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06/01/2010

Documentation Feedback from Blue Cross

The following is taken from the minutes of Ohio Provider Outreach and Education (POE) Advisory Group Meeting, May 11, 2010:

 “Medical Review Update.  Carrie Weiss discussed the goal of the medical review program is to reduce payment errors by identifying and addressing documentation and billing errors concerning coverage and coding.  She stated the Palmetto GBA (OH/WV) Medical Review Department had identified the following problem areas for the second quarter of 2010. She noted this is not an all-inclusive list and is in no specific order.  The list reflects the majority of documentation issues discovered during the review process.”

 (only ithe tem pertaining to chiropractic is included here:) 

“Chiropractic Services:  Missing treatment plan with specific objective, measurable treatment goals.  Follow thru with these specific objective treatment goals on subsequent visits is often omitted.  The initial visit and subsequent visit often was missing key elements/requirements outlined in the Internet-Only Manual Medicare Claims Processing Manual 100-04, Chapter 12, section 220.  Reminder:  Subluxation may be established by either an examination or hands-on examination (P.A.R.T.)”