ARE CHIROPRACTORS BILLING MEDICARE ACCURATELY?

 

Filing an accurate Medicare claim should be a simple job for most providers: You document the services provided and you submit the claim. Yet for chiropractors, that may not be the case, as a recent HHS Office of Inspector General report found that 82 percent of all Medicare Part B payments for chiropractic services in 2013 were improper because they were for medically unnecessary services.

I spoke with Anna Grizzle, a health-care attorney with Bass, Berry & Sims in Nashville, Tenn., who said the report appears to indicate that chiropractors don’t have a strong understanding of Medicare billing requirements. “It's hard to determine if the large number of improper payments are due to fraud or overly complex payment requirements without more information on the individual providers,” Grizzle said.

While the root cause behind the large number of improper payments may not be readily apparent, Grizzle said chiropractors should view the OIG report as a wake-up call and take appropriate actions to properly bill Medicare claims and prepare for potential audits.

The OIG said the estimated $358 million in improper payments were due to ineffective Medicare payment edits and a lack of strong provider education on proper billing behavior. Medicare is authorized to pay chiropractors for manual spinal manipulations intended to correct a subluxation—a slight misalignment of the spinal bones—but not for maintenance therapy.

The American Chiropractic Association said the report doesn’t reflect recent efforts chiropractors have made to provide better documentation with their Medicare claims. The ACA said it has developed new e-training products to help chiropractors understand Medicare billing requirements, David A. Herd, president of the ACA, said in a statement.

The OIG reviewed a sample of 105 chiropractic services for which Medicare paid $2,700 in 2013, and found that 94 shouldn’t have been paid. The 94 claims were billed as services to correct subluxations, but were actually maintenance therapy.

The sample results were used to arrive at the $358 million figure.

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