[00:00:00] Speaker A: It's a great service and there's a lot of people that personal injury buoys up the rest of their practice because they do get paid better. But it's a fool's errand to try to do it without the proper training, the proper infrastructure.
[00:00:14] Speaker B: Hello, everyone. Welcome back to Chirocast, brought to you by ChiroTouch. I am Dr. Stephanie Brown and I am joined today by Danielle Habinaz.
[00:00:24] Speaker C: Yes, I'm back. I've missed being on the mic with you. I'm really excited about today's conversation because PI and workers comp comp are two topics that can feel confusing really fast, especially when the rules shift depending on where you practice.
[00:00:39] Speaker B: Yeah, exactly. PI and workers comp can feel like a different language. Like here, where I am in New York State, we don't ever call it PI. That's just not a thing. I mean, it might be in some areas, but not where I am. So it's not just paperwork. It's rules that change by state timelines and different documentation standards that really have to hold up under scrutiny. So today we're going to talk about how workers comp works, break down what PI is, how it might differ, and documentation best practices that protect your notes and your practice. Just a disclaimer. Again, like we've mentioned, there's different state laws that are going to apply to all these situations. So you always want to make sure that you're being compliant with what's required in your state. And so if we discuss something that you're not sure of or it sounds to maybe not jive with what you know to be true for your area, you just want to make sure you check that with your state board.
[00:01:31] Speaker C: Yeah. And we're going to make it practical, the kind of guidance that you can take back to your next initial eval, your next RE exam, or even your next daily soap note.
[00:01:40] Speaker B: Yeah. So today I'm very excited. Drum roll, everyone.
We are joined by Kathy Widener from KMC University. You may know her better as Kathy Mills Chang.
And Kathy and her team have helped chiropractors across the country make PI, workers comp and so much more be more understandable, manageable, and a lot less risky. Focusing on fundamentals that matter most, clarity, consistency, and defensible documentation. Kathy, we're so happy to have you. And welcome to Chirocast.
[00:02:14] Speaker A: Thank you so much for asking. I'm excited to be with you today.
[00:02:17] Speaker B: Yeah, of course.
So to set the foundation, when a chiropractor says P I, what does that actually mean in a practical Day to day chiropractic setting.
[00:02:29] Speaker A: Well, you brought up a very good point. I also worked six years in New York, and PI there is just simply called no fault because no fault is a subdivision of PI.
In its most generic form, PI stands for personal injury. That could be a car accident, that could be a slip and fall accident. I've seen it all.
But it is when an individual is injured and a different type of insurance, then health insurance usually will come into play. Whether that's auto insurance, the patients or the adverse drivers, whether it is in a case like New York, it's no fault. It's very different than in many other places.
The three divisions are called tort, PIP and no fault. And every state falls into one of these three categories. So you are very wise to share that. Everyone should really best understand what their rules are in their state. And where I see a lot of issues happen, as I'm sure we'll visit about, is, you know, having someone in your office who has an active personal injury claim in another state that may be different than the way that you normally handle it. For sure.
[00:03:44] Speaker B: Yikes. So in that scenario, is there a set rule where one state's laws are going to take precedence over another? Is it always the state where the injury occurred or usually.
[00:03:55] Speaker A: Yes, where the injury occurred. So someone from New York comes to Colorado, where I am, their claim is in New York with a New York state payer. And so therefore all the bills go there and they pay in that very unfortunately minuscule fee schedule that goes along with that. What do you mean?
[00:04:15] Speaker B: It's great.
[00:04:16] Speaker A: Yeah.
Probably very different. 1994, when I worked there, it was like $18.
[00:04:22] Speaker B: Yes, yes. I mean, I think the state associations have been working on it and it's improved, but it's still difficult. Yeah, Actually a super, super long time ago, somewhat related, but different. I had a patient that was actually here for college from Canada.
She had been in an accident at home. And so even then I had to send the bill, like, to. I don't even. It was like their insurance company in Canada and they were on ICD10 at the time, not ICD9, but we were still on ICD9. Oh, yeah. So one of my Canadian friends had to help me, like, cross over the codes.
It was wild. But it worked out and I got paid. So that was weird and hopefully not something most people have to deal with.
But yeah. So also, what's new to me, and I would say new just because of what, how we do things here, but situations where like the payout's actually coming from a lawyer. Like what is that? Like the tort situation. Help me out here.
[00:05:19] Speaker A: Yeah, so if, if we look at each one of the three of those kind of categories, starting with what is a traditional tort state.
So in most of these states, someone purchases car insurance for themselves and in a car accident specifically, a little bit different in your homeowner's insurance or I slipped and fell in Walmart. I mean, there's all these different categories. But for a car accident, I purchase insurance that has my liability insurance. Should I be at fault in an accident, I have an insured motorist in case somebody hits me and they're not insured. My own policy will cover that.
Most always, it is wise for a patient to purchase medical payments coverage, which is a pot of money that will pay medical bills regardless of who's at fault.
So in many case that could be a double dipping situation.
And then there's a portion that sort of is meant for the repair of property, like your car if you ran into a fence or knocked down a light pole. So everyone has their own insurance in that type of estate.
So if I am hit by an adverse driver and it's their fault, I might have some coverage under that medical payments to take care of my bills along the way.
But ideally that adverse driver's insurance should take care of my bills, my pain and suffering, my time off work, all the things that go into that, that comes out of that liability line item on their policy.
