Does your EHR system help or hurt you?

Insurance carriers increasingly target doctors of chiropractic, exploiting vulnerabilities often found in chiropractic electronic health record (EHR) systems.

These weaknesses can lead to denied claims, delayed payments, audits or even lawsuits, posing significant risks to a practice’s legal, financial and reputational health. To protect their practices, DCs must recognize how EHR systems can either safeguard or expose them to these threats.

Common documentation problems

One of the most common pitfalls in chiropractic documentation is the repetitive nature of SOAP (Subjective, Objective, Assessment, Plan) notes. When SOAP notes across multiple visits are nearly identical, save for minor updates such as pain scale changes, insurance carriers often interpret this as evidence of insufficient or pre-determined care. Such patterns attract scrutiny and undermine the perceived legitimacy of the treatment provided.

Beyond repetitive notes, many practices fail to include critical details in their records. For instance, missing clock times for modalities or incomplete documentation of evaluation durations can lead to challenges regarding the validity of billed treatments. Treatment plans often lack references to ordered care, and procedures are frequently listed without detailed methodologies, creating additional risks.

Errors in billing codes, whether due to human mistakes or inadequate EHR system support, compound these vulnerabilities. Insurance carriers often capitalize on such gaps to justify claim denials, initiate audits or pursue legal action against providers.

How the right EHR systems can reduce your risk

A well-designed EHR system can play a pivotal role in reducing these risks by equipping you with tools that ensure thorough, accurate documentation.

For example, automated coding assistance can suggest appropriate billing codes for each service performed, ensuring compliance and reducing the likelihood of claim rejection. Built-in text randomization features can address the issue of repetitive SOAP notes by varying the phrasing, making the documentation appear more individualized and reducing the chance of carriers dismissing care as predetermined.

Efficient templates further streamline documentation, allowing providers to complete SOAP notes quickly and accurately, often in less than a minute. Modern EHR systems also offer automated note generation and pre-filled templates tailored to individual visits, saving time while enhancing documentation quality.

Set a high bar

Whether or not your documentation meets the federal Daubert Standard,which carriers use to evaluate claims and justify denials or lawsuits, is another critical aspect of EHR functionality. This standard requires a high level of documentation accuracy and thoroughness, yet many chiropractic EHR systems fail to meet these demands. Practices that rely on inadequate systems face heightened risks of scrutiny, audits and legal challenges, particularly as insurance carriers increasingly focus on exploiting such vulnerabilities.

Vitals and review of systems

Another overlooked yet essential component of chiropractic documentation is the inclusion of vitals and review of systems in patient exams. Their absence creates a “triple threat” for DCs. First, it exposes patients to potential complications, such as undiagnosed hypertension, which could lead to severe outcomes like strokes. Second, insurance carriers often view the omission of vitals as indicative of an incomplete evaluation, increasing the likelihood of claim denial.

Third, failing to document vitals damages a DC’s reputation among other healthcare professionals and attorneys who often review the records. While including vitals may not directly enhance a DC’s reputation, their absence reinforces negative stereotypes about the profession, suggesting a lack of thoroughness compared to other healthcare providers.

Lose your F.E.A.R.

Despite the clear advantages of modern EHR systems, many DCs are reluctant to switch over to them due to the F.E.A.R. (False Expectations Appearing Real) of a challenging transition. These fears often stem from past experiences with subpar systems, where the conversion process was unnecessarily difficult—sometimes intentionally, to discourage users from leaving. However, continuing to rely on an inadequate EHR system can be far more costly in the long run, exposing practices to audits, lawsuits and reputational damage. By choosing the right EHR system, DCs can enhance their documentation, protect themselves from legal and financial risks and improve overall efficiency.

Make the switch

Switching to a robust EHR system allows DCs to streamline workflows, ensuring that documentation is both compliant and efficient. For example, evaluations, including documentation time, can be completed in 30-45 minutes by leveraging modern tools and workflows. Automated note generation and tailored templates further reduce the administrative burden, freeing up more time for patient care. Importantly, a strong EHR system also helps DCs  meet the rigorous standards carriers use to evaluate claims, providing a critical layer of protection.

In an era where insurance carriers are increasingly aggressive in scrutinizing chiropractic practices, a robust EHR system is no longer a luxury—it is a necessity. By addressing vulnerabilities such as repetitive notes, incomplete evaluations, improper billing codes and the absence of vitals, DCs can safeguard their practices against unnecessary scrutiny.

Handwritten doctor’s notes can pose significant challenges, particularly in legal, medical or insurance contexts. Their primary drawback is lack of legibility; handwritten notes are often difficult to read, leading to misunderstandings or misinterpretations by other healthcare providers, patients or legal professionals. Additionally, they may lack the detail and structure of electronic medical records (EMRs), making them less credible or useful in critical situations such as court cases or insurance claims.

Unlike EMRs, handwritten notes are harder to standardize, organize and search, complicating record-keeping and provider collaboration. In legal disputes, unclear or incomplete handwritten notes are more likely to be challenged, potentially reducing their evidentiary value. Moreover, illegible or vague notes in multidisciplinary settings can hinder effective communication, delaying or complicating patient care.

Transitioning from handwritten notes to digital documentation offers greater accuracy, accessibility and professionalism, decreasing these risks and enhancing trust and reliability.

Final thoughts

Protect your practice by choosing an EHR system that meets the demands of today’s healthcare environment and empowers you to thrive in an increasingly challenging landscape. Investing in modern EHR technology reduces risks and hones efficiency, allowing providers to focus on what matters most: delivering quality patient care and spending more time with their families.

Mark Studin, DC, FPSC, FASBE(C), DAAPM, is an adjunct assistant professor at the University of Bridgeport, School of Chiropractic and an adjunct postdoctoral professor at Cleveland University-Kansas City, College of Chiropractic. He is an Adjunct Associate Clinical Professor at The State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Department of Family Medicine. He earned his Fellowship in Primary Spine Care whose courses are certified in joint providership from The State University of New York at Buffalo, Jacobs School of Medicine and Biomedical Sciences, Office of Continuing Medical Education, and Cleveland University-Kansas City, College of Chiropractic. He also runs the Academy of Chiropractic’s Personal Injury Program. He can be reached at 631-786-4253 or DrMark@AcademyOfChiropractic.com.