Mastering Chiropractic Medical Necessity in 2015 (Part 1)

Eventually, most of us will receive an insurance denial claiming that our chiropractic services were not “medically necessary.” Certainly, this is a frustrating experience. After all, who is more knowledgeable about our patients’ needs than we are? Most of us understand the concept of medical necessity and are aware that our services are reimbursable only when deemed medically necessary. For …

Why Medicare Thinks 79.5% of Chiropractic Treatment Plans are Bad

  According to the results of a dismal third quarter report by Railroad Medicare (administered by Palmetto GBA), chiropractors will continue to be audited through the 4th Quarter of 2014 due to a high error rate.  Palmetto’s latest audit investigation revealed that 79.5% of chiropractic claims were submitted incorrectly and therefore, did not merit any payment. Although Palmetto’s findings were spread …

Medicare Reveals Exactly How to Get Audited in Latest Chiropractic Review

  CMS carrier Palmetto GBA Railroad Medicare (who administers claims for Railroad Medicare beneficiaries nationwide) recently conducted a “widespread review” of chiropractic services submitted between October and December 2013. Specifically, Railroad Medicare reviewed 21,109 services that were submitted by chiropractors for CPT codes 98940 and 98941.  As you can see below, the results were eye-opening.

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 …

Sequestration! Why Your Medicare Payments for Chiropractic Services Seem Incorrect

[leadplayer_vid id=”5357E3F865F75″] Now that we are getting past the 60 day mark, many chiropractors have been noticing that there Medicare reimbursements seem a little off.  In other words, the payments aren’t exactly accurate with what they used to be. First, if you haven’t noticed, you should ask yourself a good hard question:  why?  Are you so poor at tracking your …