Well, I don't sit at a phone and, you know, work within. Well, I kind of work with insurance, but I don't work with how these insurance adjusters operate every day. So like sitting down to play Monopoly with someone who's a world champion, they do it every day. They know the rules. They know how to cheat you. And I say cheat with air, air quotes. They're not going to offer what you actually deserve. Which is why in these states you see a bazillion attorney commercials. Let us help you. Because what will happen is that for that adverse driver portion, you hire an attorney to just deal with them. They do all of it, the negotiations, et cetera. The. They work with the doctor. There are some major downsides, a lot of good sides, but some major downsides. One of them is that more and more frequently, attorneys will not really even work with a doctor unless they're willing to cut their fee, even when the attorney doesn't cut theirs. Generally an average fee for an attorney to work with a patient in this is around a third of their settlement now, used to be in the old days, they would always be able to ask for enough, probably more than you would have ever gotten on your own negotiations to cover that 1/3 fee and still get what you deserved.
Now, interesting with MedPay, if I have $5,000 bill at my doctor's office and I get it paid from my MedPay, theoretically when that $5,000 gets paid through my settlement from the adverse driver, because it will, that just adds to what I will ultimately take away from this. And yes, the attorney takes their third.
More and more tricky. Attorneys are now saying, I want all the MED pay money sent to me, I want to do it all. And then those jerks take a third of that too. Which I just wish that I could work with doctors more to help them understand what they're putting themselves into.
And the fact that so many are feeling like they're over a barrel if they, they won't get the patient referral if they don't agree to cut their bill.
So from a tort situation and an attorney, that was a long winded response to that's how an attorney deals with it involved. Yeah. And now the secondary piece of that still could have an attorney there is in lieu of MedPay, a state that would be called a PIP state.
So what PIP is Personal Injury protection is what it stands for. So some states that are not true tort states have automatically built into your own car insurance. A line item of personal injury protection behaves like MedPay automatically pays your bills when there's an injury. And it functions very similarly to MedPay. But you're not kind of paying extra because it's just what is automatic in that state. Now in no fault, that is, you know, I had a car accident in New York and it was a no fault scenario. And no fault just means it's another line item that you're in. Your insurance pays for you, their insurance pays for them.
[00:09:50] Speaker B: I will get patients all the time. Not recently really, because I've not in full time practice anymore. But they come in, they've been in an accident and they don't understand here in New York and other states that are no fault, like, well, the accident wasn't my fault. It's not, it shouldn't be under my insurance. And I played the game with somebody once and I was like, okay, well we'll see what happens here. So I just let it go and we sent it into the other driver and it was this big mess and, and it got denied because it's like, well, you're not an inferred on the other driver's policy. This is not how it works. It did end up getting paid and we sent it to hers. But do you have advice to doctors on how they can prevent that and explain if it's applies in your state like no patient, this has to go, you have to report this to your insurance within a certain amount of time. And if you want to hear here, it has to go through your insurance.
[00:10:39] Speaker A: You know, I think it's part of a traditional financial report of findings that not enough offices do where you sit down and say this is how this will work. I will agree to wait to be paid and extend you credit because your car insurance has a provision to pay my bill. But there are things you need to do and there are things I need to do. Now I will tell you that in most no fault states they have a rule, this actually happened with my accident, that when your bills and liability issues exceed a certain threshold at that point through an attorney you have the ability to pursue that adverse driver, but only after it's hit a certain threshold. So that's again, you never know what you're going to get with a patient, but that's how that works. So I just, I think there's not enough, you know, maybe the staff doesn't understand it enough to do it but to sit down and explain it. And I think there are some brochures out there that help to identify what that is. I'm sure state associations can help by saying this is what we know about it.
How many things could AI put together these days for explain no fault to a dummy, like no fault for dummies and just have a one sheet that you can hand to your patient and this is how it works. You don't believe me, call your agent.
[00:11:58] Speaker C: Well, now I understand why a lot of chiropractors, they want nothing to do with it. There's like two sides. You're either all in and you, you know it, you love it, you breathe it. And then the other side, they want nothing to do with it. When a patient walks in and they don't tell you right away they were in an accident, it's like, oh no, what are we going to do?
[00:12:19] Speaker A: I think that's a different problem. They walk in, that means we're not asking the right questions. If somebody is walking in and they don't tell us they're in an accident, I blame the office for that. And granted you're going to have 5% of people that are doofuses and they're just gonna go, I'm not an accident. Then they come back later when they find out what the bill is and they say, no, I think I should put this through my accident.
So I completely agree with you. But I have a number of clients who really thrive in the personal injury environment. But then we get into the whole fee schedule nightmare because of course that's a way to get your full fee when I'm then discounting cash by more than is appropriate.
So there are a lot of layers to doing personal injury correctly, including the fee schedule. And it's something we love to work with. Now in our library of training we have two really great courses. One that is how insurance works and it breaks down every different kind of insurance as a module. And then its sister course is how to verify every one of those different things. Because we, you know, there's a module for each one of the same things and we have verification forms like what should we should be asking up front, what we should be saying when we call the payer for verification and eligibility?
Because it is complicated. Same with workers Comp.
[00:13:36] Speaker C: So with PI and workers comp, you are able to verify benefits similar to if you were billing Blue Cross or
[00:13:42] Speaker A: Medicare and what have you most of the time. What I suggest is that, and this again is let's do a proper new patient phone intake. Let's be sure we tell them everything they need to know. I have them bring what's called their declaration page of their auto policy.
