Have you ever been asked to reduce your Personal Injury bill, possibly by a ridiculous percentage? Or have you ever had your PI claims slashed and burned by an "independent" records reviewer? If so, you may have been the "victim" of poor Personal Injury specific documentation.
You do your best and what you think is right, hope that it's good enough and no one will look too closely and then in the end pray that somehow you get paid a "fair" amount. Sound familiar?
You already know the documentation required for your Personal Injury cases is quite different than for the rest of your patient base. What can you do? Why even bother trying to keep up with Personal Injury specific documentation?
Because it has a direct affect on your bottom-line. Not only are you losing revenue every day on your current cases, but you are losing even more on potential cases.
While you're thinking "at least I'm getting paid," if you take a closer look you are actually letting thousands of dollars slip away every year. I don't want to make you sick, but adding up the amount from reductions requests on current cases (let's not even talk about patients running off with a settlement check) and just 1 lost new PI referral per month over the course of your professional career (even if you do not actively seek new PI cases) could easily add up to a $250,000 - $500,000 loss, but that's OK, right?
What does all this have to do with documentation? Everything!
You lose because in Personal Injury no one shares with you specifically what documentation is important, what increases case value, what decreases cases value, issues of the med-legal arena... the whole thing is enough to get you frustrated and aggravated and drive you crazy!
But what if there were a way to improve your documentation, assist those attempting to settle your cases, and in the process make yourself more marketable? It sounds too good to be true, but the fact is it's possible and no one ever showed you how to do it.
We did not learn anything about Personal Injury in our professional training. Even if we did, the rules change every 6 -12 months, so it would be outdated anyway. Auto carriers don't exactly have an interest in teaching and sharing the information; they just love it when you make it up as you go because cases settle for less than their true worth.
So we wind up doing what we think is right, trial and error, and hope for the best. But that trial and error has serious consequences in the med-legal arena.
You may not know this, but, based upon the parameters and specifics of an accident/collision/injury, every single Personal Injury case has a potential settlement value. Let's call it "Fair Value," the maximum settlement value if everything goes right. This includes your patient, the providers and the Personal Injury attorney. There are many factors that go into the Fair Value settlement, many you as a clinician cannot control or have very little control over, so we won't worry about those right now.
But, how about the things, issues, parameters, specifics you can control, such as (you ready for this?) our clinical documentation. Every time we make a mistake in our documentation, whether it's omitting an important finding or issue or documenting something detrimental, you allow the 3rd party insurance carrier (the one responsible for a potential settlement) to chip away at the Fair Value amount.
So in Personal Injury that's why we sweat the details with items like...
- Causation Statements
- PI Specific Interrogatories
- Duties under Duress
- Loss of Enjoyment
- Discharge Summary Reports
- Weighted Value Diagnoses
- Value Drivers
- Specific Prognosis Language
- Medical Photography
- Integrative Care and Co-Management
- Diagnostic Imaging
- Objective Findings
- Medical Evidence
- Demonstrable Injuries
- Thorough Histories and Examinations
- High Quality Daily Notes
- Delays and Gaps in Care
- Missing Subjective Complaints
...just to name a few!
Any combination of these, as well as others (the above list is not all-inclusive), has the potential to decrease the Fair Value case settlement amount.
Imagine if you have 5, 10, 15 minor to moderate mistakes in your clinical documentation, or maybe just 1 significant mistake. It can easily add up to a less-than-Fair Value settlement. A less-than-Fair Value settlement can trigger a reduction request of your bill, sometimes by as much as 50% or more! It also eliminates any potential chance of referrals from Personal Injury attorneys.
Every Personal Injury attorney has a choice of whom to refer their clients. Will they send them to clinicians that make mistakes and decrease case value, which in turn costs them and their clients revenue? Or, will they actively seek out providers that can provide quality clinical documentation, avoid the mistakes and issues related to the Personal Injury arena and at least give them a chance at a Fair Value settlement. The answer is obvious, and you would do the exact same thing if you were an attorney.
The Personal Injury arena is still a very lucrative area of practice, but it is becoming more competitive with clinicians seeking alternative sources of revenue because of declining health insurance reimbursement. So what that means is those clinicians that actively seek the latest information, understand the nuances of documentation and management, and continually improve their Personal Injury practices will see the greatest benefits.
If you are not satisfied with your results or are looking to expand your Personal Injury practice there are solutions available.
Excellent Personal Injury documentation and management always has and always will continue to get you paid fairly, get you more Personal Injury referrals and distance yourself from your competitors.
That is why you should bother.
S. Scott Tauber, DC, DABCO, CPC
Dr. Tauber is COO and lead instructor of the American Institute of Personal Injury Physicians (AIPIP). He received his Doctor of Chiropractic degree in 1984 from Life Chiropractic College and is both a Diplomate of the American Board of Chiropractic Orthopedics (DABCO) and a Certified Professional Coder (CPC). Dr. Tauber is a frequent guest speaker at professional and med-legal conferences, state association events and professional schools and has been published in state and national journals.
JTECH is hosting a webinar with Dr. Tauber, Personal Injury & ICD10 - Potential Impact to Your Practice on October 1, 2015. Attendance is $49.