Dr. Hoffman:
What a terrific analysis. I want to point out a couple of things that you brought up, Sam. First, that the doctors need to be specific in their subluxation listing that they're indicating on the billing forms. That's first. In addition to that, you mentioned signatures. One of the things that I've seen is that Medicare comes back and rejects claims because, especially on post payment reviews because it's missing the doctor's signature. In this day and age, we need to get ahead of the cross to people that that is just the rules. You have to sign every single visit. It could electronic unless you're going to tell us anything different Sam. It could be electronic. One of the things that I was told to recommend some time ago, and I want to get a comment from you, is even if you did sign each visit, include if you're going to send your documentation to Medicare, always include an extra attestation statement. Meaning that you're attesting to having been the one that saw that patient on each one of those visits as sort of a backup and double check for your signature. Is there anything you can comment on that Sam for me? I tell you, I go to speak in a lot of the schools. I try to get to every senior if I can before they finish and one of the things I'll say is, "Just get use to signing your notes." It's not a big deal. It's something that if we were told that from day 1 that you just have to sign the note, we'd all do it and not worry about it. Chances are we were taught a certain way and we thought, "Oh initials are fine." What I tell everyone is Medicare doesn’t accept initials. It has to be signed. Just sign it. There's no room to argue there. Now, I agree with you and here's one thing that a doctor can do. Let's say you did just initial your notes. You can do as you what you stated do an attestation. What an attestation is, it's essentially a piece of paper that you signed that says, "I swear to God, these are my records and my patient." You sign it. Medicare accepts that. In fact, Medicare produces an attestation signature page that you can do that. I agree with you by stating it that way, you make it clear, "These are my patients, this is the work that I did." That's all Medicare is doing. It's affirming you've done the work. If you do an electronic signature it could be as simple as electronic signed by Dr. Stu Hoffman. That's acceptable. Obviously, because you're not going to sign a physical signature to an electronic note. That's acceptable and Medicare is pretty generous about that electronic signature so long as you're putting some indication at the end of each day, they're your notes, but if you're doing standard paper, just simply sign your name. Now here's one thing. I bet if I look at your signature, Dr. Stu, I probably wouldn’t know it's Stu Hoffman simply because we all know how we write signatures now, and that's acceptable as well. Just make sure they're somewhere in there that that's wiggling line equals you. With the cover page, I will put, "Please note, this signature line is my signature, Dr. Stu Hoffman." That would be acceptable. To me, it's a simple fix. I would just tell every doctors, they graduate school now, if they've heard me I’m going to tell them, "You sign your notes every day." I've gotten all the clinics that I go to, whether it's Palmer or Parker, you name it, to make sure that the doctors get used to and this clinicians I should say just sign your records and now that the new doctors did it, it's no big deal, because that's what they were always taught.
Dr. Collins:
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