That top page says everything about what their coverage is. Just bring it with you. That's no different than bringing in an insurance card for commercial insurance. And then we can see what they have. And then we may need to call their agent. If they haven't reported the claim and have a claim adjuster, then we may need to interact with the agent or if they already have them, we have a claims adjuster to interact with and we can get the details we know. But in most cases there is not necessarily a limit on coverage. Sometimes there is like they cheaped out and just bought a, you know, I have a thousand dollars of med pay. Well, if they went to a hospital first, you can kiss that goodbye. It's not going to happen. So that's another great question on a PI is what all have you given your information to and try to get your bill in first. So it take, you know, they take care of that. 5,000, 10,000. Those are, I mean it's such pennies to have this on your policy that everyone should be calling their agents and saying, do I have this coverage for myself. And by the way, Stephanie, if I'm riding in your car, I was going to ask you, let's not take you because you're in New York and it's weird.
But Danielle, if I'm in your town and I'm in your car and you have MedPay, I'm covered under your MedPay. So it's like $5,000 for each passenger kind of a thing. But when that runs out or you don't have med pay, my med pay will cover it, even though I'm in your car. So it's just. And PIP has its own rules, but it's just, again, it is so important that anyone billing in a practice just cannot leave this to chance. They have to know.
[00:15:43] Speaker C: You have to ask too. I think. You can't just assume if somebody's in an accident, you can't assume they were the driver or, you know, you have to ask, were you a passenger? And you know, all the things I was going. I was literally making a mental note to ask, well, what if I have my own coverage and I'm the passenger?
Someone that has a completely different, you know, policy than I do. So that was an awesome clarification.
[00:16:04] Speaker A: You are always covered wherever you go, but primary coverage is the car you were in.
[00:16:09] Speaker B: Interesting.
[00:16:09] Speaker A: And it gets exhausted first.
[00:16:12] Speaker B: I had a, I had a patient once who, you know, came in, they did tell us they were in an accident ahead of time. Filled out our paperwork. I get back and I'm like, okay, you know, what happened? And long story short, he, you know, most people when they say car accident, it's like car on car. And this was like person on car. And he was, yes. And I was like, okay. I'd only been practicing like two years. It had not even occurred to me that that that would be. Obviously it's a thing people get hit by cars, but coming, coming in on as like a no fault case, it was interesting. And also he didn't have a spinal complaint. It was like a knee problem. And I was just like, why?
[00:16:51] Speaker A: And in New York, that's different too. Well, and, and you know, I think it's important to remember, like, I've been involved in cases where somebody went around a corner in a grocery store with a, with a cart, took somebody out and that actually was covered under some med pay. Oh my God. One thing that is important also, I mentioned earlier, you know, your homeowner's insurance has these same kind of line items. And what you'll find on the homeowners is it's called guest medical.
So if I fall and you know, injure myself in my house, it doesn't cover me. But if you fall and injure yourself in my house, its coverage just exactly the same way up to whatever limit I have behaves the same way that MedPay works. This happened years ago. My father in law was on a ladder and fell off and it covered all of his expenses.
[00:17:45] Speaker C: Well what about. So I know that's homeowner's insurance, but I know earlier you mentioned slip and fall. So let's say I am at a big box store and I do slip and fall at the store. I imagine it's, it's very different than a car accident or homeowners. What does that look like as far as PI billing?
[00:18:03] Speaker A: Well, it's similar in that it will come out of that liability line item and they probably have their own built in line item for medical up to a certain point.
So slip and fall accidents are the very hardest to deal with because they're so subjective.
And you know, if somebody is literally seeing what happened, you have to prove liability and all of that. But very often the store will just pay any expenses out of this line item of kind of medical coverage. It's only when you go to sue them that you dip into the liability side. In which case I would never try to do that without a lawyer. And again they're very difficult. Very, very difficult. Liability proof is super hard. Unless there's something like they have to prove whatever spilled, we knew it was there and we ignored it.
And that's hard to do. That's just hard to do. I don't say don't do it, but it is slip and fall cases should always be taken with a grain of salt.
[00:19:07] Speaker B: They're gonna hire PIs to follow you around and take pictures of you doing yard work. And I mean we did have people, one or two people in that situation. There's actually was their employer though and it was got real messy. So that was like a workers comp thing. But yeah, that's. It gets tricky for sure.
[00:19:25] Speaker A: And then you add to all of this what is a really big deal and that is how does health insurance apply?
[00:19:30] Speaker B: I was going to ask you that.
[00:19:32] Speaker A: Yeah, it's crapshoot. It's truly a crapshoot because health insurance will almost always not be primary.
[00:19:40] Speaker C: Not me not going to pay for
[00:19:42] Speaker A: it, not be primary. But they will pay and they will what's called subrogate in the end to get their money back. But the challenge exists when the doctor is in Network and is forced to now not take their full fee but to take this in network crap fee. That probably happened. Now it's interesting in our personal injury training we have a letter that was think in the state of Texas that laid out a whole bunch of law stuff about why the health insurance company we are not required to accept that fee. Now I can add another layer and that's Medicare.
