By Ric Bruns
“The mission of the Office of Inspector General (OIG) as mandated by Public Law 95-452 as amended, is to protect the integrity of the Department of Health and Human Services (HHS) programs, as well as the health and welfare of the beneficiaries served by those programs. This statutory mission is carried out by the nationwide network of audits, investigations and inspections.” May 2009 OEI-07-07-00390.
The OIG and Centers for Medicare and Medicaid Services (CMS) have been charged with evaluating “inappropriate Medicare payments for chiropractic services.” This is based on data collected in 2005 and 2006 and on an OIG report.
According to this 2009 OIG report, “In 2006, Medicare inappropriately paid a total net $178 million (out of $466 million) for chiropractic claims for services that were maintenance therapy ($157 million), miscoded ($11 million) or undocumented [i.e., no response or insufficient documentation] ($46 million). These claims represent 47 percent of all allowed chiropractic claims that met the study criteria of chiropractors providing more than 12 services to the same beneficiary during 2006. 17 percent of the reviewed claims, representing $36 million, had multiple errors.”
Now that we are aware of the issues, we must be part of the solution. The Medicare system does not fully take into account how chiropractic is practiced and is using some definitions that complicate solving the problem. Until we can change that, we all must evaluate our record keeping and make sure that we are documenting and billing maintenance care according to current definitions, that we are not miscoding our services and that we are responding to all requests for records.
Whether you are a participating (PAR) or nonparticipating (non-PAR) provider with Medicare, you are not allowed to opt out of Medicare, and therefore you must provide records upon request. If you do not respond to such requests, you automatically have a negative impact on the data. Negative data complicate the changes of Medicare.
ACA, as part of its strategic plan and mission, is dedicated to improving the health and welfare of our patients. Integral to that goal is taking the many steps to attaining statutory change in Medicare to reflect our true physician status. Medicare beneficiaries must have access to the range of services we are competently trained and tested to provide to attain the best outcomes. We must improve record keeping to meet the current Medicare standards and to accurately document our outcomes as part of the process of attaining full scope in Medicare. This is something that all chiropractic physicians have the power to do.
ACA offers the resources to assist you with the coding and documentation requirements of Medicare. Our government relations and payment policy departments stand ready to help you understand and implement the changes that you need to make. Our website provides valuable resources, and our vendors stand ready to assist you in upgrading your documentation with state-of-the-art electronic health records at discounted rates for being an ACA member. You must do this for your patients. Evaluate your own records today. Please join us as help move this profession forward and improve the health and welfare of the citizens of this country.