Checklist: Chiropractic services documentation
This checklist is being provided as a tool to assist providers when responding to medical record documentation requests. It is the responsibility of the provider of services to ensure the correct submission of all required documentation.
| Check |
Documentation description |
|---|---|
| Please be sure documentation submitted is legible. |
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| Please submit records for all dates of service on the claim. |
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| Ensure the medical records submitted supports that the service is “Active treatment,” rather than maintenance. |
|
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Ensure the medical records provide justification supporting medical necessity for the service by submission of the following:
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| Any other documentation a provider deems necessary to support medical necessity of services billed, as well as documentation specifically requested in the additional documentation request (ADR) letter. |
Disclaimer
This checklist was created as an aid to assist providers. This aid is not intended as a replacement for the documentation requirements published in national or local coverage determinations, or the CMS documentation guidelines. It is the responsibility of the provider of services to ensure the correct, complete, and thorough submission of documentation.