By N. Ray Tuck, Jr., DC
The American Chiropractic Association (ACA) received news recently that the HHS Office of the Inspector General (OIG) discovered inappropriate Medicare payments to chiropractors between 2013-2016 caused by a delay on the part of CMS to implement claims processing edits that automatically deny non-covered services. A few media outlets picked up on the report, focusing on the payments, not surprisingly. But there’s more to this story.
The OIG report actually found that CMS’s billing edits were largely successful in preventing improper payments, and that most of improper payments were made prior to CMS finally implementing its edits in 2014. The report demonstrates that corrective action is needed by CMS to ensure that its edits trigger the correct response to providers in the future.
ACA has worked closely with CMS over the past several years to improve chiropractic documentation and billing practices, and significant improvement has been made by the profession and recognized by Medicare carriers. We are proud of these improvements.
So, it was surprising to read in the report that one of OIG’s suggestions to CMS was to “revise the claims processing edits to ensure that all claims for items and services ordered by chiropractors are denied.”
CMS disagreed with OIG on this recommendation, noting that “the existing claims processing edits already deny payment for most of improper payments related to ordering chiropractors.”
We appreciate CMS’ support here, but it also serves as an important reminder that the time has come to finally expand the scope of chiropractic services under Medicare so that patients and their providers are reimbursed fairly for medically necessary services.
To this end, ACA continues to lay the groundwork for a new Medicare bill. In addition to our full-time lobbyists on staff in Washington, we recently hired more lobbying muscle to get legislation introduced and passed that will allow chiropractors to perform to the fullest scope of their license and meet the needs of their Medicare patients.
Under the current system, patients are being driven away from chiropractic. They’re being driven away from a healthy, pain-free, mobile life. They’re being driven toward prescription medication. That needs to change.
Achieving Medicare parity for chiropractic will require a huge effort. It involves working on the same level as some of the most influential groups in the country, such as the American Heart Association, the Association of American Medical Colleges and the American Podiatric Medical Association. It will involve working with the U.S. House Ways and Means Committee, one of the most powerful committees on Capitol Hill.
ACA is the voice within the chiropractic profession that can make it happen, and there are ways you can be part of this change. Go to www.acatoday.org/equality. You’ll find more information about our Medicare effort. You’ll have the opportunity to sign– if you haven’t already–our Medicare petition. Ask your patients to sign it, too.
When you talk to colleagues who aren’t members, share this story or one of the others that will help keep them informed. Tell them there’s a way to be part of the solution. Help them get up to speed on our progress, what’s ahead, and how joining can make a difference.
Let’s use this latest OIG report as a spark to reignite our efforts to bring parity to chiropractors and their patients in the Medicare program.
Dr. Tuck is president of the American Chiropractic Association.