Improving the Documentation of Chiropractic Services

[@myorkdc]

Clear and concise. As a provider for 31 years, I can sympathize with the burden of documentation felt by Chiropractic practitioners. Dealing with these specific requirements differs from our long held belief that our treatment decisions are best determined by the DC and the 3rd payer should "trust and pay". This certainly feels justified by the minimal payments offered by Medicare. I have felt the pain of reimbursing an otherwise satisfied MC patient for their copay after an audit discovered I had only initialed my notes rather than signed them. Rather than staying "miffed", I sought a change. Our office endured the learning curve of installing a licensed (there are many to choose from) electric health records system. This addition has been transformational. It clearly and easily allows for complete documentation covering all medicare requirements before I see my next patient (5 per hour). My documentation is now easier, complete and I am comfortable submitting it to all my 3rd party payers. I have not been denied payment in 3 years. I encourage all practitioners to consider this option. Medicare is only going to become an even larger percentage of our practices given our aging population

[@Thecollectioncoach4u]

This was a helpful video. Making videos are hard - especially when you don't do it every day. Give these guys a break. The reason they are spending their time making a video for chiropractors is because there is a big problem nation wide. They are trying to HELP you! They cited a 54% documentation error rate in the video. That is down since a few years ago, but it is still unacceptable. Chiropractors - some in the comment below, complain that we are not paid as well as MDs. Well, you want to be treated "equal"? Step up! Document correctly.! Demand respect of the entire healthcare community! Show them, through your documentation that you know what the heck you are doing. You know whats wrong with that patient (History, Exam, MDM), you know how to get them better (treatment plan with goals and OBJECTIVE measures to prove they are better. Then, show everyone that chiropractors are the best doctor on the planet to keep them better (maintenance - which Medicare does NOT pay for any more than your auto insurance pays for oil changes). Medicare tells DCs EXACTLY what has to be documented when a service is medically necessary. When there is no further expectation of functional improvement, it is maintenance - get the ABN signed and collect from the patient. AND by all means, respond to documentation requests from your carrier. MAKE IT A PRIORITY to get the records out. And by all means, sign them! How silly to fail an audit because you didn't sign the record! To fail a medicare audit is like failing an open book test after the instructor just gave you all the answers.

[@rodeodc]

William, These rules are the same for all physicians and physician services. I do hope that you have signed the ACA petition that we will present to Congress this term asking that chiropractors be covered for all services that we are licensed to perform. Establishing medical necessity, providing legible records and signing the notes is a standard that is expected by all third party payors.

[@Docaltmed]

+William Doggett The rules are not the same -- or at least they are not applied equitably. MDs, DOs and pharmaceutical companies are routinely paid for maintenance care.

[@rodeodc]

And that surprises you, why?

[@sctdc]

+William Doggett Wm you can see in my comments that the expert was wrong about the "by hand only"- I wonder how many other concepts were wrong.

[@davidshields220]

Please show me your concern over Medical doctors billing 99215 99% of the time except when they bill 99204 for removing stiches!

[@cgneuro]

Good information. I appreciate the overview of what CMS expects regarding documentation. I was unable to find the auditing standards on CMS website, so a link would be helpful to assist in the process of self-auditing.

[@DoctorDeCubellis]

+Curt Garner A great resource is Kathy Mills Chang kmcuniversity.com. I highly recommend. She provides some free links and her program can answer this easily.

[@kathryndudley8376]

+Curt Garner look for the Chiropractic LCD on CMS website it is clearly lined out!!!

[@jimlupi]

In my experience any service over 98940 is automatically reviewed despite the fact that when cmt coading went into effect medicare anticipated that 98941 was anticipated as being the most prevalent code. also regardless of any documentation sent for 98941 42 the first review is likely to reject, it will likely be fixed on appeal. this consumption of time has the effect of most drs not billing anything over 98940 regardless of services performed.

