Chiropractic bills and records have always been under assault by the insurance company, but the process is getting much worse. With more reliance on computer models and programs that scan medical bills and records, insurance companies are using chiropractors to attack their patients’ personal injury claims without them even realizing it. Mistakes or problems in the chiropractic records have become a primary attack on plaintiffs during settlement negotiations and at trial. The following is a list of the most common attacks we see as it pertains to chiropractic medical and billing records:
1. Typographical Errors
I am routinely shocked at the number of mistakes in medical records from hospitals, large orthopedic offices, and even chiropractic offices. These often small mistakes have a huge effect on the patient’s personal injury claim because the insurance company and their lawyers are going to present those mistakes as absolute fact to a jury. The patient might testify that he or she has never had another car accident, but if the records notate that the patient had an accident in April of 2019, instead of the correct May of 2019, then the insurance company is going to present the patient’s failure to disclose her “April accident” as fact to the jury. The chiropractor can save a patient’s case by taking an extra minute to ensure that the patient’s history, past treatment, and dates are correct.
2. Copy and Paste Records
Insurance companies love attacking chiropractors and medical providers who copy and paste the same History, Examination, Assessment, and Plan sections into the records for each date of service. Insurance company lawyers have started pointing out to jurors how these sections are often repeated without any notated change in the patient’s condition. Insurance lawyers often insinuate that the chiropractor is “lazy” or is “money-hungry” and cares more about their bill than patient care through their “form records.” Assuming that the patient is receiving some benefit from the treatment plan, the medical records should reflect the improvements in the client’s condition throughout the course of that treatment.
3. Pain Scale Number Discrepancies
I believe that chiropractors often fail to properly explain the pain scale to their patients. For example, a patient who is able to walk, talk, and carry on a conversation should never have their pain listed as a “10 out of 10” on the pain scale. For example, a chiropractor can help the patient provide a correct response by explaining to a patient that a “10 out of 10” on the pain scale is equal to childbirth. Childbirth, for example, is a good benchmark that most people can understand when rating their pain. Similarly, a patient’s pain should not be a “2” then increase on the next visit to a level “8,” as such an increase signals to the insurance company that the patient likely suffered a new injury.
4. The Word “Chronic”
Using the word “chronic” in any context is damaging for a patient’s personal injury claim. Insurance companies employ computer programs that scan thousands of pages of medical records in search of buzz word. One such word is “chronic.” “Chronic,” when used in medical records, is argued by insurance lawyers to mean “pre-existing” even if it is meant to mean “chronic pain since the accident.” “Chronic” and “pre-existing” have become synonyms in the legal industry. Unless you are intending to describe your patient’s condition as pre-existing the accident, the word “chronic” should be avoided if at all possible.
5. Billing Errors
Lastly, I understand that how certain procedures or treatments are coded can greatly affect the compensation rates for chiropractors, but sometimes, the way that the treatments are coded can have a large effect on a patient’s injury claim. For example, assume you had a patient who has been treating with your office for back pain before a collision, but no neck pain. Then, that patient gets in a car accident and has new neck pain complaints. The insurance company is likely going to request all prior records for the patient. If the prior billing codes show “manipulation – all regions of spine,” then that client now faces the argument her neck pain predated the collision. Similarly, after a collision, coding your bills as “manipulation of all regions of the spine” when the patient has only neck pain complaints can jeopardize the compensation for your full bill. Coding procedures properly can protect your patients ‘ injury claims and your bill.
We see most often those five pitfalls where chiropractors can have a large effect on patients’ personal injury claims. By making these minor adjustments and putting safeguards in place to ensure that the records and bills are both accurate and correct, you can help your patient receive all the compensation that they are justified to received.
If you have any questions about your bills and records, or how we could help one of your patients, please do not hesitate to call at 678-935-6000. We are happy to provide any guidance or suggestions.