PI and workers’ comp simplified: what every chiropractor needs to know

Hello everyone. Welcome back to Chairocast brought to you by Chairo Touch. I am Dr. Stephanie Brown and I am

joined today by Danielle Javinez. 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 are two topics that can

feel confusing really fast, especially when the rules shift depending on where

you practice. 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 uh maybe not jive with what you know to be true for

your area, you just want to make sure you check that with your uh state board. 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. Yeah. So today I'm very excited. Drum roll everyone. We are joined by Kathy

Widner 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 Chairocast. Thank you so much for asking. I'm excited to be with you today. Yeah, of

course. So, to set the foundation, when a chiropractor says PI,

what does that actually mean in a practical daytoday chiropractic setting? 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 no fault is a subdivision of

PI. In its 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. Uh

but it is when an individual is injured and a different type of insurance than

health insurance usually will come into play. Whether that's auto insurance, the

patients or the adverse drivers um whether it is uh in a case like New

York, it's no fault. It's very different than in many other places. Uh 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. Yikes. So, in that scenario, is there a

um is there a 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? 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 uh 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? It's great. Oh, yeah.

194 when I worked there. It was like $18. Yes. Yes. I mean I I think the 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 I

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. Um so that was weird and hopefully not something most people have to deal with. Um 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. 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, um,

someone purchases car insurance for themselves and in 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, um, I purchase insurance that has my

liability insurance should I be at fault in an accident. Mhm. I have uninsured 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. Um, and then there's a portion that sort of is meant

for the repair of property like your car or 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 with, well, I kind of work with insurance, but

I don't work with with how these insurance adjusters operate every day. It's 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, etc. They

work with the doctor. There's 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 one-third fee and still get what

you deserved. Now, interesting with med pay, if I have $5,000 bill at my

doctor's office and I I get it paid from my med pay, 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 uh 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, an attorney, that was a long-winded response to that's how an attorney deals with it.

Involved. Okay. Yeah. And now the secondary piece of that still could have an attorney. There

is in lie of med pay 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 Med pay, automatically pays your bills when there's an injury and it

functions very similarly to Meday, 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 your your insurance pays for you, their insurance pays for them.

Can you um I don't know how to make that any more clear. So, can you talk that

though on no fault because like I will get patients all the time, not recently really because I'm 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 the other driver

and it was this big mess and it got denied because it's like, well, you're not inred on the other driver's policy.

This is not how it works. Uh, 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 get care here it has to go through your insurance 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 get it 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 you know, 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.

Okay? So, that's again, you never know what you're going to get with a patient, but that's how that works. So, I I just I

think there's not enough si, 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 um that that help to identify what that is. I'm sure state

associations can help by saying this is what we know about it. You know, how many things could AI put together these

days for explain no fault to a dummy like you know, no fault for dummies. Oh, yeah. And just have a one sheet that you

can hand to your patient. Uh, and this is this is how it works. You don't believe me? Call your agent.

Yeah. Well, now I understand why a lot of chiropractors, they 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?" Um, that's I think that's a different problem. Yeah, 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 going to go, "I'm not in 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 I 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 uh it's something we love to work with. Now in our library of training um 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 uh 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 so you're comp so with PI and workers comp you are able

to verify benefits similar to if you were billing Blue Cross or Medicare and what have you.

And it and 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. We may they if they haven't reported the claim

and have a claim adjuster then we may need to interact with the agent or uh if

they already have then 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 $1,000 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 gonna Let's not take you that. Let's take

Let's not take you because you're in New York and it's weird. But but Danielle, if I'm in your town uh and and I'm in

your car and you have med pay, I'm covered under your med pay. 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 it's just and PIP,

you know, has its own rules. But it's just again, it is is so so important

that anyone billing in a practice just cannot leave this to chance. They have

to know. You have to ask, too. I think you 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 of someone that has a completely

different you know policy than I do. So that's right that was an awesome clarification. You are always covered wherever you go.

But primary coverage is the car you were in. Interesting. And it gets exhausted first.

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 um 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 like, "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 uh also, he didn't have a spinal complaint. it was like a knee

problem and I was just like why? 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 and took somebody out and that actually was covered under some med

pay. Oh, 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, it's coverage just

in exactly the same way up to whatever limit I have. behaves the same way that

Med pay works. This happened years ago. My father-in-law was on a ladder and fell off and it covered all of his

expenses. Well, what about So, I know that's homeowners 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? 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 if somebody is literally seeing what happened, they you

have to prove liability and all of that. But very often, the store will just pay any expenses out of this line. an 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. Uh

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. Yeah, that's when they're they're going to hire PIs to follow you around and

take pictures of you doing yard work. And I mean there we did have people uh one or two people in that situation.

