Let’s discuss the common supervision categories and how they impact network reimbursements and post payment audits.
There are 3 basic categories of supervision. The first is general supervision, which is like the kind you would find in a nursing home. The medical doctor doesn’t show up to the nursing home except maybe once a week. The medical doctor looks over the work of the nurses, prescriptions and stuff like that, and then just signs off on them.
Under general supervision the doctor usually isn’t in the facility, but has established some pretty stringent processes that the nurses and others have to follow. The doctor just has to come in, check that the processes were followed and then sign off on them.
That’s general supervision. Sometimes they call that incident two supervision, and I have found that a lot of chiropractic clinics get into some pretty deep trouble by using general supervision and billing out under general supervision with a medical doctor.
That’s not to say it can’t be done, because it can be done, but you’re swimming with the sharks and can get into some serious trouble if you do it that way in a chiropractic clinic. In an integrated clinic you still have similar issues, especially if the network is looking at your clinic as if it’s a chiropractic clinic.
The next level of supervision is called direct supervision. That basically means that the doctor that is overseeing the care is in the building. The doctor might not even walk into the patient room or do anything, but because they are in the building and supervising a well educated, well trained staff that reports to them, then the doctor is providing direct supervision, even though other hands are doing the work.
This happens a lot in medical clinics and it happens a lot in chiropractic clinics, when CA’s are doing the work and it is ok to bill under the supervising doctor.
The last category is personal supervision. You’ll rarely have any problems with network audits, or problems regarding justification of care, if the doctor’s hands are actually doing all of the codes and services that are being claimed in the claim form.
Personal supervision is not typically a problem for chiropractic clinics. Basically, the closer you get to the patient, the more you’re in touch with the patient, the more you’re in the building, the better off you are in your claims and the less trouble you’ll have with network audits, post payment audit reviews and things like that.
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