January 2002

New Blanket Denial Rule Could Help Chiropractors

Washington, D.C. - Medicare carriers will no longer be permitted to issue “blanket” denials of service, according to new rules published by the Centers for Medicare and Medicaid Services.

The new policy will take effect April 1 and should have a major impact on doctors of chiropractic who have historically been subject to unfair denials. The new rules prohibit Medicare carriers from denying claims unless clear policy serves as the basis for the denial, the denial is based on medical impossibility, or no timely response was received in response to an additional documentation request letter.

The changes also permit carriers to release utilization guidelines, which could help doctors of chiropractic in determining when a carrier will deem a service to be “not reasonable and necessary.”

Doctors of chiropractic have long been required to inform their Medicare patients in advance when it was “likely” that Medicare may deny a service for not being “reasonable and necessary.” The new rule requires carriers to be more forthcoming with specific medical review criteria that will aid the doctor of chiropractic in providing a Medicare patient with the required advance notification.

“While this new policy represents an extremely positive development for the chiropractic profession, it is now even more important for doctors of chiropractic to ensure that their documentation is strong enough to withstand a complex medical review,” said Dr. Daryl D. Wills, president of the American Chiropractic Association (ACA).

Industry News from:
Chiropractic News from: