Medicare Coverage of Chiropractic Services

Medical Review Audits

Medicare contractors perform medical review audits to ensure Medicare is paying providers for appropriately covered Medicare services. Medical review examines documentation from providers to validate that the documentation supports the services and level of service billed by the provider and the documentation adheres to all Medicare coverage guidelines. Medical review performs medical review audits on prepayment claim(s) (i.e., before you have been paid) and post-payment claim(s) (i.e., after you have been paid).

Helpful Tips for Responding to an ADR

• CMS gives providers 30 days to return records to their contractor from the date the ADR is issued.
• Medical documentation submitted should support all the services and dates requested. Include your initial evaluation of the patient and any and all documentation that supports medical necessity, as well as the documentation for the date(s) of service requested.
• Submit an abbreviation or acronym key with your documentation if you use acronyms or abbreviations that are not commonly used in your profession.
• If an ABN was issued for the service, be sure to include the ABN with your documentation when responding to the ADR.

Perform a quality review on your documentation before sending it to the contractor.

Helpful Tips for Performing a Quality Review of Your Documentation

• Check for appropriate signatures and dates on treatment and/or progress notes.
• Make sure the documentation is complete and legible.
• Do not highlight medical records.

You may want to paginate the records for a quick reference to ensure all documents was received by the contractor.

Reviewed 9/11/2024