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

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

Learn More
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!

Learn More

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!

Learn More

Your documentation & coding questions answered

Q: My software has a Same As Last Treatment (SALT) feature. Is this okay to use for routine patient visits?

A: Using the SALT feature without making any changes to the record on each individual date can be considered fraudulent record keeping and can put a doctor at risk during an audit or record review. Cloning notes are under close scrutiny as they could be produced without a physician or patient present.
The unique information gathered on each patient visit is what determines whether that visit meets the medical necessity guidelines of a payer. If nothing is noted as being changed from one visit to the next, no progress is noted and care is not supported. Learn more about meeting Medical Necessity Guidelines in the Rapid Solutions titled Daily Assessment-The Essence of Medical Necessity.

Q: What do I put in Box 14 on the claim form for the Date of Onset if this patient was seen a few months ago for the same or similar condition?

A: The Date of Onset should always be the first date you saw the patient for THIS treatment episode, except in the case of Personal Injury or Workers Compensation Injury which would use the accident date as the Date of Onset.

If the patient was discharged at the end of care the last time you treated him/her for this condition, then there is an obvious stopping point from before, and starting the new treatment episode should be distinct with the new date of onset.

A date of onset over 90 days can be a red flag to an insurance carrier that indicates possible maintenance, wellness, or supportive care. There certainly can be care episodes that last beyond 90 days, but the documentation must be present to support the need for the extended care. Learn more about this in the Rapid Solutions titled Proper Use of Box 14 for Billing.

Q: How do we send in claims for orthotics to third-party payers?

A: Foot Levelers teamed up with KMC University to create a helpful guide. Basically, you need to know the medical review policy for functional orthotics of the payer you're billing - usually listed on their website as "orthotics and prosthetics." Then utilize the directions in the aforementioned guide to make sure your team asks the right questions. Make sure you've established medical necessity according to the policy for your history, exam, diagnosis, and treatment plan. Use the billing codes listed in the guide and don't forget to bill for both sides! The guide is available here.

Q: When billing the payer BCBS for a Therapeutic Procedure CPT code that starts with a 97, what modifier do I use?

A; It is our understanding that any Therapeutic Procedure code that starts with a 97 will need to have a GP modifier on it to bill BCBS, please refer to the Medical Review Policy of the BCBS plan for your area or region.

Image Image

Kathy recently gave a one hour webinar on coding and billing changes for 2023 to our membership. The feedback from attendees was extremely positive with a deep appreciation to KMCU for sharing timely, relevant and important information/changes for members to use in their practices immediately. Thank you for sharing your expertise with Vermont, KMCU!

Vermont Chiropractic Association
Image Image