subsequent visit, you go again and say, "Well, if the pain level now if a 5, what can you do more?" The patient may give information, "Oh, I slept more comfortably. I could turn my head driving the car." Those are things we can hang our hat on to show the patient's improved. To give you ... I'll leave with this, the number 1 reason chiropractors get audited is when they fall out of line with the standard providers. Just about everybody provider right now is going to get a comparative billing report. You really want to look at that report to see where you hit. For sure, if you bill a 98942 on more than 5% of your patients, Medicare has said they're going to audit you period. You want to be very careful that when you use a 98942, I’m not saying that you shouldn’t do a 42, but you want to make sure that you have 5 spinal regions indicated as well as 5-secondary diagnosis associated which is pretty hard to do. I’m not going to say it's impossible. You want to make sure if you have that you can just back it up. I’m not afraid of Medicare auditing someone. I had an audit the last were, actually a few weeks ago but I received it back this past week. The doctor did fine. I said, "Let me see your notes before you send it." One of the simple things the doctor forgot to do is to indicate which vertebrae they adjusted. It was in the subjective, they have to put it in the plan. The other one is signing their notes and this doctor now passed and had no problem even though he billed higher number of 98941. I’m never afraid of a doctor doing what he feels is necessary. We have to make sure does the documentation justify the level of care that we're providing. If the patient ever reaches a point where you think it's maintenance, always have them sign an Advance Beneficiary Notice or ABN and please bill with the GA. Here is the good news that most doctors aren’t aware. When the patient has signed an Advance Beneficiary Notice for maintenance and you bill with the GA, Medicare is forbidden from auditing those files because the patient has accepted it as maintenance. If you want to test the waters where you think it's starting to reach a point where it may not be necessary, it may be time to start thinking and talking to the patient about this care level now is not going to be level that Medicare accepts. Though we feel it's positive for you, Medicare doesn’t follow the same type of philosophy. It's something, I'd say doctors just start going through and have that list of what is required for Medicare. I in fact, have a list of what I call Medicare documentation deconstructed. If anyone would like, I'll give my email again. They're welcome to email me and I'll send it to them so they can finally get a sample of what Medicare is looking for. There's an understanding. I think chiropractors can document just fine. I say we just have to make sure someone has told us, "What do you want?" What we want to make sure that is to give those doctors this is what Medicare requires, make sure you have those. My statement too would be, "Medicare wants A, B and C. We have to give them that." If you also like to do D, E and F, I'd say, "That's fine." There is no reason you can’t put all your other things in there but make sure the requirements of A, B and C for Medicare are always included.
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