Top 10 Categories for Chiropractor "Requests for Additional Documentation" (RAD)

The Comprehensive Error Rate Testing (CERT) Documentation contractor identified 135 Chiropractic claims for which RADs were sent during the timeframe of September, 2009 through April, 2010. Of these 135 claims, a random sample of 50 claims was reviewed to analyze the various reasons for the additional documentation requests. The findings are as follows:

TOP 10 Categories for Chiropractor Requests for Additional Documentation (Missing Information) RADs/ Percentage Rate
1. Primary Care Physician Notes
  • Treatment Notes/Plan Missing
  • Office/Progress Notes Missing
  • Physician Signature for Prescription Missing

(35) 70%

(25) 50%

(2) 4%

2. Documentation to Support Chiropractor Services
  • Medical Necessity of billed Chiropractor Spinal Manipulation Missing
  • History & Physical/History of Onset and/or Present Illness Missing
  • Chief Complaint Missing
  • Symptoms Missing

(35) 70%

(7) 14%

(2) 4%

(2) 4%

3. Initial Evaluation/Visit Missing (29) 58%
4. Documentation indicating that the patient had Chiropractor Services for the period covering the preceding 6-12 months Missing (depending on the regular CERT sample versus the supplemental measure Chiro study). (29) 58%
5. Documentation to Support Chiropractor HCPCS Code Missing (17) 34%
6. Type and Location of Manipulation Treatment /Supportive Notes Missing (16) 32%
7. Legibility
  • Legible Progress Notes including authentication of Legible Identification of the Provider and/or Signature Log Missing.

(16) 32%

8. Other Pertinent Information
  • Physicians Recommended (approximate) Visits/Duration of Treatment Missing
  • Diagnostic Testing Missing
  • Pre-Operative/Operative Notes Missing
  • Physical Therapy Missing
  • Use of External Joint Support Missing (cane/crutches/walker) Missing

(12) 24%

9. Attestation of Medical Record Entry for Services Rendered Missing

(11) 22%

10. Abbreviation List to Support Chiropractor Missing (The list of abbreviations is needed because Chiropractor abbreviations vary among Chiropractors)

(5) 10%

NOTE: Of the 50 claims reviewed for RADs, some had multiple missing/insufficient documentation issues.

Page Last Updated: Thursday, 15-Dec-2011 12:06:34 CST