AllMed's Skip Freedman Talks About Chiropractic Medical Necessity

Dr. Skip Freedman of AllMed Healthcare Management authors a Chiropractic Medical Necessity article that was just published in Chiropractic Economics.

The article, entitled “Is the treatment medically necessary?
Document to show need” may be viewed by clicking the following link: http://www.allmedmd.com/resources/articles/mednes.htm?source=prleap

In the article, Dr. Freedman states that the medical necessity of chiropractic claims are decided by medical review personnel that have minimal knowledge of the chiropractic specialty. If chiropractors want to be paid, it is incumbent on them to communicate the medical necessity of the claim clearly to the case reviewer. When working with an Independent Review Organization (IRO), the claim is reviewed by a chiropractic doctor who is intimately familiar with the chiropractic specialty. The doctor can better evaluate the chiropractic claim for medical necessity than a “generalist” case reviewer.

Dr Freedman says, “This means that it’s up to chiropractors to understand what case reviewers are looking for — and to provide it or not be reimbursed. It’s also important to understand that questionable cases are often passed on to a third-party, or independent review organization (IRO) for a decision. The IRO sends the claim to be scrutinized by a chiropractic physician, who evaluates it strictly on medical necessity, established facts regarding medical necessity, and proven medical care guidelines.”

Dr. Freedman then defines “Medical Necessity” in the chiropractic context and gives helpful, concrete examples for how chiropractors should word the medical documentation to make it more likely that the reviewer will understand the claim and make it unlikely that the reviewer will reject the claim due solely to a lack of understanding.

More information on AllMed and the company's medical review services (for all medical specialties including chiropractic) can be found on AllMed’s web site at http://www.allmedmd.com/?source=prleap.

About AllMed Healthcare Management
Founded in 1995, AllMed is a URAC-accredited Independent Review Organization (IRO) serving insurance payers, providers, TPAs and claims managers nationwide. Reviews are conducted by board-certified physicians in active practice. AllMed's growing customer base includes premier organizations, such as Educator's Mutual Life, IMS Managed Care, Tenet Healthcare Corporation, HealthGuard, several Blue Cross Blue Shield organizations, TriWest Healthcare Alliance, Allianz and many other leading healthcare payers.