So Medicare has a one year timely filing deadline. So when you have a Medicare patient come in and they have this going on, my strong advice is that we do not submit to Medicare out of the gate. But we have some sort of a tickler that says a month before the year's up, make sure that we're paid. And if we're not submit it because Medicare will also subrogate back to the original. You have to put all that information on and they will get their money back. But if you can wait on health insurance and on Medicare and just not get involved in the beginning, his patients will come back educated and go forget you. I want you to charge me the fee you agreed to and then it's a fight.
[00:21:03] Speaker B: Right.
[00:21:04] Speaker A: So these to your point earlier, Danielle. You know, I really feel like personal injury can be a very robust and healthy part of a practice. I would keep it to a maybe 15 max percentage of the practice but when we cross over into they've got insurance, they've got Medicare, those are the biggest headaches for sure.
[00:21:24] Speaker B: Definitely.
What about, I hear people talking about liens and I've never truly understood how that applies. Are you putting it on the person? Does it go to the lawyer? Yeah, to do with that. Like what? How does the lien play into PI and all that?
[00:21:40] Speaker A: Couple of ways. Definitely a couple of ways. And I have a favorite way, but it doesn't always work.
So a lean document is something that we sign almost automatically in a PI that has a lawyer. The, the spirit of a lean is that you, the patient says I want my doctor paid out of my settlement before I get my money. And you get your money. That's what a lean says. We agree to wait to be paid, we're extending credit to you, interest free credit and we will wait knowing that our money is going to be guaranteed. Well now you get into all kind of hot water with what if they didn't get as much as they thought they would, yada yada, the attorney should sign that lien and agree to it and send it back.
50% of the time they blow you off at least.
So that's a lien. That's an official lien that way. I'm going to tell you about a couple different things.
In certain jurisdictions there is a county lien that you can file where I go into my county clerk and I can put a lien on the adverse driver. Settlement skips the attorney. And especially if you've got someone that doesn't have an attorney, I would 100% do this. It goes to the adverse insurance showing that you have a lien against that money just like anybody would do. Like if you have a creditor that puts a lien on your house, I mean, same similar idea but not quite as involved and that they can't settle without paying your money and then you're dealing with them. So that adds a layer of safety on those situations.
[00:23:14] Speaker B: Well, that makes sure then they don't send them settlement to the patient and then the patient doesn't pay the doctor's bill. That would prevent that.
[00:23:21] Speaker A: In that situation the third party payer would be. And in many cases with the lien, the lawyer with a proper lien would be held liable for that because they said they would pay the doctor directly. They may call and negotiate it down or something. And I have many ways that I tell doctors how to do that, but those are what liens are really for.
Ideally, of course, somebody goes to Cancun, as they often do. This is very much, you know, in my opinion, about procedures in the office where we're not paying attention. I was literally just in an on site visit last Thursday and Friday in Indiana and there's a whole slew of personal injury people that no one had followed up on. And I sat somebody down at a phone, taught them how to do it and had them call every lawyer and two things had settled and I mean there's no money.
So the office has an obligation to protect their money and to have proper procedures in place and proper training in place for these people and you might get stuck. Now that patient, in my opinion, would go straight to small claims court.
I don't play around when you took my money, I'll work with you all day long on a payment plan. Whatever. You stole the money, you got well and you took the money. All bets are off. You go straight to small claims court.
[00:24:40] Speaker B: Yeah, no good.
[00:24:41] Speaker C: I imagine it doesn't happen too often, but you'll have a patient, they get 12 to 15 visits in and then the attorney drops them for whatever reason and then the docs are left scrambling. What, what can they do in that scenario?
[00:24:58] Speaker A: So this is the gospel according to Kathy. It may not be on Everybody's wheelhouse, but it's mine. I think that patients who have no out of pocket cost are your worst patients, the very worst patients.
So what I'll often advise doctors to do, especially in these situations where it might be you're just waiting on the settlement.
Find some copay that they pay every visit, $10, $15, I don't care what it is. But they're paying something toward their balance every visit.
So if something happens that you get hosed in the end, you've got something to show for it. And the patient is now participating and not going, I'm going to suck this for all it's worth and I don't care if you get paid. I think there's personal responsibility that comes along with this.
Unfortunately, we can't do that on workers comp cases. But they're the other ones that are often the worst offenders. They don't keep their appointments. There's so much stuff.
And this is another reason, Danielle, I think doctors really just don't want to deal with it. But I think there's nothing in the world that stops. Maybe no fault, I have to look. But that would stop someone from collecting a small copay each visit to say, this is just going to go towards your balance. This is good faith for both of us.
And here's what it is. But I have to do that financial report of findings to get that done.
[00:26:21] Speaker B: Yeah, I think if you can make sure the patient has skin in the game when you're allowed to, that's going to help.
They care more, they're going to be more compliant. And in my experience with both, but especially workers comp. Once they start not showing up for appointments and whatnot, it's usually because they're better, but they're just trying to like ride it for as long as they can somehow.
[00:26:40] Speaker A: And end of the world. Yes, exactly.
[00:26:43] Speaker B: Yeah. Maybe that's not nice to say, but it was true a lot of the times in my experience. So.
Yeah.
Wild, wild things. I had someone once who was like held out of work, but then taking weekend jobs, but then obviously, therefore he's fine and he could have gone back to work, but it was a mess. I mean, it was a mess. And so.
Yeah. So how.
Okay, all right. So every state is kind of different. There's groupings for how they might manage, like auto cases. But every state has a workers comp board. Right. Or they might call it something else, but something similar.
