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SUMMER 2008, ISSUE 1

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What To Do About Audits‌

Are You Burying Your Head In The Sand?

Mandated EHRs Coming To A State Near You The Fastest Compliant Patient Note In The Profession


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Welcome to the First Issue of

Clinic of the Future

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a mini-news magazine for customers and friends of Future Health Software

My name is Mark Beardmore and I'm the Customer Advocate for Future Health, Inc. My role is to make your transition from the time you choose Future Health, until your software is up and running, seamless and stress free; and then, to ensure that your experience as a customer is a positive, productive one. Our ultimate goal is to improve your practice for better efficiencies and more profitability. This publication is one effort to answer your questions, while at the same time reminding you of the many benefits that Future Health software has to offer. We will use this publication to educate, inform, and share with you pertinent, applicable information you can use to maximize the many benefits of Future Health software and lower your overhead and grow your practice through technology. Please feel free to contact me with any thoughts or comments you may have about this publication, your software, or the state of the profession as it relates to office management issues. Again, welcome to CLINIC OF THE FUTURE TM. Sincerely

Mark Beardmore

Future Health Customer Advocate 1-800-348-7657 Ext. 504 mbeardmore@FutureHealthSoftware.com

table of contents Page 1: Welcome and Table of Contents Page 2: Questions & Answers about 3rd Party Audits Page 4: States Mandate EHRs Page 5: Solution Spotlight: Documentation Page 6: Latest News From Future Health Back cover: Save the date for THE FUTURE seminar

Future Health Inc. • www.FutureHealthSoftware.com • 1-800-348-7657


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Issues Facing The Chiropractic Profession

A Candid Conversation With Dr. Steven Kraus About The Audits Threatening The Chiropractic Profession Q: Dr. Kraus, can you share with us what’s going on with these chiropractic audits? Dr. Kraus: There’s a lot of pressure on third-party payers to reduce costs, and one way they can do this is by recouping money. Insurance companies must validate that they are watching the premium monies properly, and they’re making sure that they’re only paying for necessary care. So, they are going after doctors. Q: How serious do you think this is really going to be? Dr. Kraus: It’s very real. If they can go out and recoup a million dollars, it makes good business sense. As it’s said, “So goes Medicare, so goes the rest of the third-party payer industry.” That has been true for rules and regulations [and] it’s also true in their whole business operation. If Medicare has determined it’s good business to audit chiropractors (and they have), the third-party industry is also going to say it’s good. Q: Are they picking on chiropractors? Dr. Kraus: No, actually Medicare carriers are required by law to perform audits on all health care professions, and they’re supposed to recoup a certain dollar amount. Chiropractors have made themselves an easy target, especially with the recent 2005 Office of Inspector General report revealing that our documentation is extremely sub par. Why wouldn’t the thirdparty payer go after the chiropractor? It’s easy pickings. For those who are conspiracy theory individuals or

who know that some insurance companies do have a prejudicial tone against chiropractic, you can bet those insurance medical directors who do have a bias against our profession are going to target our profession.

3 THINGS YOU CAN DO TO REDUCE THE LIKELIHOOD OF AN AUDIT PROBLEM 1. Become aware of proper documentation criteria. Attend CE classes on standardized documentation. 2. Be aware of the variety of guidelines that exist, that you’ve actually signed up and agreed to, and understand your state board guidelines. 3. Get a tool or a software system to help you create the documentation in an efficient manner that is compliant with those guidelines. Q: Exactly what are we doing wrong? Dr. Kraus: Doctors are not adequately documenting the services they are providing or the need for continued care. They either don’t know how to demonstrate progress, or they are just so overloaded with the day-to-day business of seeing patients that they don’t have the time to properly document. Current documentation methods are either a paper system or an inadequate note generator. These systems are too basic for doctors to get the meat and potatoes into the clinical record to tell the story of what’s happening with the patient. We need to inform the person who is reviewing the records why chiropractic care should be paid for or why care should be extended if clinically indicated. Q&A continued, page 3

