ACA PART System - American Chiropractic Association...

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American Chiropractic Association Commentary on Centers for Medicare and Medicaid Services (CMS)/PART Clinical Documentation Guidelines
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2 DISCLAIMER The American Chiropractic Association provides this commentary in order to assist its members to better understand the Medicare PART clinical documentation guidelines. These are Centers for Medicare and Medicaid Services (CMS) guidelines that apply to Medicare only. CMS guidelines are not endorsed or approved by the ACA and this commentary is provided only for informational assistance and is strictly advisory in nature. The ACA recommends that you direct inquiries to your local Medicare carrier regarding any questions about CMS guidelines and this commentary does not take precedence over any federal regulation or directive. The ACA will take no action to enforce or otherwise require member compliance with this commentary. ACA reserves the right to lobby governmental entities to revise or rescind any portion of the described documentation guidelines.
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3 Documenting Medical Necessity for Medicare Integrating PART to Ensure Compliance Under the policies developed by the Centers for Medicare and Medicaid Services (CMS), coverage of chiropractic services is specifically limited to manual manipulation of the spine to correct a subluxation . Unless this subluxation is properly documented, medical necessity has not been established and claims may be rejected by Medicare. In this piece, we will review the documentation guidelines CMS has established. We will help identify what the carriers are looking for, when they want it, and where the documentation must appear. Utilization guidelines for chiropractic services require the following three components in order to establish medical necessity: 1 Presence of a subluxation that causes a significant neuromusculoskeletal condition. Medicare will not pay for treatment unless it is by manual manipulation of the spine to correct a subluxation. The subluxation must be consistent with the complaint/condition. 2 Documentation of the Subluxation A subluxation may be demonstrated by one of two methods: x-ray or physical examination . If documented by physical examination, the PART system (as described below) must be used. 3 Documentation of the Initial and Subsequent Visits Specific documentation requirements apply whether the subluxation is demonstrated by x-ray or by physical examination. PRESENCE OF A SUBLUXATION The subluxation is defined as a motion segment in which alignment, movement integrity, and/or physiological function of the spine are altered although contact between joint surfaces remains intact. Medicare will not pay for treatment unless it is “manual manipulation of the spine to correct a subluxation.” Therefore, you must document in your patient’s physical examination, their initial chart notes, and subsequent chart notes
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This note was uploaded on 01/03/2012 for the course TECHNIQUE 61603 taught by Professor Bhogal during the Fall '09 term at Palmer Chiropractic.

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ACA PART System - American Chiropractic Association...

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