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Don't miss the July 2023 edition!

We know you count on us to keep you up to date with the most important information in the profession. We have compiled updates, blogs, and news for you into this convenient digital publication.

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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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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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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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...You have been so much help to me and my office.  You are always prompt with your responses and thorough in meeting my needs.  I enjoy working with you immensely and feel that your years of experience and knowledge are beyond impeccable! I am so very glad that we signed up with KMC and have had amazing results! 

Jeana W.