Ways to Lower Risk

Dr. Murkowski, leading expert in chiropractic billing and coding, expert witness for both plaintiffs and defendants, and author of 20 books, gives some advice to keep practitioners safe with the new legalities of client care.

“There is a lot of fear of the unknown,” says Dr. Murkowski. “But my definition of fear is False Evidence Appearing Real. When you are armed with knowledge and good information, it is going to be to your benefit and that of your staff.”

Dr. Murkowski explains in a recent webinar some ways that chiropractors can keep themselves legally safe.

  1. Document, document, document! A sprain or strain is called “common domain diagnostic terminology.” That diagnosis also has three parts: mild, moderate and severe. Mild (self-limiting) and severe (needing surgical repair) are not conditions that can or should be fixed by a chiropractor. So you will want to make sure you are documenting the sprain or strain as moderate, and then grading it as a 1, 2, 3, or 4 when you are documenting your diagnosis. Sprain or strain should never be your primary diagnosis it should be part of a more comprehensive, precise diagnosis.
  2. Vertebral subluxation complex. This is probably the best diagnosis because it is multifaceted. The first thing that every chiropractor has to understand is that the federal law deals with a subluxation complex. Every state law includes subluxation, so you can then go on to break that down using your ICD codes in your documentation.
  3. Groupon. Everyone is tuned into electronic marketing and electronic communication these days, but some of these have to be scrutinized. Right now there’s the Anti-Kickback Law, previously known as the Stark Law which has an off shoot called the Safe Harbor Law, which has to do with inducing patients to come to your practice – either by paying them or offering free services. Check with your legal counsel about the interpretation of the Federal Inducement laws in your state. You don’t want your practice to be in jeopardy because you have used Groupon.
  4. 8 Types of Patients. There are 8 types of patients, and they all come with their own different set of complex needs
    a. General health patient: the type of patient that may come to your office and have insurance for general health care. They could come in and want to pay cash. They may be interested in a wellness program or they may want to come to you for some type of rehabilitation.
    b. Auto patient: these are the clients who have been in an automobile accident.
    Personal Injury client: this isn’t necessarily an auto or worker’s comp patient. This is anyone who has had an injury.
    c. Workers compensation: get your state’s rules and regulations in regards to workers compensation patients.
    d. Medicare patients: Medicare is very specific with the rules and regulations you must follow. For example, they must all have a detailed treatment plan. There have been many audits in multiple states and the federal government has already collected $1 billion in audits just from chiropractors because they have not documented properly or did not have a treatment plan.
    e. Medicaid patients: This is a state program that some states offer that is partially federally funded.
    f. Athletes: Athletes can be categorized either to a general athlete, college athlete or professional athlete. There are special considerations for someone whose livelihood relies on their recovery.
    g. Rehabilitation patient: patient that needs rehab for a variety of reasons.

No matter who the patient is, the most important thing you can do is read up on your state regulations and make sure you keep detailed documentation that includes your ICD codes.