Theirs 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. Well, and then you add to all of this what is a really big deal, and that is

how does health insurance apply? I was going to ask you that. Yeah, it's crapshoot. It's truly a

crapshoot because health insurance will almost always

not be primary. Not me. I'm not going to pay for it. Not be primary. But they will pay and

they will what's called subregate 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 um that was I think in the state of Texas

that laid out a whole bunch of law stuff about why a health insurance company uh

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 subregate 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 because 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, right? 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.

Definitely. What about I hear people talking about leans and I've never truly understood

how that applies? Are you putting it on the person? Does it go to the lawyer

to do with that? Like what how does a lean play into PI and all that? 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 lean and agree to it and send

it back. 50% of the time they blow you off at least.

So, that's a lean. That's an official lean that way. I'm going to tell you about a couple different things. In

certain jurisdictions, there is a county lean that you can file where I go into

my county clerk and I can put a lean 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 lean against that money just like

anybody would do. Like if you have a creditor that puts a lean 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. Well, that makes sure then they don't

send the settlement to the patient and then the patient doesn't pay the doctor's bill. That would prevent that.

In that situation, the third party payer would be and in many cases with the lean, the lawyer uh with a proper lean

would be held liable for that because they said they would pay the doctor directly. Now, they may call and

negotiate it down or something. And I have many ways that I'd tell doctors how to do that, but those are what leans are

really for ideally. Got it. 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 I 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.

Yeah. No good. I've also seen where p so it doesn't

happen 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

so this is the gospel according to Kathy it may not be in everybody's wheelhouse

but it's mine I think that patients who have no out-ofpocket 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 co-ay 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. You know,

unfortunately, we can't do that on workers comp cases, but they're the other ones that are often the worst, you know, the worst offenders. They don't

keep their appointments. There's so much stuff. And and this is another reason, Danielle, why 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 co-ay 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. 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. And end of the world. Yes. Exactly. Yeah. Maybe that's not nice to say, but

it was true a lot of the times in my experience. So, yeah. Um, 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

um yeah. So how all right so every state is kind of different. Um 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. Yeah. And and both of these categories are kind of medical

legal categories which are very different than everything else that practices deal with. Workers comp varies

by state. Um some have a very specific workers compensation fee schedule that

you accept the patient. We call that a regulated fee. HIPP is a regulated fee.

No fault is a regulated fee. Workers comp is a regulated fee. I have run upon

some states where it's they don't have a set fee schedule. It's just your fee, which is great. Um, you have to follow

that. Um, 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, do 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 workers'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 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's compensation patient. Question. So would it would it be

beneficial? I I mean I don't know where a chiropractor could start, but you mentioned that they would call the

providers and they're performing the referrals. 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 corporate. There's no rules. 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 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. Um, 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's 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 ass 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.

Yeah. It's really getting that key information then like before the patient even steps foot in the office as much as

That's right. Yeah. 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, is 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.

Kathy, what if the employer is the federal government? Then what?

It's the worst. It doesn't go through the state workers comp. It does not. And it's the worst. I swear

from injured post carriers. It's usually them. That was great, but it was a long time ago. Well, and and it's done through the

Department of Labor. That's the different place it has to go. And it and when I say it's not the worst, like

sometimes the approvals are difficult. The payment back and forth is okay, but

the problem exists when an office has no idea that federally insured people are different.

Yeah. You have to have that knowledge. You learn along the way. Yeah. I Yeah. My first one I had no

clue, but the patient was really good at like giving me all the info for 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

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 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. Yeah, exactly. 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. Yeah. You can't just take those people right. That's right.

You have to be on a somewhere with them. Yeah. I have to be on a list that I didn't know. Um, and so

that was a roadblock for a lot of the chiropractors and it it wasn't a quick turnaround process for getting on that

list. Um, so I think that's a piece of the puzzle here to take into consideration as well. 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. Yeah. Awesome. Um, 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? Sure. Does, 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 is pretty simple. Everybody knows that. But date

of onset and initial treatment date. I talk to chiropractors every day that

have no clue what to put in those two boxes. Do you have Well, there's really only one box and it's super simple. They just are talking

themselves out of logic. I think I think so too. 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 uh 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. Okay? 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 that

matches with the treatment plan. So, auto and work comp are different. Got it. Okay, cool. Yeah. Um, and then I

run into this a lot too, but I think I I've asked this question before I think actually in in um 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 offices 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,

what do you do? That's not the point to go back and change your note really. So, but you could add an addendum very

easily. Patient came back and corrected that they didn't fall off a stool uh of

two feet, they fell off a stool of 20 feet. You know, that's important to add into the addendum, which touch does a

great job of allowing for that. Um, we don't want to have to go back and update things. And yes, the note should

be signed contemporaneously within 24 hours. Yeah. Okay. I 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

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 5 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. But if it's wacky, sure, go ahead and call them. I have heard of um 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 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. Um it's going to help them,

but you'll be the one on the hook if you're falsifying your medical records. I mean, well, and and I would say that we have

dealt with situations before where the attorney has to do that because the doctor's documentation is terrible.

