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I often receive calls and emails pertaining to chiropractic services and mysterious Medicare denials and requests for documentation.  There can be a number of reasons for both.  I will be releasing more articles on specific billing issues that are common to chiropractic services, but today we will focus on documentation errors due to the timeliness of the subject.

Documentation Errors Raise Red Flags
Documentation Errors Raise Red Flags

Trailblazer Health Enterprises has just released a new job aid that outlines the findings from recent feedback files from their CERT contractor along with claim processing system edits.  The findings reflect the providers’ understanding of and compliance with the Medicare program’s payment rules and coverage policies.

Some of the errors and their fixes are highlighted below.  The entire report can be read at http://www.trailblazerhealth.com/Publications/Job%20Aid/ChiropracticDocumentationErrorsPartBJ4.pdf

Error: Initial visit documentation lacking

Fix: Documentation of the initial visit should contain the history; description of present illness; evaluation of musculoskeletal nervous system; diagnosis; treatment plan; date of initial treatment

Error:  Review of progress notes presents treatment as maintenance care.

Fix:  Maintenance therapy is not a covered benefit.  Once the maximum therapeutic benefit has been achieved for a given condition, ongoing maintenance therapy is not covered under the Medicare program. The AT modifier must not be place on the claim when maintenance therapy has been provided. The patient should sign an ABN form and may be billed directly, or Medicare can be billed without the AT modifier and with the GA modifier in order to bill any secondary plan that may cover the treatment.

Error: Documentation indicates “full spine adjustment” when there is insufficient documentation to support the billed service.

Fix:  Provide only the services the patient needs to address the chief complaint. Document the service rendered in the medical record. Bill the CPT/ICD-9-CM codes that accurately reflect the services rendered and documented.

Tips for successful claim submission:

  • Provide only the services the patient needs
  • Document the service rendered
  • Bill the correct CPT/ICD-9-CM codes that reflect the services
  • Documentation must support the service billed

Following these guidelines will reduce the number of documentation requests from your Medicare contractor and the number of denied claims.

CRT offers consulting services to review your documentation and billing practices in order to improve cash flow, reduce costs, and lower any possible red flags being raised which could trigger an audit. Feel free to contact us for more information.