In September the Office of Inspector General (OIG) of the Department of Health and Human Services (HHS) issued a new report targeting questionable and inappropriate payments for chiropractic services in Medicare. In the report the OIG made several specific recommendations for action to be taken by the Centers for Medicare & Medicaid Services (CMS) that could affect you. Once again our profession has been “targeted”, but a detail examination of the results of this study may surprise you. CERT reports continue to indicate the need for improved documentation, however, this report refutes past claims that almost 50% of paid chiropractic claims were for maintenance care. As a profession we do have a serious problem, however, it appears that our biggest one is a “2 per cent problem.” Of the total $502 Million paid for chiropractic services, 81.4% was deemed “Neither inappropriately nor questionably paid”. The report also admitted that the four measures that identified questionable payments did not provide conclusive evidence of improper or fraudulent payments. Rather, the measures were “intended to identify Medicare payments to chiropractors that exceed those of other chiropractors in ways that raise program integrity concerns.” The most criticized area in past studies was related to the over-utilization of Medicare for the provision of “maintenance care”. The statistical analysis of ALL claims for chiropractic services in 2013, however, revealed that 44,528 chiropractors (98%) had an average of 8.65 paid claims per beneficiary for the entire year. In addition to being high-volume providers, … 53% of the claims from the 962 (2%) were suggestive of maintenance therapy … and …“In contrast, just 3 percent of the claims for all other chiropractors (98%) paid by Medicare in 2013 were suggestive of maintenance therapy.” Obviously, there is a huge difference from the past soundbite that ” over 50% of chiropractic claims are for maintenance care and inappropriate”, and the current revelation that “only 3% of the claims from 98% of chiropractors are for maintenance care …”. This doesn’t mean that we don’t have a documentation problem, but it does mean that the past extrapolation of data received from the audited claims was not valid … probably because the samples were NOT RANDOM. It does mean, however, that if you as a chiropractor are operating in the parameters above the 98th percentile, your documentation validity and accuracy better be above the 98th percentile as well.
- The Chiropractic Profession – coming together under the banner of the Chiropractic Summit -- has targeted elimination of discrimination against chiropractic patients as the highest legislative-action priority for 2016. Recent federal legislative changes with H.R. 2, (the Medicare Access and CHIP Reauthorization) that were passed in April of 2015 has alerted the ICA about multiple serious threats to patient coverage. In fact, coverage for the adjustment to correct a subluxation has been targeted for severe restrictions and/or elimination by 2017. In addition, Sec. 514 of HR 2 requires a medical review process for spinal subluxation services provided by a chiropractor to a Medicare beneficiary. Medicare administrators continue to publish earlier CERT (Comprehensive Error Rate Testing) reports claiming that over 40% of paid chiropractic claims are inappropriate "maintenance adjustments". However, a recent OIG report reveals that past criticisms of the chiropractic profession could be considered highly exaggerated and misleading, and only targets 2% of the profession with highly questionable payment records.