Future Health Inc. • www.FutureHealthSoftware.com • 1-800-348-7657


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Q&A continued

Q: Is there anything we can do? Dr. Kraus: We need to elevate our documentation because that is how we are being judged. We’d like to think that the answer is research studies, but research studies take years to go to publication and then to reach the thirdparty industry. Research can help us in the long run, but not always immediately in an audit. These audit mechanisms mean immediate dollars for the insurance company. The only thing chiropractors can do to save themselves is to elevate their level of documentation.

number of procedures that you’re doing that are higher than what your peers are doing. For example, if you have a high percentage of therapeutic exercise compared to your peers, you might be a candidate for an audit. They’ll look at it from a dollar perspective. They might simply audit you because they are paying you a lot of money, and they want to make sure that you’re not doing anything against the standard of care to justify why they’re paying you a lot of money. Q: Is there really anything a chiropractor can do to prepare? Dr. Kraus: You have to assume you are going to get audited. You should go to a CPA because you want to make sure you have a professional examining the documents that you’re submitting to the federal government for your taxes. Why wouldn’t a chiropractor make sure that they have a professional system in place to prepare them for an insurance post payment audit?

We were recently audited by Cigna Government Services (Medicare) for a post-payment review of services billed. I am using Future Health’s Dashboard Documentation system, so all I had to do was locate the notes and press print. When I got the audit results back, we were found to be compliant with a $0 dollar overpayment finding!” —Dr. Berkowitz, North Carolina

Q: How bad is an audit? Dr. Kraus: It’s not that you would have somebody storming your office demanding hundreds of records. But an audit is a stressful experience. Q: What triggers an audit? Dr. Kraus: It depends. Some audits are simply random. Most third-party audits are triggered because of your utilization statistics. It comes down to a certain

Q: You’ve mentioned many times that it’s the quality of the note that is hurting the profession and leading to who gets audited. Can you be more specific? Dr. Kraus: Take a look at a note from a medical specialist to whom you’ve referred a patient. Notice the font, the typing and the structure of the note but also what’s inside in terms of how the sentences are structured, the clinical depth of the note, as well as graphs and images inside the note. They are all properly organized, structured in the correct flow and with accepted standards for documentation. They are often three to five pages. It’s practically a report in itself. But it really is their daily note since specialists only see patients sparingly. That’s what claim reviewers are used to seeing for documentation from what they call “real doctors”. If we want the same respect, same authorization for utilization resulting in payment, and credibility, we need to elevate our documentation. ■

Steven J. Kraus, D.C., DIBCN, CCSP ®, F.A.S.A. is the CEO of Future Health, Inc. Dr. Kraus has owned 18 practices and is the Chairman of the Iowa Board of Chiropractic and past president of the Iowa Chiropractic Society. For more information, contact us at skrausdc@FutureHealthSoftware.com.

Future Health Inc. • www.FutureHealthSoftware.com • 1-800-348-7657


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Whether We’re Ready or Not!

