WHY your don't hear much about what happens in an AUDIT:

  1. The audited doc is embarrassed, or
  2. If they have made a settlement with the carrier to repay $$$$ in a recoupment (which can be tens or hundreds of thousands of dollars), there is usually a stipulation in the settlement contract that they cannot discuss/divulge details of their audit.


This DISEMPOWERS us as a profession!

...I NEVER would have beliEved you. Here's MY AUDIT STORY:

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I received MY audit letter in 2017...

My largest insurance carrier asked me for 6 months' worth of notes on 10 patients going back almost a year prior. (I was lucky: dozens of colleagues were audited in Virginia that year, and some offices had to supply up to 30 patient files) My staff printed out almost a thousand pages of notes. I read through every single page. TWICE. And I did NOT like what I saw.

My documentation that I *thought* was pretty good-looking on the computer screen...really wasn't.

It actually looked, shall we say, less-than-stellar when printed out. TRY IT: it's called a "Self-Audit." And almost NOBODY does them. I would highly recommend that you do this BEFORE the real thing hits you.

I was VERY worried.

My notes were filled with conflicting information. Huge swaths of text "SALT-ed" over from visit to visit, which made it hard to see where I HAD put in hard work. Lots of required information and "carrier documentation protocol" elements that I NOW know should have been there...wasn't.

I mailed it all off in a box and hoped for the best.

Which I NOW know is the WORST thing you can do IF you know that you have documentation problems: doing nothing about it while you wait to hear back from the carrier while you hope that things will be OK. Things did not go well in the Spring of 2018 when I received my "Audit Findings" phone call (which I was utterly unprepared for, BTW).

I FAILED my AUDIT and was placed under "Prepayment review."

BEFORE anyone gets all "Shame-y" and "Judge-y" about that, READ my 5/21/2020 Blog post "Why YOU would <probably> FAIL an AUDIT."

IN ALL FAIRNESS: When ANYONE is audited, your audit will go back at least year before your audit findings phone call. By the time I was placed on "Pre-payment Review", it was based on what my documentation was like 1 1/2 YEARS PRIOR, not their current state....before I had implemented many updates. If YOU are audited, the same will apply: ALL THE MORE REASON to fix things NOW.


I had THREE WEEKS to get my documentation in even better shape. I spent dozens of hours watching my EHR training videos, updating my macros and fixing content in my documentation, changing office policies, and educating my staff and patients. MANY nights I went back to my office after putting my daughters to sleep and stayed there PAST MIDNIGHT. It was HORRIBLE

But I DID IT. 

(I do NOT recommend this as a compliance strategy, by the way)

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IF you don't know exactly what "Prepayment Review" means:

All ongoing services that you provide to that carrier's insureds are required to be submitted on paper claim forms, along with all printed documentation relevant to that visit. IF the carrier determines that the documentation does not support the carrier's definition of "Medical Necessity" AND meet all of their documentation parameters, they will deny the claim and not pay you. The carrier may -- or may NOT-- be forthcoming about the exact reason WHY those claims were denied.

AND...you are required to continue offering care to the carrier's insureds, because you are contracted to do so. (yes, this means what it sounds like: if your claims are denied, you won't get paid, yet you have to continue to provide services to those patients.

I paid an outside expert to evaluate the current state of my documentation, receiving a grade of B+

That was BEFORE I implemented any suggested changes.

IT DIDN'T MATTER. When you hear *anyone* say "as long as you show 'due diligence' " or "if you are demonstrating an effort to improve your notes and you'll be OK," THIS IS NOT TRUE.

Claims denied for erroneous reasons (MANY of mine were) will not be paid while in dispute.

Yes, you may appeal those claims. But this will takes months. Or years.

 In Spring 2020, I am still fighting for over $10,000 in unpaid services that were erroneously denied.

EVEN THOUGH I WAS PREPARED, when PREPAYMENT REVIEW hit...

it slowed my cash-flow from 75% of my practice down to a trickle... for SIX MONTHS. This was financially devastating to my practice and my family. The carrier had the upper hand, and myself and my colleagues in Virginia had little guidance on how to properly respond. And when it was clear that things weren't as fair as you would hope they would be I didn't know how to fight back. The AUDIT ultimately forced me to sell my office. 

About a dozen Chiropractic colleagues and I collectively lost over A MILLION DOLLARS that year.

To be honest, I wish i didn't have the job that I do.

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But I feel COMPELLED to share what I have learned, and to help keep what happened to my colleagues and me from happening to ANYONE ELSE.

IF you decide to ACT and FIX THIS. NOW.


NON-COMPLAINT DOCUMENTATION is a HUGE problem, not just for Chiropractors (over 1/3 of all DC's), but for other healthcare providers* to the tune of BILLIONS of dollars. Don't think carriers are going to close their eyes and you can continue to fly under the radar!


Want to know a Dirty Little Secret? MOST Chiropractors (and docs of most health disciplines) HAVEN'T READ THEIR CARRIER GUIDELINES. Going to a workshop is NOT enough. It's NOT as scary as you think. Let's GO:


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With my "CONFIDENTLY COMPLIANT MASTERCLASS" I will take you and your TEAM on a step-by step journey to FREEDOM.

FINALLY create compliant provider EHR documentation and don't worry about not getting paid due to an audit EVER AGAIN.


DON'T WAIT