Lets Quit Whining

Posting Date:  Jun 13, 2020

I talk to and hear from a LOT of chiropractors who tell me how much they HATE Medicare. And this isn’t just your everyday HATE. It’s more of a visceral HATE.

So, why the hate?

Some doctors hate the idea of getting reimbursed so little from Medicare. I get it. All doctors hate the Medicare fee schedule. Chiropractors hate that Medicare only pays us for a spinal adjustment and nothing else. If we play our cards right, this might actually change.

Some doctors hate Medicare because they’re afraid of the documentation requirements and they’re terrified of getting audited and paying all that money back. We’ve all heard the stories. One doctor got popped for more than $500,000. Others have had to pay back tens of thousands of dollars. If that doesn’t make your sphincter tighten, I don’t know what will.

So, here’s the thing.

Medicare creates the rules for ALL of healthcare. They created the ICD-10 codes, along with the National Center for Health Statistics. Medicare also creates the documentation rules, which everyone else follows. You want to know how to document for Blue Cross Blue Shield and Aetna? Learn Medicare. You want to know how to document for Personal Injury? Learn Medicare. You want to know what your state board expects of your documentation. That’s right…

Learn Medicare.

The good news, though, is that Medicare is quite specific about what they require from us. It’s just that some chiropractors want to keep arguing about it. I think arguing about it, for the most part, is an exercise in futility. How ‘bout, instead, we learn how to do it and crush it.

Medicare requires TWO things from us. When I review PI records for insurance companies (a LOT of records), I look for the same TWO things:

Pain AND Function

Medicare requires that we document PAIN assessment on each visit. Medicare requires that we document a FUNCTIONAL OUTCOME ASSESSMENT at a minimum of every 30 days, which means every 30 days OR SOONER.

Let’s start with documenting PAIN. What’s the easiest, fastest and most efficient way to track the patient’s pain on every visit? First, have the patient rate the intensity of each symptom. I do this on paper, with my intake forms. If the patient says that their pain is an 8/10 or above, I ask them if they consider their pain mild, moderate or severe. A LOT of patients just don’t understand the meaning of SEVERE pain. I tell them that a 10/10 means they’re unconscious in the Emergency Department at the local hospital. A 9/10 means they’re on their way to the hospital and an 8 out of 10 means their looking for a ride to the hospital. That tends to get them thinking. If they tell me they consider their pain to be moderate, I ask them to rate it between 4 and 7. That’s a whole lot less numbers than 0-10, and a whole lot easier for them to consider. Document that number. For each subsequent visit, I compare to the previous visit’s number: “Your headache was a 7/10 last time. Any change since then?” The patient may say, “It’s a little better. Let’s give it a 6/10.”

Well. That was easy.


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