Federally Mandated EHRs Are Coming… I

f you’re already using Future Health’s electronic health records (EHRs), then consider yourself way ahead of the curve. New developments in legislation are moving us closer to an era of federally mandated EHRs. As Dr. Steven Kraus has written in various professional media, some states are already acting to force EHRs adoption because of cost savings to the public, providers and error reductions. Recently, Minnesota’s state government passed a series of resolutions that will make EHR compulsory by 2015. This date is significant because it matches federal talking points that have been publicized by President George W. Bush since 2004. It means that other state governments are likely to follow through with probable federal mandates, making it all the more likely that the federal government will follow through on its promises to create national EHR legislation for participation in Medicare and federal reimbursement programs by 2014. Although such a federal mandate hasn’t been written at this time, the leading 2008 presidential candidates support the expansion of EHR legislation. They do so because, according to a study by the RAND Corporation, 77 billion dollars a year can be saved by the government with widespread use of electronic health records. According to some, 77 billion is actually a conservative estimate. In addition the Veteran’s Hospitals have been successfully using a nationally connected EHR for the past few years. So what did the Minnesota legislation say, specifically? The mandates say that: (1) all healthcare claims must be filed via electronic means by January 2009; (2) all prescriptions for state employees and their dependents must be electronically prescribed by 2009; and (3) “interoperable EHRs” by all physicians and hospitals are required and must be in place by 2015. It does mean that Minnesota is going to start adopting EHRs at a faster rate, forcing the rest of healthcare to do so before 2015. Essentially, it’s going to become impossible to be a licensed provider in Minnesota in a few short years unless you have an operable EHR in your practice.

Latest Information & News Regarding Electronic Health Records • 2005 OIG (Office of the Inspector General) Report indicated 67% of claims contained documentation errors inappropriate for Medicare reimbursement. • OIG Report also noted that 2 out of 3 claims were deemed inappropriately paid. • It is estimated that moving from paper to digital patient records will result in a national healthcare savings of $77 billion. • VA Hospitals are already using electronic health records. • President Bush has mandated the potential use of EHRs by the year 2014. • By 2025, 1 in 4 Americans will be 65 or older using Medicare. • In 5-7 years, EHRs may be required to participate in Medicare. • Medicare has paid incentive payments for adopting certified EHR software.

Congratulations to our Future Health doctors in Minnesota who are setting the standard for other chiropractors in the state. Unfortunately, there is still more work to be done in your state and elsewhere in the U.S. There are still thousands of chiropractors who are using digital note generators who believe that the technology is actually an interoperable EHR. They’re going to need your help if they want to meet Minnesota’s mandates. Do them a professional favor and show them the difference between their digital note generator and a true EHR before this discrepancy has legal consequences. Future Health was rated the number one best overall EHR for the chiropractic profession by an independent Boston firm, IHCPR. For everyone else, we’ll keep you up-to-date on any of the important regional and national developments that will affect the way you document. ■

Future Health Inc. • www.FutureHealthSoftware.com • 1-800-348-7657


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Solution Spotlight

DASHBOARD DOCUMENTATION

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ou and other customers tell us all the time how incredible Dashboard DocumentationTM is and how happy you are with this futuristic record-keeping system—but are you sure that you are maximizing the power of Dashboard DocumentationTM? Did you know that your Dashboard DocumentationTM system has advanced integration capabilities that increase the effectiveness of your office management system? We call it Fusion Technology™. It is the technology that is defining EHR integration. • Fully integratable with internal systems such as scheduling, billing, and patient education. • Also completely integratable with leading third-party diagnostic devices like digital x-ray, thermoscans, PulStar adjusting devices, and J-Tech ROM & muscle testing systems. • Uniquely integratable with our Virtual Educator ■

The most comprehensive patient note in chiropractic, yet our HyperSpeed NoteTM technology allows you to quickly demonstrate medical necessity.

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And look what’s new with our Dashboard DocumentationTM system: •The new Dashboard DocumentationTM workflow engine lets you practice the way you want. You control the order in which your screens appear on the monitor. You can even customize your workflow to different patient/exam types based on diagnosis or pay classification so that you can follow certain treatment protocols or practice guidelines. •The new Dashboard DocumentationTM treatment plan builder lets you create your favorite treatment plans to save you even more time. Now you can preload

The Dashboard DocumentationTM system has advanced integration capabilities that increase the effectiveness of your office management system. hundreds of treatment plans exactly as you want or use the templates already pre-loaded so that, at the necessary time, your treatment plan of choice is just one click away. Now, instead of having to construct separate treatment plans at the time of visit for each patient, Dashboard DocumentationTM includes everything required—goals to frequency to services on specific visits. It creates instant communication and awareness for the entire staff to know exactly what to do for each patient on each visit; and, autotracking of which visit number or how many visits from the pre-authorized care remain. Better patient care and compliance with 3rd party guidelines are also something to expect. Get the most out of your Future Health system by using our integrated Dashboard DocumentationTM system. Get in touch with Future Health if you have any questions or want to learn more. ■

Future Health Inc. • www.FutureHealthSoftware.com • 1-800-348-7657


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What’s New at Future Health

Future Health’s 24/7 website training is now available! Experience convenience with web-based training videos any time, any day you or your staff members want!