[00:27:18] Speaker A: Yeah. And both of these categories are kind of medico legal categories which are very different than everything Else that practices deal with.
Workers comp varies by state.
Some have a very specific workers compensation fee schedule that you accept the patient. We call that a regulated fee. Hip is a regulated fee. No fault is a regulated fee. Workers comp is a regulated fee. I have run upon some states where they don't have a set fee schedule. It's just your fee, which is great.
You have to follow that also.
More and more and more, you keep in mind that who you're dealing with is really the employer.
And we talked earlier about verification. That's the first stop on one of these. Now more employers, in order to limit their liability, will even have a doctor on staff. Depending on the size of the employee of the employer. If they have a warehouse or something, they have to go see that nurse before they can do anything. And the employer controls who the patient can go to.
So when you get the phone call, so much has to happen. I'm shocked at doctors that don't train their front desk CAS in all of these situations. On that phone call, if I find out I was in, you know, the specific question in our training is, do you have some type of insurance you'd like our assistance with filing for you? Yeah, I was in a worker's comp accident. Awesome. Where do you work?
Have you reported it? Do we know that you are able to come here without your employer's, you know, referral? Like you have to ask all those questions and this is all about just even allowing them to be in your office before we get anywhere.
And sometimes it's not in house, but they have to go to another doctor first, and that doctor controls the case for referrals. So we have to know how that works in the state as we accept a workers compensation patient question.
[00:29:18] Speaker C: So would it be beneficial? I mean, I don't know where a chiropractor could start, but you mentioned that they would call the providers and they are performing the referrals. So. So it could be beneficial to create relationships with folks in your area, businesses, employers. Yeah, I mean, I don't know the rules. With like big, like corporate, there's no rules.
[00:29:41] Speaker A: So you can establish, you can absolutely go and hold yourself out as an expert. In fact, you know, back in the day, before we just focused in on reimbursement and compliance, did a lot of marketing training and, you know, a lot of these places.
I'd love to come in and do an ergonomic talk. I'd love to come in and talk about lifting. You know, you are the expert for them. And of course, after A while. Then they begin to trust you and know you. But I think those relationships are important. Sometimes the relationship starts by one of their people coming to you and it's how you behave in that relationship that determines what they're going to think of you going forward and how well you do all the things that you need to do to keep that, you know, keep the employee at work, keep them, you know, getting better quickly.
Another factor to think about is what a lot of employers will do is on their workers compensation insurance, they will be self insured.
Some of them will be self insured only up to a certain dollar amount. So they might say, I'm going to cover the first $10,000 of any injuries, time off, work out of my own pot.
But when it gets over 10,000, essentially a $10,000 deductible now it will go to the over here. And they save thousands of dollars on premiums by doing this. So again, who do I bill? Do I bill the employer? Am I billing a payer? All of that is information in the eligibility and verification step. So new patient phone call, the next thing in the data gathering is I have to know, is there eligibility to come here in a workers comp? That's very specific. I need verification of the benefits of the services I intend to deliver.
Do they cover laser? Do they cover decompression? We have to do that before we know anything. And then if there's a medical review policy associated with it, we got to know that those four steps, gosh, if offices would just do those four steps, they would have 50% fewer problems easily, if not more.
And so that's a lot of it.
[00:31:45] Speaker B: Yeah, it's really getting that key information then like before the patient even steps foot in the office as much as possible.
[00:31:51] Speaker A: That's right.
[00:31:52] Speaker B: Yeah.
[00:31:53] Speaker A: So we can make that call to the employer before they walk in. So and so called they indicated they had an accident. You know, do you have that on file? Are they allowed to come directly here? Do I need to wait for a referral before you put yourself in that situation, then you call the patient back and schedule them.
[00:32:08] Speaker B: Kathy, what if the employer is the federal government? Then what?
[00:32:15] Speaker A: It's the worst.
[00:32:16] Speaker B: It doesn't go through the state workers comp.
[00:32:19] Speaker A: It does not. And it's the worst.
[00:32:21] Speaker B: I swear I had some injured post carriers.
[00:32:25] Speaker A: It's usually them.
[00:32:26] Speaker B: That was great. But it was a long time ago.
[00:32:29] Speaker A: Well, and it's done through the Department of Labor. That's the different place that it has to go in it. And when I say it's not the worst. Like, sometimes the approvals are difficult, the payment back and forth is okay, but. But the problem exists when an office has no idea that federally insured people are different. Yeah, I didn't know to have that knowledge. You learned along the way.
[00:32:52] Speaker B: Yeah, I. Yeah, my first one, I had no clue. But the patient was really good at, like, giving me all the info from God and they were motivated to get better and all the things, so it was great. But, yeah, you have to. You have to go through the Department of Labor for that.
[00:33:06] Speaker A: And those are regionally handled most of the time. Yeah. So every one of the. The government regions does their own thing, but it's important to know it exists, and then if you have one to do it right. And, you know, we recommend offices. As you come upon something for the first time, write it up in your standard operating procedure, so the next time it happens, you've got all of the steps to do in your procedure manual, and then you won't. You won't have the same problem again.
[00:33:33] Speaker B: Yeah, exactly.
