A segment of personal injury (PI) attorneys are competent, valuable medical providers and pay 100% of reasonable chiropractic bills.
These attorneys are looking for competent DCs who refer to specialists when medically indicated and conduct their chiropractic personal injury billing in a way that is reasonable, supportable and defensible at deposition or trial.
Of course, the less scrupulous attorneys are out there, too. These attorneys seek to pay you less, regardless of your care, your value in the recovery or your reasonable billing practices.
In the world of chiropractic personal injury, you will need to deal with both.
So how do you cross the bridge from working with good PI attorneys (who value your services and pay your full bill) while also recovering proper payments from those not-so-scrupulous attorneys who want to put financial burdens on the backs of medical providers? That bridge includes building blocks to make it strong and durable, including setting reasonable fees that are supportable and coding properly for the nuances of PI.
Setting and supporting reasonable fees
Your ability to attract the best attorneys so you can collect 100% of your bill (at least 80% of the time) starts by establishing a process for demonstrating you charge reasonable fees. That might sound easy, but the biggest contention area in medical lien recovery generally isn’t your treatment; it’s the amount of your bill.
In a PI case, nothing will come under more scrutiny than the reasonableness of your fees and charges. Indeed, even if your fees are lower than the competition’s, your fees will likely be attacked, purely as a tactic. If an insurance adjuster or an attorney on the defense side can find a way to demonstrate some problem in your fees, you can bet they will.
And there’s a trickle-down effect at play. If the insurance adjuster or defense attorney manages to demonstrate your fees are “unreasonable,” the patient’s attorney will use that to attack your bill and pay you less so more money can stay in their client’s pocket. The buck keeps getting passed, and that buck keeps getting smaller each time it does.
When you establish the propriety of your treatment and the reasonableness of your fees from the outset, with plenty of support, you accomplish two important things:
- You can help the patient’s attorney defend your fees to the defense’s insurance adjuster or attorney.
- You can take the wind out of an attorney who tries to argue your bills aren’t reasonable down the road. After all, if the patient attorney defended your bills to the insurance adjuster, it will be hard for them to turn around and claim your bills are unreasonable when it is time to pay up.
Reasonableness is based upon a number of factors, such as:
- Your area(s) of healthcare specialization
- The geographical location where the services are rendered
- The personalized treatment plan, including the range and types of procedures and specialized care you provide
- Whether the treatment was medically necessary
- The actual time spent administering the treatment
- The application of proper treatment codes
- Your credentials and level of training
Various sources can be used to evaluate your fees, such as usual, customary, reasonable (UCR) publications or an online source, such as FAIR Health Consumer (fairhealthconsumer.org). Chances are, you will find a lot — and maybe most or all — of your current fees are less than what UCR, Fair Health and other sources would designate as average fees for the codes you use.
The best practices in chiropractic personal injury are these:
Do your own research to ensure your fees are reasonable. Then, during patient intake, give the patient these four things:
- A copy of your fee schedule
- A good-faith estimate per the No Surprises Ac
- A fee comparison that shows your rates as they measure up against UCR or FAIR Health fees
- A lien or letter of protection that protects you far more than I suspect your current lien or the usual letter of protection from an attorney does (it matters)
Retain proof the patient received these four documents, and, of course, that the attorney signs your lien, and then send this same set to the patient’s attorney, who also needs to sign the lien or issue you that (enhanced) letter of protection, depending upon your state.
Monthly thereafter, send the patient and the patient’s attorney interim billing statements so they have ongoing notice and time to speak up if any issue is presented (and if they remain silent, that’s to your advantage). Upon discharge, send them both a discharge (final) billing statement. Be able to prove transmission and receipt of these documents for your own protection.
By following these best practices, you’ll communicate that the not-so-scrupulous attorneys need to shape up. You will also be a hero to the attorneys who want medical providers with a strong understanding of PI in their corner.
Coding and documentation
And what about coding? Using improper codes can bring down the value of the PI case in the adjuster’s eyes. It can also give the patient’s attorney a headache, and you don’t want to be the cause of an attorney’s headache. After all, the attorney wants to be able to rely on you, the medical provider, to know and understand how your coding practices can impact a case.
Here are a few things to consider for coding in chiropractic personal injury.
More is not better. Using a laundry list of codes can make it seem like you are padding your bills. Diagnose all injured body areas, of course, and then treat those that fall within your specialty. Do not go on a Where’s Waldo? hunt looking for obscure codes you can apply. Instead, apply the right codes and move on.
Never, ever upcode. If you apply additional codes to PI patients to pad the bill, you open your bill to attack. Worse, you may become guilty of medical billing fraud.
Remember that your job is to do what is medically necessary. You may have used some modalities early on that simply are no longer necessary. For instance, did you apply a hot pack when the patient first limped into your office? That hot pack was likely medically necessary, but the patient can apply their own hot packs in future visits. Did you timely refer out to imaging or a specialist as soon as medically indicated? Delays in PI are attackable inactions.
Consider the use of trauma and trauma-related codes. From a legal perspective, trauma is the name of the PI game, leading to higher “pain and suffering” awards. It can elevate the value of a Chiropractic personal injury case.
Consider the reasonableness of your per-visit fees. Your fees-per-code might be reasonable, but is your total per-visit charge also reasonable? If you are applying too many codes with an associated price tag, you might be accused of padding your bills.
Document, document, document. Documentation in most medical practices is sorely lacking. In PI, that can be a case killer. Your documentation should tell the story of the patient’s health before and after the PI incident, and how the incident impacted that patient’s life through their activities of daily living (ADLs). Your documentation needs to tie into and support your diagnosis, treatment and billing. Proper and thorough documentation is a key area of coding, especially in PI.
Here are a couple of do nots related to documentation:
Never diagram accidents, and never ask your patients to diagram accidents. Neither you nor your patient are an accident reconstructionist. What your patient described to you might not be the same as what the patient described to the attorney or an adjuster, so your diagram might hurt the case. A savvy adjuster or defense attorney will use any reason they can find to not pay, so the diagram you keep might create a liability or causation issue where none existed before.
Do not use pain scales that the patient identified alone. Pain scales are horribly subjective. One patient might think a stiff neck is unbearable and mark her pain as “very severe” (a “10”). Another patient with the same injury might think, “Well, I suppose getting tortured would be more painful, and I don’t want to come across as a baby, so I’d say this is mild” (a “3”). Again, keep in mind that the defense will look for holes, so never ask a patient to identify their pain on a pain scale unless you are there to explain the rating system, answer questions and guide them through the process.
Final thoughts
At the end of the day, attracting the best attorneys boils down to this: taking care of your patient, setting reasonable fees and using proper coding supported by documentation. When you know what a patient’s attorney is up against—namely, insurance—you can shift your behavior so you make life a lot easier for the best attorneys and keep them on your side, sending you a steady stream of referrals.
MICHAEL COATES, ESQ., is a California-licensed attorney. Over the last decade, Coates has established himself as a national authority on medical lien law, lien recovery and negotiations. He is a recognized innovator, advocate, coach, instructor and mentor. Having seen the good and the bad in the personal injury (PI) business, he has helped hundreds of providers recover millions of dollars from law firms of all shapes and sizes. Coates is the country’s top lien and letter of protection negotiator. His company, Personal Injury Made Easy, gives providers, owners and staff a true business advantage in the PI space. Coates also has a company, personalinjurybillingpros.com, that serves as an outsourced lien negotiator for medical providers. His book, Personal Injury Made Easy, a guide for providers, is available on Amazon.com.