Hundreds of Millions in Medicare Payments for Chiropractic Services Did Not Comply With Medicare Requirements

This report from the OIG delivers a strong message to Chiropractic. If you are one of the many who think that you can get by with hand written notes and with old and outdated methods, you may be in for a big surprise. DBC has been telling Chiropractors for about 7 years that it is time to modernize the way you document clinical care. The full report can be found here: https://oig.hhs.gov/oas/reports/region9/91402033.pdf. I have made my living on Chiropractic for nearly 32 years and I share this with you because I care about the outcome . Here are a couple of excerpts that Chiropractors should pay close attention to. I can already hear some of the protestations like “We don’t see many Medicare patients.” and the like. Statements like this are, of course, utter nonsense and a poor excuse for rationalizing behaviors. Where Medicare goes – the rest of the carriers follow and soon the novel idea of being a cash practice (and losing half of your patients) will become a defacto standard and a reality.

“The chiropractors submitted claims for all 105 services with the AT modifier and initial treatment date, indicating that the services were for active/corrective treatment for subluxation and all documentation required by Medicare was being maintained on file. However, the documentation provided by the chiropractors for 94 services did not support the medical necessity of the services; 37 of these services had more than 90 days (approximately 3 months) between the date of initial treatment and the date of service, which may indicate that the services were maintenance therapy.”

“CMS informed us that there was a system edit to deny claims without the AT modifier. However, our claim data analysis and audit results suggest that chiropractors submitted claims with the AT modifier regardless of whether the services were for active/corrective treatment for subluxation. All but 29 of the more than 17 million chiropractic services included in our review were on claims that had the AT modifier, and of the 105 sampled chiropractic services, 94 were not medically necessary.”

“CONCLUSION
CMS could have saved Medicare an estimated $358,800,549 for CY 2013 if it had had effective controls to ensure that Medicare paid only for chiropractic services that were medically necessary. Strong controls to prevent improper payments for chiropractic services are important to program integrity.

The high payment error rate (82 percent) that we identified in this review demonstrates that additional controls are needed to ensure that chiropractic services paid by Medicare are medically necessary. Further, the increase in payment error rates as the number of services provided to a beneficiary increased also demonstrates the need for additional control