HIT Advisor: Consistent Documentation Drives Compliance
by Ted A. Arkfeld, DC, MS
 The rapid expansion of pain
management clinics and the fact that many are turning into multidisciplinary clinics
throughout the country has provided patients with a one-stop shop for healthcare. The
advantages can be numerous for physicians and non-physician providers in delivering
various services in different specialty areas. The problems and/or red-flags can also be
numerous due to insurance carriers viewing these arrangements with suspicion because of a
few unscrupulous doctors engaging in abusive billing, coding, and documentation procedures
and, at the worst, committing fraud. Utilization review companies look at the consistency
of the documentation of everyone involved in the patient’s case file. If the file
lacks consistency, then the stage is set for further investigation and a possibly negative
post-payment audit requiring large sums of monies to be repaid.
Pain Scales
There has been considerable progress in pain assessment, theory, and measurement in recent
years. One method employed every day in offices nationwide is the use of a numeric rating
scale where pain patients are asked to give a rating on a 0 to 10 scale. This type of
scale is easily understood by patients and is obtained by either written or oral means.
The main problem is that both patient and doctor may walk into the exam room with a
different pain scale definition.
For example, a provider asks a male patient on a scale of 0 to 10, what is the pain
rating today? The patient responds while sitting very comfortably with no visual signs of
distress that he is currently at a 10. The doctor is now put into a very delicate
situation of having to determine what is this patient’s motivation for such a high
pain rating when he appears to be doing just fine. The patient may not realize this level
is in conflict with the physician’s own definition. The patient simply based their
definition on what was explained to them during a previous visit.
The patient may also find himself in the middle of two or more providers he may be
seeing in the same facility who cannot agree on a pain scale definition among themselves.
A patient first sees Dr. A, who inquires about their pain level and, if the rating is
deemed extraordinarily high, is instructed on that doctor’s own definition. The
patient then goes to see provider B, who is of another specialty, and is asked what his
pain level is for the day and, when given the scale number, tells the patient that
can’t be right and then gives their definition. The poor patient is caught in the
middle and leaves both irritated and concerned that these providers cannot agree on a pain
scale definition.
Please refer to the October 2008 issue for the complete text. In the event you need to order a back issue, please click here.
— October 2008
The full article is now available as a PDF and may be
purchased for $5 and downloaded immediately:
|