What Documentation to Use with Different Classes of Patients

WEBVTT 1 00:00:01.560 --> 00:00:04.799 Hi Everyone, and welcome to this episode of catch up with CAIRA touch. 2 00:00:04.799 --> 00:00:08.839 I'm your host, Dr Brian Blast. Today I have a return guest. 3 00:00:09.000 --> 00:00:12.759 Dr Mark Student Is Back. He's in the hot seat today to talk to 4 00:00:12.800 --> 00:00:19.160 me about what documentation to use for different classes of patients, such as personal 5 00:00:19.160 --> 00:00:24.600 injury, workers compensation, Medicare and manage care. Dr Marks been in practice 6 00:00:24.600 --> 00:00:29.640 since one thousand nine hundred and eighty one, teaches both chiropractic and medical academia 7 00:00:29.679 --> 00:00:35.399 as a national lecturer and consults doctors of Chiropractic in forty nine states. I 8 00:00:35.479 --> 00:00:39.200 give you the very abridge version of this background. Bottom Line, Dr Mark 9 00:00:39.280 --> 00:00:44.479 knows his stuff and I'm excited to spend some time again with him today. 10 00:00:44.520 --> 00:00:48.359 Thanks for joining me, Dr Mark. Hey Brian, thank you for those 11 00:00:48.439 --> 00:00:51.679 nice accolades. Now, unfortunately I have to I have to live up to 12 00:00:51.719 --> 00:00:53.840 them. Well, yeah, I mean, if you've been in the business 13 00:00:53.840 --> 00:00:59.439 long enough, it's an experience. So just before we started we talked about, 14 00:00:59.600 --> 00:01:03.719 you know, which baseball team that we both followed, and fact I 15 00:01:03.760 --> 00:01:07.439 want to let you know that I tell my clients if you start with me 16 00:01:07.480 --> 00:01:12.599 and you were Red Sox, Fan your feet automatically doubles. Okay, and 17 00:01:12.760 --> 00:01:17.480 don't be surprised if I don't pick up the phone off. Okay, because 18 00:01:17.760 --> 00:01:19.359 US Yankee fans, you know, we think of the Red Sox. Oh, 19 00:01:19.480 --> 00:01:23.319 of course. If if there's a red sox fan on my little league 20 00:01:23.359 --> 00:01:26.480 team, I make them that last all, your kinder than I am. 21 00:01:26.519 --> 00:01:30.280 It's just it's just the way it is. You know, just don't know. 22 00:01:30.359 --> 00:01:34.920 I don't know. So that's just the way life goes. But we're 23 00:01:34.959 --> 00:01:40.280 talking today about documentation. Correct what do you want me to delve into first? 24 00:01:40.599 --> 00:01:42.480 Well, it's a big it's obviously a large part of the business. 25 00:01:42.480 --> 00:01:46.120 When it comes to a chiropractor. We are a valume based business, as 26 00:01:46.159 --> 00:01:49.799 most people are, and we have to make sure we're doing compliant documentation. 27 00:01:49.920 --> 00:01:53.920 But the bet were fast about it. So the first thing I hear from 28 00:01:53.959 --> 00:01:57.799 my cash practices, or when I'm to work with cash practices, I'm sure 29 00:01:57.799 --> 00:02:01.359 you do as well, is kind of a shorter report. I needed less 30 00:02:01.359 --> 00:02:06.200 detail in the for my cash patients. Okay, so I'm going to give 31 00:02:06.239 --> 00:02:10.919 you a broad stroked on this and a couple of stories to help underscore the 32 00:02:12.000 --> 00:02:16.520 reality. It is a rookie mistake. That is the shortest road to hell, 33 00:02:16.560 --> 00:02:21.919 and I mean hell, to think that you have different standards for different 34 00:02:22.000 --> 00:02:29.080 financial classes. You have one standard of documentation and if you don't believe me, 35 00:02:29.199 --> 00:02:32.120 just ask your license. You Board. I've gotten many, many phone 36 00:02:32.120 --> 00:02:36.800 calls and one just sticks out in my head and it was a very good 37 00:02:36.800 --> 00:02:40.960 friend of mine call me up and said, you know, I had all 38 00:02:42.000 --> 00:02:46.759 these cash patients and I did this level of documentation, but from Blue Cross 39 00:02:46.800 --> 00:02:50.919 Bu Shield I did that level of documentation. Now getting called in by the 40 00:02:50.960 --> 00:02:54.840 license, Youre Board because Blue Cross made her a complaint. The patient made 41 00:02:54.919 --> 00:02:59.400 a complaint, on and on and on, and I'm a healer. I 42 00:02:59.400 --> 00:03:01.080 could just put what I want. I don't have to do too much, 43 00:03:01.199 --> 00:03:06.639 especially the cash and blue cross was complaining, and the reason being is because 44 00:03:06.680 --> 00:03:09.639 the patient no longer had benefits than they turned to cash. He did a 45 00:03:09.680 --> 00:03:14.960 different level of documentation. Blue course, subpoena the records. Now they got 46 00:03:14.960 --> 00:03:19.319 the blue cross records in the cash records and it was two standards of documentation. 47 00:03:19.800 --> 00:03:22.639 Turn them in to the licensure board and the guy had a dance, 48 00:03:22.719 --> 00:03:25.039 the dance and not the happy one, and he was and he was actually 49 00:03:25.159 --> 00:03:30.560 cited by the licensure board from this conduct, and I can go on and 50 00:03:30.599 --> 00:03:35.120 on and on and on. You have one standard, folks. It's the 51 00:03:35.120 --> 00:03:38.199 same thing. You're going to build a nine, nine two hundred two and 52 00:03:38.280 --> 00:03:42.639 right now it's based upon time and elements and levels of complication. The nine, 53 00:03:42.960 --> 00:03:46.520 nine two hundred and three. You have to meet those levels, based 54 00:03:46.599 --> 00:03:51.120 upon what those levels are, and bill for it. Now it's very important 55 00:03:51.159 --> 00:03:54.680 that you understand what those levels are. And when I am I've talked about 56 00:03:54.680 --> 00:03:59.319 this in our previous podcast, when I on board a client, the very 57 00:03:59.400 --> 00:04:02.479 first thing I do, as I say, send me all of your intake 58 00:04:02.599 --> 00:04:08.319 forms, your last new patient, your em evaluation, including the intake, 59 00:04:08.360 --> 00:04:11.560 which is your evaluation in management, nine two or two, two, three, 60 00:04:11.560 --> 00:04:13.639 two, four, twenty five, and your first. So No, 61 00:04:14.319 --> 00:04:15.839 and I want to see what you're doing. And they say, well, 62 00:04:15.959 --> 00:04:19.120 do you want to pay? I case, I said it doesn't matter, 63 00:04:19.160 --> 00:04:24.480 I want to see your last one because I will know if you have compliance 64 00:04:24.519 --> 00:04:30.319 issues. Now I happen to have a relationship with the attorneys for various different 65 00:04:30.360 --> 00:04:35.240 insurance companies, both personal injury and non personal injury, and I know what 66 00:04:35.279 --> 00:04:40.319 they're looking for. They look for things like predetermined treatment plans. They look 67 00:04:40.360 --> 00:04:45.240 for things like cutting corners. The last one was a lawsuit from Lacrosse Blue 68 00:04:45.279 --> 00:04:48.480 Shield against the doctor. They invoked the Rico case, and Rico is under 69 00:04:48.519 --> 00:04:55.319 the Organized Racketeering Act, which means use a paper instrument to deforti financial institution, 70 00:04:55.399 --> 00:05:00.439 meaning your your or eanm notes, your solf notes, to De Fraud 71 00:05:00.399 --> 00:05:05.360 The insurance company, which is a financial institution in a systematizes matter. So 72 00:05:05.480 --> 00:05:12.839 what this doctor did was is the doctor cut every corner, but he build 73 00:05:13.000 --> 00:05:15.000 for a nine, nine, two hundred and three. Cut every corner. 