Yeah, great point. I love it. 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 saying 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. Yeah, that's a really good distinction. I like it.

Yeah. Um, do you is there would you say there's a recommended cadence on when

somebody should be doing an documenting re-exams or is that going to be really condition specific or payer not payer

specific but sometimes sometimes it's payer specific. I know that HNS in in uh North Carolina

does has a whole bunch of rules around that. It depends on the network that you're in. But I 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 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

re-evaluation um except in these odd circumstances with certain payers, I don't really

think they're necessary. I think a re-evaluation 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. Um, 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 any PI 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 reavail 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.

Yeah. Don't ask on social media either. God, no.

Good times. Good times. I was going to say, 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 they don't change their note from visit to visit at all. Yeah.

Well, I will tell you that personal injury has its own kind of genre is what I will say. And I think that you guys

have a doctor that's written some notes, a guy from the Northeast. I can't think of his name right now. You know who I

mean? maybe, but I can't think of his name either. Yeah. Yeah. So, anyway, a lot of these people follow Art Croft.

Art Croft is kind of the guru of uh 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 um created some macros that are blended in 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 Ky Touch unless

he's pulled them. Gosh, I feel like his last name starts with an S. Um 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, you know, worked with car touch to create them that it will do the daytoday

prompting for what needs to be said and how that needs to be done. We can add some flare around personal injury a

little bit, particularly when a 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 craft stuff is.

The measurements you take, some of all of that that adds a layer on top of what we already have.

Got it. Awesome. Here's here's a funny question. Is there ever any such thing as overdoccumenting?

I say yes. Okay. Absolutely. Um, I I think

I think that, you know, I just saw a note literally I told you I was on this on-site visit and I I pulled down two

complete records that I could take back and audit and then you work with the doctor on and what they're doing is

salting forward from the first visit so that everything is going and all of that

all of it and it very little very little else but

there's really not a heck 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 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 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. Um, on the AMA side of the world, they call it note bloat.

You know, we're just adding stuff. In fact, um, it's all about administrative simplification right now from Medicare,

from the AMA, um, 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. Yeah. Yeah. You can't make something

look or be medically necessary just because you wrote a lot about it. That's right. That's right. 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 um 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 wasn't 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.

That's right. That's right. Yeah. 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-m." Yeah. If somebody's auditing you. Yeah. You can't bill on time, but not

say time. Belongs right at the end. Yeah.

Oh my god, I love it. Well, I just want to say too, your guys program and your website is phenomenal. Um, I have my own

membership. um 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 PI or what have you. Um 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 learn how to do stuff just correctly from the beginning. And um I don't know where

chiropractic would be without you, Kathy. Not 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. Um but more and more people

are doing um you know one-on-one from one to four hours a month where they really need training and follow our

protocols. Um 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 it just it's hard and I I

it's just really hard because I it's hard to watch. Yeah, absolutely. So, for listeners who

want to learn more about KMC University, is it just kmcuniversity.com?

It is www.kmcuniversity.com. Um, 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, chyro 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

Chyro Touch users. So instead of 99, it's 69. uh if they just want to get on

with a specialist and talk something through and work something out, um we're always happy to to do that.

I love it. Awesome. I know they appreciate that, too. So, we

covered how to get in touch with you and yeah, so just 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 u safeguards in place to protect the office. Um, but it's on the patient to to supply that correct

information. And yes, it is hard, but I h 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. Um, I feel like there's this sense among docs sometimes that

like, well, you have to help everybody and it would be nice to help everyone, but that's not always practical. Um,

that's right. Yeah. Um, 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. I 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 fall off your chair. That would be interesting. What would happen? Um, but yeah, we like I would

want someone to to take care of me. So, I think doing workers comp, no fault PI, like those are super important services

to offer to patients when they're in need. And um 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 done to get

it done. 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. Yeah. Perfect. Okay. Great. Danielle,

anything you want to add? Um just 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. Um, 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 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. Sounds like you know exactly what you're talking about. Might be.

Thanks, Kathy. Thank you for having me. All right, everyone. Well, thanks for tuning in today. If you have any

questions for Kathy and her team, just pop over to their website, kmcuniversity.com,

and they will jump in to help you write out. And thank you so much for joining.

If you ever have questions for us here at Chairocast, you can drop us an email. It's chairocastyroouch.com.

And we'll see you soon. Bye. Bye-bye. Thank you for joining us on this episode of Chairocast. Insights for modern

chiropractors. Brought to you by Chairo. Hosted by Dr. Stephanie Brown and Danielle Havas. Produced by Debbie

Brooks. Editing from Matthew Dodge. And title animation by Eric Madden. Our theme song, House Five, 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.

‍