Medicare 103: Medicare and Chiropractic Services Coverage, No Coverage Exclusions and Medicare Necessity
This course is designed to clarify Medicare’s definitions of what chiropractic services are covered and how medical necessity of those services is established. This webinar will identify the various Medicare references and resources available on these issues; several confusing terms that are frequently used inappropriately or inconsistently; an overview of services that are excluded from payment; and a discussion on treatment patterns that include what constitutes an episode of care.
- Recognize and differentiate frequent and commonly misunderstood and confusing terms, such as Acute & Chronic, Active & Maintenance, Condition & Care, Noncovered & Excluded
- Identify and discuss the components of diagnosing the existence of a subluxation through physical examination
- Recall and explain criteria that qualifies a neuromusculoskeletal condition as necessitating a covered spinal manipulation.
Speaker: Mollie Frawley
Mollie Frawley currently works with the Florida Chiropractic Association as Insurance Liaison Coordinator providing FCA members information on regulatory, insurance and general business issues. A Registered Nurse and a legal nurse consultant, she is also a diplomate of the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) and is a Certified Case manager (CCM). Ms. Frawley worked 9 years as a hospital clinical nurse, 16 years for the State of Florida in Medicaid, Corrections and Workers’ Compensation, 10 years as an independent consultant with her own business, and 3 years as a telephonic case manager handling litigated workers’ compensation cases. Her career has included thirty years of medical record review, health care monitoring and fraud and abuse investigations and 18 years of professional speaking including the development of nursing and medical continuing education programs. These experiences have included consulting, expert witnessing, developing administrative rules, assisting InterQual in developing the initial quality and utilization review program for Corrections, organizing and implementing a utilization and peer review program for the Division of Workers’ Compensation, identifying data queries to red-flag inappropriate billing practices and creating internal processes to identify, document, and track activity in order to monitor and analyze outcomes. As a volunteer, she has served on 2 fraud task forces assisting in creating a wallcard of "red flags" for identifying potential fraud, has participated on her certification board’s committee that prepared and reviewed test questions under the oversight of the National Board of Medical Examiners, has served as a Florida Supreme Court certified County Mediator in Leon and Gadsden Counties’ Small Claims Courts promoting alternative dispute resolutions and as a member of the Corrections Medical Authority’s Quality Management Committee. Her nonprofessional organizational interests include various fund raising activities for local nonprofit agencies as a local chapter leader with her religious fraternal organization, receiving the 2008 Volunteer Excellence Award within the Florida Region.
*Note: THIS CLASS IS NOT FOR CONTINUING EDUCATION. FCA Member cost for this course is FREE, Non-Members is $15. Members, make sure you are logged in to receive this discount. Any questions, email email@example.com
A few notes before you begin:
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- When your program pauses at the end of a video, you have completed the end of that section. Close out of your window, give the system a moment to reset, then click the "next" button at the bottom right area of your screen. This will bring up the next section of the webinar. You can always note the completed sections on the Course Progress-Tracker on the left side of the screen.