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 should be including to show the payer what is obvious to you?!
Objective measures can be a number of things:
- Standardized patient assessment instruments OR
- Outcome measurements tools OR
- Measurable assessments of functional outcome.
Your use of these objective measures at the beginning of treatment, during and/or after treatment helps quantify patient progress, prove medical necessity and justify continued treatment. Some chiropractor may use forms (Oswestry, Roland Morris, etc.) to measure treatment effectiveness. (Note from Railroad Medicare: If this is the case, then a patient would need to complete the form on every visit.)
Additionally, some forms may not contain answers that are objective; in other words they do not include actual measures or values. For example, the form may use the term ‘severe’ for the evaluation of pain. ‘Severe’ is not an objective measure. The pain would need an actual value –i.e. quantify it or give it a number.
In a recent article, Railroad Medicare also gave a clear example of objective measures to evaluate goals. See below:
Examples of objective measures to evaluate goals include:
- Baseline: 9 on a scale of 1-10
- Goal: Decrease pain to 1
Measuring ADL’s – Standing:
- Baseline: Only able to stand for 20 minutes
- Goal: Able to stand for more than 1 hour
Measuring Function: ROM
- Baseline: Lumbar spine flexion of 53 degrees and extension 11 degrees
- Goal: Increase lumbar flexion to 80 and extension to 25
Hope this helps clarify some of the mud surrounding your chiropractic documentation of objective measures!