frequency of visits / maximum medical improvement (mmi)

All services provided must be properly documented in the health care record.  The care provided to and the frequency of visits billed to HNS contracted payors must be supported by documented medically necessity, consistent with the patient's chief complaint, clinical findings, diagnoses and treatment plan.

Per the N. C. Board of Chiropractic Examiners Practice Guides:

"The physician should re-evaluate the appropriateness of further care after whichever comes first, approximately twelve office treatments or four weeks of care (i.e., one "treatment cycle").

 

If the patient shows improvement, the physician may recommend another treatment cycle.

For as long as improvement can be objectively demonstrated, the patient may continue treatment cycles.

However, if re-evaluation fails to demonstrate additional improvement after any two consecutive treatment cycles, the physician should assume that maximum therapeutic benefit has been reached.

Patients who have reached maximum therapeutic benefit may be candidates for supportive care, elective care, referral or release.

Once the goals of treatment have been realized, the patient may continue to need supportive care in order to prevent deterioration or relapse.

If a patient with an uncomplicated condition fails to show initial improvement after two treatment cycles, or a patient who initially showed improvement subsequently fails to show further improvement after one additional treatment cycle, the physician should assume that maximum therapeutic benefit has been achieved.

Patients who have reached maximum therapeutic benefit may be candidates for supportive care, elective care, referral or release."

The frequency of treatment should gradually decline until the patient reaches the point of discharge or converts to supportive or elective care. An acute exacerbation may require more frequent care. The treatment time may be extended due to complicating factors.

For some patients, the physician may determine, in the exercise of clinical judgment, that a period of trial treatment is warranted. An initial trial period of up to two weeks may be appropriate. If re-evaluation shows no improvement, a second trial period, lasting a maximum of two weeks and utilizing a different method of treatment, may be instituted. If there is still no demonstrable improvement, the physician should refer or discharge the patient.

Some patients may require supportive care using passive therapy if efforts to withdraw treatment results in deterioration of clinical status.

Healing the sick, injured and infirm is an art, and no health care provider, regardless of professional training or category of license, can guarantee the success of treatment.

If a patient's recovery is slower than expected, the physician should search for complicating or extenuating factors by engaging in a reassessment interview with the patient, including a review of the patient's activities of daily living.

If a patient with an acute condition shows signs of becoming chronic, the physician should review and consider altering the treatment plan to de-emphasize passive care and focus on active care.

If a patient with an uncomplicated condition fails to show initial improvement after two treatment cycles, or a patient who initially showed improvement subsequently fails to show further improvement after one additional treatment cycle, the physician should assume that maximum therapeutic benefit has been achieved.

Patients who have reached maximum therapeutic benefit may be candidates for supportive care, elective care, referral or release."