Medicare Archives

Use of OATS to Create Effective Short Term Goals

One of the key elements in Medicare’s documentation requirements is the stating of short- and long-term goals within the treatment plan of the initial visit. An easy way to determine goals is to use and evaluate Outcomes Assessment Tools (OATs) with each episode of care. This brief training outlines the ways that using OATs can…

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Incident, Burst, or Episode

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…

Medicare Diagnosis Rules

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…

Medicare’s Definition of Medical Necessity

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…

Medicare Documentation Requirements Explained

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

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…