74 00:05:15.040 --> 00:05:19.120 So the carrier said, I'm subpoenaing your last fifty records. Is there a 75 00:05:19.160 --> 00:05:24.480 pattern? So again, it doesn't matter if it's personal injury, it's managed 76 00:05:24.519 --> 00:05:29.879 care. Cash is even worse than getting in trouble because then you get in 77 00:05:29.959 --> 00:05:32.480 trouble with an insurance company, a patient of US insurance, who do they 78 00:05:32.480 --> 00:05:36.800 complain to? They complain to the Insurance Company, but when you have a 79 00:05:36.839 --> 00:05:43.720 patient that has no insurance and only cash, the only people they can complain 80 00:05:43.800 --> 00:05:47.800 to is your state licensure board, and they complain vociferously because you're taking money 81 00:05:47.839 --> 00:05:51.920 out of their pocket, not the insurance company's pocket and they get angrier, 82 00:05:53.240 --> 00:05:58.279 and the and the state licensure boards are so grossly understaff that if they get 83 00:05:58.279 --> 00:06:00.040 their hooks into you, they've got to make an example out of you. 84 00:06:00.240 --> 00:06:06.839 So the bottom line is there is one standard of documentation depending upon the level 85 00:06:06.879 --> 00:06:13.639 of evaluation you're doing, and you've got to understand what elements are required for 86 00:06:13.839 --> 00:06:17.240 that element. So when we start a client and on our consulting side, 87 00:06:17.279 --> 00:06:24.759 there is actually a whole section dedicated to documentation and it's called documentation made easy. 88 00:06:24.879 --> 00:06:28.560 Now I do have to tell you that if you follow the Cairo touch 89 00:06:28.680 --> 00:06:32.360 of bouncing ball, and I mean that sincerely, when you follow what's supposed 90 00:06:32.399 --> 00:06:36.439 to be done, past medical history, review of systems, it's all in 91 00:06:36.480 --> 00:06:43.680 there, you'll be fine and most people get in trouble when you start cutting 92 00:06:43.680 --> 00:06:48.120 corners. Follow the bouncing ball. It's there for you to use. And 93 00:06:48.160 --> 00:06:53.680 if you have the the the bullet touch program which is partially a macro set, 94 00:06:53.800 --> 00:06:56.839 amongst other things in there that I helped them, by the way, 95 00:06:56.879 --> 00:07:00.600 they don't pay me and I say things they don't like. Sometimes don't really 96 00:07:00.639 --> 00:07:05.639 care, but the reality is is that if you use what's there, the 97 00:07:05.839 --> 00:07:11.839 system that. I've said this before. The the Algorithm, which means computer 98 00:07:11.839 --> 00:07:17.959 program will protect you from you. And I've seen a myriad of other system 99 00:07:17.959 --> 00:07:23.040 I've seen every system in our industry because I do compliance reviews with every doctor 100 00:07:23.040 --> 00:07:27.519 I on board. And you know, as much as you might complain about 101 00:07:27.720 --> 00:07:30.720 Cairo touch, you have, what yours is is light years ahead of just 102 00:07:30.800 --> 00:07:35.600 about every other program I've seen in the industry if used properly, and all 103 00:07:35.600 --> 00:07:40.319 it matters is how to push the buttons and once you're comfortable, it's just 104 00:07:40.399 --> 00:07:43.399 easy. That's a detail that we're looking for right. I mean it's it's 105 00:07:43.439 --> 00:07:46.160 I love the the anecdotal, you know, reference to other providers. Say 106 00:07:46.160 --> 00:07:49.040 Hey, I'm not just saying yes, you have to do more detail for 107 00:07:49.079 --> 00:07:53.639 cash patients, I'm telling you what has happened in the real world. So 108 00:07:53.759 --> 00:08:00.839 yes, don't be lazy. Use the program document appropriately so you don't have 109 00:08:00.879 --> 00:08:05.399 that legal exposure. Here's the other issue with legal exposure, and this I've 110 00:08:05.439 --> 00:08:09.240 seen on the personal injury side sue to trickle down to the managed care side. 111 00:08:09.279 --> 00:08:13.920 It's called predetermined treatment plans. And the carrier, the carriers for the 112 00:08:13.920 --> 00:08:18.079 past few years, you know, and in war they come up with names 113 00:08:18.079 --> 00:08:26.199 for campaigns like dday was the attack on Normandy. They come up with names. 114 00:08:26.240 --> 00:08:30.120 The carrier has a name called fraud for profit, and what they've done 115 00:08:30.199 --> 00:08:35.240 is they've come up with a profit center and there and they're they're charging fraud. 