Audit Proof Chiropractic SOAP Note Software and EMR/EHR
I have been in the chiropractic software and billing industry for a long time. Managing a business that develops software to help doctors get paid on time and protect their earnings from an audit is one thing. When your income is tied to your clients income, like it is for many of my clients, that is another thing. I have both perspectives. If a doctor does not get paid I don’t either. If they get audited, and lose, we all lose.
A lot is said by software vendors out there about their SOAP notes. They are the “best”, the “fastest”, “bullet proof”. I question how many of them have tried to get a claim appeal won with the notes their systems generates. I can say lots of things if I were just selling software one time but clients of mine buy, or do not buy, every day. When doctors using other software lose and appeal or get audited is their first call to the software vendor? I think not. I would like to share real world experience when it comes to audits and SOAP notes, not hot air that will not help you at all, let alone make you bullet proof.
First understand that the biggest money maker (most profitable) for insurance companies today is not higher premiums like you might think. It is Audits. A 13:1 ROI has been reported. If I spent $1 on marketing and got $13 back I would be dumping all of my money into whatever gave me that return. So here is my prediction. You, and your bullet proof notes, are going to get audited. That goes for me too by the way. I made this prediction 7 years ago before doctors really knew what an audit was. The frequency and scope of audits has since skyrocketed and broadened dramatically. So it is coming to a head.
Insurance companies are actively building technology, processes, and gathering the man power to efficiently audit everyone and become even more profitable doing it. Here is what will happen, if you ask me.
- There will be automated technology that scans EVERY SOAP note to look for weak points. Of course that means every insurance company would need a digital copy of every note for every visit. Have you heard of some insurance companies requesting notes on all visits? I have.
- Sophisticated systems are being built and have been around for years to profile what codes you bill and what you charge.
- Wouldn’t it be nice if the government mandated that every doctor have an electronic health record? Even better if there was government regulated certification so all the systems worked the same way right? That would really help patients so much.
- More on the levels of audits in a bit.
- I am already hearing reports in some states where every doctor who billed a specific carrier got an audit letter.
- Man Power
- Insurance companies are hiring outside independent contractors to conduct the audits. This gives them basically an unlimited number of auditors. They share a % of the money collected in the audit with these contractors.
- They are outsourcing claims processing, note review, and appeal processing to India and other countries at a fraction of the cost you would pay to defend against them.
All the stars are aligning. Every claim, every note, audited in real time. There is one final automation that will happen and is actually happening already on some level. The technology will “pluck” providers and spoon feed them to audit teams. The audit team will on lower levels be more computers. The computers will generate threatening letters. Some doctors will pay just to avoid the hassle.
With this in mind your question should be “How do I minimize the chance that when the technology scans my profile, I do not look like easy pickings”.
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