It has begun.
Railroad Medicare has stated on their website that they are targeting chiropractic claims for audit “due to the high percentage of errors” identified by CERT testing.
Palmetto GBA, which administers the Railroad Medicare program, states that 10% of all chiropractic claims will be reviewed. If you receive a request for records for one or more patients please use the following guidelines to submit your information:
- Provide all documents requested on the Additional Document Request letter. These include your daily notes (electronic or paper) for the date(s) in question, your most recent exam/re-exam and treatment plan, all outcomes assessment forms the patient filled out, radiology reports and any additional paper documentation pertaining to the date(s) in question.
- Make a copy for Palmetto and another for your records. This additional set will help you should your claim be denied. It will be clear what information was provided to the reviewer.
- You have 30 days to respond. If you fail to respond, your claim will be denied on the 45th day. If your response is received between day 30 and 45 – it may not be processed.
- You will receive the results of the review in approximately 60 days.
- If you disagree with the decision of Palmetto Reviewers you will have 120 days from the decision date to appeal.
Do not delay in responding to this request.
Failure to respond will result in a denial - and an increase in your error rate.
If your claim is denied, we can help you appeal.