116 00:08:35.320 --> 00:08:37.879 So what they are saying is is if you have a predetermined treatment plan, 117 00:08:39.000 --> 00:08:41.159 that's fraud. So what they'll do is they'll doc they'll get it, 118 00:08:41.399 --> 00:08:48.399 they'll put their computers to work and they'll crudge out statistics that ninety six percent 119 00:08:48.480 --> 00:08:52.519 of your patients get x rays, ninety seven percent of your patients have the 120 00:08:52.559 --> 00:08:58.799 same diagnosis, s four percent, and and that's a predetermined treatment plan. 121 00:08:58.960 --> 00:09:03.840 Now that is true if you don't have the appropriate documentation behind it. Also, 122 00:09:03.919 --> 00:09:11.000 if you follow some of the Gurus in the self proclaimed gurus and the 123 00:09:11.039 --> 00:09:15.120 personal injury world who are trying to sell you programs, will tell you you 124 00:09:15.240 --> 00:09:18.919 need to do twenty, thirty or forty diagnosis on every patient. Well, 125 00:09:18.919 --> 00:09:22.879 guess what the purpose of that is to build more money out of the insurance 126 00:09:22.919 --> 00:09:28.480 company on its on a on a predetermined plan. You will win and then 127 00:09:28.519 --> 00:09:31.120 you'll give it all back threefold. In Arico case, you've got to be 128 00:09:31.200 --> 00:09:35.039 real careful. So I mean it's just unusual. Try to stay, if 129 00:09:35.080 --> 00:09:37.120 you can, as a rule, within the Hick for twelve and if you 130 00:09:37.159 --> 00:09:41.720 need to do more occasionally, that's fine. But if you're just doing that 131 00:09:41.799 --> 00:09:46.759 because it was it was sold to you by a plan on this on this 132 00:09:46.840 --> 00:09:50.919 program you're buying because you're going to get all these Pi cases and make more 133 00:09:50.000 --> 00:09:54.799 money, you what you want to do is you want to try to get 134 00:09:54.879 --> 00:10:00.559 that person who told you to do that to personally indemnify you for any and 135 00:10:00.679 --> 00:10:03.240 all retribution, which they'll never do, because you've got to be careful. 136 00:10:03.279 --> 00:10:07.600 You're going to be in the crossairs. So that's the type of legal explosure 137 00:10:07.679 --> 00:10:15.320 you have to be careful of. And I am the most aggressive conservative person 138 00:10:15.440 --> 00:10:20.159 you will ever meet when it comes to compliance. I am ultra, ultra 139 00:10:20.480 --> 00:10:24.879 conservative. It's got to be on firm ground and listen, you know, 140 00:10:24.919 --> 00:10:28.399 we talked, I don't know if it was in this programmer last but I've 141 00:10:28.440 --> 00:10:33.720 presented to over three hundred fiftyzero lawyers in thirty nine states, including many, 142 00:10:33.840 --> 00:10:37.600 many inside the insurance of this dream. So as a result of that, 143 00:10:37.759 --> 00:10:41.919 I get to see what they're going after. I know what's happening before they 144 00:10:41.960 --> 00:10:45.399 do it, because I talk to them. They tell me what's going on 145 00:10:45.799 --> 00:10:48.480 and we get to look at trends and we had to get to look at 146 00:10:48.519 --> 00:10:52.279 actual things occurring in the courts or's going to occur to keep you ahead of 147 00:10:52.320 --> 00:10:58.440 the curve. And it's conservative, Conservative, conservative. If you're doing something 148 00:10:58.480 --> 00:11:03.600 that's a by report code, be careful, be careful if you're take if 149 00:11:03.639 --> 00:11:07.080 you're billing insurance companies for it, and if you're doing something to buy report 150 00:11:07.080 --> 00:11:11.679 code, and even if you're taking their money on lean and not billing them 151 00:11:11.679 --> 00:11:16.879 directly, you're still taking their money. So be careful, be careful, 152 00:11:16.879 --> 00:11:20.919 be careful. As we you know, we'd started getting deeper into documentation. 