, dizziness, loss of appetite, sleep disruption, ringing in the ears, loss of taste or smell, TMJ, and extremity pain. Each one can be reimbursable and, when combined, they can add a lot of value to the case settlement.
Admittedly, this may take more time than you are used to or be cumbersome. You can, however, develop procedures or forms for your history to help expedite this process. Aside from the symptom value, a failure to fully document can have serious ramifications for the provider.
4. Consider early diagnostic imaging
Acute trauma to the cervical spine requires a thorough work-up, well beyond the normal provider-patient history and examination. Most providers either obtain post-collision plain radiographs or take a series of films in their office. In the cervical region, consider a minimum of five film series, including the flexion and extension views.
After taking the initial three cervical films, consider waiting several days to a week before the flexion and extension views. This allows for some of the initial swelling and muscle spasm and guarding to subside. These views can then be useful in identifying any ligamentous injuries and instability.
In addition to plain films, new providers often forget about advanced imaging such as MRI. Ordering an MRI may be unusual for new practitioners. In the PI arena, however, an MRI can be a relatively inexpensive tool to help document acute traumatic injuries. It also goes a long way toward protecting yourself by mitigating risk, liability, and the potential for serious consequences.
Think of the number of possible causes for the two most common PI symptoms; headaches and neck pain.
Your physical examination and plain radiographs can only identify so much. Conditions such as spinal cord contusion, edema, disc injury, High Intensity Zone (HIZ), occult fracture, vertebral artery insult—all can cause or mimic these two symptoms. And these conditions may only be demonstrable on an MRI.
As a rule, when ordering any diagnostic imaging, it best to have a well-documented clinical rationale. In addition, perform the testing early, when there is the greatest chance of capturing acute findings.
5. Keep everything reasonable.
The final tip, especially for new providers, is to keep everything reasonable. If you are not familiar with that term, it is all over the medicolegal arena: reasonable person, reasonable bills, reasonable and necessary, reasonable treatment, reasonably expected to, and so on.
Here’s the catch: What is reasonable to one person may not be reasonable to another. One way of looking at “reasonable” is to remove yourself from the equation. Then take an honest and objective view of everything, including your documentation, care, and treatment.
Reasonable care and treatments in your office are directly under your control. This includes how many treatments, the type of treatments, and the cost associated with those treatments. Many providers approach PI cases, especially those cases with PIP (Personal Injury Protection) or Med-Pay as a “bank of funds.” Some providers feel entitled to all those funds and often will attempt to exhaust them. That aggressive approach can quickly set you on the path to unreasonableness.
Remember, all PI cases are scrutinized to some extent. Depending on the specific case parameters, they may be highly scrutinized. Those that do not adhere to the “reasonable” standard may rapidly find themselves squarely in the auto carrier crosshairs. That can have a litany of unintended consequences.
In conclusion, consistent application of these five steps in all your PI cases will significantly reduce your risk and liability, while improving your case outcomes and values. A powerful secondary benefit of these actions is that they also make you more marketable.
S. Scott Tauber, DC, DABCO, CPC, is the COO and lead instructor for the American institute of personal injury physicians (AIPIP). AIPIP trains physicians of all specialties to improve, protect, expand, and market their pi practices. Tauber is a diplomate of the American Board of Chiropractic Orthopedists and a certified professional coder. He can be contacted at 888-924-7479 or firstname.lastname@example.org