For those just getting started in personal injury (PI), this next sentence might be shocking: Doctors of chiropractic who understand PI can get paid 100% on 80% of their reasonable PI bills. In turning this goal into a reality, though, proper documentation can make or break you.
This article highlights five documentation strategies DCs can use to position, protect and prepare themselves to succeed in PI, including:
- Comply with the No Surprises Act (NSA).
- Treat every patient as unique.
- Use storytelling documentation.
- Communicate the “PI mantra.”
- Send monthly packets during treatment.
1. Comply with the No Surprises Act.
Congress passed the No Surprises Act (NSA) in 2021 in response to the distrust between patients and the medical industry. The industry has thus far failed to take personal initiative to give patients the financial disclosures they needed, so the government stepped in with legislative mandates.
Namely, medical providers are required to provide a good-faith estimate (GFE), in advance of care when treating self-pay or uninsured patients. This includes transparency of scope, duration and cost of all anticipated healthcare services so patients can shop for a better deal should they desire.
The larger issue for DCs is for a mere $25, a patient can initiate a dispute against your bill, perhaps getting all or part of your outstanding bill waived. This danger will grow as more patients and PI attorneys become aware of this law. The requirements for initiating a dispute are twofold: First, you misestimated by at least $400 (without a timely update of any expected bill increase); and second, the patient initiated their dispute within 120 days of their receipt of your detailed bill.
Providing the attorney with your detailed bill will not equate to the patient receiving it in the government’s eyes. Consequently, you could be exposed years after your PI cases settle, once your patients become aware of the requirements.
To cover yourself, comply with the NSA by giving your patients a GFE. Update your estimate as soon as you know it is incorrect by more than $400. Track, document and keep evidence your patients received your detailed bill on a specific date. Then, monitor that 120 days have passed without a dispute initiation.
2. Treat every patient uniquely.
I have had seven children, and not one has the same personality, likes or dislikes. Discipline (and rewards) for one did not work for the other.
And, these are people who share my DNA. So imagine how unique every patient, staff member, peer and community member is. Patient uniqueness should be reflected in your documentation of the treatment plan, SOAP notes and billing.
If you are a cut-and-paster, stop. If you treat all patients to the same number of visits, modalities and billing amounts, stop. You are setting yourself up for huge issues. Not only are you and your billing subject to greater attack over “medical necessity” and proper billing, but State Farm, Allstate, Geico and no doubt others are filing lawsuits in various states against DCs for “predetermined treatment protocol” (PTP).
In short, PTP litigation involves an assertion a DC is using a cookie-cutter approach for the purpose of maximizing insurance benefits and not for unique medical necessity. Right now, that’s focused mostly on personal injury protection (PIP) clawbacks, but expect it to roll into medical expense coverage (MedPay), and health insurance. Insurers are serious about PTP litigation, and this can be a practice killer.
Documenting each patient uniquely, in all respects, is your best defense. It is also your best offense when time to get paid, and for use by attorneys to get higher recoveries because of your enhanced documentation skills.
3. Use storytelling documentation.
This strategy will endear you to your patient’s attorney and make the best attorneys seek your services. Essentially, this strategy asks you to include “storytelling” in your SOAP notes.
When a case goes to trial, the outcome of that case depends heavily on whether the attorney is a great storyteller. Can the attorney tug at the jury’s heartstrings so it wants to reward the patient? Can the attorney incite the jury’s anger so it wants to punish the defendant?
If you help the attorney tell a great story, you’ll be helping them win larger jury verdicts and move toward higher and faster settlements. In a way, a trial attorney is a salesperson, and every expert salesperson can weave a great story.
Your job, then, is to paint a picture of the patient’s life before and after the accident in your SOAP notes. You can do this by asking questions centered around the patient’s activities of daily living (ADLs) such as:
- In comparing your quality of life before and after the injury, to what extent have injuries made you rely on the help of others?
- What emotional or mental health changes have you experienced with your work, regular daily activities or hobbies?
- How have your injuries changed your energy, fatigue or stress levels or interest in maintaining your usual activities?
- How have the injuries changed your normal family and other important social relationships?”
- To what extent have you experienced increased feelings of fear, anger, frustration, irritation, isolation or sadness?
- What changes in appetite, sleeping patterns or sexual activity have occurred?
Documenting the patient’s change in quality of life and their ADLs pre- and post-injury is where the storytelling takes place. When you do this well, you make it simple for anyone — attorneys, judges, juries, experts and your patient — to understand the patient’s healthcare journey, all because of your storytelling documentation.
4. Communicate the PI mantra.
In PI, this cannot be emphasized enough: “The patient owes the full balance of the bill regardless of the outcome of the case.” The not-so-scrupulous attorneys out there will have your patients believe otherwise. They will trick them into thinking you have agreed to a lien reduction. They will even tell you the law requires you to reduce the bill. They will tell you reducing your bill is “custom and practice.”
Here is the truth: With a few exceptions, in most states, the patient owes the full balance of the bill no matter what happens with the PI case. You aren’t on a contingency fee tied to the case outcome. You have agreed to wait to be paid, not to be paid less.
This communication should start from the first patient visit, in your lien agreement or letter of protection, in your initial communication to the attorney and as you follow the matter through claim or case resolution. Communicating the PI mantra in documents (and verbally) sets the table so when it’s time to get paid, you get paid all or most of your bill.
5. Send monthly packets during treatment.
In PI, there is no such thing as “overcommunicating” with the patient and the patient’s attorney about the status of your bill. You can do this by sending monthly statements to the patient and the patient’s attorney during treatment.
This works in your favor for two reasons:
If you are transparent from the beginning, and the patient’s attorney later says your fees are too high and you should reduce your lien, you can argue fees were disclosed at the first appointment, monthly thereafter and at the conclusion of treatment. You can then provide evidence these bills, statements and fee schedules were sent, as well as when they were sent. You can demonstrate no prior objection or issue was ever brought up, and if it was a real issue, it would have been brought up and acted upon long ago.
Sending a monthly packet makes it easy on the patient’s attorney, who can then use this information with the insurance adjuster in the case for settlement purposes.
To that end, here is what you should include in your monthly packet:
- Your fee schedule, as well as support for your fee schedule, which might include fee comparisons from usual, customary, reasonable (UCR) publications or online resources such as FAIR Health Consumer.
- Your good-faith estimate, along with any later updates to that GFE should the estimate change by more than $400.
- An updated, detailed billing statement.
Final thoughts
Other than actually treating patients, maintaining proper documentation practices is one of the most important acts you perform and communicate on a regular basis. Documentation is also the area where many DCs are deficient. Staying current with and implementing best documentation practices will ensure you comply with medical mandates and protect yourself from a growing number of attacks.
MICHAEL COATES is a national authority on personal injury medical lien recovery and the founder of PIMadeEasy.com, which educates, coaches and trains medical providers and their staff to accelerate their success in personal injury. If you have questions, please contact michael@pimadeeasy.com and through his free Facebook group, PI Made Easy Insiders, at facebook.com/groups/pimadeeasy.