153 00:11:20.960 --> 00:11:24.919 Then what's important there? Then within a soak, done like a general everyday 154 00:11:24.039 --> 00:11:26.840 visit while we're seeing patients, you know, multiple times. So what what 155 00:11:26.879 --> 00:11:31.879 are the important components there in what you consider an important component of so oak? 156 00:11:31.919 --> 00:11:35.000 Note, everybody, get a pencil of paper out. I'm about to 157 00:11:35.000 --> 00:11:39.399 tell you something very short you have to write down, which will protect you. 158 00:11:39.960 --> 00:11:43.440 Okay, and then I'll give you a little anecdote about what happened to 159 00:11:43.480 --> 00:11:48.840 someone who chose not to listen for every area you touch. Write this down. 160 00:11:48.000 --> 00:11:56.960 For every area you touch you need a symptom, a clinical find them 161 00:11:56.720 --> 00:12:03.039 and the diagnosis documented on every visit. You don't need anything else. For 162 00:12:03.200 --> 00:12:09.519 every are you touch you need a symptom, a clinical finding and a diagnosis. 163 00:12:09.840 --> 00:12:13.840 There was a young man in Gloucester Massachusetts about ten years ago, maybe 164 00:12:13.879 --> 00:12:18.960 seven years, ten years ago, and encompass insurance, which is a subsidiary 165 00:12:20.039 --> 00:12:26.200 of all state, suit him under ego and the Federal Racketeering Act for billing 166 00:12:26.240 --> 00:12:33.519 fraudulently on a systematized matter. You see, he was patients came in and 167 00:12:33.559 --> 00:12:39.480 he would diagnose cervical, cervical and Lumbar, lumbar, and rarely, if 168 00:12:39.480 --> 00:12:43.639 ever, diagnosed thoracic because people don't complain about that. So what they did 169 00:12:43.759 --> 00:12:50.039 was is they did a computer program, they rent a spreadsheet on them and 170 00:12:50.080 --> 00:12:54.399 they found he had seventy two cases and encompass and seventy two cases, seventy 171 00:12:54.480 --> 00:13:00.600 of them he adjusted and documented that. He adjusted thoracic and built for that 172 00:13:00.679 --> 00:13:05.120 extra region without diagnosic thoracic or having a symptom for but he said, I'm 173 00:13:05.159 --> 00:13:09.039 a full spine adjuster and it's part of the spine and it needs to be 174 00:13:09.039 --> 00:13:13.559 corrected. And on the healer. So they, the attorney, retained me 175 00:13:13.600 --> 00:13:18.200 to do a forensic analysis. Now I get twenty five hundred a case a 176 00:13:18.440 --> 00:13:22.879 chart for forensic analysis. It takes me two full days of work to do 177 00:13:22.039 --> 00:13:28.080 one chart in a forensic analysis. After ten charts, I said to the 178 00:13:28.120 --> 00:13:35.000 attorney settled, there's a pattern of fraud because he did not document a symptom 179 00:13:35.039 --> 00:13:37.200 and a diagnosis for the region he touched. Yeah, he took an x 180 00:13:37.279 --> 00:13:41.759 ray of it. He sees rotation and there's motion, peal patient and on 181 00:13:41.840 --> 00:13:46.120 and on and on. But he did not diagnosis, symptom or a diagnosis. 182 00:13:46.159 --> 00:13:50.879 So therefore it's constitutes insurance fraud and I said settle now. He had 183 00:13:50.000 --> 00:13:56.080 seven seventy two cases and out of those seventy two cases, here collected five 184 00:13:56.200 --> 00:14:00.120 hundred and Fiftyzero dollars. That was over seven years. That's less than one 185 00:14:00.159 --> 00:14:03.480 case a month, not a whole lot, less than one case a month. 186 00:14:05.360 --> 00:14:07.480 So he said on the Heeler, I did the work, I'm not 187 00:14:07.519 --> 00:14:09.519 giving it back. You know what the Guy Hears every morning? Now, 188 00:14:09.519 --> 00:14:16.440 attention walmart shoppers. He lost and I'm not being sarcastic. He lost the 189 00:14:16.480 --> 00:14:20.279 case five hundred and fifty plus treble damages, which is too one and Rico. 190 00:14:20.360 --> 00:14:24.919 He got a judgment against them from one point six five million dollars. 