Palmetto GBA (Railroad Medicare) recently released the results of their “Widespread Review of Chiropractic Services for the first quarter of FY 2016” and while the overall charge denial rate of 45.4% was lower than the denial rate of the 4^th Quarter FY 2015 review which was 60%, there is still reason for the chiropractic profession to be concerned. 

In the most recent review more than 53.5% of all denials were related to “non-response to requests for documentation” (doctors not sending in their documentation) and in the previous review more than 60.2% of all denials were related to non-response to requests for documentation. The next biggest reason for denials in both reviews was insufficient documentation. 

While it is encouraging to see that the overall denial rates are decreasing it is still alarming to see that, for whatever reason, many chiropractors are not sending in their documentation when it is being requested.  We can only speculate, but the biggest assumption that one could make is that the doctor doesn’t feel his or her documentation will meet the requirements so they are just not sending it in.  While you could argue that the rules are not always easy to understand and that there are grey areas, with all of the quality documentation resources available today, including the ChiroCode Deskbook, does it really mean the doctor just doesn’t want to take the time to learn, follow, and implement the rules in their documentation?

 There is help available.  If you are a doctor that has not submitted documentation when a payer has requested it because you don’t feel it would meet the requirements, or if you are a doctor that has not yet received a documentation request but are nervous because you know your time is coming, Chiropractic Compliance Solutions (ChiroCode partner) has an answer for you.  For only $599, our team of experts will review seven of your files and will provide you with a full report, including recommendations for improvement and correction of your documentation, coding, and billing.  If you are interested in this service or to learn more go to www.compliantchiro.com.

The choice is yours.  Be proactive and make the commitment to improve your documentation or keep doing what you’re doing and “Based on the high error rate, Palmetto GBA (Railroad Medicare) will continue the service specific prepayment reviews.”

Jeff Smith MCS-P, is the Director of Revenue Cycle Management Services at Chiropractic Compliance Solutions.