Download Support Tool The terms incident, burst and full episode were coined by us here at KMC University as a way for providers to consider the length of an episode of care. When sitting down to document the initial visit of a new episode, consideration of the potential length of the episode can be put…
For Medicare coverage, there must be a diagnosis of subluxation, along with a secondary neuromusculoskeletal diagnosis in a spinal region. Medicare has, in recent years, allowed for a wider variety of secondary code to couple with the segmental dysfunction primary code. This brief training outlines the Medicare guidelines and requirements for diagnosis, both in the…
Every payer has a definition of medical necessity and Medicare is no exception. Medicare Administrative Contractors (MACs) release a Local Coverage Determination (LCD) where they provide healthcare providers of all specialties their rules and definitions so they can determine if the care they are providing to their patients is payable. The following definitions pertaining to…
Download Support Tool Medicare has specific requirements for documentation used to prove medical necessity. These standards are published in most chiropractic Local Coverage Determination (LCD) documents or coding articles from your Medicare Administrative Contractor (MAC). Just as no two patients are the same, the documentation must be appropriate for the conditions being treated and may…
Medicare’s Documentation Requirements for Medical Necessity One of the most fundamental obligations in healthcare is proper medical record documentation. The Grandaddy of all requirements are those published by the Center for Medicare and Medicaid Services (CMS). Because there are few payers or state Boards of Examiners who have a stiffer requirement, mastery of Medicare’s documentation…
Medicare publishes helpful documents and alerts to keep providers in the know about important topics. Included here are several documents that relate specifically to Chiropractic care and medical necessity. These tools relate to the proper use of the AT Modifier, Chiropractic documentation and the overall rulebook for Medicare policy, The Benefit Policy Manual.
Download, study, and save these documents in your Medicare training materials as essential references for Chiropractic Medicare.
Use of the AT Modifier for Chiropractic Billing |
Medicare Documentation Job Aide for DCs |
Medicare Benefit Policy Manual – Section 240, Chapter 15 |