Audits and Stimulus Money – The Impact on Your Practice Obama is pushing all doctors to employ a certified electronic health record (EHR) system. The incentives were enacted into law in the Stimulus bill passed by Congress and signed by President Obama. There are two incentives that affect you.

The first incentive in the Stimulus is a total of $44,000 in bonus payments from Medicare if you begin using a certified electronic health record system by the end of 2010.

The second incentive is a punishment for not utilizing a certified electronic health record system. Beginning in 2014, for each practice that does NOT use a certified electronic health record program, Medicare payments will be reduced by 1% in 2015, the reduction will be 2%; and in 2016 Medicare payments will be reduced by 3%.

Although the insurance auditors have gone wild with requiring specific items in your daily SOAP note documentation, new Medicare requirements are typically copied by other insurance carriers. This requires that you meet the Medicare documentation standards for non-Medicare patients in addition to the documentation required by State law and the insurance companies. If you are audited, and you do not meet all the standards for proper SOAP note documentation, the insurance companies will require reimbursement from you for payments already made. In other words, the standards required of certified EHR will apply to you regardless of your involvement with Medicare.

The stimulus money comes with government strings attached that will have a very serious impact on your practice, even if you do not qualify to receive the stimulus money. The first “string” is having a certified electronic health record computer program. As this article is being written, there is not yet any Chiropractic specific EHR system that has received certification. There are a few companies actively working to obtain this certification, and you can expect to see Chiropractic specific EHR software with the necessary certification by mid 2010.

The next “string” is that the EHR program must be able to generate data about your patients to whatever agency or company which may require it. Examples of this data include, but are not limited to, diagnosis statistics and treatment results.

Another “string” is that your SOAP documentation must demonstrate that your patient is making progress. You are required to show this through functional assessment evaluations while your patient is under active treatment. And there needs to be a method of proving that the patient, not you or your staff, completed the functional assessment forms. This should be reflected over time with changes in the patient’s diagnosis and treatment plan, and the functional assessment grade or score obtained once every 4 to 8 weeks recorded in your SOAP note.

Insurance and Medicare SOAP documentation requirements are being put in place to force you to reduce time spent with a patient and make you spend more time on bureaucracy. The ultimate goal of the insurance industry is to reduce the number of patients you can treat and, thereby, limit the amount of money you can collect. If you were to produce a handwritten SOAP note that meets all the currently required documentation standards, it would take at least 15 minutes to complete. A similar SOAP note produced in an EHR system takes only a few seconds.

 Whether it is for Medicare or some other company, claims examiners and auditors are going to review your notes to see if they meet the standards established by Medicare and all the insurance carriers. The result for those that do NOT reach the imposed guidelines will be fines, demands for refunds, and accusations of fraud. The cost to you could be horrific.

The bottom line is that the EHR guidelines are soon going to be employed by many insurance companies, not just Medicare. The only efficient method of performing up to the EHR standards is to get and use an EHR system in your practice as soon as possible, whether or not you accept Medicare or qualify for the Medicare stimulus.


Dr. Paul Bindell is a 1975 graduate of Palmer College of Chiropractic, in practice in Rockaway, NJ, since 1976. Dr. Bindell is a past Chairman of Public Relations for the Northern (NJ) Counties Chiropractic Society. In 1991. Dr. Bindell and his family began Life Systems Software so that the profession would have reliable computer programs based on real chiropractic practice. Dr. Bindell is available to speak to your group or organization and can be reached by email at [email protected], or you can call 1-800-543-3001.

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