The Office of the Inspector General (OIG) of the US Department of Health and Human Services has recently issued the “Medicare Needs Better Controls to Prevent Fraud, Waste, and Abuse Related to Chiropractic Services” portfolio that identified vulnerabilities and reiterated recommendations from prior reports that have not been implemented or have been implemented ineffectively. It acknowledged that fraud, waste, and abuse “is a concern.”

The Centers for Medicare & Medicaid Services (CMS) Comprehensive Error Rate Testing (CERT) program, which measures improper Medicare fee-for-service payments annually, has identified chiropractic services as having the highest improper payment rates among Medicare Part B services from 2010 – 2015. The improper payment rate ranged from 43.9 percent to 54.1 percent with yearly overpayments from $257 million to $304 million. In total, Medicare has paid more than $2.9 billion for chiropractic services over the 6-year period.

The OIG has provided recommendations for CMS to consider implementing:

1. Work with contractors to educate chiropractors on the training resources that CMS has already made available to them.

2. Educate beneficiaries on which chiropractic services are and are not covered by Medicare Part B and encourage beneficiaries to report chiropractors that are providing services that should not be covered by Medicare.

3. Identify chiropractors with high-service denial rates or aberrant billing practices, estimate the amount of overpayments made through a statistically significant sample, and recover them.

4. Establish a threshold for the number of services that may be provided before a medical review is needed.

What Can You Do?

The report noted that improper payments were made for services that were medically unnecessary, billed with an incorrect procedure code, not documented, or insufficiently documented. Many chiropractic practitioners and beneficiaries were not fully aware of the medical necessity, documentation standards, and coverage requirements of chiropractic services under Medicare Part B (Medical Insurance).

In view of the OIG’s latest report, chiropractors can expect the CMS, Medicare Administrative Contractors (MAC), and other regulators to increase their audits of chiropractic medical claims. Providers may also expect a rise in compliance oversight through educational resources, medical reviews, and documentation requirements.

Chiropractors must ensure that complete and accurate records of their patients’ visits are taken. To avoid claim denials and receive maximum reimbursement, it is vital for chiropractors to submit accurately coded medical claims and complete all documentation requirements. These tasks are both challenging and time consuming.

Comprehensive Revenue Cycle Management Outsourcing

Healthcare quality depends on the integrity of patients’ medical records. The best way to ensure the reliability of the clinical documentations of your chiropractic firm is through Outsourcing your Medical Record Abstracting and Auditing, Coding and Billing needs. This can greatly help with your practice in identifying problem areas and formulating comprehensive Revenue Cycle Management Solutions to minimize rejected claims and avoid fraud.

Outsourcing is a powerful transformative business tool and it can be applied to almost any business model, in any sector. You can save 40-60% on your staffing costs, while driving innovation and growth. The opportunities really are huge.

As a chiropractor, you don’t need to sacrifice quality care in performing repetitive tasks that could easily be automated. Automation technology is improving chiropractic care by integrating Electronic Health Records (EHR) and practice management software that can enable you to spend less time managing your firm and more time focusing on your patients.

What We Can Do

Whether you need Patient Services, Claims Processing, Eligibility Verification, Medical Abstraction, Auditing, Coding, Billing, or Transcription, or a full suite of Healthcare Management Solutions, the Infinit-O Global team is here to help you succeed! We handle all aspects of the revenue cycle management outsourced process for various types of healthcare practices.

With Infinit Healthcare, you gain access to topnotch healthcare professionals. Our registered nurses, licensed clinical abstractors and auditors, and certified medical coders and billers are experts at utilizing the latest healthcare technologies and software. They are adepts at the Medicare regulations for Chiropractic care, ensuring that all documentation requirements are complete and maximizing your reimbursements with payers.

For free quotes or more details on how Infinit-O Global can help automate your chiropractic care functions, increase revenue cycle, and improve patient engagement, please fill out the Contact Form or call our teams: USA +1(866) 727-2504, UK +44(292) 002-6274, AU +61(2) 8405-7542.