[00:33:34] Speaker C: I want to touch on. On the Department of Labor, because I worked with a lot of chiropractors that it was nuanced where it wasn't necessarily that you're in network with them or maybe. Maybe it is a thing, but they had to get in. I'm going to say in network. I'm probably not saying the right term, but like a vendor. Yeah. With the Department of Labor. And that was the step that had. That was missed a lot of the time.
[00:33:56] Speaker B: You can't just take those people, Right?
[00:33:58] Speaker A: That's right. Yeah.
[00:33:59] Speaker C: You have to be on a.
Somewhere with them. Yeah, I have to be on a list that I didn't know.
And so that was a roadblock for. For a lot of the chiropractors. And it wasn't a quick turnaround process for getting on that list. So I think that's a piece of the puzzle here to take into consideration as well.
[00:34:17] Speaker A: And that's part of the reason that I went.
Just because there's a lot to it doesn't mean it's not great. But there's just a lot to being able to do that. And awareness is the first step.
[00:34:29] Speaker C: Awesome.
[00:34:30] Speaker B: Okay. We talked a lot about, like, the technical pieces here, but what about records? So I have two very specific questions. Do you. Do you want them one at a time?
[00:34:38] Speaker A: Sure does.
[00:34:40] Speaker B: And this might vary by state, but, like, you know, there's like, date of onset, date of injury, or initial treatment date, and then there's the accident date's Pretty simple. Everybody knows that. But date of onset and initial treatment date.
I talked to chiropractors every day that have no clue what to put in those two boxes. Do you have.
[00:35:01] Speaker A: Well, there's really only one box and it's super simple. They just are talking themselves out of logic, I think.
[00:35:07] Speaker B: I think so too.
[00:35:08] Speaker A: The date of accident and the mechanism of injury belong in the initial history of the initial visit in their episode of care. That whole thing needs to be a part of that documentation. What happened, how did it happen, what are the circumstances, mechanism of injury and the date it happened. That date would move to box 14.
If it is an accident and it may say onset, it may say all those things. But when it is a workers comp or a PI specifically, I want that accident date in box 14.
That's important when I'm talking about insurance or I'm talking about any Medicare anybody else, I don't want that mechanism of injury date to be in box 14. I want box 14 to be today's date that we're starting this episode. Episode that matches with the treatment plan.
So auto and work comp are different.
[00:36:03] Speaker B: Got it. Okay, cool. Yeah.
And then I run into this a lot too, but I think I. I've asked this question before, I think actually, and some of the trainings that you guys have for members, like monthly and whatnot, but just to get it out in the open in general, like, if you're using an electronic health record, is there an expectation that you're actually clicking the sign button? I mean, in general, but specifically for like these workers comp. And no faults. Because I find.
And docs are like scared to click sign because what if I have to go back and change something? And I kind of always say like, well, you do. That's not the point to go back and change your note really.
[00:36:41] Speaker A: But you could add an addendum very easily. Patient came back and corrected that. They didn't fall off a stool of two feet, they fell off a stool of 20ft. You know, that's important to add into the addendum, which chirotouch does a great job of allowing for that.
We don't want to have to go back and update things. And yes, the note should be signed contemporaneously within 24 hours.
[00:37:05] Speaker B: Yeah.
[00:37:06] Speaker C: Okay. I think also talking, if there's an attorney involved, having that relationship with them, call them. Call them and have a conversation about how they might want to see that laid out. They might want to see, you know, you fill out the addendum a certain way that's going to help them when they take the case further. Versus guessing. You don't want to guess how you're supposed to do things. I would say have a conversation with these folks to kind of.
[00:37:32] Speaker A: Yeah, I don't really care what the attorney thinks. I care about the health record and my obligation with my license. Now, we. It depends on what you need to say. If you think it's completely wacky and this is going to kill a case, give them a call. But an easy addendum of something that you're adding back into the note that might have been missed the next day because we're not going to go out five months and go back and enter it. That's crazy. But if there is something that you were just adding back in, it's none of their business. You're. You're taking care of you, your license and your record. Yeah. If it's wacky, sure. Go ahead and call them.
[00:38:05] Speaker B: I have heard of docs that it sounds like the lawyer is kind of telling them how to write the note. And, you know, I stay out of it, depending on my role and why we're on the phone in the first place. But that just sounds like a really terrible, A terrible idea because, I mean, they have no liability on what your medical record says. So why, like, they don't care if it's right, wrong, whatever, it's going to help them. You'll be the one on the hook if you're falsifying your medical records. I mean, well, and, And I would
[00:38:32] Speaker A: say that we have dealt with situations before where the attorney has to do that because the doctor's documentation is terrible.
[00:38:39] Speaker B: Yeah, I love it.
[00:38:42] Speaker A: And they should not be even working with that doctor. If I'm a lawyer, I don't want that hassle.
Now. I can. We've worked with attorneys who've had called us and said, can you please go work with this doctor? And we've done it. But I think, I think when the notes are just flat, no good, they need to be called out on. You're not putting the vital information.
Like you just can't say same, better or worse, period. You can't do it. Why are they same, better or worse? What does that mean? And they never put it in that there's no continuity to the, to their health record.
So I can see an attorney bringing it up, but they should not be telling them what to say.
[00:39:20] Speaker B: Yeah, that's a really good distinction. I like it.
[00:39:23] Speaker A: Yeah.
[00:39:24] Speaker B: Would you say there's a recommended cadence on when somebody should be Doing and documenting RE exams or is that going to be really condition specific or payer?
