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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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PART Documentation

Medicare’s Guidance for the PART Process of Identifying a Subluxation

Document in a manner that gets you reimbursed by third-party payers who want to see objectively measurable data. That’s where PART comes in:

P= Pain or Tenderness: Pain elicited during the course of the examination, described in terms of location, quality, and intensity

  • Observed facial expressions of pain/discomfort
  • Antalgic postures and movements
  • Grooming deficiencies that could be due to pain limitations
  • Mood
  • Overt pain behaviors
  • Pain scales
  • Pain diagrams and drawings
  • Functional questionnaires (outcomes assessments)
  • Pain resulting from static palpation
  • Pain resulting from motion palpation
  • Pain reported duration regional and/or segmental ROM
  • Pain reported during physical, orthopedic, neurological and/or chiropractic examination procedures

A= Asymmetry or Misalignment: Asymmetry or misalignment may be described at the regional or segmental level

  • Observable regional asymmetry (posture/scoliosis screening)
  • Observed local asymmetry (static palpation)
  • Antalgic posture
  • Gait abnormalities
  • Functional or anatomical leg length discrepancies
  • Muscle atrophy and asymmetry

R= Range of motion abnormality: Abnormal range of motion, either hypermobility or hypomobility, may be described at the segmental or regional level; instruments that quantify range of motion or estimates are allowable

  • Active ROM
  • Passive ROM
  • Resisted ROM
  • Segmental motion palpation
  • Joint fixation (hypomobility)
  • Joint laxity (hypermobility)
  • Joint crepitus
  • ROM measuring devices

T= Tissue tone changes: Describe changes in the tone of the soft tissue such as muscles, tendons, fascia, skin, and ligaments.

  • Observable hypertonicity, spasm, hypotonicity, and atrophy
  • Fasciculations
  • Edema
  • Bruising, discoloration
  • Heat
  • Muscle-tendon crepitus
  • Muscle weakness
  • Heat measuring instruments
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KMC University provides a valuable service for chiropractic providers. I purchased a library membership and a coach to guide me as I audited and made changes to clinic SOPs. This program is useful in ensuring compliance, training staff, and confirming the decisions I make for the practice. Even though the practice is operating smoothly, I rely on KMC University to keep me informed of updates and changes in the industry. I continue to be a KMC member and utilize an individual coaching session as the need arises. You will not go wrong with KMC University. From the help desk to Kathy Weidner herself, every individual I have encountered has been friendly, helpful, and provided value.

Jessica D.