191 00:14:24.960 --> 00:14:28.840 His legal fees were over three hundredzero dollars and he went bankrupt. But he 192 00:14:28.919 --> 00:14:33.240 still has to pay them back because he has a federal judgment against them and 193 00:14:33.360 --> 00:14:39.200 they garnish his entire life until that's paid back. Didn't listen, so you've 194 00:14:39.200 --> 00:14:43.919 got to understand. Now again let's talk about thoractic spin. Now I teach 195 00:14:43.960 --> 00:14:48.399 a three chiropractic colleges and two medical schools at various levels, and one of 196 00:14:48.399 --> 00:14:52.279 the things we talked about is e listening. So a lot of us, 197 00:14:52.399 --> 00:14:56.360 like myself, for a full spine adjuster. Someone will complain of a cervical 198 00:14:56.399 --> 00:14:58.720 problem, lumbar's problem, so I'll take my hand and run it down the 199 00:14:58.720 --> 00:15:03.919 SP on. I've never had an area that needed to be adjusted, whether 200 00:15:03.039 --> 00:15:07.440 we're not taught, and tender fibers, so I'll miss it. Jones, 201 00:15:07.480 --> 00:15:11.399 is this tender t six on the right? Yes, so I would diagnose 202 00:15:11.879 --> 00:15:18.159 or symptom elicited symptom t sis on the right pain scale, two out of 203 00:15:18.200 --> 00:15:22.879 ten on a pain scale of zero, one of ten. Okay, that's 204 00:15:22.960 --> 00:15:28.879 number one. And then my diagnosis is mild phacitus and the thoractic spine and 205 00:15:28.000 --> 00:15:33.480 I document it. Now. I have a symptom, a clinical finding which 206 00:15:33.519 --> 00:15:37.519 is almost identical and the diagnosis for that area I justed. So you've got 207 00:15:37.519 --> 00:15:41.759 to be careful for every area you touch. Let me say it again, 208 00:15:41.799 --> 00:15:48.840 this is a nonnegotiable mark rule to keep you out of the crosshairs. For 209 00:15:48.919 --> 00:15:54.600 every area you touch. You need a symptom, a clinical finding and a 210 00:15:54.720 --> 00:16:00.639 diagnosis for every area you touching. It must be documented on every soap note. 211 00:16:02.000 --> 00:16:07.600 Please don't repeat for me on your soap notes past medical history or review 212 00:16:07.639 --> 00:16:12.519 of systems. I've seen all this crap. Okay, now, symptom, 213 00:16:12.559 --> 00:16:18.039 clinical finding, diagnosis, anything else you want to put you more than Malcolm. 214 00:16:18.120 --> 00:16:21.240 It's fluff. It's not necessary. Those are e. those are m 215 00:16:21.320 --> 00:16:25.399 issues. So you want to cull it down to just those things and that 216 00:16:25.440 --> 00:16:30.360 will protect you from any issues. That does the education that we need here 217 00:16:30.639 --> 00:16:36.559 and in the industry and very easy to do in Cairo. Touch with the 218 00:16:36.559 --> 00:16:40.759 bullet, touch macros again, when you say those things. People think that, 219 00:16:40.799 --> 00:16:41.879 they roll their eyes and I think all that's just more to work for 220 00:16:41.960 --> 00:16:45.279 me. Right, I have to do that. Yeah, but you're protecting 221 00:16:45.320 --> 00:16:49.279 yourself and you're doing it with one or two clicks. It's taking you five 222 00:16:49.320 --> 00:16:55.000 seconds to protect yourself against possible bankruptcy, right, as you spoke about. 223 00:16:55.159 --> 00:16:59.639 So being able to use a system and document appropriately protects you. That's why 224 00:16:59.639 --> 00:17:07.440 it's important. I want to shift gears to imaging. Do I need to 225 00:17:07.519 --> 00:17:11.240 order MRIs for non personal injury cases? I know you spoke before, we 226 00:17:11.279 --> 00:17:15.759 spoken in a previous podcast about MRIs and personal injury. So I want your 227 00:17:15.759 --> 00:17:21.160 focus more here on MRI's for personal injury and non personal injury cases. Please, 228 00:17:21.240 --> 00:17:25.880 if you're ordering MRIS FOR JUST PI cases, be prepared to lose your 229 00:17:25.920 --> 00:17:32.119 license. Simple because are you pandering to the plaintiffs attorney to make the case 230 00:17:32.440 --> 00:17:37.079 if you order an MRI of every Pi case? Listen, that's absurd. 