Transcript Slide 1

Actual Conversation @ Concussion Case
Claims adjuster: “but she didn’t hit her head.”
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Eggleston: “Her head hit the head restraint.”
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Adjuster: “It doesn’t say that anywhere in the medical records.”
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Eggleston: “it is so obvious that doctors don’t waste their time writing it down.”
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Adjuster: “but it’s not in the records.”
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Eggleston: “If you fall out of a boat on a lake, would you hit water?”
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Adjuster: “Of course.”
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Eggleston: “It is just as obvious that your head will hit the head restraint in a rear-ender. That’s the name
of the device, to restrain the head during a rear-end impact.”
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Adjuster: “But it doesn’t say she hit her head so we don’t believe she could have a concussion.”
Write it Down
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“Head hit the head restraint”
The doctor’s records are “Just The Facts, Maam”
of the case.
Doctor’s records are essentially ALL the facts
used by both sides to negotiate.
If you don’t write it down, it doesn’t exist in the
legal negotiations when settling a case.
“The Doctor’s Job”
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Symptoms
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Physical Exam
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Test all reported symptoms
Write down all test results
Make it understandable
Diagnosis
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Get them ALL
Write them ALL
Make it understandable
Diagnose EVERY Symptom
Write EVERY Diagnosis
Make it understandable (use ICD-9 codes)
Treatment Plan
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Make Treatment PLAN for EVERY Diagnosis
Write EVERY proposed treatment (aka “plan”)
Make it understandable (use CPT codes)
“Be Accurate, Honest, & Thorough”
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Injuries Diagnosed & Treated
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Prior/Subsequent Injuries
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Medical Supply
Medication
Ambulance
Dental & Orthodontic Treatment
Disfigurement
Impairments
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AMA Guides WPI
DUD
LOE
Disability
Depression/Anxiety
TMJ
LOE
Future Medical
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Narrative
MUST
Include
Majority/Minority
Medical Supplies Prescribed
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ICD-9 (“9+”)
CPT (“Active”)
Prognosis for EVERY ICD-9
Complaints (“Symptoms”)
Treatments (“Treatment Plan”)
Intensity (“Intensive” = >3x/wk sometime during Tx Plan)
Duration (“Prolonged” = >30 days meds, >90 days active Tx)
Testing (“Positive”)
Probable (50-75% = 1x multiplier)
Definite/Certain (75-100% = 2x multiplier)
Failure to Address
Each & Every
One of These Items
Is BELOW
Minimum
Competency
To treat PI Patients
How to Write a Narrative Report
►Get
all the SYMPTOMS
 Update Monthly to show Duration (“Prolonged”)
►Make
all the DIAGNOSES
 Update Monthly to show Duration (“Prolonged”)
►Show
the positive EXAM TESTS
 Update Monthly to show Duration (“Prolonged”)
►Show
all your TREATMEMTS
 Update Monthly to show Duration (“Prolonged Active Tx”)
 Update Monthly to show Intensity (“Intensive”)
Throw OUT…
► Your
OLD Intake Forms
► This
is all you need
► Stop
doing “Accident Reconstruction”
► You
are a DOCTOR. Be a GOOD one.
► Symptoms
– Diagnosis – Exam – Treatment are a
four-leg chair. Remove any one of these essential
“legs” of your records and the chair is unstable.
The Symptoms
Form should be
filled out like this
Blacken in all the boxes
Do not make check marks
Do not make X’s
On re-exam days, explain to
patient to check any symptoms
they are experiencing
“intermittently”, even if he/she is
not experiencing them at that
moment in the office. Otherwise,
your paperwork is not accurate.
This is easy to read from a 4th or
5th generation photocopy, which is
what the claims adjuster looks at
when deciding how much to give
the patient in the PI settlement.
The
Diagnosis
Form Must
by Filled In
Like This
Note the ICD-9 Codes are on it
The Doctor must
give a diagnosis
for every injured
body part. There
are 5 “body parts”
in each body area.
(1)Bones
(2)Tendons
(3)Ligaments
(4)Muscles
(5)Nerves
The Doctor must make ALL
Diagnoses the patient has…
(1)Not just chiropractic ones
(2)Not just those he treats
ALL of them
Be Accurate, Be Truthful
Use this form
to document
the treatment
to be
delivered to
the patient.
This form tells Colossus both your
in-office treatment and your
patient’s home treatments.
CPT Codes
This form contains CPT codes
for 2 reasons. It helps the
office biller work more quickly
AND helps the Colossus data
entry person work more
quickly to settle the claim.
Keeping good medical records
makes the claim adjuster and
all attorneys’ jobs easier
because they have all the
“facts” to know what is wrong.
Symptoms, Exam, Diagnosis, Tx Plan…
Doctor, this is your job.
Do it well.
Be accurate in your RECORDS
because that is what adjusters and
lawyers look at (not what is in your
head.)
Here is an example of BAD use of my forms
Symptoms = Low Back Pain
Diagnoses for Low Back = NONE
Treatment for Low Back = a lot
Does this make sense?????
Here is another example of BAD use of my forms
Patient reports Symptoms of Anxiety
No Anxiety Diagnosis
Treatment Prescribed for Condition with No Diagnosis
Please… Be GOOD Doctors
Be Accurate
Be Honest
Be Thorough
Steven C Eggleston, D.C., Esq.
Attorney at Law
2601 Main St., Suite 800
Irvine, California 92614
(877) 424-4765
www.HBTinstitute.com