Every case that is paid in full starts with a framework of success that leads to getting your patient to Maximum Medical Improvement (MMI).
There are so many obstacles, hurdles, and different opinions throughout a patient's treatment plan in PI care that it can become very overwhelming! Where does an attorney or practitioner even start?
Believe me, I've been in this for over a decade and a half and still see the challenges crossing my desk. Getting the most accurate diagnosis and treatment plan is just the tip of the iceberg. There is also detailed documentation, correct billing processes, frequent reporting, accurate referring out, co-management of cases, and performing REASONABLE AND NECESSARY treatment.
All of which are incredibly time consuming! I know and feel your pain.
The first time this happened to me, I remember the time when I worked on a patient for months, charging a very reasonable fee, working my butt off day and night, and getting the dreaded phone call of "Dr. Carter, we are going to have to cut your bill by 50%".
My reply was just like yours I'm sure, "What the HELL?"
Nobody ever told me that my PI bill had the potential of getting cut! According to the insurance claims adjuster, if I would have followed a better system it would have never happened!
Let's just say I was confused, frustrated, and let way too many expletives fly off of my tongue, all in front of my staff. Month after month, my bills kept getting cut.
To make matters worse, I calculated the endless HOURS of sitting in front of the computer typing report after report, and realized I could have been making more money at 7-11 selling Slurpees!
I was finished with the series of unfortunate events. The patient was obviously injured, the attorney had no other way to ensure payment, and the insurance was walking away with an unfair settlement.
Ultimately, the patient was angry with the attorney, the attorney never spoke with me again, and the claims adjuster had won, AND RIGHTFULLY SO!!!
I could either not see any more PI patients, or, it was time to research the WHY of PI. After writing down dozens of questions I set out on a mission. I studied everything that I could get my hands on with whiplash injury. I read books, including the AMA Guides 5th edition, watched videos, studied the internet, saved research papers, contacted other physicians, went to law libraries, and spoke with many attorney colleagues in regards to PI cases.
I began to realize that even the attorneys that I spoke with didn't understand all of the stuff I was questioning, and many didn't even care. In fact, at lunch one day, an attorney said, “There is no way to get any more money for your typical soft tissue case than what we are getting paid on right now.”
I began to be obsessed with coming up with a system that not only reduced the amount of bills I had cut, but actually paid my bills in full with the insurance and attorneys thanking me!
You don't need to be the expert on the best formats for reporting and documentation or have a desire to read through all of the AMA guidelines and understand its intricacies (but we recommend you do that).
The easiest way to consistently get your cases paid is, 1) get them to MMI and 2) a streamlined system integrated into your practice to prevent your bill from being cut.
When you don't have to spend your time messing around with documentation and the technicalities of structuring the best reports for your case, you can focus your energy on what matters. Your business, your patients, and most importantly, yourself.
I have created a system that has improved clinical outcomes and prevented hundreds of bills from being cut.
These are the fundamental building blocks to get your client to MMI.
Causation Depends On The Accurate Review Medical Documentation
Accurate Diagnosis And Working With A Claims Adjuster
Help Insurance Companies Understand The Severity Of Injuries
We have taught these principles to many doctors, attorneys, and paralegals around the country and it has changed their perspective on their clients. Do you want to evolve, or do you want to go by the wayside?