Urgent Medicare Bulletin: Service-Specific Prepayment Reviews of Chiropractic Services
Category: Insurance News
May
08
SERVICE-SPECIFIC PREPAYMENT REVIEWS OF CHIROPRACTIC SERVICES (CPT CODES 98940 AND 98941)
Attention Services for Jurisdiction K Part B Chiropractic Providers in Connecticut and New York
National Government Services will be conducting service-specific prepayment reviews on CPT code 98940 in the Queens, NY area and CPT Code 98941 in CT and the upstate and downstate NY areas.
A prepayment review consists of a medical review of claims prior to payment. Request for records are most frequently electronically generated and referred as ADS letters. Please note that when medical records are requested for chiropractic services, it is necessary to submit all the specific documentation as notated in the ADS, which would include but is not limited to:
Providers can assist in this process by:
Attention Services for Jurisdiction K Part B Chiropractic Providers in Connecticut and New York
National Government Services will be conducting service-specific prepayment reviews on CPT code 98940 in the Queens, NY area and CPT Code 98941 in CT and the upstate and downstate NY areas.
A prepayment review consists of a medical review of claims prior to payment. Request for records are most frequently electronically generated and referred as ADS letters. Please note that when medical records are requested for chiropractic services, it is necessary to submit all the specific documentation as notated in the ADS, which would include but is not limited to:
- Services up to three (3) months prior to and including the date(s) of service in question
- Advance Beneficiary Notice of Noncoverage
Providers can assist in this process by:
- Reviewing all contractor publications and LCDs
- Understanding Medicare coverage requirements
- Ensuring office staff and billing vendors are familiar with claim filing requirements
- Performing self-audits of medical records against billed claims using coverage criteria, LCD, and coding guidelines
- Responding to request(s) for records in a timely manner (CMS requires that providers respond to an ADS within 30 days of the request)
- Ensuring documentation is legible and demonstrates that the patient’s condition warrants the services being reported and billed
Reports show that from June 2013 through March 2014, the average error rate for CPT code 98941 was:
LOCATION - ERROR RATE (PERCENT)
Connecticut - 81.0
Downstate, NY area - 81.1
Queens, NY area - 91.2
Upstate, NY area - 76.6
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