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About - Why was Sequoia Visions created?
The insurance industry has aggressively revolutionized its practices and procedures over the last two decades. This revolution has adopted the use of computer programs (Colossus, Decision Point, ICE, AIM, ADP, MBRS, Med-Data and Mitchell Medical Expert), which allow the insurance industry to reduce the payout of claims. It has also had a direct impact on:
1. The number of claim files each insurer’s employees can handle.
2. What amount of training is needed for the claim handlers to be most effective in reducing the claim payout?
3. Reducing the number of experienced and higher salaried employees.
4. Eliminating individual analysis by a claim handler based on experience and intelligence.
5. Standardizing the process by which each claim is reviewed and processed.
6. Increasing the profits of each insurer by the reduction of both first party and third party severity payments.
Unfortunately, the Chiropractic community has, to a great degree, assisted the insurance industry in its success. During the last two decades, the insurance industry has capitalized on the unreadable and inaccurate chart notes produced by Chiropractors. This alone has allowed the insurance industry to attack treatment duration, type and frequency of all Chiropractic physicians. In the absence of accurate and proper documented patient daily chart notes, the Chiropractic community is finding itself receiving less than full reimbursement for their patient treatment. The Chiropractor of today is forced to accept a reduced payment from the insurers on first party claims. The Chiropractor of today is repeatedly asked to accept a discounted payment from the attorney representing the patient on a third party claim because the claim settlement payment was significantly less than expected.
Is it any wonder that this is occurring to Chiropractors more so than any other rehabilitating physician? The answer to this question is, NO. Consider for just a moment what percentage of claims presented to the insurance industry are “soft tissue”. Some insurers claim over 80% percent of all claims are “soft tissue”. This huge body of “soft tissue” claims is more often than not receiving treatment from Chiropractors. Again, most insurers recognize the Chiropractic involvement in treating these types of claims exceeds 80%. This natural progression of type of claims, number of claims and treating physician for these claims has been the impetus to the insurance industry’s focus on Chiropractic treatment costs. By reducing the cost of Chiropractic treatment costs, the insurance industry has and will continue to realize immeasurable reduction of claim payout and increased profits.
The focus of the insurance industry will not diminish in the future. In fact, with the introduction of computer programs capable of making claim decisions that reduce Chiropractic treatment costs and subsequently, third party claim settlement costs, the insurance industry is motivated to become even more aggressive in the future. Until such time as the Chiropractic community begins to adopt some very simple practices, it will continue to be the victim of this trend.
The solution is now available for the Chiropractor to address and realize full reimbursement of patient treatment. It begins with proper daily chart note recording. It would help a great deal if this was also readable. The eight most important issues in any claim for the insurance industry are the following:
Correct use of ICD-9 and CPT codes
Proper identification of injuries
Identification of all injuries (even those the physician isn’t treating)
Correct documentation of all symptomology
Manifestations (Duties under Duress and Loss of Enjoyment
Accurate prognosis with consideration for active as well as passive treatment
Documentation of daily active as well as passive treatment
Probable or Definite determination of future treatment
Documentation of specific body part reaching MMIDetermination of impairment ratings
Some of this information the insurance industry requires to be validated by a medical doctor. Unfortunately, the insurance industry currently places more credibility in medical doctors than Chiropractors. This isn’t a medical fact. It’s a fact of the insurance industry’s procedures, practices and training. Fighting that battle today won’t reflect a full payment of treatment tomorrow. Not that the battle isn’t worth fighting, it just won’t realize an immediate success.
The solution also involves the Chiropractor understanding the insurance industry’s accepted computer program terminology, injury definition, acceptable symptomology, prognosis and manifestations. There are points assessed to each aspect of these categories which allow the insurance industry’s programs to accept or deny payment and credibility of Chiropractic treatment in determining claim value. This information can be acquired by extensive investigation and education by the individual Chiropractor. However, it would be unlikely the Chiropractor would ever realize complete knowledge absent being employed in the insurance industry. The answers can also be found in software currently available to the Chiropractic community. The only software which enables the Chiropractor full knowledge and user friendly access to this information is sold by Sequoia Visions, Inc. Of course, being owner and president of Sequoia Visions, Inc., might influence my preference of software.
In an attempt to educate and assist the Chiropractic community, I have created a “Quick Review” of issues to consider when completing daily chart notes. I was also limited in the amount of space allotted to this endeavor. Subsequently, the following listing developed specifically for this article. I hope that you find it both educational and surprisingly succinct. I would strongly recommend that each Chiropractor include the issues as presented on this listing in daily practice and patient recording. The result will be amazingly successful each Chiropractor and Attorney that does.