Mastering Chiropractic Medical Necessity in 2015 (Part 2)

  In Part One of this article, we looked at a few medical necessity “traps” that are plaguing chiropractors.  In other words, things NOT to do when attempting to document or meet criteria for medically necessary care. We also discussed that one of the challenges with mastering the maze of medical necessity is that the definitions may vary from payer …

Why A _ _ _ a May Be Dangerous to Your Chiropractic Practice

As many of you loyal blog readers over the years have come to realize, I have an unusual pastime of watching the activities of insurance payers and reporting on their shenanigans to the chiropractic community.  In performing some of my recent watchdog rounds, I stumbled upon a video blurb (3 minutes) from the CEO of Aetna who was seriously slopping on some …

Medicare Auditor’s Reveal 2 Biggest EHR Weaknesses That May Lead to “Fraud”

  Buried amidst a flurry of OIG recommendations, targets and auditing hoopla are two gems that can help us as chiropractors reduce the possibility of EHR-induced documentation problems.  The news is riddled with stories about the cost of health care “fraud” (current guestimates put this between $75 billion and $250 billion) and are starting to spook even the most jaded …

Chiropractic Documentation: What Exactly are Objective Measures?

The denial is plain in black and white, but you still don’t understand it.  The payer states that the service is denied (or that you must pay it back) because your documentation lacks “objectively measurable” goals. You are befuddled.  To you, the patient’s progress can easily be seen. And you documented that. So what exactly are these “objective measures” that you …

Simple Strategies to Avoid Trouble with Chiropractic Tx Goals, PRN & Maintenance Care

Many chiropractors dangerously dance right into the grey area with respect to treatment goals between medically necessary care, maintenance care and PRN care. Unfortunately, every payer requires a treatment plan and without one, your claims could be deemed maintenance. Worse, depending on your office procedures, your fee policies on “cash” or “time of service” patients who may be receiving maintenance or PRN …

Small Chiropractic Documentation Errors That Lead to Big Problems

With auditors examining our every move, many chiropractors are growing increasingly concerned about the state of their documentation.  Here’s the really bad news: as a Certified Professional Auditor and Professional Coder myself, I have reviewed countless chiropractic records and many DCs have good reason to worry. Here’s the good news: this article will teach you how to avoid surprisingly common …

Aetna Denials for 97140 Manual Therapy and Chiropractic Adjustments (Again!)

If you haven’t been personally afflicted by the latest round of shenanigans from Aetna in regards to bundling chiropractic adjustments and manual therapy (97140), be forewarned – Aetna’s abusive practice is spreading quickly.  Over the last several weeks, I have been inundated with emails from perplexed chiropractors in all parts of the country who have suddenly noticed that their 97140 …

Why Your Chiropractic Assistant, Fraud, & Insurance Verifications are Ruining Your Revenues ( & What Chiropractors Can Do About It)

These days, it’s tough to tell where problems start.  Some of you know you, doctor, are the primary contributor.  For others, it’s the staff.  Still others feel it’s insurance or even healthcare at large. You all may be correct – which is why this article may help point you in the right direction… Recently, I saw an interesting graphic that …

How to Survive a Chiropractic Audit (Part 2)

In Part One of this article “How to Survive a Chiropractic Audit” we focused on what to do if and when you get notification that your chiropractic practice is being audited.  My primary focus in that article was to prevent you from having a heart attack, from fleeing to a fortress in Slovenia, from unnecessarily declaring bankruptcy or from throwing …