[@mikesimone1]

Nice video. Why are maintenance treatments not covered when performed by a chiropractor but the exact same maintenance treatment provided by a physical therapist is covered? The PT's won a court case a few years ago against CMS allowing maintenance treatment. Why wouldn't CMS apply the same to chiropractors providing the exact same treatment?

[@Chiromedicare]

Certainly we can easily ridicule aspects of this video, but there is only one question that matters; can you take the information provided in this video and improve your documentation? Your opinion would be valuable in evaluating the effectiveness of this video. After you have viewed this video, please reply to this post with a yes or a no to answer the above question.

[@justindietrich4684]

Great video review, but here's a huge, long question no one has been able to give me precise answers to: If Medicare requires us to do re-exams and allows us to do x-rays and understands therapy is within our scope of practice and pays for these services to MD's and D.O.'s, then why have we not been allowed to get reimbursed for the same services?

[@Chiromedicare]

+Justin Dietrich Because the law is written such that we are only allowed to be paid for the adjustment. The ACA effort to get us parity in Medicare is all about getting the law amended so we can be paid for all of those things.

[@raymondbgaskey2937]

+Justin Dietrich - is this Justin from Beach Rd ?

[@Chiromedicare]

Also, a "cowerpractor" is a doctor who adjusts people in rural western communities.

[@Right_Hand_Watch]

+Chiromedicare Chiro...Practor...Cower?

[@danieltaylordc]

It's like sitting through school all over again...

[@tiarapaquette3796]

I wish youtube allowed you to speed up videos...

[@sctdc]

Medicare Carriers manual part 3 chapter11, 2251coverage of chiropracters services 22521.1 Activator may be used instead of hands only. Someone needs to publish a retraction and start over.

[@sandramarcano9508]

DRA. PICHARDO. Y. DR. JAVIER. EN. LA. OFICINA. DE LA. DRA. PICHARDO. EN. ORLANDO. FLORIDA. QUIROPRACTICO

[@dr.jeffmoore2149]

I imagine the majority of MD's are connected with large institutions who have the funds to specialize in coding experts who really enjoy this kind of work. DC's must take on this extra work load themselves or pay for a specialist in this area (and this has more impact on prosperity of the practice due to the usually smaller size as compared to medical institutions. Codes were not developed for natural health care ie care for health maintaining wellness. Make the codes for drugless and non surgical techniques and see how this affects the problem Last point, these guys need Toastmasters training. Good info is useless if a video feels like squeaky chalk. If a script is to be read, at least use a little voice inflection.

[@Docaltmed]

What a farce. My documentation invariable exceeds Medicare requirements, and I haven't been paid for a single service in nearly a decade. I also love the fact that they are including billing of non-covered services as a "chiropractic documentation error" when every chiropractic association and billing specialist has been telling us for the past decade to bill for everything we do, to build a case for fair payment to DCs. Finally, the whole argument that "chiropractors can lose a significant amount of money" by not responding to review requests is a laugh. When you've got a less than 10% chance of getting paid on review, and the amount Medicare pays for a chiropractic visit is about the same as a haircut, well, it just doesn't make much sense to waste time and money responding to a review. It's cheaper to write it off. Again, I've never gotten paid when a claim has gone to review, even though medical necessity and all the other requirements were clearly documented. This is just a joke, and I wasted 20 minutes of my time watching it.

[@kathryndudley8376]

+Dr. Avery Jenkins our office became a non participating provider about 7 years ago and since we have never had a problem with reimbursement. It was difficult at first to train our Medicare patients to pay upfront and I still have a few that wont but it has really freed up the process and have not had a request for medical records or denial since!

[@Chiromedicare]

For a more thorough review of this subject matter with practical information that the doctor can translate into direct protocols and procedures in your office go to chirocode.com/making-sence-cms-training-video.

[@barakuna]

Cmon, show some emotion, this vid is horrible and basic knowledge