231 00:17:37.559 --> 00:17:41.160 You treat the patient. I don't care if it's a personal injury non personal 232 00:17:41.240 --> 00:17:48.839 injury. It doesn't matter if there's a significant ridiculopathic or milopathic component. Regardless 233 00:17:48.880 --> 00:17:53.079 of the ideology, you should consider an MRI because x ray is not going 234 00:17:53.119 --> 00:17:57.920 to show you that space occupying leisure. You have to know. Is there 235 00:17:59.039 --> 00:18:00.519 or Herny at it? This is it? Is it a protrusion? Is 236 00:18:00.559 --> 00:18:06.039 it an extrusion? Is it a fragmentation? Do you have a tumor? 237 00:18:06.119 --> 00:18:10.039 Is An epidurl? Is it as an intradul do you have is? Do 238 00:18:10.119 --> 00:18:12.279 you have a varicks? And you have to know what variicies are. Is 239 00:18:12.319 --> 00:18:15.880 Their court a demon or a milopathy or a mile of Malaysia? Actually, 240 00:18:18.079 --> 00:18:19.559 you have to know all of these things and you got to kind of know 241 00:18:19.599 --> 00:18:23.640 what those things mean as well. Remember, when you went to school, 242 00:18:23.680 --> 00:18:30.599 you were given the minimal amount of knowledge to graduate and pass your licensure boards. 243 00:18:30.680 --> 00:18:33.759 After that it's on you. So if you don't know all of those 244 00:18:33.759 --> 00:18:38.200 things I just shared with you, go learn, go learn. You need 245 00:18:38.279 --> 00:18:42.279 to know when you need to take an MRI, if a patient has radiating 246 00:18:42.319 --> 00:18:48.200 pain down a limb, if it's lancenating electric if when you do a compression 247 00:18:48.279 --> 00:18:52.920 the patient, patient gets worse. You need to consider those things. All 248 00:18:52.960 --> 00:18:59.240 of those things are critically important and I don't care whether there are a Pi 249 00:18:59.359 --> 00:19:02.839 case or not. None of it should matter. That's what you do with 250 00:19:02.839 --> 00:19:08.079 a patient and don't be delivering a high velocity thrust into a patient where you 251 00:19:08.079 --> 00:19:11.759 don't know what's going on. GET THAT MRI ordered. You know, for 252 00:19:11.799 --> 00:19:17.400 me I usually, and this is an unofficial statistic, I've not done a 253 00:19:17.440 --> 00:19:22.400 full research program one, but about three percent of your patients should be getting 254 00:19:22.519 --> 00:19:26.440 MRI's. That's an unofficial number, three out of a hundred. If you 255 00:19:26.480 --> 00:19:30.799 have a pure Pi practice the number goes up to eighty and eighty five percent. 256 00:19:30.839 --> 00:19:33.799 We're out of family practice and I'm very few PI cases, not a 257 00:19:33.799 --> 00:19:37.119 whole lot, but when I had a Pi practice, a lot, because 258 00:19:37.400 --> 00:19:41.880 my car accident cases, a lot of them radiating pain. That's what we 259 00:19:41.920 --> 00:19:45.599 need. So there's your answer. MRI is a tool and if you don't 260 00:19:45.720 --> 00:19:49.839 use it you can hurt your patient. If you don't know, you don't 261 00:19:49.839 --> 00:19:56.240 guess, and that is a hard, hard rule. And again, document 262 00:19:56.279 --> 00:20:00.640 the rationale and findings correct well, you always have to document why, why 263 00:20:00.680 --> 00:20:04.279 are you ordering the MRI? And then you have to document how it change 264 00:20:04.279 --> 00:20:08.119 a treatment plan. That's critical. Those are two things that will get you 265 00:20:08.119 --> 00:20:12.920 out of trouble and fall out of the predetermined treatment plan scenario and that the 266 00:20:14.000 --> 00:20:17.279 carriers are looking to take you to task with. How does it Change Your 267 00:20:17.279 --> 00:20:22.960 Treatment Plan? It might be considering the neurosurgical consultation. I'm not adjusting this 268 00:20:22.079 --> 00:20:27.000 area, or it might say it confirmed that there is a space occupying lesion, 269 00:20:27.440 --> 00:20:32.839 but there is no