Just in case you haven’t heard the noise due to the headaches from your ICD-10 hangover, Medicare is on the prowl for chiropractors…again.

A few weeks ago, chiropractors did poorly on yet another Office of Inspector General (OIG) review. The OIG is essentially the federal “auditing arm” of Medicare that targets who will be audited thanks to their performance. Interestingly enough, in this most recent OIG review, chiropractors actually improved from our past reviews. But our numbers are still in the gutter and so audits will continue.

As a result (or perhaps in addition to) the OIG report, several Medicare carriers have planned audits for chiropractic services.

For example, Noridian Medicare — who covers much of the Western half of the US — has launched their audit attack on chiropractors performing 98941 (See link for specifics)

Railroad Medicare (administered nationwide by Palmetto) also conducted its umpteenth widespread review of chiropractic services for all Railroad beneficiaries and, again, we didn’t fare too well with an error rate of 60%.

Just in case you are tempted to ignore this news, I’m not the only one making noise here. Note the recent reports from ChiroCode and Ray Foxworth, DC of ChiroHealthUSA – who is spot on with his warning as well.

Next Steps (Good and Bad)

  1. Respond to ANY Medicare documentation requests promptly – you may think your notes are bad, but it’s an automatic failure if you don’t send them in and this pretty much guarantees you a ticket for a future audit.

 

  1. Watch Service Level – Medicre repeatedly finds that we bill for one level of service (98941, for example) when a lower one should have been performed (98940). This can be the result of a few errors:

 

  • You are not diagnosing the correct number of levels – if you want to adjust 98941, you need three areas of subluxation findings to justify it
  • You are not reporting objective findings in those levels – again, if you adjust 98941, there better be documentation of at least three levels of objective findings to substantiate the adjustment
  • You are not adjusting the levels billed – if you bill 98941, your notes should state that you adjusted at least three levels.
  • You didn’t prove medical necessity for the adjustment level – this is essentially a combination of all the above, but it can also include other factors as well. For example, if your patient only has a chief complaint in one area and you consistently adjust 98941, you may have a hard time justifying the medical necessity of 98941

 

  1. Draw the Line on Maintenance – in repeated reports, chiropractors are found to bill for services deemed maintenance. As unpleasant as it is to patients, you need to establish a hard line between what constitutes maintainence vs active treatment and quit billing AT for everything. If it’s maintenance care, its not active care.

 

  1. Expect to Be Audited and Be Prepared to Appeal – the bad news is that chiropractors continually are getting a bad rep in Medicare for our billing practices, so it should not cause you great surprise when you are audited. The good news is that the recent OIG report found that 2% of the chiropractors are causing approximately 50% of the problems. So, be prepared to appeal and defend yourself that you are not in that group.

 

How can chiropractors prepare and protect themselves?

Stay tuned – that’s exactly what we will discuss in Part 2 of this article…arriving in a few days!!

In the meantime, you may also want to check out our FREE Chiropractic Audit Emergency Kit which can help you if that dreaded audit day comes…or let you know what to do in advance.