Episode Transcript
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.
