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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The 59 modifier is used to indicate to the carrier that a “distinct procedure code” is involved and the procedures should be paid separately.
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In January 2014 the Department of Health and Human Services Office of Inspector General (OIG) announced that electronic health records (EHRs) have created new exposures to healthcare fraud and abuse, and, as a result, they requested CMS and their contracted MACs revise their approaches to protect against fraud and abuse.
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