April 2001

Clinical Documentation Key To Reimbursement
For Chiropractic Claims

ARLINGTON, VA. - Do insurers ask you repeatedly for patient records or for information that you have already provided to them? Is the administrative hassle frustrating you and costing you time and money? The American Chiropractic Association (ACA) and a group of major national insurers have issued a list of recommendations that they say can simplify the reimbursement process and help ensure that your claims are handled fairly and efficiently.

Last year, representatives from 13 of the largest insurance companies in the United States met with ACA representatives during the second meeting of the ACA-sponsored Claim Solutions Work Group. According to insurers at the meeting, they, too, are frustrated by the documentation process. Some of them said they felt that some chiropractic clinical documentation was unreadable, unspecific and did not effectively convey the improvement being made by the patient.

Based on the suggestions made during this meeting and on recent trends, ACA has recommended a set of 11 documentation requirements to be considered as appropriate in patient record keeping. Some of the insurers present at the meeting agreed that using these practices could reduce clinical record requests by 50%.

According to the ACA, you can avoid excessive medical record requests from insurers if you know and use these simple steps for patient documentation:

*Subjective, objective and treatment (if rendered) components should be incorporated into patient records on each visit. Any significant changes in the clinical picture (e.g. significant patient improvement or regression) should be noted.

*All ICD-9-CM diagnosis codes and CPT treatment and procedure codes must be validated in the patient chart and coordinated as to the diagnoses and treatment code descriptors.

*Uniform chiropractic language should be used within the profession for describing care and treatment. Non-standard abbreviations and indexes should be defined.

*Documentation for the initial (new patient) visit, new injury or exacerbation should consist of the history and physical and the anticipated patient treatment plan. The initial treatment plan, except in chronic cases, should not extend beyond a 30- to 45-day interval.

*Subsequent patient visits should include significant patient improvement or regression if demonstrated by the patient on each visit. As the patient progresses, the treatment plan needs to be reevaluated and appropriately modified by the treating doctor of chiropractic (chiropractic physician) until the patient can be released from care, if appropriate.

*If the patient is disabled, a statement(s) on the extent of disability and activity restriction is needed at the initial and subsequent visits as appropriate over the course of care.

*Records can be attached to each billing to pre-empt requests; however, it is not mandatory. Local insurers should be contacted for preferences (i.e., no fault PIP insurers may require records every visit, while health insurers may not).

*All records must be legible and understandable, released within the authority given by the patients, in a secure, confidential manner and in compliance with existing state (or federal) statutes.

*The patient name and initials of the person making the chart notation (especially in multi-practitioner offices) should appear on each page of the medical record.

* Tell insurers who ask for unnecessary medical records you have complied with nationally accepted standards endorsed by the ACA. In addition, youcan point out that further requests for records with disregard to these guidelines represent unfair claim practices.

Contact the American Chiropractic Association Office of Professional Development by phone at (800) 986-4636, ext. 222, or by e-mail at pjackson@amerchiro.org for more information.

Source: American Chiropractic Association

Industry News from:
Chiropractic News from: