News & Information
Seven Things That Will Cause Medicare to Deny a Claim
Written by Kelli Moore, MCS-P,I   
Thursday, September 07, 2017 12:21 PM

A Working Guide for What to Do When Medicare Denies for Medical Necessity

By Kelli  Moore, MCS-P, I

Medical Compliance Specialist – Physician, Instructor

Getting a notice from Medicare that your services were not medically necessary and therefore not payable is not the response any doctor or biller wants to see. No one wants to work for free. So, getting this ambiguous denial, “These are non-covered services because this is not deemed a medical necessity by the payer”, is both alarming and frustrating. It raises questions: what causes this denial from Medicare? What can one do to fix this and keep it from happening in the future? Is there any hope of getting paid after getting this denial?

The Cause

First, there are the seven main reasons that will trigger this unfavorable denial:
1. Wrong primary diagnosis
2. Wrong secondary diagnosis
3. Not enough diagnosis for the CPT code reported
4. Wrong modifier
5. More than 30 visits in a calendar year
6. More than 12 visits in a calendar month
7. The date of first consult is older than 90 days
Written by Andrea Howard   
Wednesday, August 30, 2017 04:05 PM

Chiropractors Helping In Relief Operations (C.H.I.R.O)

Texas Chiropractic Association (TCA), in conjunction with Parker University and Texas Chiropractic College (TCC), created the initiative, Chiropractors Helping In Relief Operations (C.H.I.R.O), which is dedicated to helping our doctors in their time of need. 

Initially started as a response to Harvey as a way to offer assistance to Texas Doctors of Chiropractic whose practices were affected by the hurricane/storm, the C.H.I.R.O. will continue as a way to support those who may be affected by catastrophic events in the future.

The ultimate goal of C.H.I.R.O. is to help you get back to caring for your patients.

If you would like to make a donation, you can donate online or download and fill out the PDF. Checks can be sent to TCA office at 1122 Colorado St., Ste. 307, Austin, TX 78701 and please put CHIRO Fund in the memo line.

 If you have been affected by a catastrophic event, please fill out the online form or download and fill out the PDF and email it to You can also fax it to (512) 477-9296.

You can also call the TCA office at (512) 477-9292 to make a donation by credit card. Monetary donations are not tax deductible, but equipment donations may be considered a business donation. Please check with your tax preparer for verification.  

Recommendations for Flood Damaged Patient Records
Written by Editor   
Tuesday, August 29, 2017 05:27 PM

One malpractice insurer recommends the following if your patients' records were destroyed or damaged:

If you utilize paper records, you can't replace the destroyed records. However, you can create a new record.

TCA Response to TDI-DWC Proposed Changes
Written by Andrea Howard   
Friday, August 25, 2017 12:55 PM



TCA Members and Texas Chiropractors,

As many of you are aware, the Texas Department of Insurance, Division of Workers’ Compensation (the “Division”) published informal working draft rules regarding Designated Doctor Procedures and Requirements. The draft rules can be found here:

Doctors of Chiropractic from across Texas have contacted TCA to express their grave concerns about the impact several of these rules would have on injured workers and chiropractors. TCA shares these concerns. While TCA will be submitting comment on the proposals to the Division on behalf of its membership, the Association strongly encourages Doctors of Chiropractic to review the draft rules and submit their individual comments to the Division. It is critical that the Division hear how these draft rules would impact the chiropractic community.

Provisions in the Division’s draft rules prioritize Medical Doctors, Doctors of Osteopathy, and board-certified specialists over Doctors of Chiropractic in case assignments within the Designated Doctor Program (see draft rule § 127.5(f)(1) and (2)). Other provisions reduce chiropractic scope of practice within the Designated Doctor Program by prohibiting Doctors of Chiropractic from examining injured workers with torso-related injuries, hernia injuries, cauda equina syndrome, fractures, dislocations, tendon and nerve lacerations, compartment syndrome, and brachial plexus and lumbosacral plexus injuries (see draft rule § 127.130(b)(3), (8) and (9)).

Designated Doctor Rule Changes Proposed
Written by Editor   
Thursday, August 24, 2017 06:57 AM

The Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC) has proposed sweeping changes to its Designated Doctor program that may negatively impact participating Doctors of Chiropractic. The proposals are extensive and include changes to scheduling and examination procedures as well as qualification criteria for various types of injuries. The “Informal Working Draft Rules” can be viewed at

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