necessity for referral because there is not a room around 270 00:20:32.839 --> 00:20:36.559 the quarter root that it wouldn't create damage. So you need to document all 271 00:20:36.640 --> 00:20:40.160 of those things and that's critical and it can be done in that crows and 272 00:20:40.279 --> 00:20:41.799 a lot of the a lot of those macros are already done for you in 273 00:20:41.839 --> 00:20:45.319 the bullet touch Pi side. Yeah, and just dropping your documentation, just 274 00:20:45.599 --> 00:20:49.160 go on with your day, but use it to protect yourself no matter what. 275 00:20:49.200 --> 00:20:53.799 And let's recap here. We want to elicit for our our listeners is 276 00:20:53.960 --> 00:21:00.880 the need to document every case and not differentiate whether it's cash, person injury 277 00:21:00.240 --> 00:21:06.559 or Kriscom Medicare. You need full documentation, and I think you did a 278 00:21:06.559 --> 00:21:11.079 wonderful job kind of hitting that, hitting that point on the head, so 279 00:21:11.119 --> 00:21:15.519 that we understand as a as a practitioner, don't don't deviate, don't be 280 00:21:15.559 --> 00:21:19.319 lazy. Put as much detail in there as you can. So lastly, 281 00:21:19.400 --> 00:21:23.480 for our listeners that haven't heard you before, can you go into some information 282 00:21:23.559 --> 00:21:26.599 about how they can get in touch with you get more information about what you 283 00:21:26.640 --> 00:21:30.680 guys teach for the Academy of Chiropractic. What we do in the Academy of 284 00:21:30.759 --> 00:21:37.480 Chiropractic. It's easy. We have a full online university and our courses are, 285 00:21:37.599 --> 00:21:41.480 I think, the best of the industry. There are professors are it's 286 00:21:41.480 --> 00:21:45.680 always with a chiropractor, but we might have a Harvard train near radiologist and 287 00:21:45.759 --> 00:21:52.759 Albert Einstein College train of Vasculine Orologists. I mean, I could go on 288 00:21:52.799 --> 00:21:56.839 and on and on and on. It's just great academics. So go to 289 00:21:56.920 --> 00:22:02.119 teach doctorscom for academics. You want to get in the consulting side, if 290 00:22:02.160 --> 00:22:04.640 you want to learn how to get your referral sources to run after you. 291 00:22:06.319 --> 00:22:08.799 And I like personal injury, I love trauma care and I like getting paid 292 00:22:08.920 --> 00:22:15.759 more than less, go to teach Chiros Shiroscom. So it's our the teach 293 00:22:15.839 --> 00:22:21.720 doctorscom. Teach chiroscom. You can go to the Academy of chiropracticcom. You 294 00:22:21.799 --> 00:22:27.599 seal our awards pages where people have earned a fellowship or qualifications, and you 295 00:22:27.640 --> 00:22:30.960 can earn those as well. Or call me my phone number six three, 296 00:22:32.039 --> 00:22:34.079 one seven eight, six, four, two five three. That's three, 297 00:22:34.160 --> 00:22:40.680 one seven eighty six, four two five three, and she call me about 298 00:22:40.680 --> 00:22:42.359 anything. I'd love to just chat. Love talking about this stuff. I'll 299 00:22:42.440 --> 00:22:48.039 chat with you about anything at any time. I truly appreciate it. You 300 00:22:48.319 --> 00:22:51.359 do a great job for our industry, so thank you again for taking the 301 00:22:51.359 --> 00:22:55.279 time. Thank you for coming on to the PODCAST. It's been eye opening, 302 00:22:55.319 --> 00:22:57.200 I think, for a lot of practitioners. Also, thank you to 303 00:22:57.200 --> 00:23:00.279 our listeners for tuning in to catch up with Cairo touch. If it wasn't 304 00:23:00.319 --> 00:23:03.559 for you, then we wouldn't have a reason to be putting on all this 305 00:23:03.640 --> 00:23:07.519 content. So thank you. You can find more catch up with Cairo touch 306 00:23:07.559 --> 00:23:12.400 episodes on spotify, itunes and Cairo touchcom slash podcast. Again, I'm your 307 00:23:12.400 --> 00:23:17.200 host, Dr Brian Blast, and I wish everyone listening well adjusted day.