The Department of Health and Human Services’ Office of Inspector General (OIG) is determined to inspect or analyze the Medicare Part B payments for the chiropractic services. In a recent report, which was released on October 19, the OIG found out that approximately 82 percent of all the Medicare Part B payments were made inappropriately.
Medicare regulations only allow repayment for “medically necessary” services. However, as per the OIG, these Medicare Part B payments were not eligible for including into this category or they simply failed to meet the necessary standard. Reports also indicated that the total estimate of $358 million, which was made as inaccurate payments could not be discovered or exposed because of the inadequate payment edits. In addition to that, OIG also suggested that a better education on the billing requirements for the providers might have declined a major portion of these claims.
This report released by OIG is actually a latest report filed by the agency in a number of reports, which are issued to document the improper chiropractic payments, which were made in the last ten years. The October report issued by the OIG noted: “A 2005 Office of Inspector General (OIG) evaluation found that as chiropractic care for a beneficiary extended beyond 12 treatments in a year, it became increasingly likely that individual services were medically unnecessary, with an even greater likelihood that services were medically unnecessary after 24 treatments.”
“In addition, four more recent OIG reviews of individual chiropractors (with reports issued between 2013 and 2016) found that Medicare made improper payments for chiropractic services that were medically unnecessary, incorrectly coded, insufficiently documented, or not documented. We conducted this review to determine whether these issues occurred nationwide,” the report added.
Officials also said that the American Chiropractic Association has already developed fresh training materials in order to educate the health providers about the billing requirements. This is actually a part of their effort to fight the improper medical billing.
The OIG also advised that the CMS should put in efforts to improve the provider education and to make the billing process for chiropractic claims a lot more simpler, as it will help the providers to grasp it quickly. CMS has already agreed to both these recommendations from the OIG. In addition to that, a National Coverage Determination (NCD) is also being developed by the CMS for the Chiropractic services.