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No Surprises

NEW COURSE! | Be Compliant with the No Surprises Act

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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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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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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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...KMC University is extremely well structured, organized, knowledgeable and efficient. The KMC Library is stuffed full of everything one would ever need to become educated in the world of HIPAA while still being user friendly by providing informational sheets, videos etc. Each section in the Library provides a flow chart as to how it should be followed and implemented. Everything is easily comprehensible for executives and staff to be trained. It is all very impressive...

Neomi Hunt, M.S.