Author: Mario Fucinari DC, CCSP, APMP, MCS-P, CPCO

Doctor writing medical note

Are Your Medicare Notes Functional

Many are seeing increased denials of care for medical necessity in Medicare. A closer look at the reasons for the denials reveals a change in Medicare’s interpretation of medical necessity and progress in care. The evolution of their interpretation actually complements what chiropractors have been saying for several years – we do not only treat pain!

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Congress Kicks the Can Down the Road; Delays ICD-10 for One Year

Congress voted to institute a 1-year “doc fix” preventing a 24% pay cut for physicians who treat Medicare patients. This is the 17th patch in 11 years whereby Congress delayed the “doc fix.” Although there was strong bipartisan support in both the House and Senate to repeal the Sustainable Growth Rate (SGR) formula responsible for the problem, the doc fix was enacted again. President Obama signed into law the Protecting Access to Medicare Act of 2014 on April 1, 2014.

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Get, Ready, Audits are on the Rise

The Department for Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) have the responsibility to make sure that the funds are properly protected. To this end, they have contractors who audit charts to prevent fraud and abuse. Among them are the Zone Program Integrity Contractors (ZPICS), who audit Medicare A and B, hospice home health, and durable medical equipment programs.

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