CMS continues to deny many chiropractic claims because they do not meet Medicare’s requirements. During the 2015 reporting period, the Medicare Fee-For-Service (FFS) improper payment rate for chiropractic services was 51.7 percent, representing approximately $300 million in improper payments and accounting for 0.7 percent of the overall Medicare FFS improper payment rate.
The most common reason for the improper payments is insufficient documentation to support the billed services. This type of error occurs when the medical records do not contain enough information for the reviewer to make a decision about medical necessity for the item or service furnished. Avoid denied claims and overpayment recovery by understanding Medicare's requirements, especially around documentation requirements and medical necessity.
HERE IS AN EDUCATIONAL VIDEO RELEASED BY MEDICARE CMS RELATED TO CHIROPRACTIC DOCUMENTATION NEEDS.
Please review and watch with your staff.
https://www.youtube.com/watch?v=tMiw1X9KvDA
HERE ARE LINKS TO MEDICARE MLN POLICY ON DOCUMENTING CHIROPRACTIC SERVICES