Medically Necessary vs. Clinically Appropriate Care in a Chiropractic Practice

What Does Medical Necessity Mean in a Chiropractic Practice?

There are many definitions and rules about medical necessity in a chiropractic office when dealing with third-party payers, including Medicare. Because there is rarely a standard of chiropractic documentation more stringent than Medicare’s documentation standards, KMC University recommends becoming familiar with these Medicare documentation definitions and documentation guidelines. Make sure your chiropractic documentation shows a functional deficit that, with chiropractic treatment and chiropractic case management, will considerably diminish or resolve.

Written Policies About Documenting Medical Necessity in a Chiropractic Practice Help Show Compliancy.

It is further advised that you apply the Medicare documentation definitions and documentation guidelines as your standard of care for your chiropractic documentation and your recordkeeping processes. Keep in mind that written policies defining the standards you embrace in your practice about how you will produce your high-standard chiropractic documentation are advisable.

How Do I Document My Chiropractic Wellness or Chiropractic Maintenance Care?

Clinically appropriate chiropractic care is rendered to a chiropractic patient based on the chiropractor’s clinical expertise that care rendered today will result in maximized health, maintenance of wellness, or help achieve peak performance. The chiropractor will document the clinical findings that lead to the conclusion that chiropractic care should be rendered today. The chiropractor will not find any significant functional deficit that may help define the chiropractic care rendered as medically necessary. Chiropractic care which is clinically appropriate, but not medically necessary, is the chiropractic patient’s financial responsibility.

Back to: Documenting Chiropractic Medical Necessity