We’re committed to continuous development and enhancement of our systems, based on your needs and suggestions. —Dr. Steven Kraus

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Take advantage of the training site by signing up for your access and password information today! Visit www.FutureHealthSoftware.com and click on Customer Log-in at the top of the home page and complete the requested information. Once submitted, you will receive your User Name and Password by e-mail within 48 hours so you can access the site.

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Your service agreement allows you to receive unlimited year-round support with Future Health’s 24/7 online web training and daily live advanced training sessions. ■

The customer support is outstanding! I can’t say enough about it and the support team and staff at Future Health.” —Thomas Blankenbaker, DC

Live Advanced Training Sessions are held Monday-Friday at 11:30 am and 1:30 pm, Central Time: You will receive an email agenda for the new release and product training twice a month. If you don’t have a Boss of the VOS on file to receive our email announcements and passcodes to training, contact training@FutureHealthSoftware.com with your Boss of the VOS’s name, clinic name, phone number and email address. Once we confirm your contact information, you will gain access to training and the announcements.

The staff at Future Health has been great. They are prompt, courteous, and professional. I look forward to seeing the evolution of the software through experience, upgrades and reception to feedback.” —Steve Gautreau, DC

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New Check-In and Check-Out Screens Future Heath’s exclusive check-in and check-out screens with EUN (Everything You Need) information center. On one screen, you will be able to view the patient’s picture, past and future appointments, treatment plans, colorcoded insurance authorizations, patient balances and more! New Insurance Authorization Screen Tracking patient’s allowable visits by insurer has never been easier! In one screen, view or change authorization codes, visits authorized, start and end dates, referring providers and specific notes regarding that patient’s account authorizations on visits. Making sure you get paid for the services you provide and properly alerting you and your staff on which cases require third party approval and when those authorizations expire. Easy and efficient! New Workflow Screen Everything you’ve ever wanted in an efficient documentation system is now yours! All doctors have their own particular workflow, and now Future Health’s Dashboard Documentation is customized for multiple workflows depending on the patient DX or their third-party guidelines. Maximize your efficiency by setting the path you want to follow and meet your documentation practice guidelines. New Future Health website Check out the new Future Health website at www.FutureHealthSoftware.com. We’ve redesigned the look and made it easier to use. Let us know how you like it. New Customer Advocate Mark Beardmore has been appointed Customer Advocate, a new position designed to enhance your Future Health experience, from the time your decision is made to purchase until the system is set-up and running. Contact Mark at 1-800-348-7657 Ext. 504. ■

Future Health Inc. • www.FutureHealthSoftware.com • 1-800-348-7657


• Learn the latest on consumer trends towards chiropractic and health care in general that can move your practice towards a more successful future. • The potential that the Baby Boomer generation provides for chiropractors that you should not miss out on.

Call Future Health at 1-800-348-7657 for more information.

• Federal government and managed care demands about electronic recordkeeping and what you can do to be fully prepared. • The role of technology in the chiropractic practice and how you can make it work for you.

Top speakers will share with seminar attendees a sneak preview as to the future of the chiropractic profession, based on:

THE FUTURE OF CHIROPRACTIC: The Seminar

December 6-7, 2008 • Minneapolis, MN

SAVE THE DATE! The one seminar you won’t want to miss.

513 N. Main St. Carroll, IA 51401


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