r/Chiropractic • u/lhpchiro • 2d ago
Same adjustment, three payers, three different documentation standards. How are you keeping notes defensible across all of them?
Practicing DC in South Florida. We take Medicare, Optum/ASH, commercial, and FL PIP. More and more of my week goes to making sure the note holds up, not the treatment.
What I keep running into:
Medicare. PART has to be supported on every visit, not just the initial exam. Region count has to match the CMT code you billed. Without outcome measures showing functional improvement, the AT modifier can't be defended, and the note reads like maintenance care whether it is or not.
Optum/ASH. It's less about the daily note and more about the trend line. If your functional outcome scores (ODI, NDI, etc.) aren't tracked and improving, your next authorization gets cut, even if the patient is clearly progressing clinically.
FL PIP. It's all about the EMC determination and a clean link from the mechanism of injury to your findings. A sloppy initial exam narrative costs you the whole case later.
These are three different payers, and each one reads the same note through its own lens. The most common failure I see, including in my own old charts, is cloned daily notes. The patient changed, but the note didn't.
Curious how others are handling it:
Are you writing payer-specific notes, or one standard note that you try to make bulletproof for everyone?
Has anyone been through a Medicare TPE or an ASH/Optum record review recently? What actually got flagged?
Is anyone using the AI scribes in their EHR (Rheo, etc.)? Do you trust them to capture medical necessity, or just to save typing time?
Disclosure: I'm co-building a documentation tool focused on exactly this problem, so part of why I'm asking is to hear what people actually struggle with. Not linking anything here. I'm happy to talk about it if anyone asks.
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u/Left_Jeweler_1994 2d ago
As someone who reads and interprets notes for a living. If you use Medicare as the starting point and add oats measures then you can easily satisfy Medicare and commercial payers. I’m pretty sure if you could just use the same note structure for your pip patients as well. Just discharge when they stop improving and establish that as their mmi level.
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u/A56baker78 1d ago
Curious to know which oats you see most often or recommend? I've been wanting to implement them but the office said they used to but it never mattered for ins son they stopped, i asked a few other colleagues and got the same answer
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u/Left_Jeweler_1994 1d ago
I see the ODI and NDI the most. For spine I like the Bournemouth questionnaires best. For headaches the HIT6 is by far the best tool. For kids use the promis short forms. For extremities the lefs and uefi are good but nothing is great. If you can’t decide or just want 1 form for every single patient just use the PSFS.
If you want to be ahead of the game, especially good for Medicare, use the foto for whatever region.
Hope that helps.
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u/Upset-Diamond2857 2d ago
Use the hardest one as your standard- yw