[00:39:33] Speaker A: Not payer specific, but sometimes, sometimes it's payer specific. I know that HNS in, in North Carolina does, has a whole bunch of rules around that. It depends on the network that you're in. But I'll make this distinction. When you're using outcomes assessment tools, they need to be redone every 30 days no matter what else you're doing.
More and more and more in our world, RE evaluations are not being paid, they're being specifically excluded.
We know that within the confines of a CMT documentation, you can get everything that you need to have and it can be done a little at a time and everything that's necessary will be in those notes. So a formal reevaluation, except in these odd circumstances with certain payers, I don't really think they're necessary. I think a reevaluation is a great opportunity to do education with the patient. Here's where you were, here's how you are now, and here's what still needs to be accomplished. So even if you're not doing the formality of it along the way, there should be a time when you're doing that with them.
Always go by the payer guidelines. If it is a third party payer situation, Workers comp and no fault may have some of those. Or workers comp and NEPI may have some of those guidances for sure.
Yeah. But it just depends, you know. But I'm a fan of There is no rule anywhere. I mean, I hear it all the time. Medicare says I have to do a re eval every 30 days. No, they don't. No, don't listen to your buddies, please. Listen to people who know what they're talking about.
[00:41:12] Speaker B: Yeah, don't ask on social media either.
[00:41:15] Speaker A: God, no.
[00:41:16] Speaker B: Good times. Yeah, good times.
[00:41:18] Speaker C: Can we briefly talk about macros and what that might look like for PI and workers comp? I know there are so many doctors that are. They're writing out their notes every single time from start to finish, and it's deviating because it's memory management or worse.
[00:41:34] Speaker B: They don't change their note from visit to visit at all.
Yeah.
[00:41:39] Speaker A: Well, I will tell you that personal injury has its own kind of genre is what I will say. A lot of these people follow Art Croft. Art Croft is kind of the guru of. And he's in San Diego, I think, and he's like the guru of medical, legal, personal injury. How to write your notes, how to do all this, what the whole Nine yards. And they go to seminars and they learn all this stuff and it's a whole thing. I want to say this guy created some macros that are blended and I think with some of the bullet touch for personal injury and what those macros should look like. And I do believe they're in Chirotouch, unless he's pulled them. Gosh, I feel like his last name starts with an S.
But there are definitely some of those options in there. You can get everything that you need just with the bullet touch macros. We made sure of that when we worked with Chirotouch to create them, that it will do the day to day to day promptings for what needs to be said and how that needs to be done. We can add some flair around personal injury a little bit, particularly when somebody's off work and you need to add in something about their ability to get back to work. Same with workers comp. But I think traditional macros, you know, work just fine to, you know, somebody's going to go to court. That's what a lot of this Art Croft stuff is. The measurements you take, some of all of that, that adds a layer on top of what we already have.
[00:43:06] Speaker B: Got it. Here's a funny question. Is there ever any such thing as over documenting?
[00:43:14] Speaker A: I say yes, okay, absolutely.
I think that, you know, I just saw a note, literally, I told you I was on this on site visit and I pulled down two complete records that I could take back and audit and then work with the doctor on. And what they're doing is salting forward from the first visit so that everything
[00:43:33] Speaker B: is going and all of that, all
[00:43:35] Speaker A: of it, and very little, very little else. But there's really not a heck of a lot that you need to say in a routine visit within an episode of care, not very much at all. We need to follow the complaints. We need to talk about changes since the last visit in the subjective and the objective in assessment. How's the patient changed or not? Do they still need more care or not? And then what did I do? Those routine visits should be very, very, very, very quick.
Now when we're. What can sometimes happen is that by trying to make it look like it's more bulky, we're actually hurting ourselves because we're repeating. It's not necessary.
On the AMA side of the world, they call it note bloat. You know, we're just adding stuff. In fact, it's all about administrative simplification right now from Medicare, from the AMA where they want more simple stuff. What is it and you find this in the evaluation and management guidelines that are changing and they're just showing we don't need all this, we need this. That's why it changed when the medical decision making and time rules changed. Yeah. Where they did away with the history and exam having to have all these bullets. It's either medically necessary or not.
[00:44:47] Speaker B: Yeah, yeah. You can't make something look or be medically necessary just because you wrote a lot about it.
[00:44:52] Speaker A: That's right. That's right.
[00:44:54] Speaker B: And that's right. You know, like our exam, when I practice full time, we kind of did some more chiropractic specific stuff that I think an insurer would probably consider like wellness or maintenance or they don't care that you did this. Took extra time to do this thing with this person. So it was necessarily appropriate for me to bill based on time just because I spent more time. Because like the meat and potatoes of what they cover really only took like 20 minutes.
[00:45:18] Speaker A: That's right.
That's right.
[00:45:20] Speaker B: Yeah.
[00:45:21] Speaker A: Good. And then they don't write down how much time it was. That's even worse. Then you're relying on somebody else and you're going, there's no time documented. Therefore I'm going to go medical decision making.
[00:45:31] Speaker B: Yeah.
[00:45:31] Speaker A: If somebody's auditing you.
[00:45:33] Speaker B: Yeah. You can't bill on time but not
[00:45:35] Speaker A: say time belongs right at the end.
[00:45:39] Speaker C: Yeah.
[00:45:40] Speaker B: Oh my God, I love it. Well, I just want to say too, your guys program and your website is phenomenal. I have my own membership.
