Comprehensive Error Rate Testing
CERT Documentation - Chiropractic and Physical Therapy Services
Recent CERT review results indicate that insufficient documentation of chiropractic and physical therapy services continues to be a factor contributing to our CERT error rate. When WPS or the CERT Contractor requests medical records for these services, it is vital that all supporting documentation is submitted.
For physical therapy services this includes the following:
- Physician's order for therapy prior to first treatment
- Current Plan of Care (must be signed by physician)
- Initial evaluation and any re-evaluation performed since start of care
- Duration and type of treatment given
- Time spent performing services to support the unit of time billed
- Provider of therapy (therapist, assistant or aide) clearly designated
- Documentation of treatment given on specific date requested
For chiropractic services this includes the following:
- Patient history for initial visit (symptoms and their onset, duration, intensity, frequency, location and radiation, past health history, mechanism of trauma, prior interventions and/or treatments and aggravating or relieving factors
- Patient history for subsequent visits (review of chief complaint, changes since last visit, and system review if relevant)
- Description of present illness, including the above factors
- Evaluation of musculoskeletal/nervous system through physical examination
- Diagnosis: The primary diagnosis must be subluxation, including the level of subluxation
- Treatment plan and date of initial treatment
- Documentation of treatment given on specific date requested - including area(s) of spine manipulated
It is important to submit adequate documentation in response to CERT requests for medical records not only to avoid costs related to overpayment requests and/or appeals of CERT denied claims. Complying with CERT requests for records significantly contributes to the reduction of our Medicare Carrier CERT paid claims error rate, and in turn, the national paid claims error rate.
For questions related to physical therapy or chiropractic documentation, please Contact Us.
