The idea of using this is we'll always allow you to show the medical necessity of your services. Let's face it. Chiropractic works very, very well. We have to make sure we're demonstrating it. One of the best ways to do it is show the functional change of the patient. A disability index will do that. All your documentation, whatever you send in for any auditor review, I sure hope that you're all including outcome assessments. The other factor is make sure that you're also indicating functional changes as a result of care, not just reduction of pain. Of course, reduction of pain is important, but it's the functional change as a result that really makes the difference. For instance, if my low back starts off at a 10 and I cannot sit, stand or even lie down comfortably. When my pain is an eight that's certainly better, but it would be far better to document when the pain is an eight, what is the patient able to do now that they were not able to do prior? For instance, now that my pain is a level eight the patient now can sit for 20 minutes or can at least lay on their side and sleeping more comfortably. Make sure that realizing that, yes, they're going to look at the services you provided. Yes, they're going to look at the time and the values. But they're also ultimately going to look at was this patient treated or over- treated if you will or the patient has already reached maximum medical improvement. Here's an example here of a physical therapy guideline. This is the National Blue Cross and I just highlighted that little bullet. “Treatment results in demonstrated progress towards measurable goals.” What you want to make sure is that you always demonstrate that the patient is getting better. Statements of the patient feels a little better today, patient slightly improved will not cut it. Make sure you always give some sort of functional status. When the patient says they feel a little better please always finish it with what can you do that makes you say it feels better now that you were not able to do before. This brings me to also just with audits. All audits take Medicare as the start and Medicare, of course, is doing more and more audits. Here are some of the most common factors of Medicare audits, what are called CERT Review, C-E-R-T. The first thing that Medicare finds is that providers are missing the subjective complaint. That almost seems comical in a way but I think what we're forgetting they're not missing a subjective complaint on the first visit. You do need to continue on each visit what is the subjective complaint of the day.
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