The way it's laid out, the ease of understanding and going to learn and like teaching yourself essentially and having a tool. I see people asking on social media probably every day like how can I teach my staff compliance? How, where can they go learn more about, you know, Medicare or all this workers comp or what have you.
And so I feel like you guys have a phenomenal organization that has everything in it that someone could need. You have different levels of service depending on what someone needs for their office and membership. And I feel like you are a, a gem for the profession of chiropractic that really, really, really is saving a lot of people's butts. But more importantly on the front end helping them lear do stuff just correctly from the beginning. And I don't know where chiropractic would be without you. Kathy.
[00:46:41] Speaker A: Thank you. Well, you know, I appreciate that we have all different levels of membership and different levels of interaction. You know, the think your membership is really very much self service with a live and an email help desk and that's maybe all people need but more and more people are doing, you know, one on one from one to four hours a month where they really need training and follow our protocols.
We are very proud to have been, you know, 18 years in business. We have the largest team of certified specialists under one roof. I, you know, we get people that have unfortunately been trying to jump from free webinar to free webinar or social media, talking to God knows who, telling them their answers and it just is hard and I, it's just really hard because I, it's hard to watch.
[00:47:31] Speaker B: Yeah, absolutely. So for listeners who want to learn more about KMC University, is it just
[00:47:38] Speaker A: KMCuniversity.com it is www.kmcuniversity.com discovery consultations are always no cost. You can sign up for that right on our homepage or call us and let's figure out if you're even in the right place or if it's something we can help with. By all means. Kairo Touch users always get for an actual, let's say you need up to 30 minute consultation. We honor our member pricing for that for Kyra Touch users. So instead of 99, it's 69.
If they just want to get on with a specialist and talk something through and work something out, we're always happy to, to do that.
[00:48:15] Speaker B: I love it.
[00:48:16] Speaker C: Awesome.
[00:48:17] Speaker B: Yeah. So just to recap our fun hour we had here. So to be successful with workers comp and PI it really starts before the patient's even there. You need to find out as much information as possible about that person injury, how did it happen, was it reported? Who is going to be responsible for paying that bill.
Get all of that information ahead of time and then that's really your first steps. But it's about getting that information. The patient does have some responsibility there. So I really think it, it's on the office to ask and to have their own safeguards in place to protect the office but it's on the patient to, to supply that correct information. And it is hard but I, I have turned away people before because they were not willing to get that information and I think yeah, you know, people really need to be empowered to stand up for themselves and don't take a case if the patient is not cooperating or you know, you don't have the information about how you're going to get paid.
I feel like there's this sense among docs sometimes that like while you have to help everybody and it would be nice to help everyone but that's not always practical.
[00:49:29] Speaker A: That's right.
[00:49:30] Speaker B: Yeah.
So I feel like we highlighted a lot of the annoying bad stuff about workers comp or PI. But I will say I've had a lot of patients that wanted to get better and did and it went great.
Yeah, it's obviously a very viable way to run a practice if you do it right. So I don't. We don't want to poo poo it. And also, you know, I've never been hurt at work, but good Lord. I mean, I hope if I ever do, which would be hard because I'm just sitting in my house, but. But fall off your chair, that would be interesting. What would happen.
But yeah, we, like, I would want someone to take care of me. So I think doing worker's comp, no fault PI, like, those are super important services to offer to patients when they're in need. And, you know, it's very. Well, it's probably not simple, but it's easy to get the information to make sure that you're set up correctly to get it done.
[00:50:21] Speaker A: That's right. It's a great service. And there's a lot of people that personal injury boys up the rest of their practice because they do get paid better and at least they, you know, they have that. But it's. It's a fool's errand to try to do it without the proper training, the proper infrastructure, the proper general knowledge. And lots of us can help with that.
[00:50:42] Speaker C: Thank you. Kathy, you. You made this practical, not intimidating. I'm sure there are a lot of listeners out there that are probably going to knock on your door because they want to add this to their practice.
So thank you for allowing them to walk away with a clearer sense of what to tighten up right away and things that they could implement today and
[00:51:04] Speaker A: moving forward, I'm very happy to do it. Thank you so much for having me. And I wasn't sure what I was going to say, so I'm always encouraged when it just falls out of my mouth. That's awesome.
[00:51:13] Speaker B: Sounds like you know exactly what you're talking about.
[00:51:15] Speaker A: Might be.
[00:51:17] Speaker B: Thanks, Kathy.
[00:51:18] Speaker A: Thank you for having me.
[00:51:19] Speaker B: All right, everyone. Well, thanks for tuning in today. If you have any questions, questions for Kathy and her team, just pop over to their
[email protected] and they will jump in to help you right out.
And thank you so much for joining. If you ever have questions for us here at Cairo Cast, you can drop us an email. It's chirocastirotouch.com and we'll see you soon.
[00:51:44] Speaker C: Bye. Bye.
[00:51:46] Speaker D: Thank you for joining us on this episode of Cairo. Cast insights for modern chiropractors, brought to you by chirotouch. Hosted by Dr. Stephanie Brown and Danielle Hevinas. Produced by Debbie Brooks. Editing from Matthew Dodge. Our theme song, House 5, is from Scott W. Brooks. If you enjoyed today's show, don't forget to like, link and subscribe. We appreciate your support and we'll catch you next time.
