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Online CEUs

Upcoming Live CE Webinar!

The Secrets of Chiro-Compliant Coding
Tuesday, April 9, 2024
11:00 AM - 12:00 PM MST

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Chiropractic documentation gap analysis

Recognize what’s missing to master your reimbursement and collections!

This Documentation Gap Analysis allows us to evaluate the significant components of your current Documentation program. It should take less than 5 minutes to complete.

Take The Billing GAP Analysis
Telemedicine

Need more guided help? Work with a KMC coach 1-on-1

Sometimes you need more than a self-service, on-demand program and need an expert to analyze your issues, train the corrections, and help you implement the changes, so they stick

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Dr Alan Sokoloff 1

New Course Available!

This course explains the significant role chiropractic care can play in the sports industry and how a DC can succeed as a Sports Chiropractor. Start your steps to success here!

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OIG

There's no need to fear the OIG. We've got your back!

The most effective chiropractic OIG compliance programs are scaled according to the size of the practice!

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Find Your Medical Necessity Definitions for Your Chiropractic Practice

Who Defines Medical Necessity?

All third party-payers, including Medicare, get to decide what type of chiropractic care they will actually pay for and what the definition of medical necessity is for their insured. Below you will see a couple of examples of medical necessity definitions for chiropractic care. Medicare is very straight-forward in its description of medical necessity in a chiropractic office, other carriers are not as helpful.

Medicare’s Medical Necessity Definition:

“The patient must have a significant health problem in the form of a neuromusculoskeletal condition necessitating treatment, and the manipulative services rendered must have a direct therapeutic relationship to the patient’s condition and provide reasonable expectation of recovery or improvement of function.”

Aetna Shares About Medical Necessity:

Some plans have limitations or exclusions applicable to chiropractic care. Please check benefit plan descriptions for details.

My Chiropractic Claims Just Got Denied for Medical Necessity. Now What?

Make sure the care you rendered met the stated medical necessity definition of the third-party payer. Also, verify your chiropractic documentation contains all the required details to prove their definition of medical necessity was met. Begin the appeals process to get your chiropractic claim properly adjudicated.

Explain Medical Necessity to Your Patients

Back to: Documenting Chiropractic Medical Necessity

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I am so grateful for Dr. Milo and Dr. Liebing allowing me to the opportunity to attend KMC University's seminar in Denver. Continuing education is so important and Kathy does such a great job at explaining things and helping you through challenges in the office. Her and her staff are so fun to be around and really make the experience great! I highly recommend attending a seminar through KMC University! Thank you Kathy and Staff!

Kenlee G.