Medicare Archives

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…

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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…

Medicare’s Medical Necessity Reference Documents

Download Reference Documents 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…

FAQ-Medicare Active vs. Maintenance Care

Active vs. Maintenance Care FAQs Q: If a Medicare patient moves from Medical Necessity treatment to Wellness and we have him/her sign an ABN, are we required to continue to bill Medicare with the appropriate modifier or can we convert the patient to cash? A: The ABN offers three options at the bottom of the…