- Chiropractic Services: High Improper Payment Rate within Medicare FFS Part B
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. (Source)
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.
- Improving the Documentation of Chiropractic Services educational video gives a thorough presentation on medical necessity and proper documentation
- April 2013 Medicare Quarterly Provider Compliance Newsletter has an article on chiropractic claims
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