What "Triggers" the Medicare Audit?

Updated: January 31, 2011
Dear Doctors and Staff,

As long as we file a "clean" claim, most all Medicare carriers simply pay. However, there are a few things that "pop" out in a claim and lines us up for audits.

1. Item #14, Date of Current:
If date of current does not change in 60 days and the claim is with an "AT" modifier, an audit is probable. Date of Current #14 should change for any accidents, exacerbations, exams, x-rays, evaluations, etc.

2. Diagnosis must support care rendered:
The diagnosis for a patient with an exacerbation may be something like...Subluxation of L5, degenerative joint disease (if you have an x-ray less than one year) and sprain/strain, all in the same spinal region.

3. Patient Notes Review:
When asked to send one or two patient visit notes to your Medicare carrier and your patient notes only include S.O.A.P. notes and NO other "documentation" for the necessity of Chiropractic care, there is a problem. Now the Medicare carrier knows you do not know how to "document" and will do a full audit for money recovery.

Those are the three most prevalent reasons for an audit. Audits can be rough, however, if you know the correct way to do Chiropractic Medicare, after winning that first audit they will leave you alone.
BOTTOM LINE: If you wish to learn how to do Chiropractic Medicare correctly, including "documenting" by federal standards, please consider ordering our Chiropractic Medicare DVD and booklet. It explains piece by piece every important step in doing and billing Chiropractic Medicare so there are no limits for the chiropractic adjustment. If you are audited you will have done Medicare correctly and win your audit. You and your staff will be very happy you have this important and mandatory information. I promise it will make a difference in your understanding of Medicare and how you bill Medicare.
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Keep in mind, Medicare is the only insurance type program that if done incorrectly is fraud, a felony, a fine and/or jail.

I promise you will be more than satisfied that you made the right decision to purchase this information or attend our presentation. Please give me a call if you have questions. 1-618-395-3162

Best regards,
Dr. Gary R. Street

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