How to Get Referrals with Chiropractic Case Notes | FREE Template

Are you sending case notes?

If you're like most docs I speak with the answer is unfortunately "no." Maybe you think it takes too much time, perhaps you don't know what to send.

Either way, if you are not sending chiropractic case notes, then you are missing out on an enormous opportunity to showcase the co-management of patients, show off the fantastic results of your care, and begin the process of building referral relationships.

Sending chiropractic case notes is the foundation of building referral relationships with other healthcare providers in your community. If you think you are too busy, or that case notes are a waste of time- then keep reading. It's easier, faster, and more impactful than you think.

This article will show you the four key elements to have on every single case note that you send. Additionally, I'll show you the best time and cadence to send those notes (it's NOT on every visit). By the end of this short article, you'll have all the information you need to send out effective case notes quickly, start bridging the gap, and begin building referral relationships.

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Spoiler alert: Case notes alone have never flooded a chiropractic office with referrals. Sending notes is not a silver bullet to building a relationship. But, sending timely and well-crafted case notes is an essential foundational layer of our physician outreach.

Benefits of Sending Case Notes:

1- Showcase the Great Results You Get with Your Patients (B2B Testimonial)

2- Social Proof of Co-Management

3- Additional Marketing Touch Point

I like to think of case notes as patient-centric testimonials. Most practices are hyper-focused on getting Facebook ratings and Google reviews. These type of reviews are known as B2C marketing. They are business (B) to (2) consumer (C) outreach. Reaching out with B2C testimonials is great...but, what about the other half of the coin?

The other half is your B2B channels. These are your business to business testimonials- and there is no better B2B communication than a case note. Your case notes show the social proof that you are actively co-managing, as well as the fantastic results you get with your patients in your practice.

If I asked you the question of what percentage of your patients leave your office happier and healthier than when they first walked in, I bet your answer would be over 90%.

My next question is, how often have you taken the additional 2 minutes to create a case note that shows off those unbelievably fantastic results? Probably not as often as you could or should!

Not sending case notes showing off the results of your care and the improvement of your patients is a huge missed opportunity that you need to start taking advantage of immediately.

So how often should you send case notes?

We have seen the best results by sending case notes at initial evaluation, any re-evaluation, and discharge from active care.

Discharge from active care is defined as the last visit before a patient goes to as needed, PRN, maintenance, or wellness care. Anytime you are billing a 99201-99204 or 99212-99214, that is a good indication that you should be sending a case note.

What to include in your case notes:

The 4 Essential Components of a Case Note

1. Patient Name

2. Date of Service

3. Diagnosis

4. Treatment Plan

Your case notes should not be long and include every test under the sun. Powerful, effective case notes are typically concise (under 1 page) and contain four critical pieces of information.

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Just as a primary care doctor doesn't care about what size screw a surgeon uses during an operation, they don't care about every single orthopedic test you performed.

They do care about, who did you see (patient name), when did you see them (date of service), what did you find (diagnosis), and what are you going to do about it (treatment plan)? Keep it simple.

In an ideal world, your case note should be leaving your office as a one-page document. I say that for pragmatic reasons. When I was working in large scale orthopedic groups, we'd continuously get case notes from doctors in the community.

Unless they were relating to an emergency, the notes would be put into the patient chart by a medical assistant and not looked at until the patient came back into the office. The patients next appointment could have been two days, two weeks, or 2 months after the case note was sent.

Let's get real if the doctor is walking down the hall ready to see the patient, and they open the chart to find a 10-page case note from you...it's not getting read! But, what if they open the chart and see a one-page note which clearly and concisely shows your name, the patient diagnosis, the date of service, and the expected treatment? You now have a high likelihood of them opening the door and asking the patient how they are doing in your practice.

As we went through earlier- the odds are in your favor! Chiropractors typically have sky-high patient satisfaction and remarkable results. So there is an excellent chance that the patient will praise your care- which is precisely the "win" you are looking for.

Think about how many patients you see each month in your practice. Then, think about how many in-active patients have been in your practice since you opened your doors.

Now imagine you had sent case notes for every eval, re-eval, and discharge visit for these patients. You could have hundreds, thousands, or maybe even tens of thousands "touches" to other healthcare providers showcasing the great results that you achieve. I KNOW that would make a massive difference in how many referrals you get each month.

Before you send a case note, you need to know who you are sending it to. The easiest way to do this is to make sure you have a spot on your intake form for patients to enter their primary care doctor.

Typically, this will be filled out 50-60% of the time. When it's left blank, I recommend asking a simple question:

“Hey, John, I noticed you left this blank. We'd love to have that information to communicate and coordinate your care. Do you mind if we have your primary care doc name?"

By asking that question, you should be able to collect the primary care doctor information on 90% of the people who begin care in your practice.

Case notes are one leg of the referral relationship stool. The others are sending research updates (marketing) and taking meetings (trust and rapport). At The Evidence Based Chiropractor, we've had the honor of working with hundreds of chiropractic practices. Using our system, they have generated tens of thousands of referrals that have resulted in millions of dollars in additional revenue.

Think about the amount of time you spend with your patients during treatment. Think about the energy, effort, and expertise it takes to help them get well. To not take 5 minutes and show off your results with case notes is crazy!

If you want to start getting more referrals from other physicians in your community, then become a member of The Evidence Based Chiropractor. I'd love to work with you. You'll receive the entire process, tools, support, and systems needed to bridge the gap. Get out there showcase your practice and improve the health and well-being of the people in your community.

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What No One Tells You About Documentation- by The Evidence Based Chiropractor

Fact: Chiropractors leave millions of dollars on the table due to incorrect third party payor denials each and every year. Unfortunately, chiropractors also return millions of dollars each and every year due to incorrect coding and billing. It goes without saying that patient care, billing, and coding should always be executed with the highest amount of integrity. However, it is foolish to not be paid for your hard work due to inadequate documentation.

For instance, did you know that time is NOT a primary determining factor in your examination coding?

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The 3 Criteria for Properly Coding Chiropractic Examinations

1. History

2. Examination
3. Medical/Chiropractic Decision Making

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Compliance experts like John Davila have helped hundreds of chiropractors sort out their documentation standards and create a playbook for success. Some chiropractors are not in need of a full internal compliance audit, but simply need improve day to day documentation to substantially increase their bottom line and decrease medical denials.

So, you spend X thousands of dollars on a new EMR system. Then you implement your intake, examination, and daily soap notes based on your previous forms or you grab a template from a friend.

Let me ask a 3 simple questions-

1. What determines the inclusion or exclusion of information on your forms (clinical, educational, required by law,required by documentation standards)?
2. Did the form creator just "make it up" or develop it off of coding guidelines?
3. Are you confident in your documentation to bill the appropriate examination, or do you just try to fly under the radar?

If you just attempt to fly under the radar you are more than likely leaving money on the table. If you are unsure of the requirements to code (and bill) for a examination at 99203 then you may be putting yourself at risk for denials due to incomplete records. Either way is potentially detrimental to your practice. The good news is that you don't need to spend 100 hours learning the ever changing documentation standards relating to examination coding. We have created a simple, easy to follow guide to the documentation standards necessary for billing and coding examinations. It comes free with our Chiropractic Office Forms set. For docs that may need a little more help, we even offer a Professional Package with one-on-one implementation. For docs that need just the basics we offer a Basic Package. 

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-The Evidence Based Chiropractor has assisted hundreds of chiropractors around the globe build interdisciplinary referral relationships.

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